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Background: Sepsis is a complicated disorder highlighted by the concurrent acceleration of coagulation and inflammation as a consequence of microbial assault. It has an important influence on hospitalized patients' need for mechanical ventilation and ICU admission. Objectives: The study's primary goal is to determine whether septic patients who require invasive mechanical ventilation fared well and whether their clinical condition improved or worsened after being connected to mechanical ventilation. The research also attempts to evaluate how additional medical interventions and other comorbidities affect the patient's prognosis. Material and methods: From November 2017 to May 2018, 160 patients with severe sepsis or septic shock were taken part in a prospective cross-sectional trial. The information was gathered using a straightforward, standardized questionnaire that included questions regarding the admission, progress, and outcome of septic patients who received mechanical ventilation in an intensive care unit. Results: 58 (36%) of the 160 patients were female, with 102 (64%) of the patients being male. In the age range of 60 to 70 years, 41 of them (or 25.6%) were detected. The majority of patients (59/369) had sepsis from a chest infection. Most of the patients, 87 (54.4%), got a combination of midazolam and fentanyl for sedation and analgesia. The majority of the patients, 85 (53%) had SIM/PS ventilation. Ultimately, 71 patients (44.4%) died, 80 patients (50%) were extubated, and 9 patients (5.6%) remained stationary and had a tracheostomy. Additionally, age, reasons, sedative type, and duration of stay were all substantially linked with the MV consequences (P 0.05). Conclusion: The better the outcome, the earlier septic patients who need IMV were identified and attached to IMV. It has been demonstrated that receiving IMV decreased mortality in septic patients by around 50%. The findings suggest that this intervention should be made more widely available and more reasonably priced by the authorities, along with the training of additional staff and the development of standard protocols for treating patients with such a condition. Focusing on health education awareness, establishing a focused outpatient department, and promptly screening patients who necessitate early referral to a tertiary care facility are the three most crucial aspects.

Objectives: It was previously thought that adiponectin influenced insulin activity in tissues. Insulin resistance caused by obesity is associated to reduced plasma adiponectin levels. Researchers may be able to better understand the role of adiponectin in insulin resistance and type 2 diabetes by comparing adiponectin levels in T2DM patients to non-diabetic patients, as well as its connection with BMI and WC. Method: A case-control study was conducted at the Abu A'gla Health Care Center for diabetes care in Wad Madani, Gezira State, Sudan, between April 2012 and March 2013. The study involved a total of 181 participants. To measure adiponectin, FPG, and HbA1C levels, patients were divided into diabetes and non-diabetic groups. The body mass index (BMI) was calculated, and the waist circumference (WC) was measured. Personal information (age and gender) were obtained. Samples were analyzed for many biochemical parameters using the A15, a random-access auto-analyzer bio system. To quantify adiponectin, ELIZA employed the techniques of a human adiponectin ELISA kit. A statistical software for social sciences was used to conduct the statistical analysis (SPSS version 16, Chicago, IL, USA). Result: The mean BMI (29.007) increased significantly between diabetic and non-diabetic groups (p=0.001) indicating that the study participants were overweight. There was significant increased (p

COVID-19, caused by the SARS-CoV-2 virus, is spreading rapidly worldwide, with devastating consequences for patients, healthcare workers, health systems, and economies. As it reaches low- and middle-income countries, the pandemic puts healthcare workers at high risk and challenges the abilities of healthcare systems to respond to the crisis. This study measured levels of knowledge and preparedness regarding COVID-19 among physicians and nurses. A cross-sectional survey was conducted among healthcare workers in Libya between February 26 and March 10, 2020. We obtained 1,572 valid responses of a possible 2,000 (78.6%) participants from 21 hospitals, of which 65.1% were from physicians and 34.9% from nurses. The majority of participants (70%) used social media as a source of information. A total of 47.3% of doctors and 54.7% of nurses received adequate training on how to effectively use personal protective equipment. Low confidence in managing suspected COVID-19 patients was reported by 83.8% of participants. Furthermore, 43.2% of healthcare workers were aware of proper hand hygiene techniques. Less than 7% of participants received training on how to manage COVID-19 cases, whereas 20.6% of doctors and 26.3% of nurses felt that they were personally prepared for the outbreak. Awareness and preparedness for the pandemic were low among frontline workers during the study. Therefore, an effective educational training program should be implemented to ensure maintenance of appropriate practices during the COVID-19 pandemic.

