Background: Obesity is a prevalent health concern worldwide, affecting various aspects of patient care and surgical outcomes. Total laparoscopic hysterectomy (TLH) is a common gynecological ...procedure, but its impact on obese patients remains an area of interest. Understanding the perioperative challenges and financial implications associated with TLH in obese individuals is crucial for optimizing patient care and resource allocation. Objectives: to assess perioperative problems and financial outcomes in obese who undergo total laparoscopic hysterectomy (TLH), in comparison to nonobese. Patients and methods: A retrospective cohort study conducted on patients who underwent TLH at Benha university hospital and private centers over 5 years, to compare the TLH outcomes between class 1 and 2, with BMI between 30-39.9 kg/m2and nonobese with BMI 18.5 - 29.9 kg/m2. Results: Among the 360 patients, who underwent TLH, 140 were obese (class 1 or 2) and 220 were nonobese. Surprisingly, there were no statistically significant differences in intraoperative complications between the two groups (P>0.05). However, the impact of obesity class on clinical and financial outcomes was evident. Obese patients experienced longer hospital stays, increased operative blood loss, higher drug consumption, and elevated costs. Notably, the incidence of surgical site infections and overall postoperative complications was significantly higher in obese patients (P<0.05). Conclusion: Successful execution of TLH is feasible in obese patients, despite the higher adverse perioperative clinical and financial consequences associated in obese class 1 and 2 patients when compared to nonobese patients.
Multilineage-differentiating stress-enduring (Muse) cells are a population of pluripotent stage-specific embryonic antigen 3 (SSEA3)+ mesenchymal stem cells first described by Mari Dezawa in 2010. ...Although some investigators have reported SSEA3+ mesenchymal cells in umbilical cord tissues, none have quantitatively compared SSEA3+ cells isolated from Wharton’s jelly (WJ) and the cord lining (CL) of human umbilical cords (HUCs). We separated WJ and the CL from HUCs, cultured mesenchymal stromal cells (MSCs) isolated from these two tissues with collagenase, and quantified the percentage of SSEA3+ cells over three passages. The first passage had 5.0% ± 4.3% and 5.3% ± 5.1% SSEA3+ cells from WJ and the CL, respectively, but the percentage of SSEA3+ cells decreased significantly (P < 0.05) between P0 and P2 in the CL group and between P0 and P1 in the WJ group. Magnetic-activated cell sorting (MACS) markedly enriched SSEA3+ cells to 91.4% ± 3.2%. Upon culture of the sorted population, we found that the SSEA3+ percentage ranged from 62.5% to 76.0% in P2–P5 and then declined to 42.0%–54.7% between P6 and P9. At P10, the cultures contained 37.4% SSEA3+ cells. After P10, we resorted the cells and achieved 89.4% SSEA3+ cells in culture. The procedure for MACS-based enrichment of SSEA3+ cells, followed by expansion in culture and a re-enrichment step, allows the isolation of many millions of SSEA3+ cells in relatively pure culture. When cultured, the sorted SSEA3+ cells differentiated into embryoid spheres and survived 4 weeks after transplant into a contused Sprague-Dawley rat spinal cord. The transplanted SSEA3+ cells migrated into the injury area from four injection points around the contusion site and did not produce any tumors. The umbilical cord is an excellent source of fetal Muse cells, and our method allows the practical and efficient isolation and expansion of relatively pure populations of SSEA3+ Muse cells that can be matched by human leukocyte antigen for transplantation in human trials.
During the growing season of 2021-2022, a total of 145 symptomatic tomato leaf and fruit samples were collected from different locations in Riyadh Region, Saudi Arabia, showing a moderate-to-severe ...mosaic with dark green wrinkling, blistering, narrowing, and deformation with necrosis spot on tomato leaves, while irregular brown necrotic lesions, deformation, and yellowing spots rendering the fruits non-marketable were observed on tomato fruits. These samples were tested serologically against important tomato viruses using enzyme-linked immunosorbent assay (ELISA), and the obtained results showed that 52.4% of symptomatic tomato samples were found positive for Tomato brown rugose fruit virus (ToBRFV), wherein 12 out of 76 samples were singly infected; however, 64 out of 145 had mixed infection. A sample with a single infection of ToBRFV was used for mechanical inoculation into a range of different host plants; symptoms were observed weekly, and the presence of the ToBRFV was confirmed by ELISA and reverse transcription-polymerase chain reaction (RT-PCR). A total RNA was extracted from selected ELISA-positive samples, and RT-PCR was carried out using specific primers F-3666 and R-4718, which amplified a fragment of 1052 bp. RT-PCR products were sequenced in both directions, and partial genome nucleotide sequences were submitted to GenBank under the following accession numbers: MZ130501, MZ130502, and MZ130503. BLAST analysis of Saudi isolates of ToBRFV showed that the sequence shared nucleotide identities (99-99.5%) among them and 99-100% identity with ToBRFV isolates in different countries. A ToBRFV isolate (MZ130503) was selected for mechanical inoculation and to evaluate symptom severity responses of 13 commonly grown tomato cultivars in Saudi Arabia. All of the tomato cultivars showed a wide range of symptoms. The disease severity index of the tested cultivars ranged between 52% and 96%. The importance ToBRFV disease severity and its expanding host range due to its resistance breaking ability was discussed.
