Search

Objective The aim of this study was to explore North American neonatal health care professionals' (HCPs) experience, confidence, skill, and training with the laryngeal mask airway (LMA). Study Design This was a cross-sectional survey. Results The survey was completed by 2,159 HCPs from Canada and the United States. Seventy nine percent had no clinical experience with the LMA, and less than 20% considered the LMA an alternative to endotracheal intubation (EI). The majority had received LMA training; however, 28% of registered nurses, 18% of respiratory therapists, 17% of physicians, and 12% of midwives had never inserted an LMA in a mannequin. Less than a quarter of respondents agreed that the current biennial Neonatal Resuscitation Program instruction paradigm is sufficient for LMA training. All groups reported low confidence and skill with LMA insertion, and compared with all other groups, the respiratory therapists had the highest reported confidence and skill. Conclusion This survey study, which is the first of its kind to include midwives, demonstrates that neonatal HCPs lack experience, confidence, skill, and training with the LMA, rarely use the device, and in general, do not consider the LMA as an alternative to EI. These findings contribute to, and support the findings of previous smaller studies, and in conjunction with the diminishing opportunities for EI, highlight the need for programs to emphasize the importance of the LMA for neonatal airway management and prioritize regular LMA training, with focus that parallels the importance placed on the skills of EI and mask ventilation. Key Points Lack of training for laryngeal mask airway use in neonatal resuscitation. Neonatal health care professionals rarely use the laryngeal mask airway as an alternate airway device. Neonatal health care professionals lack confidence and skill with the laryngeal mask airway. [ABSTRACT FROM AUTHOR]

Background: Medical students' preparedness for clinical practice is well researched, yet little is known on the extent to which students are being prepared for a medical career. This paper reports the construction of a short medical inventory titled eXploring medical sTudents' caReer reAdiness (XTRA) to measure students' career readiness based on Super's theory of career maturity. Approach: We designed an instrument consisting of a series of 5‐point Likert‐scale to identify participants competencies regarding career exploration and planning during their undergraduate studies. The instrument was completed by 348 medical students from 41 universities in the United Kingdom. We examined the validity and reliability of the instrument through Exploratory Factor Analysis, Cronbach's coefficient α and Pearson correlation. Evaluation: Exploratory Factor Analysis revealed that 16 of the 20‐items survey were aligned with the exploration stage of Super's theory: Crystallisation (Career goals), Specification (Career pathways) and Implementation (Career accomplishments). The four items that formed two separate statistical factors were specific to a current medical career in the UK. Internal reliability for Super's factor subscales were acceptable (α = 0.71 to α = 0.81). A significant positive relationship was found between students' overall rating of career readiness and the three factors, indicating construct validity. Implications: The XTRA Inventory is a short instrument with construct and content validity specifically designed to measure career readiness of medical students. Further work on its psychometric properties will help establish this inventory to be used as a guidance and career counselling tool by medical educators and educational institutions in developing career development programmes. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Laparoscopic repair of different female genitourinary fistulae has been recently reported, including both conventional and laparoendoscopic single-site surgery (LESS). We present our 10-year single-center experience of the laparoscopic repair of different types of female genitourinary fistulae. Methods: A retrospective analysis of our records over the last 10 years was performed. Type of fistula, etiology, laparoscopic approach, operative data, postoperative outcome, and follow-up were recorded. Results: Overall, 46 patients with laparoscopic repair of genitourinary fistulae were reported: 25 had vesicovaginal fistulae (VVF), 14 had vesicouterine fistulae (VUF), and 7 had ureterovaginal fistulae (UVF). Thirty-three patients had conventional laparoscopic repair, whereas 7 VVF and 6 VUF had LESS repair. In all patients with VVF and VUF, extravesical repair was carried out by excising the fistulous tract and closing both the bladder and the vagina or the uterus with interposing tissue in-between. In patients with UVF, extravesical ureteric re-implantation was performed. Mean operative time was 176 ± 25 min. Mean blood loss was 105 ± 25 cc. No intraoperative or postoperative complications occurred. None was converted to open surgery. Mean postoperative hospital stay was 3.2 ± 1.2 days. After a mean follow-up of 6.3 ± 3.1 years, all patients had undergone successful repair, except for one patient with complex VVF. Conclusions: Laparoscopic repair of VVF, VUF, and UVF is a feasible procedure with a high success rate and low morbidity. LESS repair of VVF and VUF has a comparable success rate to conventional laparoscopy, but with a shorter hospital stay and fewer analgesic requirements. [ABSTRACT FROM AUTHOR]

