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Introduction : Fluid shear stress (pulsatile and laminar) and pressure comprise of the two in vivo physical forces to which vascular endothelium is constantly exposed. Besides, vasodilator and autacoids, nitric oxide is the main endothelium derived relaxing factor (EDRF) released in response to alterations in blood pressure and shear stress, which constitute hemodynamic stress.The aim of the present study was to study the effect of pulsatile/laminar shear stress on endothelial nitric oxide production . Methodology: A perfusion system was used to study the effect of shear stress on endothelialnitic oxide production. It was designed as a close continuous flow loop in which the pressure was superimposed with flow through a pressure head with adjustable height. Results: At hydrostatic pressure of 70 cm water (normotensive condition) and at 150 cm water (hypertensive condition), an increase in nitric oxide concentration was observed. The increase was 10 fold higher at 150 cm with respect to static values than the increase observed at 70 cm ofwater. Conclusion: Laminar shear stress and pressure induce the release of endothelial nitric oxide, which may aid to understand the role of wall shear stress during arterial resistance in hypertension.

Baharudin Abdullah,1 Amir Hamzah Abdul Latiff,2 Anura Michelle Manuel,3 Faizah Mohamed Jamli,4 Harvinder Singh Dalip Singh,5 Intan Hakimah Ismail,6 Jeevanan Jahendran,2 Jeyasakthy Saniasiaya,7 Kent Chee Keen Woo,8 Phaik Choo Khoo,9 Kuljit Singh,3 Nurashikin Mohammad,10 Sakinah Mohamad,1 Salina Husain,11 Ralph Mösges12,13 1Department of Otorhinolaryngology - Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia; 2Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia; 3Prince Court Medical Centre, Kuala Lumpur, Malaysia; 4Department of Paediatrics, Hospital Serdang, Selangor, Malaysia; 5Department of Otorhinolaryngology - Head and Neck Surgery, Hospital Raja Permaisuri Bainun, Ipoh, Perak; 6Department of Paediatrics, Universiti Putra Malaysia, Selangor, Malaysia; 7Department of Otorhinolaryngology, Universiti Malaya, Kuala Lumpur, Malaysia; 8Gleneagles Hospital Kuala Lumpur, Kuala Lumpur, Malaysia; 9Subang Jaya Medical Centre (SJMC), Selangor, Malaysia; 10Department of Internal Medicine, Universiti Sains Malaysia, Kelantan, Malaysia; 11Department of Otorhinolaryngology-Head & Neck Surgery, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia; 12Institute of Medical Statistics and Computational Biology, University of Cologne, Cologne, Germany; 13ClinCompetence Cologne GmbH, Cologne, GermanyCorrespondence: Baharudin Abdullah, Department of Otorhinolaryngology - Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia, Tel +60 97676416, Fax +60 97676424, Email baharudin@usm.my; profbaha@gmail.comAbstract: The goal of allergic rhinitis (AR) management is to achieve satisfactory symptom control to ensure good quality of life. Most patients with AR are currently treated with pharmacotherapy. However, knowledge gaps on the use of pharmacotherapy still exist among physicians, particularly in the primary care setting, despite the availability of guideline recommendations. Furthermore, it is common for physicians in the secondary care setting to express uncertainty regarding the use of new combination therapies like intranasal corticosteroid plus antihistamine combinations. Inadequate treatment leads to significant reduction of quality of life that affects daily activities at home, work, and school. With these concerns in mind, a practical consensus statement was developed to complement existing guidelines on the rational use of pharmacotherapy in both the primary and secondary care settings.Keywords: allergic rhinitis, pharmacotherapy, consensus, primary care, secondary care, Malaysia

