Search

Background: The efficacy of high flow nasal canula oxygen therapy (HFNO) to prevent invasive mechanical ventilation (IMV) is not well established in severe coronavirus disease 2019 (COVID-19). The aim of this study was to compare the risk of IMV between two strategies of oxygenation (conventional oxygenation and HFNO) in critically ill COVID 19 patients. Methods: This was a bicenter retrospective study which took place in two intensive care units (ICU) of tertiary hospitals in the Paris region from March 11, to May 3, 2020. We enrolled consecutive patients hospitalized for COVID-19 and acute respiratory failure (ARF) who did not receive IMV at ICU admission. The primary outcome was the rate of IMV after ICU admission. Secondary outcomes were death at day 28 and day 60, length of ICU stay and ventilator-free days at day 28. Data from the HFNO group were compared with those from the standard oxygen therapy (SOT) group using weighted propensity score. Results: Among 138 patients who met the inclusion criteria, 62 (45%) were treated with SOT alone, and 76 (55%) with HFNO. In HFNO group, 39/76 (51%) patients received IMV and 46/62 (74%) in SOT group (OR 0.37 [95% CI, 0.18–0.76] p = 0.007). After weighted propensity score, HFNO was still associated with a lower rate of IMV (OR 0.31 [95% CI, 0.14–0.66] p = 0.002). Length of ICU stay and mortality at day 28 and day 60 did not significantly differ between HFNO and SOT groups after weighted propensity score. Ventilator-free days at days 28 was higher in HNFO group (21 days vs 10 days, p = 0.005). In the HFNO group, predictive factors associated with IMV were SAPS2 score (OR 1.13 [95%CI, 1.06–1.20] p = 0.0002) and ROX index > 4.88 (OR 0.23 [95%CI, 0.008–0.64] p = 0.006). Conclusions: High flow nasal canula oxygen for ARF due to COVID-19 is associated with a lower rate of invasive mechanical ventilation. [ABSTRACT FROM AUTHOR]

The aim of this paper is to explore the reasons of oil price volatility. It analyses the information function of oil future market and investigates the relation between speculation and spot oil price in the short run. Furthermore, the paper constructs a model for long run equilibrium able to produce reliable and reasonable oil price forecasts. Findings prove that in the short run, changes in oil inventories Granger cause changes in oil price. In the long run however, findings prove that, the oil demand, the oil supply, the $/SDR exchange rate, the speculation in oil future market (New York Mercantile Exchange) and the oil inventories are associated in a long run relationship. [ABSTRACT FROM AUTHOR]

Recently, there has been an increased interest in producing electronic courses. However, literature shows that adopting e-learning does not guarantee improved learning. This is because mixing technology and content does not necessarily yield effective learning. This paper presents a systematic design process for developing blended courses for undergraduate higher education. The instructional design process is based on instructional design theories and utilized three taxonomies: Bloom Taxonomy, Redeker Taxonomy and Guerra scale. A mapping model is proposed and embedded in the design process to develop a blended course starting from the objectives and content of a traditional course. This paper also presents a evaluation process that estimates the effectiveness of the selected technologies in the design of the blended course. This effectiveness is evaluated in terms of three dimensions: course content formats, interaction and collaboration. A case study is presented to demonstrate the proposed design approach on a System Analysis and Design blended course under development. [ABSTRACT FROM AUTHOR]

