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This report describes the medical coverage provided for 10KSA, a charity event held in Saudi Arabia for breast cancer awareness. More than 10,000 women attended the event. A total of 41 attendees sought medical care; four patients (9.8%) presented directly to the clinic and 37 patients (90.2%) presented to the first aid units, mostly for check-ups. This report may be helpful for care providers arranging medical coverage for future events with similar challenging situations (women only, distant location).AlAssafWI. EMS coverage of a female-only event with 10,000 attendees: preparation and implementation in one week. Prehosp Disaster Med. 2017;32(6):694–698.

Introduction/Objective Recent reports suggest that though COVID-19 is predominantly a respiratory pathogen, one of its presenting features can be gastrointestinal symptoms. We hereby present a case of a female with COVID-19 infection whose hospital course was complicated by colonic pseudo-obstruction caused by pseudomembranous colitis resulting in an emergent hemicolectomy. Methods A 59-Year-old female with history of hypertension, diabetes, and breast cancer post mastectomy presented with pneumonia and was confirmed to be COVID-19 positive. She was admitted to the hospital and was treated with Azithromycin for 6 days. Patient developed constipation on day six of hospitalization and started having abdominal pain on day eight with elevated WBC count. Imaging showed distension of cecum and proximal colon. She underwent exploratory laparotomy which revealed a necrotic appearing cecum that was massively dilated and had a serosal tear. These findings prompted emergent hemicolectomy with loop ileostomy. Grossly cecum was black/green, dilated, thin walled with a 5 x 5 cm yellow green raised plaques. Microscopy of the plaques revealed focal erosion of colonic mucosa with overlying acute inflammatory cells, fibrin deposits, mucus, and necrotic epithelial cells consistent with pseudomembranous colitis. Conclusion Review of literature shows no reported cases of intestinal pseudo-obstruction due to pseudomembranous colitis in a COVID-19 patient. Not only this, but there are also only a limited number of case studies of pseudomembranous colitis presenting as intestinal pseudo-obstruction without diarrhea. Though this patient’s presentation could be from Clostridium difficile infection secondary to Azithromycin, it is not a common antibiotic to cause this. Also, one of the known causes of pseudomembranous colitis is ischemia. Given that COVID-19 infection is a pro-thrombotic condition, possible ischemia secondary to COVID-19 infection related coagulopathy should also be a consideration.

Providing therapies tailored to each patient is the vision of precision medicine, enabled by the increasing ability to capture extensive data about individual patients. In this position paper, we argue that the second enabling pillar towards this vision is the increasing power of computers and algorithms to learn, reason, and build the 'digital twin' of a patient. Computational models are boosting the capacity to draw diagnosis and prognosis, and future treatments will be tailored not only to current health status and data, but also to an accurate projection of the pathways to restore health by model predictions. The early steps of the digital twin in the area of cardiovascular medicine are reviewed in this article, together with a discussion of the challenges and opportunities ahead. We emphasize the synergies between mechanistic and statistical models in accelerating cardiovascular research and enabling the vision of precision medicine. ispartof: EUROPEAN HEART JOURNAL vol:41 issue:48 pages:4556-+ ispartof: location:England status: published

Measurements of the left ventricular (LV) pressure trace are rarely performed despite high clinical interest. We estimated the LV pressure trace for an individual heart by scaling the isovolumic, ejection and filling phases of a normalized, averaged LV pressure trace to the time-points of opening and closing of the aortic and mitral valves detected in the individual heart. We developed a signal processing algorithm that automatically detected the time-points of these valve events from the motion signal of a miniaturized accelerometer attached to the heart surface. Furthermore, the pressure trace was used in combination with measured displacement from the accelerometer to calculate the pressure–displacement loop area. The method was tested on data from 34 animals during different interventions. The accuracy of the accelerometer-detected valve events was very good with a median difference of 2 ms compared to valve events defined from hemodynamic reference recordings acquired simultaneously with the accelerometer. The average correlation coefficient between the estimated and measured LV pressure traces was r = 0.98. Finally, the LV pressure–displacement loop areas calculated using the estimated and measured pressure traces showed very good correlation (r = 0.98). Hence, the pressure–displacement loop area can be assessed solely from accelerometer recordings with very good accuracy.