Abstract Background Intravenous immunoglobulin (IVIG) has been used as an immunomodulatory therapy to counteract severe systemic inflammation in coronavirus disease 2019 (COVID-19). But its use in COVID-19 related acute respiratory distress syndrome (ARDS) is not well established. Methods We conducted a retrospective analysis of electronic health records of COVID-19 patients admitted to intensive care units (ICUs) at Hazm Mebaireek General Hospital, Qatar, between March 7, 2020 and September 9, 2020. Patients receiving invasive mechanical ventilation for moderate-to-severe ARDS were divided into two groups based on whether they received IVIG therapy or not. The primary outcome was all-cause ICU mortality. Secondary outcomes studied were ventilator-free days and ICU-free days at day-28, and incidence of acute kidney injury (AKI). Propensity score matching was used to adjust for confounders, and the primary outcome was compared using competing-risks survival analysis. Results Among 590 patients included in the study, 400 received routine care, and 190 received IVIG therapy in addition to routine care. One hundred eighteen pairs were created after propensity score matching with no statistically significant differences between the groups. Overall ICU mortality in the study population was 27.1%, and in the matched cohort, it was 25.8%. Mortality was higher among IVIG-treated patients (36.4% vs. 15.3%; sHR 3.5; 95% CI 1.98–6.19; P

Abstract Background Timely identification of patients at risk of worse clinical outcomes is vital in managing coronavirus disease 2019 (COVID‐19). The neutrophil‐to‐lymphocyte ratio (NLR) calculated from complete blood count can predict the degree of systemic inflammation and guide therapy accordingly. Hence, we did a study to investigate the role of NLR value on intensive care unit (ICU) admission in predicting clinical outcomes of critically ill COVID‐19 patients. Methods We conducted a retrospective analysis of electronic health records of COVID‐19 patients admitted to ICUs at Hazm Mebaireek General Hospital, Qatar, from March 7, 2020 to July 18, 2020. Patients with an NLR equal to or higher than the cut‐off value derived from the receiver operating characteristic curve were compared to those with an NLR value below the cut‐off. The primary outcome studied was all‐cause ICU mortality. The secondary outcomes evaluated were the requirement of mechanical ventilation and ICU length of stay (LOS). Results Five hundred and nineteen patients were admitted to ICUs with severe COVID‐19 infection during the study period. Overall, ICU mortality in the study population was 14.6% (76/519). NLR on ICU admission of ≥6.55 was obtained using Youden's index to predict ICU mortality, with a sensitivity of 81% and specificity of 41%. Mortality was significantly higher in patients with age ≥60 years (p

Linear codes with complementary duals, or LCD codes, have recently been applied to side-channel and fault injection attack-resistant cryptographic countermeasures. We explain that over characteristic two fields, they exist whenever the permanent of any generator matrix is non-zero. Alternatively, in the binary case, the matroid represented by the columns of the matrix has an odd number of bases. We explain how Grassmannian varieties as well as linear and quadratic complexes are connected with LCD codes. Accessing the classification of polarities, we relate the binary LCD codes of dimension k to the two kinds of symmetric non-singular binary matrices, to certain truncated Reed–Muller codes, and to the geometric codes of planes in finite projective space via the self-orthogonal codes of dimension k.

Baharudin Abdullah,1 Selvamalar Vengathajalam,1 Mohd Khairi Md Daud,1 Zahiruddin Wan Mohammad,2 Aneeza Hamizan,3 Salina Husain3 1Department of Otorhinolaryngology-Head & Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; 2Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; 3Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur 56000, MalaysiaCorrespondence: Baharudin AbdullahDepartment of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, MalaysiaTel +6097676416Fax +6097676424Email profbaha@gmail.comPurpose: The allergic phenotype of chronic rhinosinusitis (CRS) and central compartment atopic disease (CCAD) have been described. The CCAD is a radiological phenotype in patients with CRS that presents as a central mucosal disease due to allergy. The subset of patients having chronic rhinosinusitis with nasal polyps (CRSwNP) has not been well characterized. We aim to describe the clinical and radiological characterizations of patients presenting with the allergic phenotype of CRSwNP.Patients and Methods: A cross-sectional study at a tertiary hospital was performed. Adult patients diagnosed with CRSwNP who had both allergology and radiological assessments were enrolled. The symptoms of allergic rhinitis, Lund–Kennedy (LK) endoscopic scoring, Lund–Mackay (LM) computed tomography scan of paranasal sinuses (CTPNS) scoring, CCAD features, skin prick test (SPT) and level of specific IgE were assessed. All the patients underwent SPT for house dust mites.Results: A total of 38 patients were enrolled. Symptoms, endoscopic and CTPNS scores were higher in the allergy and CCAD groups compared to the nonallergy and nonCCAD groups. The symptom of “need to blow nose” was statistically significant in allergy vs nonallergy (p=0.01) and CCAD vs nonCCAD (p=0.02). There were significant differences in the endoscopic scores in both allergy and CCAD (allergy vs nonallergy, p=0.01; CCAD vs nonCCAD, p=0.03), and CT scores in both allergy and CCAD (allergy vs nonallergy, p=0.02; CCAD vs nonCCAD, p=0.02). All patients with CCAD have worse scoring than nonCCAD (LK score, p=0.03; LM score, p=0.02). Patients with allergy have more polypoidal involvement of the middle turbinates (left middle turbinate, p=0.141; right middle turbinate, p=0.074) and CCAD (left middle turbinate, p=0.017; right middle turbinate, p=0.009) than nonallergy and nonCCAD patients.Conclusion: Allergic phenotype of CRSwNP has a worse clinical and radiological disease burden. Optimal treatment of allergy is essential for a better outcome.Keywords: allergy, atopy, chronic rhinosinusitis, nasal polyps, central compartment atopic disease