Antimicrobial resistance (AMR) is currently one of the global public health threats. Increased antibiotic consumption in humans, animals, and agriculture has contributed directly to the spread of ...AMR. Upper respiratory tract infections (URIs) are one of the most common conditions treated by antibiotics, even if unnecessary as in cases of viral infections and self-limited conditions which represent the most cases of URIs. Investigating physicians' knowledge, attitudes, and practice regarding antibiotic prescriptions in children with acute URIs may reflect the problem of antibiotic over prescription. This study aims to assess the problem in our community and provide information for further planning of appropriate interventions to optimize antibiotic prescriptions. This is a cross-sectional study for all non-specialized physicians dealing with acute upper respiratory tract infections (URIs) in pediatrics sittings in Assiut district, Egypt. We used a self-administered questionnaire to assess physicians' knowledge, attitudes, and practice. In addition, four clinical vignettes addressing different URI scenarios were included in the questionnaire to assess the patterns of antibiotic prescriptions in common cases. Our study included 153 physicians whose mean age was 32.2 ± 8.7, most of whom were pediatric residents in different health institutes in Assiut district. They had good knowledge as out of the 17 knowledge questions,the mean number of correct answers was 12.4 ± 2.9. Regarding their attitudes, mean attitude scores for inappropriate antibiotic prescribing were low. However, of those scores, the responsibility of others had the highest score (3.8 ± 0.61). Prescribing practice in special conditions of URIs showed that 80% of participants prescribed antibiotics if fever continued for more than five days and 61.4% if the child had a yellowish or greenish nasal discharge. Among 612 clinical vignettes, 326 contained antibiotic prescriptions (53.3%), and appropriate antibiotic prescriptions represented only 8.3% overall. Physicians dealing with acute URIs in outpatients' clinics in the Assiut district have good knowledge about antibiotic use and resistance and demonstrate a good attitude toward appropriate antibiotic use. Although the percentage of inappropriate prescriptions in clinical vignettes in high, more research is required to investigate the factors of antibiotic inappropriate prescribing practice and non-adherence to guidelines. Also, it is essential to set up a national antibiotic stewardship program to improve antibiotic prescribing and contain antimicrobial resistance problems.
Background
Unfavourable clot microstructure is associated with adverse outcomes in ST elevation myocardial infarction (STEMI). We investigated the effect of comorbidities and anti-platelet treatment ...on clot microstructure in STEMI patients using fractal dimension (df), a novel biomarker of clot microstructure derived from the visco-elastic properties of whole blood.
Methods
Patients with STEMI (n = 187) were recruited sequentially receiving aspirin with Clopidogrel (n = 157) then Ticagrelor (n = 30). Patient characteristics and blood for rheological analysis obtained. We quantified df using sequential frequency sweep tests to obtain the phase angle of the Gel Point which is synonymous with the clot microstructure.
Results
Higher df was observed in males (1.755 ± 0.068) versus females (1.719 ± 0.061, p = .001), in patients with diabetes (1.786 ± 0.067 vs 1.743 ± 0.046, p < .001), hypertension (1.760 ± 0.065 vs 1.738 ± 0.069, p = .03) and previous MI (1.787 ± 0.073 vs 1.744 ± 0.066, p = .011) compared to without. Patients receiving Ticagrelor had lower df than those receiving Clopidogrel (1.708 ± 0.060 vs 1.755 ± 0.067, p < .001). Significant correlation with df was found with haematocrit (r = 0.331, p < .0001), low-density lipoprotein (LDL) (r = 0.155, p = .046) and fibrinogen (r = 0.182, p = .014). Following multiple regression analysis, diabetes, LDL, fibrinogen and haematocrit remained associated with higher df while treatment with Ticagrelor remained associated with lower df.