Summary: Twenty-nine children with malignancies and age, gender-matched controls were prospectively studied over 14 months. Patients had higher parathyroid hormone (PTH) levels and fat mass, lower bone mass, and bone mass increments at follow-up than controls. Lean mass, age at diagnosis, systemic and intrathecal therapy were predictors of bone mass changes on adjusted analyses. Introduction: Children with hematologic malignances have low bone mass. We prospectively investigated anthropometric, clinical, and hormonal predictors of changes in bone mass in children receiving cancer therapy. Methods: Twenty-nine children, mean age of 9 ± 2.9 years and 32 age and gender-matched controls, were studied. Seven had completed their course 40 ± 22 weeks prior, while 22 were still receiving therapy for 80 ± 28 weeks. Age at diagnosis, calcium intake, exercise activity, systemic corticosteroids in dexamethasone (Dex) dose, and methotrexate (MTX), and intrathecal MTX therapy received within follow-up period were assessed. Routine chemistries, PTH, 25-hydroxy vitamin D (25-OHD), bone remodeling markers, bone mass, and body composition were measured at baseline and 14 months. Results: Patients had lower exercise activity, sun exposure, and bone markers levels than controls. They had higher PTH levels and fat mass, lower bone mass at the spine, hip, and total body, and lower increments at these sites on follow-up. Predictors of bone mass changes on univariate analyses were: age at diagnosis ( R = −0.50 to −0.44, p < 0.05), Dex-MTX doses ( R = −0.58 to −0.41, p < 0.05), intrathecal therapy ( p < 0.03),% changes in lean mass ( R = 0.37 to 0.54, p < 0.04), 25-OHD levels ( R = 0.39, p < 0.03), and PTH levels (R = −0.47 to −0.41, p < 0.05). Lean mass, age at diagnosis, systemic and intrathecal therapy were predictors of bone mass changes on adjusted analyses. Conclusion: This study provides insight into the pathophysiology of bone loss in children receiving cancer therapy and possible interventions to optimize their skeletal health. [ABSTRACT FROM AUTHOR]

This work was conducted to evaluate the safety and efficacy of emergency ureteroscopic lithotripsy in patients with ureteral stones. From May 2003 to December 2010, 244 patients (184 men and 60 women, mean age 45.6 ± 12.7 years (range 22-73 years) were treated with emergency ureteroscopic lithotripsy for ureteral calculi. All patients were divided into three groups according to the stone location in the ureter. Intracorporeal lithotripsy when necessary was performed with the Swiss lithoclast. The overall stone-free status was defined as the complete absence of stone fragments at 4 weeks, postoperatively. A double J stent was inserted in selected patients if there was significant ureteral wall trauma, edema at the stone impaction site, suspected or proved ureteral perforation, and if the stone migrated to the kidney. The overall success rate was 90.6%. The success rates were different according to the stone site. The success rate of groups A, B and C was 69.4, 94.8 and 96.6%, respectively. The overall rate of ureteral stent insertion at the end of the procedure was 177/244 (72.5%). The rate of stent insertion was 41/49 (83.7%), 32/46 (69.6%) and 104/149 (69.8%) in groups A, B and C, respectively. The overall complication, failure, and stricture rate was 32/244 (13.1%), 23/244 (9.4%) and 0.8%, respectively. With the recent advances in ureteroscopic technology, intracorporeal probes and stone extraction devices, emergency ureteroscopy is found to be a safe and effective procedure with immediate relief from ureteral colic and ureteral stone fragmentation. [ABSTRACT FROM AUTHOR]

universities where students enjoy flexibility in selecting courses, the Registrar's office aims to generate an appropriate exam timetable for numerous courses and large number of students. An appropriate, real-world exam timetable should show fairness towards all students, respecting the following constraints: (a) eliminating or minimizing the number of simultaneous exams; (b) minimizing the number of consecutive exams; (c) minimizing the number of students with two or three exams per day (d) eliminating the possibility of more than three exams per day (e) exams should fit in rooms with predefined capacity; and (f) the number of exam periods is limited. These constraints are conflicting, which makes exam timetabling intractable. Hence, solving this problem in realistic time requires the use of heuristic approaches. In this work, we develop an evolutionary heuristic technique based on the scatter search approach for finding good suboptimal solutions for exam timetabling. This approach is based on maintaining and evolving a population of solutions. We evaluate our suggested technique on real-world university data and compare our results with the registrar's manual timetable in addition to the timetables of other heuristic optimization algorithms. The experimental results show that our adapted scatter search technique generates better timetables than those produced by the registrar, manually, and by other meta-heuristics. [ABSTRACT FROM AUTHOR]