Objectives: To investigate the effects of nutraceuticals on key processes associated with atherosclerosis in vitro and in vivo. Background: Atherosclerosis is an inflammatory disease of the vasculature in which macrophages play key roles at all stages and represent promising therapeutic targets. Unfortunately, current therapies against atherosclerosis are not fully effective and associated with other issues such as adverse side effects. In addition, there have been many failures on pharmaceutical agents identified from drug discovery programs. Nutraceuticals represent promising alternatives in the prevention and treatment of atherosclerosis but requires a thorough understanding of their actions together with the underlying mechanisms. The purpose of this study was to address this with emphasis on key macrophage processes associated with atherosclerosis. Methods: A combination of macrophage cell lines and primary cultures were used with gene expression analysed by atherosclerosis profiler arrays and real time quantitative PCR. Foam cell formation was investigated by following the uptake of fluorescently labeled modified LDL, intracellular lipid profiling and cholesterol efflux assays. Inflammasome activation was evaluated by following the release of interleukin (IL)-1beta using an ELISA and ROS production using a kit from Abcam. The effects in vivo were analysed in C57BL/6 mice fed a high fat diet. Results: The studies focused on polyphenols, flavanols and omega-6 polyunsaturated fatty acids. These either inhibited or had no effect on several key macrophage processes associated with atherosclerosis such as pro-inflammatory gene expression, the uptake of modified LDL, macropinocytosis, ROS production and the activation of the inflammasome. In addition, where analysed, the nutraceutical inhibited several atherosclerosis-associated markers in mice fed a high fat diet. The mechanisms underlying such actions will be presented. Conclusions: The studies provide new insights into the beneficial actions of nutraceuticals in atherosclerosis.

Introduction/Objective A liposarcoma is a tumor derived from primitive mesenchymal cells undergoing adipose differentiation. Liposarcomas are uncommon in childhood, representing only about 2% of childhood sarcomas. Among liposarcomas, is a very rare subtype, the so-called ‘pleomorphic myxoid liposarcoma’ which has extensive myxoid changes and scattered pleomorphic cells. Here we report an autopsy case of an extensively metastatic pleomorphic myxoid liposarcoma. Methods A 12 year-old, African-American boy presented in the ED with ascites and shortness of breath, who later expired despite resuscitation. Autopsy finding showed a primary lesion in the left superior orbital fissure with diffuse metastasis to liver, replacing most of the liver parenchyma (liver weigh 8500 g). Metastatic foci are also present in gallbladder, pancreas, large intestine, bilateral lungs, and inner and outer surfaces of cranium. Histologically, tumor at all sites shows similar morphology, revealing scattered pleomorphic lipoblasts and a myxoid background with arborizing vasculature. Lipoblasts show indented and distorted nuclei and cytoplasmic vacuoles. Immunohistochemically the tumor cells are immunoreactive for p16 (diffusely and strongly) (Figure, D) and S100 (weakly) and negative for AE1/AE3, myogenin, synaptophysin, GFAP, EMA, and CD34. FISH was negative for MDM2 and t(12;16)(q13;p11.2) FUS-DDIT3 rearrangement, ruling out conventional myxoid liposarcoma. Conclusion This case shows the aggressive nature of a poorly studied entity in an uncommon age group and emphasize the need to study childhood liposarcomas in more detail.

Easy to use devices for the rapid detection of toxic metal ions in drinking water is essential for improving monitoring, identification and management of water resources. In 2014, over 100,000 residents of Flint, Michigan, were exposed to high levels of lead in their drinking water, leading to serious environmental and health issues. The problem faced by Flint is a perfect example of the need for a portable device for on-site detection system that can sense the presence of high concentrations of toxic metal ions in the environment in natural pH with no sample pretreatment. In this work, an easy to use method for metal ion detection in natural water samples was developed. Preconcentration of ions at the electrode surface was achieved by optimizing a nanostructured layer consisting of gold nanoparticles and a conductive polymer, which improved detection sensitivity and selectivity withing limits that cover the EPA levels for metal ion exposure. The method was demonstrated for the detection of As, Pb and Hg in natural waters, using anodic stripping voltammetry (ASV). Several parameters were optimized in order to achieve the highest detection sensitivity, including pH, ionic strength and deposition time. Local water samples were tested for heavy metal ion content and validated using lab-based methods, including atomic absorption spectroscopy (AAS) and ICP-MS. This methodology was applied onto the surface of low-cost screen-printed electrodes which are easy to use and portable.