Conclusions
The biomarker df uniquely evaluates the effect of interactions between treatment and underlying disease on clot microstructure. STEMI patients with diabetes and elevated LDL had higher df, indicating denser clot. Ticagrelor resulted in a lower df than Clopidogrel signifying a less compact clot.
Over-prescription of antibiotics contributes to antibiotic resistance, which is a global health threat. Egypt has alarmingly high rates of antibiotic over-prescription for acute upper respiratory ...tract infections (URIs) in children. To effectively address this issue, it is important to understand the various factors that influence prescription behaviors. The Teixeira antibiotic prescription behavioral model (TAPBM) offers a comprehensive framework through which these factors can be explored. This qualitative study sought to investigate the perspectives of key stakeholders involved in pediatric healthcare in Egypt, with the primary goal of identifying the underlying determinants that contributed to this problem.
This qualitative study was conducted in Assiut City, Egypt, between January and March 2023. Purposive sampling was used to select participants, including consultant pediatricians, supervisors of pediatric training programs, and specialists in infection prevention and control. Thirteen semi-structured in-depth interviews (IDIs) were conducted, audio-recorded, and transcribed. Thematic analysis was performed using MAXQDA 2020 software.
Two main themes emerged from the analysis: intrinsic factors related to physicians, extrinsic factors related to patients, and nonphysician factors. Intrinsic factors encompass personal characteristics and attitudes. Prescribing decisions were influenced by factors such as fear of complications, limited follow-up visits, and competition. Knowledge and education also played a significant role. Moreover, diagnostic uncertainty in distinguishing between bacterial and viral infections posed a challenge. Extrinsic factors included patient and caregiver factors, such as parental expectations and demands for antibiotics, driven by the belief that they produced rapid results. Moreover, patients' demographic factors, including socioeconomic status and living conditions, affected their prescribing behavior. Health system-related factors, such as the type of healthcare institution and the absence of formal national guidelines, were identified as influential factors. Additionally, this study highlighted the influence of the pharmaceutical industry. The potential impact of the COVID-19 pandemic on antibiotic prescriptions was addressed.
The study highlights the intricate interplay between intrinsic and extrinsic factors that shape antibiotic prescription decisions, underscoring the significance of addressing these factors in mitigating overprescribing.
Despite the interwoven nature of platelet activation and the coagulation system in thrombosis, few studies relate both analysis of protein and cellular parts of coagulation in the same population. In ...the present study, we use matched ex vivo samples to determine the influences of standard antiplatelet therapies on platelet function and use advanced rheological analyses to assess clot formation. Healthy volunteers were recruited following fully informed consent then treated for 7 days with single antiplatelet therapy of aspirin (75 mg) or prasugrel (10 mg) or with dual antiplatelet therapy (DAPT) using aspirin (75 mg) plus prasugrel (10 mg) or aspirin (75 mg) plus ticagrelor (90 mg). Blood samples were taken at day 0 before treatment and at day 7 following treatment. We found that aspirin plus prasugrel or aspirin plus ticagrelor inhibited platelet responses to multiple agonists and reduced P-selectin expression. Significant platelet inhibition was coupled with a reduction in fractal dimension corresponding to reductions in mean relative mass both for aspirin plus prasugrel (−35 ± 16% change, p = 0.04) and for aspirin plus ticagrelor (−45 ± 14% change, p = 0.04). Aspirin alone had no effect upon measures of clot structure, whereas prasugrel reduced fractal dimension and mean relative mass. These data demonstrate that platelets are important determinants of clot structure as assessed by fractal dimension (d
f
) and that effective platelet inhibition is associated with a weaker, more permeable fibrin network. This indicates a strong association between the therapeutic benefits of antiplatelet therapies and their abilities to reduce thrombus density that may be useful in individual patients to determine the functional relationship between platelet reactivity, eventual clot quality, and clinical outcome. d
f
could represent a novel risk stratification biomarker useful in individualizing antiplatelet therapies.
Maternal mortality is a worldwide problem. Measuring maternal mortality and identifying its causes is essential, and should be assessed regularly for the purpose of planning, monitoring and ...evaluation of provided maternal health care. Quality of care indicators such as case fatality rate is used to measure the facility performance, in particular, quality and promptness of care. This descriptive study aimed to calculate maternal mortality ratio, quality of care indicators such as maternal mortality index, case fatality and direct obstetric case fatality rate for the Women's Health Hospital and identify causes of maternal mortality, and the main deficits in medical records. The Maternal mortality ratio was alarmingly high in Women's Health Hospital, Assiut University, Egypt reaching 225/100,000, however, those who delivered in the hospital, the MMR was 100.5/100,000. The leading causes of maternal death were obstetric haemorrhage (38.3%), complications of caesarean sections (27.7%) and pre-eclampsia/eclampsia (23.4%). Nearly half (42%) of the deaths occurred during vacations. Quality indicators revealed poor quality of health care.