Background and objectives: Neonatal endotracheal tube (ETT) size recommendations are based on limited evidence. We sought to determine data-driven weight-based ETT sizes for infants undergoing tracheal intubation and to compare these with Neonatal Resuscitation Program (NRP) recommendations. Methods: Retrospective multicenter cohort study from an international airway registry. We evaluated ETT size changes (downsizing to a smaller ETT during the procedure or upsizing to a larger ETT within 7 days) and risk of procedural adverse outcomes associated with first-attempt ETT size selection when stratifying the cohort into 200 g subgroups. Results: Of 7293 intubations assessed, the initial ETT was downsized in 5.0% of encounters and upsized within 7 days in 1.5%. ETT downsizing was most common when NRP-recommended sizes were attempted in the following weight subgroups: 1000 to 1199 g with a 3.0 mm (12.6%) and 2000 to 2199 g with a 3.5 mm (17.1%). For infants in these 2 weight subgroups, selection of ETTs 0.5 mm smaller than NRP recommendations was independently associated with lower odds of adverse outcomes compared with NRP-recommended sizes. Among infants weighing 1000 to 1199 g: any tracheal intubation associated event, 20.8% with 2.5 mm versus 21.9% with 3.0 mm (adjusted OR [aOR] 0.62, 95% confidence interval [CI] 0.41-0.94); severe oxygen desaturation, 35.2% with 2.5 mm vs 52.9% with 3.0 mm (aOR 0.53, 95% CI 0.38-0.75). Among infants weighing 2000 to 2199 g: severe oxygen desaturation, 41% with 3.0 mm versus 56% with 3.5mm (aOR 0.55, 95% CI 0.34-0.89). Conclusions: For infants weighing 1000 to 1199 g and 2000 to 2199 g, the recommended ETT size was frequently downsized during the procedure, whereas 0.5 mm smaller ETT sizes were associated with fewer adverse events and were rarely upsized. [ABSTRACT FROM AUTHOR]

Contexte : La formation en résidence inclut des simulations de réanimations néonatales (SRN). Peu est connu concernant l'anxiété générée par ces simulations. Objectif : Evaluer le stress généré par les SRN. Méthodes : Les résidents de pédiatrie ont fait 2 SRN. La performance a été évaluée à l'aide d'évaluations standardisées du Programme de réanimation néonatale (PRN) et révisée par 2 experts indépendants. Une mesure du cortisol salivaire a été effectuée à 3 reprises : valeur de base (lors d'un cours), présimulation (Tl) et post-simulation (T2) - (après la lèœ simulation). Un questionnaire a été rempli après les simulations. Résultats : 53 résidents (87 %) ont répondu au questionnaire dont 60 % étaient juniors. Les résidents juniors avaient fait en moyenne 3 SRN durant leur résidence, tandis que les seniors 4 à 10. Les résidents juniors avaient eu une exposition plus récente à la néonatalogie. 80 % croient que les SRN reflètent la réalité : quand la réanimation est adéquate, le mannequin s'améliore. 50 % des résidents se disent confortables à diriger la réanimation. 46 % se disent plus anxieux lors de SRN que lors d'une vraie réanimation. 42 résidents ont fait les SRN. Les scores de performance démontrent une moyenne de 81 % pour la performance totale, 75 % pour la ventilation, 90 % pour le massage cardiaque, 87 % pour l'intubation, 76 % pour le cathéter ombilical et 87 % pour les techniques avancées. Alors que 57 % des résidents avaient un score <75 % pour la ventilation, pour le massage cardiaque et les techniques avancées, ce pourcentage était respectivement 5 et 14 %. Les scores étaient similaires chez les juniors et seniors. Le cortisol salivaire augmente significativement entre T0 et Tl (stress d'anticipation). T2 est significativement plus élevé que Tl et n'est pas associé avec le score de performance. 52 % des résidents ont mentionné avoir vécu un stress plus grand ou égal à 7/10 durant les simulations. Conclusion : Les SRN causent un stress qui n'est pas en lien avec la performance. Les résidents croient que les SRN reflètent la réalité alors que c'est faux. En clinique, les nouveau-nés ne s'améliorent pas toujours avec la réanimation. 5 % des naissances nécessitent une ventilation et 2 % un massage cardiaque. Malgré une performance satisfaisante, elle est meilleure pour les manœuvres avancées que celles de base. Les performances similaires chez les résidents juniors et seniors peuvent suggérer une association entre les compétences en réanimation et l'exposition clinique à la néonatalogie. [ABSTRACT FROM AUTHOR]