To evaluate the influence of diabetes mellitus (DM), chronic renal failure (CRF), and malignancies on the rate of bacteriuria and double J ureteric stent bacterial colonization. One hundred and twenty patients were included in this prospective study. Midstream urine samples for culture were obtained before ureteric stent insertion. Patients with negative culture were given ciprofloxacin 500 mg orally q 12 h for 5 days as a prophylaxis. All the stents were removed or changed as indicated after having voided midstream urine sample for culture on the day of stent removal. Stents were sent for culture. Culture was obtained from the outer surface of the stent by gentle scraping with a sterile scalpel. Significant bacteriuria was defined as a count of colony-forming units per milliliter of urine of >105. The patients were between 20 and 74 years of age (mean 42.5 ± 13) and the duration of stent insertion ranged between 14 and 120 days (52.5 ± 7.2). In 29 patients (24.2%), double J stent bacterial colonization was positive (12 males and 17 females). Of these patients, 27 (22.5%) had positive urine cultures (11 males and 16 females). The most commonly isolated pathogen was Escherichia coli. DM, CRF, or malignancies showed a higher risk for bacteriuria and stent bacterial colonization. Immune-compromising diseases such as DM, CRF, and malignancies are proved to be risk factors for urinary tract infection and stent colonization in patients with ureteric stent insertion. Stent cultures are not needed as the same microorganisms grow in urine cultures. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine the prevalence of ED and its health-related correlates in a nonselected population from a Mediterranean country. The abridged 5-item version of the international index of erectile function (IIEF-5) was used as a diagnostic tool. A total of 905 men aged 18 years and above from Jordan were included in the study and answered the questions about medical history, lifestyle habits and sexual behavior. A logistic regression model was used to identify significant independent risk factors for ED. In this sample the prevalence of all degrees of ED was estimated as 49.9%. In this group of men, the degree was mild in 25%, moderate in 13.5% and severe in 11.4%. The prevalence of severe ED increased from 2.7% in men in their twenties to 38.6% in their sixties and 46% in those aged 70 years and above. Age is the single most significant risk factor. Other important risk factors include lower household income, physical inactivity, obesity, smoking, diabetes mellitus hypertension and ischemic heart disease. This study provides a quantitative estimate of the prevalence and the main risk factors for ED in our region. This condition, which represents a source of distress, should be evaluated more effectively by rigorous and standardized methods, particularly as effective treatments are now available. [ABSTRACT FROM AUTHOR]

To assess the effects of two different doses of botulinum toxin A (Dysport®: 500 and 1,000 IU) injected repeatedly into the bladder for the treatment of neurogenic detrusor overactivity (NDO) in terms of safety, durability, and improvement of continence status and urodynamic parameters. In this study we analyzed the effects of successive doses of 500 or 1,000 IU of Dysport®, endoscopically injected into the detrusor muscle. Clinical, urodynamic, and satisfaction assessments were performed at baseline and 6 weeks after each injection. The results of injections and corresponding follow-ups were analyzed and compared with baseline. Twenty-two patients (13 men and 9 women) with repeated four injections were included, of whom 12 (55%) with mean age 35.7 years (range 16–52 years) received 500 IU of BTX-A and 10 (45%) with mean age 33.8 years (range 18–50 years) received 1,000 IU in each treatment. No statistically significant differences were found in efficacy duration with the two Dysport doses (500 IU: 7.7 months, 1,000 IU: 8.5 months; P > 0.05). Maximum cystometric capacity (MCC), reflex volume (RV), and bladder compliance (BC), and patient satisfaction improved significantly after each treatment compared with baseline values and there were no statistically significant differences after each retreatment for the two treatment groups ( P > 0.05). After repeated injections the effect of BTX-A remained constant. The cause of repeat treatment is relapse of overactive bladder symptoms. Results with the 500 and 1,000 IU doses were interesting and approximately equivalent in terms of duration and efficacy, with better but not significant results when 1,000 IU was used. The optimum dose of Dysport for incontinence secondary to NDO is not yet defined; 1,000 IU probably has a nonsignificant longer effect than 500 IU but may expose the patient to major complications. Further studies evaluating the clinical efficacy of 750 IU of Dysport are necessary. [ABSTRACT FROM AUTHOR]