A miniaturized accelerometer attached to the heart has been used for monitoring functional parameters such as early systolic velocity and displacement. Currently, processing of the accelerometer signal for derival of these functional parameters depends on determining start systole by detecting the ECG R-peaks. This study proposes an alternative method using only the accelerometer signal to detect start systole, making additional ECG recordings for this purpose redundant. A signal processing method for automatic detection of start systole by accelerometer alone was developed and compared with detected R-peaks in 15 pigs during 5 different interventions showing a difference of 30 ± 17 ms. Furthermore, the derived early systolic velocity and displacement using only accelerometer measurements correlated well (r 2 =0.91 and 0.82, respectively) with minor differences compared to the current method using ECG R-peaks as time reference. The results show that an accelerometer can be used to monitor cardiac function without the need to measure ECG which can simplify the monitoring system.

Background: Primary menstrual pain is a well-known gynecological disorder among adult females including nursing undergraduate students. Nursing students tend not to seek medical treatment. As a result, this affects their quality of academic life and also absenteeism rate is increased. Objectives: To evaluate the prevalence of menstrual pain and its effect on sickness absenteeism on nursing student. Methods: This is a descriptive survey research design study by means of using a validated and modified questionnaire. Questionnaire information regarding menstrual pain severity, history and absenteeism were included. The research took place in the collage of nursing at the largest University in the world, Princess Nourah Bint Abdelrahman University, Riyadh, Saudi Arabia. A total of 100 single, female, unmarried undergraduate nursing students (Year 1, 2, 3, 4) were recruited by personal invitation during lectures. Result: The prevalence of menstrual pain was 92%. Most of the nursing students 27% had menstrual pain of moderate grade 5 - 6 and 38% of nursing students did not take pain medication for it. Lecture and collage absenteeism due to menstrual pain was present in 9% and 30% respectively. Finally, there was no significant correlation between menstrual pain and age of menarche, age and height. Conclusion: Menstrual pain is widely common prevalent among nursing undergraduates. As a result, it affects the quality of students’ day-to-day life routine. The majority of nursing students’ rarely seeks medical treatment. Providing health and patient education to improve awareness on managing menstrual period might help in avoiding students’ absence from classes.

As Ebola has spread beyond West Africa, the challenges confronting health care systems with no experience in managing such patients are enormous. Not only is Ebola a significant threat to a population’s health, it can infect the medical personnel trying to treat it. As such, it represents a major challenge to those in public health, emergency medical services (EMS), and acute care hospitals. Our academic medical center volunteered to become an Ebola Treatment Center as part of the US effort to manage the threat. We developed detailed policies and procedures for Ebola patient management at our university hospital. Both the EMS system and county public health made significant contributions during the development process. This article shares information about this process and the outcomes to inform other institutions facing similar challenges of preparing for an emerging threat with limited resources. The discussion includes information about management of (1) patients who arrive by ambulance with prior notification, (2) spontaneous walk-in patients, and (3) patients with confirmed Ebola who are interfacility transfers. Hospital management includes information about Ebola screening procedures, personal protective equipment selection and personnel training, erection of a tent outside the main facility, establishing an Ebola treatment unit inside the facility, and infectious waste and equipment management. Finally, several health policy considerations are presented. (Disaster Med Public Health Preparedness. 2015;9:558–567)

Measles (rubeola) is a highly contagious airborne disease that was declared eliminated in the U.S. in the year 2000. Only sporadic U.S. cases and minor outbreaks occurred until the larger outbreak beginning in 2014 that has become a public health emergency. The “Identify-Isolate-Inform” tool will assist emergency physicians to be better prepared to detect and manage measles patients presenting to the emergency department. Measles typically presents with a prodrome of high fever, and cough/coryza/conjunctivitis, sometimes accompanied by the pathognomonic Koplik spots. Two to four days later, an erythematous maculopapular rash begins on the face and spreads down the body. Suspect patients must be immediately isolated with airborne precautions while awaiting laboratory confirmation of disease. Emergency physicians must rapidly inform the local public health department and hospital infection control personnel of suspected measles cases. [West J Emerg Med. 2015;16(2):212–219.]