Copyright of Pédagogie Médicale is the property of EDP Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Pédagogie Médicale is the property of EDP Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The Djibouti area is located in the Afar depression which corresponds to the core of a major hot spot at the junction of three rifts: The Red Sea oceanic rift, the Gulf of Aden oceanic rift and the East African continental rift. In the extension of the Gulf of Aden, the opening of the Gulf of Tadjourah in the last 30 million years was followed by the establishment of parallel NW-SE oriented depressions (Gobaad, Hanle, Gaggade, Assal-Ghoubbet). This region is characterised by high heat flow, complex volcanic and tectonic activity, and a dense network of faults favorable to the development of hydrothermal activities. A field survey was conducted to study the gas composition and origin in thermal springs and fumaroles along a transect running from the Lake Abbhé to Djibouti. Hydrogen traces were detected at fumaroles and hot springs associated with hydrothermal systems at the edges of the Gobaad, Hanlé, Gaggade, Assal-Ghoubbet and Arta area. The processes governing to the origin of H 2 and its consumption at different levels of the magmatic-hydrothermal systems are discussed. H 2 is interpreted as related to several processes including, chemical equilibrium in magmatic gases, alteration of FeII-rich rocks, and oxidation of volcanic H 2 S. Methane associated with the hydrogen has mostly an abiotic origin and could result from the reaction of hydrogen with carbon oxides. Also, helium emanations have been observed notably on the sides of the Lake Abbhé in boiling hot springs. Gas samples have shown R/RA isotopic ratios of helium up to 10, which is are characteristic values for helium of mantle origin characterized an 3He enrichment with respect to air values. • H 2 and He are present in volcanic gases of the Afar area. • H 2 is generated at several level of the volcanic system by chemical equilibrium of volcanic gas, country rocks oxidation and H 2 S oxidation. • H 2 is also consumed at several level by magmatic SO 2 and CO 2 reduction. • The volcanic gas shows relatively high helium contents with high 3He/4He ratios. [ABSTRACT FROM AUTHOR]

Copyright of Pédagogie Médicale is the property of EDP Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Synthetic mid-urethral slings (MUSs) are the gold standard treatment for female stress urinary incontinence (SUI). Recently, there have been reports of serious adverse events with synthetic tapes such as urethral erosion, vaginal erosion, and mesh infection. Tension-free vaginal flap (TVF) operation has been proven to be successful as a natural alternative to synthetic slings. We propose our novel technique, the transobturator tension-free vaginal flap (TO-TVF), utilizing native vaginal tissue and being suspended via transobturator route. Methods: This prospective study was conducted on 72 female patients with SUI, presenting at Alexandria University Hospital. Patients were randomized into 2 groups, group 1: 37 patients subjected to TO-TVF and group 2: 35 patients to conventional transobturator tape (TOT). In TO-TVF, a rectangular vaginal wall flap is created. A polypropylene monofilament mesh is sutured to each edge of the vaginal flap. This is inserted like conventional outside-in TOT. Patients were subjected to PGI and UDI-6 questionnaires and urodynamic study before and 6 months postoperatively. Results: Both groups showed comparable and significant improvements in questionnaires. Mean operative time for TO-TVF and conventional TOT was 26.31 ± 5.2 min and 21.8 ± 3.1 min, respectively. Cure rate was 89% in group 1 and 91.4% in group 2, which was not statistically significant. No significant intraoperative complications were encountered. We had no cases of vaginal or urethral erosion in both groups. Conclusions: TO-TVF is a cost-effective, feasible, safe, and effective surgical alternative to synthetic MUS. Synthetic mesh tissue anchoring properties are maintained for better adjustment of tension. However, long-term follow-up on a large cohort of patients is still needed. [ABSTRACT FROM AUTHOR]