A molecular assay with enhanced specificity and sensitivity has been developed to assist in the surveillance of Karnal bunt, a quarantineable disease with a significant impact on international trade. The protocol involves the release of DNA from spores, PCR amplification to enrich Tilletia-specific templates from released DNA and a five-plex, real-time PCR assay to detect, identify and distinguish T. indicaand other Tilletiaspecies (T. walkeri, T. ehrhartae, T. horridaand a group comprising T. caries, T. laevis, T. contraversa, T. bromiand T. fusca) in wheat grains. This fluorescent molecular tool has a detection sensitivity of one spore and thus bypasses the germination step, which in the current protocol is required for confirmation when only a few spores have been found in grain samples. The assay contains five dual-labelled, species-specific probes and associated species-specific primer pairs in a PCR mix in one tube. The different amplification products are detected simultaneously by five different fluorescence spectra. This specific and sensitive assay with reduced labour and reagent requirements makes it an effective and economically sustainable tool to be used in a Karnal bunt surveillance program. This protocol will also be valuable for the identification of some contaminant Tilletiasp. in wheat grains. [ABSTRACT FROM AUTHOR]

Objective To report a successful delivery of a healthy infant fathered by an infertile 46, XY true hermaphrodite who suffered from a seminoma. Design Case report Setting IVF unit in University hospital Patient(s) Male 41 years (true hermaphrodite), his wife 35 years Main Outcome Measures Laboratory, pathology tests and ultrasound tests Results The above patient treated and cured from seminoma, the couple had in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) using frozen testicular sperm and had a healthy baby. Conclusion This is the first case report of a successful delivery of a healthy infant fathered by an infertile 46, XY true hermaphrodite who suffered from a seminoma. Once treated and cured, the couple had IVF and ICSI using frozen testicular sperm and had a healthy baby. [ABSTRACT FROM AUTHOR]

Nitric oxide (NO) is formed from the conversion of L-arginine by nitric oxide synthase (NOS), which exists in three isoforms: neuronal (nNOS), endothelial (eNOS), and inducible (iNOS). nNOS is expressed in penile neurons innervating the corpus cavernosum, and eNOS protein expression has been identified primarily in both cavernosal smooth muscle and endothelium. NO is released from nerve endings and endothelial cells and stimulates the activity of soluble guanylate cyclase (sGC), leading to an increase in cyclic guanosine-3',5'-monophosphate (cGMP) and, finally, to calcium depletion from the cytosolic space and cavernous smooth muscle relaxation. The effects of cGMP are mediated by cGMP dependent protein kinases, cGMP-gated ion channels, and cGMP-regulated phosphodiesterases (PDE). Thus, cGMP effect depends on the expression of a cell-specific cGMP-receptor protein in a given cell type. Numerous systemic vasculature diseases that cause erectile dysfunction (ED) are highly associated with endothelial dysfunction, which has been shown to contribute to decreased erectile function in men and a number of animal models of penile erection. Based on the increasing knowledge of intracellular signal propagation in cavernous smooth muscle tone regulation, selective PDE inhibitors have recently been introduced in the treatment of ED. Phosphodiesterase 5 (PDE5) inactivates cGMP, which terminates NO-cGMP-mediated smooth muscle relaxation. Inhibition of PDE5 is expected to enhance penile erection by preventing cGMP degradation. Development of pharmacologic agents with this effect has closely paralleled the emerging science.International Journal of Impotence Research (2004) 16, 459-469. doi:10.1038/sj.ijir.3901256 Published online 1 July 2004 [ABSTRACT FROM AUTHOR]

The aim of this paper is to analyze how aggregate activity in Lebanon fluctuates with regard to recurrent shocks. The research starts by identifying the Lebanese economic business cycle from the first quarter of 1998 to the fourth quarter of 2015 adopting a statistical method. Furthermore, this research studies the relationship between the capacity utilization rate and the inflation rate to explore theoretically and empirically how monetary and real shocks account for the disturbances that affect the economic activity. Findings prove that, over the studied period, the Lebanese economy performs largely under its full capacity and that the capacity utilization rate is related to inflation in the short run, but not in the long run. In other terms, findings prove that monetary factors account for business cycle disturbances of the Lebanese economy in short run, but not in the long run. [ABSTRACT FROM AUTHOR]