Abstract Introduction COVID‐19 can occasionally complicate into spontaneous pneumothorax (SP) and/or spontaneous pneumomediastinum (SM). This study aims at exploring the occurrence of SP and or SM, risk factors, and outcomes in COVID‐19 patients. Materials and Methods All patients with COVID‐19, which complicated into SP and/or SM at Hamad Medical Corporation (the principal public healthcare provider in Qatar) from March to September 2020, were retrospectively enrolled. The clinical diagnosis was confirmed by CXR and CT. Between‐group comparisons were performed by using Chi‐square and t‐test. Differences were considered statistically significant at P ≤ .05. Results A total of 1100 patients were admitted, and 43 patients developed SP, SP + SM, or SM. Most patients were males (42/97.9%), and the most common comorbidity was diabetes mellitus (13/30.2%). All patients had acute respiratory distress syndrome (ARDS), and most patients had low lung compliance at the time of developing SP or SM. Twenty‐two of the patients developed SP (51.2%), 11 patients had both SP and SM (25.6%), and 10 patients had SM only (23.3%). There was no significant difference in the development of SP or SM and patients' gender or blood group or whether patients were on invasive or noninvasive ventilation or even the mortality (P > .05). Lung compliance was significantly (P

The use of steroids and other immune modulatory therapies in the treatment of severe COVID-19 pneumonia predisposes patients to the reemergence of opportunistic infections. Cytomegalovirus (CMV) reactivation can be one of them. A 55-year-old gentleman with severe COVID-19 pneumonia and hypoxic respiratory failure who was ventilated and received steroids but no other immunomodulatory drugs; had altered sensorium and multiple episodes of seizures in the later course of his illness. Brain MRI showed leptomeningeal enhancement and encephalopathy changes, electroencephalography (EEG) was suggestive of diffuse encephalopathy and his cerebrospinal fluid (CSF) analysis revealed high Cytomegalovirus PCR DNA titers (103,614). The patient made a complete recovery after treatment with Ganciclovir. Altered sensorium in cases of COVID-19 can be multifactorial. High index of suspicion for reactivation of dormant infections is warranted. CMV meningoencephalitis is one of the differential diagnoses. We believe this is the first case reported of CMV meningoencephalitis in the setting of severe COVID-19 infection.

The invention of smart low-power devices and ubiquitous Internet connectivity have facilitated the shift of many labour-intensive jobs into the digital domain. The shortage of skilled workforce and the growing food demand have led the agriculture sector to adapt to the digital transformation. Smart sensors and systems are used to monitor crops, plants, the environment, water, soil moisture, and diseases. The transformation to digital agriculture would improve the quality and quantity of food for the ever-increasing human population. This paper discusses the security threats and vulnerabilities to digital agriculture, which are overlooked in other published articles. It also provides a comprehensive review of the side-channel attacks (SCA) specific to digital agriculture, which have not been explored previously. The paper also discusses the open research challenges and future directions.