During the coronavirus 2019 (COVID-19) pandemic, the implementation of non-contact infrared thermometry (NCIT) became an increasingly popular method of screening body temperature. However, data on the accuracy of these devices and the standardisation of their use are limited. In the current study, the body temperature of non-febrile volunteers was measured using infrared (IR) thermography, IR tympanic ther- mometry and IR gun thermometry at different facial feature locations and distances and compared with SpotOn core-body temperature. Poor agreement was found between all IR devices and SpotOn measurements (intra-class correlation coefficient <0.8). Bland--Alman analysis showed the narrowest limits of agreement with the IR gun at 3 cm from the forehead (bias = 0.19°C, limits of agreement (LOA): --0.58°C to 0.97°C) and widest with the IR gun at the nose (bias = 1.40°C, LOA: --1.15°C to 3.94°C). Thus, our findings challenge the established use of IR thermometry devices within hospital settings without adequate standard operating procedures to reduce operator error. [ABSTRACT FROM AUTHOR]

Background Hypersensitivity pneumonitis (HP) is an increasingly recognized form of diffuse parenchymal lung disease. Krebs von den Lungen-6 (KL-6) is now classified as a human MUC1 mucin protein, and regenerating type II pneumocytes are the primary cellular source of KL-6/MUC1 in the affected lungs of patients with interstitial lung diseases (ILD). Serum KL-6/MUC1 levels have been demonstrated to be useful for the evaluation of various ILD. To determine the role of circulating KL-6 in evaluating the disease activity and management of HP. Methods An observational cross-sectional study was conducted on 51 patients with HP and 20 healthy controls. Serum KL-6 levels were measured in both groups. Patients were further assessed based on chest high-resolution computed tomography (HRCT), pulmonary function test, 6-minute walk test, echocardiography, bronchioalveolar lavage, and/or transbronchial biopsy. Patients were divided into the fibrotic and non-fibrotic groups according to the HRCT findings. Results The median serum KL-6 levels were significantly higher in HP patients as compared to the control group. The median serum KL-6 levels were found to be higher in the non-fibrotic HP group (1,900 IU/mL) as compared to the fibrotic group (1,200 IU/mL). There was a significant inverse correlation between serum KL-6 serum level and the dose of steroids as well as the duration of steroid therapy. Conclusion The presence of higher KL-6 levels in the non-fibrotic HP group implies its enhanced production by regenerating pneumocytes in response to alveolar injury. The significant association between serum KL-6 levels and the dose and the duration of steroid therapy emphasizes the significant role of steroids in the stabilization of the disease.