[eng] Background: Renal dysfunction is one of the most common co-morbidities in heart failure, and it raises mortality, morbidity, complexity, and cost of care dramatically. Renal impairment is linked to poor outcomes in heart failure patients. Objectives: The goal of this study was to assess the prevalence of renal function impairment, as well as clinical predictors and hospital outcomes of renal impairment, among hospitalized heart failure (HF) patients. Methods: The study was conducted at Wad-Madani Heart Center, a tertiary hospital that serves Gezira and the surrounding state. All adults admitted to Wad-Madani Heart Center and diagnosed with heart failure between June and August 2018 are included in the study. Patients with a known instance of kidney illness, those on dialysis, and those who had had a kidney transplant were excluded. Patients file, echography report, and Renal function test reported personal and clinical data were collected in a questionnaire. There may be multiple reasons for hospitalization or etiological diagnoses for each patient. Results: Males made up 54.5 % of the 55 patients in the study, while females made up 45.5%. Below forty years, 3.6%, between forty and sixty years, 32.7%, and above sixty years, 63.6%. Mild HF affects 29.1% of the population, whereas moderate HF affects 52.7%and severe HF affects 18.2%. Hypertension, diabetes, and smoking were the most common cofactors for HF, accounting for 81.8%, 70.9%, and 43.6%of cases, respectively. Impaired renal function developed in 87.3%of cases, whereas 16.4%had mild impairment. Renal failure developed in 32.7%of the intermediate cases, 36.4% of the severe cases, and 1.8%of the cases. Hyperkalemia affects 3.6%of people. More than 5.5 mmol/l and 52.7 hyponatremia in 1.8%of people. Heart failure is caused by isquemic heart disease (IHD) in 78.2% of cases, valve disease in 10.9% of cases, and cardiomyopathy in 20% of cases. Conclusion: Heart failure is common in Sudan, and it is one of the leading causes of hospitalization. It is more common in men, and it increases in proportionality with age, with most cases occurring beyond sixty years. IHD is responsible for more than three-quarters of HF cases. Renal dysfunction is predicted by increased baseline serum creatinine, urea, and eGFR90 ml/min, as well as a patient’s history of diabetes, high blood pressure, and smoking., [spa] Antecedentes: La disfunción renal es una de las comorbilidades más frecuentes en la insuficiencia cardíaca, y aumenta la mortalidad, la morbilidad, la complejidad y el coste de la atención de forma espectacular. La disfunción renal está vinculada a malos resultados en los pacientes con insuficiencia cardíaca (IC). Objetivos: El objetivo de este estudio fue evaluar la prevalencia del deterioro de la función renal, así como los predictores clínicos y los resultados hospitalarios del deterioro renal, entre los pacientes con insuficiencia cardíaca hospitalizados. Métodos: El estudio se llevó a cabo en el Centro Cardíaco de Wad-Madani, un hospital terciario que atiende a Gezira y el estado circundante. Se incluyen en el estudio todos los adultos ingresados en el Centro Cardíaco Wad-Madani y diagnosticados con insuficiencia cardíaca entre junio y agosto de 2018. Se excluyeron los pacientes con un caso conocido de enfermedad renal, los que estaban en diálisis y los que habían recibido un trasplante de riñón. Se recogió en un cuestionario el expediente de los pacientes, el informe de la ecografía y los datos personales y clínicos comunicados por la prueba de función renal. Puede haber múltiples motivos de hospitalización o diagnósticos etiológicos para cada paciente. Resultados: el 54,5% de los 55 pacientes del estudio eran varones, mientras que el 45,5% eran mujeres. Menores de cuarenta años, 3,6%, entre cuarenta y sesenta años, 32,7%, y mayores de sesenta años, 63,6%. La IC leve afecta al 29,1% de la población, mientras que la moderada afecta al 52,7% y la grave al 18,2%. La hipertensión, la diabetes y el tabaquismo fueron los cofactores más frecuentes de la IC, representando el 81,8%, el 70,9% y el 43,6% de los casos, respectivamente. El 87,3% de los casos presentaba deterioro de la función renal, mientras que el 16,4% tenía un deterioro leve. La insuficiencia renal se desarrolló en el 32,7% de los casos intermedios, en el 36,4% de los casos graves y en el 1,8% de los casos. La hiperpotasemia afecta al 3,6% de las personas. Más de 5,5 mmol/l y 52,7 de hiponatremia en el 1,8% de las personas. La insuficiencia cardíaca está causada por la Cardiopatía isquémica (CI) en el 78,2% de los casos, la valvulopatía en el 10,9% de los casos y la miocardiopatía en el 20% de los casos. Conclusión: La insuficiencia cardíaca es frecuente en Sudán y es una de las principales causas de hospitalización. Es más frecuente en los hombres y aumenta proporcionalmente con la edad, presentándose la mayoría de los casos después de los sesenta años. La CI es responsable de más de tres cuartas partes de los casos de IC. La disfunción renal se predice por el aumento de la creatinina sérica, la urea y el FGe90 ml/min, así como por los antecedentes de diabetes, hipertensión arterial y tabaquismo del paciente.