Abstract Background More than 200 combinations of antiplatelet and anticoagulant drugs can be given during an acute cardiac event. However, no biomarker is available to assess their global effect on ...clot formation and structure. Fractal dimension (Df ) and clot formation time (TGP ) are global markers of haemostasis that have been validated in healthy and anticoagulated blood. In contrast to standard coagulation assays, these biomarkers use unadulterated whole blood and are measured immediately at the bedside. Df quantifies clot microstructure whereas TGP is a real-time measure of clotting time, and both are calculated from the gel point (GP). We aimed to validate Df and TGP in ST-segment-elevation myocardial infarction (STEMI) and assess the effect of therapeutic intervention. Methods We recruited prospectively patients with STEMI undergoing primary percutaneous coronary intervention (PCI). Venous blood samples were collected on admission (after 300 mg of aspirin), after PCI (after clopidogrel, heparin, and bivalirudin), and 24 h after admission. In addition to assessment of Df and TGP , each sample was assessed by standard coagulation tests and a full blood count. Wilcoxon signed-rank and paired t tests were used to compare changes from admission to after PCI and at 24 h. Spearman's correlation analysis was done to explore any associations. Normality was assessed with the Shapiro-Wilks test. This study was approved by the local Research Ethics Committee (REC Number 07/WMW02/34) and written informed consent was obtained from all participants. Findings 33 patients (mean age 69 years SD 12; 19 men, 14 women) were included. Df on admission (mean 1·75, SD 0·05) was higher than values we have previously reported in healthy individuals despite use of antiplatelet therapy. Df after PCI was significantly lower than Df on admission (mean 1·64 SD 0·06 vs 1·75 0·05, p<0·0001) whereas Df at 24 h was similar to that on admission. TGP was significantly prolonged at after-PCI measurement compared with admission (median 723 s IQR 492–1793 vs 210 173–314, p<0·0001). Df correlated negatively with TGP ( r =−0·75, p<0·0001), prothrombin time ( r =−0·49, p<0·001), and partial thromboplastin time ( r =−0·52, p<0·0001) but positively with fibrinogen ( r =0·36, p=0·0009). There was no significant correlation observed between Df and platelets or haematocrit. Interpretation Therapeutic manipulation in STEMI especially with drugs given during PCI had a striking effect on clot structure and rate of coagulation as measured by Df and TGP . Larger studies are in progress to evaluate potential therapeutic strategies based on these biomarkers and their accuracy in detecting hypocoagulable and hypercoagulable states, and predicting cardiovascular risk. Funding National Institute for Social Care and Health Research, Engineering and Physical Sciences Research Council.
Background Stroke is the second largest cause of death worldwide. Abnormalities in hemostasis play an important role in the pathophysiology of ischemic stroke (IS). These hemostatic defects can be ...detected using rotational thromboelastometry (ROTEM) as a global method of measuring coagulation.This study assessed the effects of IS on blood hypercoagulability using ROTEM method, before and subsequent to therapeutic interventions. Methods In a prospective observational cohort study, whole blood coagulation using ROTEM, along with full blood count and standard coagulation tests, were compared between patients with IS and an age-matched control group of healthy volunteers. Further assessment took place at 2-4 hours and at 24 hours in the stroke group after therapy to assess the effects of therapeutic intervention. Results Seventy-two patients with IS were age-matched to 71 healthy subjects. Clotting time (CT) INTEM ( P = .01) and maximum clot firmness (MCF) INTEM ( P = .02) were significantly different between stroke patients at baseline and healthy subjects, but this difference disappeared when controlled for by smoking status. There was no association between ROTEM parameters and time from stroke symptom onset or stroke severity as reflected in The National Institute of Health Stroke Scale score. Significant but small changes in the values of MCF-EXTEM, clot formation time (CFT) EXTEM, and alpha-EXTEM CT were observed after therapeutic intervention (thrombolysis or aspirin treatment). Conclusions ROTEM testing does not seem to detect a hypercoagulable state in patients with IS. Nonetheless, some ROTEM parameters had a small change after antiplatelet therapy or thrombolysis.
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