The combined impact of complete resection (oncological goal) and no functional loss (functional goal) in glioblastoma subgroups is currently unknown. This study aimed to develop a novel onco-functional outcome (OFO) to merge these two goals into one outcome, resulting in four classes: complete without deficits (OFO1), incomplete without deficits (OFO2), complete with deficits (OFO3), or incomplete with deficits (OFO4). Between 2010–2020, 858 patients with tumor resection for eloquent glioblastoma were included. We analyzed the impact of OFO class on postoperative surgical outcomes using Cox proportional-hazards models with hazard ratios (HR) or logistic regression with odds ratios (OR), followed by specific subgroup analyses. We developed a risk model to predict OFO class preoperatively using logistic regression. The OFO classification stratified the four OFO classes for overall survival (OS:19.0 versus 14.0 versus 12.0 versus 9.0 months), progression-free survival (PFS), and adjuvant therapy. OFO1 was associated with improved OS [HR= 0.67, (0.55–0.81); p < 0.001], and PFS [HR = 0.68, (0.57–0.81); p < 0.001] in the overall cohort and all clinical and molecular subgroups, except for MGMT-unmethylated tumors; and higher rate of adjuvant therapy [OR= 2.81, (1.71–4.84);p < 0.001]. In patients≥ 70 years, only OFO1 improved their survival outcomes. Safe surgery was especially important in patients with a preoperative KPS ≤ 80 to qualify for adjuvant treatment. Awake craniotomy more often led to OFO1 compared to asleep resection [OR = 1.93, (1.19–3.14); p = 0.008]. OFO1 was associated with improved OS, PFS, and receipt of adjuvant therapy in all glioblastoma patients with IDH-wildtype and MGMT-methylated tumors. Awake craniotomy was associated with achieving this optimal OFO status. Preventing deficits was more important than complete surgery. • For the first time, an onco-functional outcome (OFO) classification was developed. • OFO classes can be predicted before surgery to aid with personalized decision making. • These OFO classes are able to stratify for survival and adjuvant treatment. • OFO 1 class was beneficial for all IDHwt, MGMT methylated glioblastoma patients. • OFO class should be a stratification factor for therapeutic neuro-oncological trials. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the use of magnetic resonance imaging (MRI) in preoperative delineation and surgical planning for the management of female urethral and periurethral cystic vaginal swellings, with emphasis on postoperative surgical outcomes. Materials and methods: This is a retrospective analysis of females complaining of periurethral and urethral cystic swellings referred to our tertiary center, who underwent MRI for preoperative planning in the period from January 2014 till January 2021, with a total number of 57 patients. Data retrieved from the medical records included: patients' demographics, presenting symptoms and signs, preoperative radiological investigations, duration of symptoms, previous surgical intervention, detailed intraoperative data, postoperative complications, and postoperative follow-up. Results: Urethral diverticulum was the commonest cystic lesion representing (64.9%) followed by Skene gland cysts in 14%, Mullerian cysts in 7%, Gartner cysts in 3.5%, and dermoid inclusion cysts in 10.5%. MRI precisely diagnosed the various pathological entities and anatomical complex lesions prior to surgery. This was confirmed after surgery and pathology analysis. All patients were followed up with a mean duration of 35 months, without any evidence of recurrence. Conclusion: MRI as a standalone imaging technique is mandatory for diagnosis of all urethral and periurethral cystic lesions, as it offers the most accurate diagnostic modality for delineation of these lesions and hence aids in the preoperative surgical planning, aiming to avoid recurrence and improving surgical outcomes. [ABSTRACT FROM AUTHOR]

Background: Several agents have been added to local anesthetics to increase the quality of anesthesia and to prolong postoperative analgesia. The current study investigated the effect of using dexmedetomidine and magnesium sulphate as additives to levobupivacaine 0.5% for spermatic cord block (SCB) anesthesia in testicular sperm extraction (TESE) surgery. Methodology: It was a prospective, randomized double-blind study, performed on 113 subjects undergoing TESE surgery using local anesthesia. The subjects were randomly divided into four groups. Bilateral SCB was performed for each patient using levobupivacaine 0.5% 18 mL in combination to 2 mL of either normal saline (Group C), dexmedetomidine 1 μg/kg (Group D), magnesium 100 mg (Group M), or a mixture of the same doses of both magnesium and dexmedetomidine (Group MD) according to the group assignment. Patients were compared according to the time of first analgesic dose, and analgesic intake in the first 24 h. Results: The time elapsed till receiving the first analgesic dose was noted to be longer in the Group MD when compared to those in the Groups C, M and D, (20 ± 1.5 vs 9 ± 1.5, 14.4 ± 2.3 and 15.6 ± 2.2 h, respectively; P < 0.001). Moreover, the requirement of postoperative analgesia was noticeably lower in the Group MD when compared to the other groups. Conclusion: Using magnesium and dexmedetomidine as additives to levobupivacaine for ultrasound-guided spermatic cord block prolonged postoperative analgesia, and decreased the total postoperative analgesic consumption [ABSTRACT FROM AUTHOR]