This paper aims to develop a framework for the entrepreneurial orientation in Egypt to cope with the required level of competitive advantage to be achieved by SMEs in the Egyptian context through the mediating role of sustainability. This illustration will be tackling every dimension of entrepreneurial orientation, Sustainability, and competitive advantage. Then the relationship between the three variables will be tested and examined. Literature and prior studies related to this field are reviewed to construct the research hypotheses which state that there is a significant relationship between entrepreneurial orientation and sustainability, there is a significant relationship between sustainability and competitive advantage, Sustainability mediates the relationship between entrepreneurial orientation and competitive advantage. These hypotheses will be tested throughout the research study. Primary data is collected from entrepreneurs of Egyptian SMEs in the food and beverage sector using a quantitative approach (Questionnaire). The data collected is analyzed and then the results of the analysis and findings are demonstrated by the end of the research with some recommendations to Egyptian SMEs to enhance their competitive advantages.

This study presents the isolation of a novel strain of Dehalococcoides mccartyi, NIT01, which can completely dechlorinate up to 4.0 mM of trichloroethene to ethene via 1,2-cis-dichroroethene and vinyl chloride within 25 days. Strain NIT01 dechlorinated chloroethenes (CEs) at a temperature range of 25–32 °C and pH range of 6.5–7.8. The activity of the strain was inhibited by salt at more than 1.3% and inactivated by 1 h exposure to 2.0% air or 0.5 ppm hypochlorous acid. The genome of NIT01 was highly similar to that of the Dehalococcoides strains DCMB5, GT, 11a5, CBDB1, and CG5, and all included identical 16S rRNA genes. Moreover, NIT01 had 19 rdhA genes including NIT01-rdhA7 and rdhA13, which are almost identical to vcrA and pceA that encode known dehalogenases for tetrachloroethene and vinyl chloride, respectively. We also extracted RdhAs from the membrane fraction of NIT01 using 0.5% n-dodecyl-β- d -maltoside and separated them by anion exchange chromatography to identify those involved in CE dechlorination. LC/MS identification of the LDS-PAGE bands and RdhA activities in the fractions indicated cellular expression of six RdhAs. NIT01-RdhA7 (VcrA) and NIT01-RdhA15 were highly detected and NIT01-RdhA6 was the third-most detected. Among these three RdhAs, NIT01-RdhA15 and NIT01-RdhA6 had no biochemically identified relatives and were suggested to be novel functional dehalogenases for CEs. The expression of multiple dehalogenases may support bacterial tolerance to high concentrations of CEs.