There are limited studies examining water consumption among individuals in hot climates. We assessed the daily total water intake from plain water, other beverages, and food in a nationally representative sample of children and adolescents aged 6−18 years in the United Arab Emirates. Total water intake was compared against the recommendations of the Institute of Medicine and the European Food Safety Authority. Sociodemographic information, 24 h dietary recall, physical activity levels, and anthropometric data were collected from 527 participants. The mean ± SE of total water intake was 1778.4 ± 33.8 mL/day. Plain drinking water was the largest contributor to total water intake (51.6%), followed by food (27.3%). Sugar-sweetened beverages constituted 13.9% of water intake. The proportion of participants who met the Institute of Medicine recommendations ranged from 15% (males aged 14−18) to 25% (children aged 6−8). The proportion of participants who met the European Food Safety Authority recommendations ranged from 31% (females aged 14−18) to 36% (males aged 14−18). The water-to-energy ratio was 1.0−1.15 L/1000 kcal, meeting recommendations. The majority of participants failed to meet water intake recommendations, highlighting the need for targeted interventions to promote increased water consumption among children and adolescents.

Introduction: Kidney Allocation System (KAS) was implemented by United Network for Organ Sharing in 2014 to reduce allocation disparities. Research Questions: Outcomes of highly sensitized patients (calculated panel reactive antibody (cPRA) ≥ 97%) before and after KAS were compared to low-risk recipients (cPRA <10%) in the post-KAS era were examined. The impact on racial disparities was determined. Design: This was a retrospective study of national registry data. Two cohorts of adult candidates waitlisted for deceased donor transplantation during 3-year periods before and after KAS were identified. Results: Highly sensitized patients (N = 1238 and 4687) received a deceased donor kidney transplant between January 1, 2011 and December 31, 2013 and between January 1, 2015 and December, 31, 2017. Racial disparity for highly sensitized patients improved, yet remained significant (P < 0.001), with Black patients comprising 40% and 41% of the highly sensitized candidates and 28% and 34% of the recipients pre- and post-KAS. While posttransplant death-censored graft failure for highly sensitized recipients was similar overall, post-KAS was associated with improved graft survival in the first year after transplant (HR 0.56, 95% CI 0.40-0.78). When compared to contemporaneous lowrisk recipients, both death-censored and all-cause graft failure were similar for highly sensitized recipients and was associated with increased risk for death-censored graft failure beyond the first year (HR 1.39, 95% CI 1.11-1.73). Conclusion: The allocation system led to an increase in transplantation in highly sensitized candidates without compromising outcomes. Although KAS has led to more balanced transplant rates between highly sensitized Black and White patients, racial inequalities persist. [ABSTRACT FROM AUTHOR]

Posttraumatic stress disorder (PTSD) after acute medical events is associated with medication nonadherence. The mechanisms of PTSD-related nonadherence are poorly understood. We tested whether patients with elevated PTSD symptoms induced by suspected acute coronary syndrome (ACS) were more likely to have aversive cognitions towards cardiovascular medications. We enrolled a consecutive cohort of patients who presented to the emergency department with suspected ACS. One month after discharge, ACS-induced PTSD symptoms were assessed using the PTSD Checklist (PCL-S), and patients were asked 'how often did' (1) 'you miss your heart medication because you did not want to be reminded about your heart problem'; (2) 'thinking about your heart medication make you feel nervous or anxious'; and (3) 'thinking about your heart medication make you think about your risk for future heart problems.' Logistic regression was used to determine the association between elevated PTSD symptoms and each aversive cognition, adjusting for age, sex, race, ethnicity, education, depression, and ACS status. Of 424 patients included, 15.8% had elevated PTSD symptoms (PCL-S [greater than or equal to] 34). In adjusted analyses, higher PCL-S scores were associated with missing medications to avoid reminders of heart disease (OR 1.22 per 5-point PCL-S increase, 95%CI 1.07-1.40), as well as anxiety (OR 1.34, 95%CI 1.19-1.51) and thoughts of future risk (OR 1.19, 95%CI 1.08-1.32) when thinking about cardiovascular medications. We concluded that patients with elevated PTSD symptoms following suspected ACS were more likely to report aversive cognitions about their cardiovascular medications, suggesting that medications can act as traumatic reminders of the cardiac event and ongoing risk in this group., Author(s): S. Ali Husain [sup.1] [sup.2] , Donald Edmondson [sup.1] , Marin Kautz [sup.1] , Redeana Umland [sup.1] , Ian M. Kronish [sup.1] Author Affiliations: (Aff1) 0000 0001 2285 2675, [...]