Highlights • Experimental flexural stiffness of CFFT columns. • Study design variables effect on flexural stiffness of CFFT columns. • Developing design equations for the effective flexural stiffness of CFFT columns. • Prediction of effective flexural stiffness at service and ultimate loads. Abstract This research work presents new design equations to adequately determine the effective flexural stiffness (EI e) of concrete-filled fiber-reinforced polymer (FRP)-tubes (CFFTs) columns. Based on an experimental parametric study and theoretical simulation, factors influencing the effective stiffness of reinforced CFFT columns are discussed. The main variables considered are: the axial load ratio (P u /P o) , the eccentricity to diameter ratio (e/D) and the slenderness ratio (L/D). Approximately 3,400 reinforced CFFT columns with different combination of specified variables, in symmetric single curvature bending were simulated to generate the stiffness data. Extensive comparison for the proposed stiffness expressions is made with the results of 74 experimental tests conducted by the authors and others. It is shown that the proposed stiffness equations have a good correlation with the test results. The proposed equations are applicable for any load levels including both service and ultimate loads. Since the proposed expressions give a realistic representation of the actual column behavior, they are recommended for general use in the design of FRP-confined concrete columns under different load levels. [ABSTRACT FROM AUTHOR]

Aim: The safety of SwabCap alcohol impregnated disinfection caps was questioned in our unit because of malfunctions in luer access valves. We examined whether SwabCaps affected the integrity of two luer access valves and were associated with alcohol injected into the lines.Methods: Our bench test study included seven circuits using SmartSite or CARESITE valves exposed to two environmental temperatures. Passive circuits consisted of a 96-hour contact system using SwabCap without other interventions. Active circuits consisted of nine sham injections during a 24-hour period, with the SwabCap replaced after each injection. The active control circuit used isopropyl alcohol impregnated pads to disinfect valves. Isopropyl alcohol was measured at the extremity of all active circuits by gas chromatography.Results: The visual appearance of all SmartSite valves and 67% of the CARESITE valves was changed by SwabCap use. The mean isopropyl alcohol dosages were 52 mmol/L in the SmartSite and 8 mmol/L in the CARESITE at room temperature and 73 and 7 mmol/L, respectively, at 35°C. No alcohol was found in the control circuit.Conclusion: The SwabCap altered the valves' appearance and allowed significant amounts of isopropyl alcohol to be injected. It should not be used for neonates without further research. [ABSTRACT FROM AUTHOR]

Saturated fatty acids ( SFA) have been reported to alter organelle integrity and function in many cell types, including muscle and pancreatic β-cells, adipocytes, hepatocytes and cardiomyocytes. SFA accumulation results in increased amounts of ceramides/sphingolipids and saturated phospholipids ( PL). In this study, using a yeast-based model that recapitulates most of the trademarks of SFA-induced lipotoxicity in mammalian cells, we demonstrate that these lipid species act at different levels of the secretory pathway. Ceramides mostly appear to modulate the induction of the unfolded protein response and the transcription of nutrient transporters destined to the cell surface. On the other hand, saturated PL, by altering membrane properties, directly impact vesicular budding at later steps in the secretory pathway, i.e. at the trans-Golgi Network level. They appear to do so by increasing lipid order within intracellular membranes which, in turn, alters the recruitment of loose lipid packing-sensing proteins, required for optimal budding, to nascent vesicles. We propose that this latter general mechanism could account for the well-documented deleterious impacts of fatty acids on the last steps of the secretory pathway in several cell types. [ABSTRACT FROM AUTHOR]

Abstract: This article presents a comparison of different color spaces including RGB, IHLS and L⁎a*b* for color texture characterization. This comparison is based on the fusion of the independent spatial structure and color feature cues. In IHLS and L*a*b*, two channel complex color images are created from the luminance and the chrominance values. For such images, two dimensional complex multichannel linear prediction models are used to perform parametric power spectrum estimation and the structure feature cues are computed from this estimated power spectrum. Quantitative comparison of auto spectra of luminance and combined chrominance channels for different color spaces is done. This comparison is based on the degree of decorrelation between luminance and chrominance information provided by different color space transformations. Three dimensional histograms are used as color feature cues. Then, to classify color textures, Kullback–Leibler divergence based symmetric distance measures are calculated for pure color, luminance structure and chrominance structure feature cues. Individual as well as combined effect of information from all feature cues on classification results is then compared for different color spaces and different color texture data sets. The proposed color texture classification method performs better than the state of the art methods in certain cases. The L*a*b* color space gives us a better characterization of the chrominance spatial structure as well as the overall spatial structure for all of the chosen data sets. Experimental results on pixel classification of color textures are also presented and discussed. [Copyright &y& Elsevier]