Chloroethenes (CEs) are widespread groundwater toxicants that are reductively dechlorinated to nontoxic ethene (ETH) by members ofDehalococcoides. This study established aDehalococcoides-dominated enrichment culture (designated “YN3”) that dechlorinates tetrachloroethene (PCE) to ETH with high dechlorination activity, that is, complete dechlorination of 800 μM PCE to ETH within 14 days in the presence ofDehalococcoidesspecies at5.7±1.9×107 copies of 16S rRNA gene/mL. The metagenome of YN3 harbored 18rdhAgenes (designatedYN3rdhA1–18) encoding the catalytic subunit of reductive dehalogenase (RdhA), four of which were suggested to be involved in PCE-to-ETH dechlorination based on significant increases in their transcription in response to CE addition. The predicted proteins for two of these four genes, YN3RdhA8 and YN3RdhA16,showed 94% and 97% of amino acid similarity with PceA and VcrA, which are well known to dechlorinate PCE to trichloroethene (TCE) and TCE to ETH, respectively. The other twordhAs,YN3rdhA6andYN3rdhA12,which were never proved asrdhAfor CEs, showed particularly high transcription upon addition of vinyl chloride (VC), with75±38and16±8.6mRNA copies per gene, respectively, suggesting their possible functions as novel VC-reductive dehalogenases. Moreover, metagenome data indicated the presence of three coexisting bacterial species, including novel species of the genusBacteroides, which might promote CE dechlorination byDehalococcoides.

Benign peritoneal multicystic mesothelioma is a rare tumor of the visceral peritoneum. The authors present an atypical case of a 74-year-old man who presented with a multicystic mesothelioma of the ascending colon.

High-normal blood pressure and visit-to-visit blood pressure variability are common in clinical settings. They are associated with cardiovascular outcomes. No population based studies have assessed the association between these two phenomena. Our objective was to test the relationship of high-normal blood pressure with visit-to-visit blood pressure variability.A cross-sectional study.We used data from the cross-sectional Third National Health and Nutrition Examination Survey to test the relationship between high-normal blood pressure and visit-to-visit blood pressure variability; we conducted multivariable regression analyses to evaluate the relationship between these two variables.The analysis included 6,071 participants. The participants' mean age was 37.16 years. The means of visit-to-visit systolic and diastolic blood pressure variability were 5.84 mmHg and 5.26 mmHg. High-normal blood pressure was significantly associated with systolic and diastolic blood pressure variability (p values0.05).High-normal blood pressure is associated with visit-to-visit blood pressure variability. Additional research is required to replicate the reported results in prospective studies and evaluate approaches to reduce blood pressure variability observed in clinical settings among patients with high-normal blood pressure to reduce the subsequent complications of blood pressure variability.

A 61 year old male patient undergoing gastrectomy under general anesthesia developed severe anaphylactoid shock after 15 minutes from starting 5% albumin infusion. His blood pressure went from 101/67 down to 44/23 with his heart rate going up from 91 to 99. A total of 1600 mcg of phenylephrine were given without any improvement in the hemo-dynamics. We then gave 50 mcg of Epinephrine to which blood pressure rapidly responded going up to 141/60 (mean 88). Then 15 mg of Dexamethasone were given. Blood pressure remained stable with the mean between 75 and 90, without requiring anymore pressors. 5% albumin is considered among the safer colloids with a risk of anaphylactoid reactions less than gelatins and dextrans and comparable to starches. However, severe life threatening anaphylaxis has been reported with Albumin infusion. With the still ongoing crystalloid colloid debate, with many studies showing no survival benefit with colloid use for volume resuscitation, the risk of severe anaphylactic shock, even with the safer colloids like albumin should drive to a more conservative use of albumin for volume resuscitation, specially under general anesthesia, when recognizing the signs and symptoms of anaphylaxis and the offending agent maybe more challenging.