Objectives: To investigate the effects of nutraceuticals on key processes associated with atherosclerosis in vitro and in vivo. Background: Atherosclerosis is an inflammatory disease of the vasculature in which macrophages play key roles at all stages and represent promising therapeutic targets. Unfortunately, current therapies against atherosclerosis are not fully effective and associated with other issues such as adverse side effects. In addition, there have been many failures on pharmaceutical agents identified from drug discovery programs. Nutraceuticals represent promising alternatives in the prevention and treatment of atherosclerosis but requires a thorough understanding of their actions together with the underlying mechanisms. The purpose of this study was to address this with emphasis on key macrophage processes associated with atherosclerosis. Methods: A combination of macrophage cell lines and primary cultures were used with gene expression analysed by atherosclerosis profiler arrays and real time quantitative PCR. Foam cell formation was investigated by following the uptake of fluorescently labeled modified LDL, intracellular lipid profiling and cholesterol efflux assays. Inflammasome activation was evaluated by following the release of interleukin (IL)-1beta using an ELISA and ROS production using a kit from Abcam. The effects in vivo were analysed in C57BL/6 mice fed a high fat diet. Results: The studies focused on polyphenols, flavanols and omega-6 polyunsaturated fatty acids. These either inhibited or had no effect on several key macrophage processes associated with atherosclerosis such as pro-inflammatory gene expression, the uptake of modified LDL, macropinocytosis, ROS production and the activation of the inflammasome. In addition, where analysed, the nutraceutical inhibited several atherosclerosis-associated markers in mice fed a high fat diet. The mechanisms underlying such actions will be presented. Conclusions: The studies provide new insights into the beneficial actions of nutraceuticals in atherosclerosis.

In this study, five isolates of Sinorhizobium meliloti were obtained from root nodules of alfalfa plants collected from agricultural soils of different regions of Nineveh governorate/Iraq. Local isolates, RW8, RW9, RW10, RW11 and RW12 incubated for periods 1, 2, 3, 4 and 5 days. Biomass (g/l), production of poly-β-hydroxybutyrate (g/l) and production percentage (of dry cell weight) were recorded. Results revealed that RW9 isolate was the best among isolates of S. meliloti.It gave the best production percentage of poly-β-hydroxybutyrate which reached 43.05 % when grown in YEM (Yeast Extract Mannitol Broth) medium two days of incubation, whereas maximum average of biomass production reached 1.97 g/l. The effect of addition of different carbon sources growth medium on poly-β-hydroxybutyrate production by S. meliloti isolate RW9 showed that glucose, as carbon source, promote the productivity of the polymer that reached to 65.07 % two days after incubation. The optimal concentration of glucose to support highest production was 2.0 % that enhance production to 82.55 %. The effect of addition of different nitrogen sources at 0.10 % concentration to YEM broth medium (supplemented with 2.0 % glucose) revealed that glutamic acid gave the best productivity which reached 86.51 % two days after incubation. The effective concentration of glutamic acid support the best productivity was the used concentration (0.10 %). According to the obtained results RW9 isolate which accumulated high level of poly-β-hydroxybutyrate may be superior to be employed in industrial production when this isolate grown in optimum conditions.

Scalable data is the demand of many of the emerging technologies. In order to target scalability, query processing plays an important role. The target is to achieve the maximum performance in terms of less execution time and more output. This could be achieved with any selected data and implementing advanced algorithms in any platform. This paper has worked in ArcMap in order to handle data of maps through different layers. Map reduction in size eases the process of query processing and generates the resultant records much faster. In addition, query category contributes to scalability as well. Classifying a compound query into a simple one adds positive impact on the results. Query payload and cost are controlled by maintaining execution time of the query and enhancing retuned records per command. This is helpful in analyzing different map layers for selected area of interest. Scalable map data is selected, analyzed with different map layers and results are obtained of processed queries that clearly indicates the successful achievement of scalability of the data through controlled process of query handling in smart and efficient way.

In recent years the need for informal home care in European countries is growing quickly due to increased life expectancy and demographic change. Informal caregivers have to overcome many obstacles ranging from a lack of adequate training to misjudging their physical and psychological abilities. The aim of this project is to create a low cost wearable device, which unobtrusively measures the physical stress load on caregivers. Two parameters with the most impact on performance and well-being of the caregiver have been identified: (i) fatigue and (ii) back-stress. Based on the measurements, an alert is issued if caregivers are not performing a task correctly, or if they are overexerting themselves. This paper discusses the design of such device and description of an initial prototype, its advantages and possible further development and applications.

This paper presents the design of a low cost and portable EMG circuit for signal acquisition and signal processing of surface EMG along with motor control and drive circuitry. The proposed circuitry was successfully tested on a prosthetic arm. The paper discusses various approaches that were tested and highlights the best possible approach. The highlighted approach is best for acquiring a high fidelity EMG signal, increase its SNR and process the signal into a form best suited for motor control via a microcontroller. The paper further discusses the use of various types of surface electrodes and the variety of components that can be used in the circuitry depending upon their availability in the local market and their economic aspect.