Objectives: To compare success and safety of endotracheal tube (ETT) exchanges with primary intubations and identify factors associated with ETT exchange outcomes., Design: Retrospective observational study of prospectively collected National Emergency Airway Registry for Neonates data. ETT exchanges are the placement of a new ETT when one is already in place, whereas primary intubations do not have a pre-existing ETT. The primary outcome was first-attempt success. Secondary outcomes included number of attempts, adverse tracheal intubation-associated events (TIAEs), severe TIAEs, desaturation and bradycardia. Descriptive statistics compared characteristics for ETT exchanges and primary intubations. Univariable and multivariable analyses compared primary and secondary outcomes and identified factors independently associated with ETT exchange outcomes., Results: A total of 1572 ETT exchanges and 9999 primary intubations across 21 sites were included from October 2014 to September 2022. ETT exchanges represented 2.3%-31.2% (mean 13.6%) of intubations across sites. Patient, provider and practice characteristics varied significantly between ETT exchanges and primary intubations. In univariable analyses, ETT exchanges were associated with higher first-attempt success (70.5% vs 53.6%; p<0.001) and fewer safety events. In multivariable analyses, ETT exchanges were associated with an increased adjusted OR (aOR) of first-attempt success (1.71; 95% CI 1.57 to 1.86; p<0.001). ETT exchanges were associated with lower aOR of all safety outcomes except severe TIAEs. Factors independently associated with ETT exchange first-attempt success included video laryngoscopy and paralytic premedication., Conclusion: Compared with primary intubations, ETT exchanges were associated with higher first-attempt success and fewer safety events. Video laryngoscope and paralytic premedication were associated with improved ETT exchange outcomes., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Background: Emergency medicine (EM) residents must complete both adult and paediatric entrustable professional activities (EPAs). During their paediatric emergency medicine rotation at a university paediatric hospital, EM residents struggled to receive EPA assessments because preceptors had not yet been trained due to the stepwise implementation of EPAs. This study aimed to evaluate the impact of a workshop on behaviour change by measuring the number of EPA assessments., Methods: A comparative pretraining and posttraining study involving 27 invited faculty members was conducted to assess the impact of a faculty development programme. The training was delivered via videoconference with experiential learning techniques to practise every aspect of the supervision of an EPA, including selecting the appropriate EPA according to mirroring real-world situations, giving feedback, evaluating autonomy and recording the EPA in the resident's logbook., Results/findings: In total, 20 out of 27 eligible faculty members (74%) agreed to participate in the study. Their main challenges reported were a lack of trainee initiative, preceptor training and competence in supervising EPAs. Over the 12-month analysis period, the enrolled faculty assessed 125 EPAs for 38 EM residents, including 52 pre-intervention EPAs and 73 post-intervention EPAs. Calculation of data points above the median showed a 1-point difference in the EPAs assessments to resident ratio between the pre- and post-intervention periods (3/7 vs. 4/7)., Conclusion: Our findings suggest that faculty training using multiple educational strategies may enable EM residents to receive more EPA assessments during their paediatric emergency medicine rotation., (© 2024 The Author(s). The Clinical Teacher published by Association for the Study of Medical Education and John Wiley & Sons Ltd.)

Background Diabetic ketoacidosis (DKA) is one of the leading causes of morbidity and mortality in children with diabetes, often requiring intensive care unit management. This study aimed to identify factors associated with the severity of DKA in infants and children hospitalized in pediatric intensive care. Methodology This retrospective, monocentric, descriptive, analytical study included infants and children aged one month to 17 years who presented with DKA meeting the International Society for Pediatric and Adolescent Diabetes 2022 criteria. The study was conducted at the Pediatric Intensive Care Unit of the International University Hospital Cheikh Khalifa in Casablanca from July 2018 to February 2023. For data analysis, patients were divided into two groups, namely, severe DKA and non-severe DKA. Data analysis was performed using Jamovi software. Results Of the 63 children included, 26 (41.3%) had severe DKA, and 37 (58.7%) had non-severe DKA. The mean age was 8.92 ± 5.18 years, with a sex ratio of 0.97. Statistical analysis revealed a significant clinical difference between DKA severity and the presence of dyspnea at admission (p = 0.004) and drowsiness (p = 0.003). Regarding biological parameters, the study showed that patients with severe DKA had significantly higher white blood cell (WBC) counts (p = 0.013), as well as significantly higher procalcitonin (PCT) levels (p = 0.038) and C-reactive protein (CRP) concentrations (p = 0.011) compared to children admitted with non-severe DKA. No significant differences were observed between the two groups regarding age, sex, symptoms, triggering factors, or clinical outcomes. Conclusions The severity of DKA in children is associated with the presence of neurological disturbances and dyspnea at admission, as well as a significant elevation in WBC count, CRP, and PCT., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ahmed Houssein et al.)

Sickle cell disease is one of the most common autosomal recessive genetic disorders with 23% and over 70% of men with this condition, experiencing episodes of ischaemic priapism and stuttering priapism, respectively, with potentially severe consequences. The effective prevention of sickle cell disease induced ischaemic priapism and stuttering priapism requires a multidisciplinary and multimodal approach. A search of the English literature was performed utilising Pubmed® and Google Scholar to identify publications on contemporary and novel treatment options, with their associated treatment outcomes if available, that are utilised to prevent stuttering priapism episodes and hence a fulminant ischaemic priapism. This narrative review focuses on three main aspects which include firstly, patient education and lifestyle modifications. Secondly, strategies aimed at preventing stuttering priapism episodes with traditional treatments such as alpha-adrenergic agonists and hormone manipulation strategies among others. Finally, we review treatments utilised to treat the underlying sickle cell disease with contemporary options such as hydroxyurea to more novel therapies such as crizanlizumab and voxelotor. The role of potentially curative techniques such as gene therapy and stem cell transplantation are also reviewed and summarised., Competing Interests: Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

In this study, we designed and synthesized novel analogues of roflumilast that exhibit selective inhibition of PDE-4B. To accomplish this target; synthesis of novel series (4a-u, 5a-i, and 6) was done, aiming at obtaining new PDE-4B inhibitors hits based on the proposed pharmacophore, 1-(cyclopropylmethoxy)-2-(difluoromethoxy) benzene moiety. Enzyme assay was used to measure the IC 50 values for the PDE-4B inhibition of all the synthesized compounds along with roflumilast as a reference drug. The results demonstrated that most of the examined candidates exhibited considerable inhibitory activity against the PDE-4B enzyme. The four compounds (4i, 4k, 4p, and 4q) exhibited the highest potency (IC 50  = 7.25, 7.15, 5.50, 7.19 nM, respectively) with no significant inhibition difference from roflumilast (no statistical difference at p < 0.05). Interestingly, compound 4p with 3-OH and 4-OCH 3 substituents was found to be the most potent against PDE-4B enzyme (IC 50  = 5.50 nM), compared to that of roflumilast (IC 50  = 2.36 nM). Moreover, the most potent derivatives 4i, 4k, 4p, and 4q were further tested for PDE-4D inhibitory activity to investigate their PDE-4D/PDE-4B selectivity ratio. Compound 4k showed the highest selectivity towards PDE-4B isozyme more than the reference drug roflumilast (PDE-4D/4B IC 50 ratio for compound 4k and roflumilast = 3.22 and 3.02, respectively). Additionally, compound 4p was chosen to test its selectivity for PDE-4B over PDE-8A, PDE-11A, and PDE-1B compared to thereference drug roflumilast. Compound 4p showed approximately 6-fold selectivity for PDE-4B over PDE-8A, about 5-fold selectivity for PDE-4B over PDE-11A, and about 11-fold selectivity of PDE-4B over PDE-1B. Compound 4p showed a higher selectivity towards PDE-4B than PDE-1B, more than the reference compound roflumilast. Furthermore, the most potent compounds (4i, 4k, 4p, 4q) were subjected to further investigation, and their effects on the cAMP level and percentage of inhibition of tumor necrosis factor-alpha (TNF-α) were studied and compared with reference drug roflumilast. Compound 4q showed the highest increase in the level of intracellular cAMP (6.55 ± 0.37 pmol/mL) and compound 4i showed the highest % of TNF-α inhibition (77.22 %). On the other side, a molecular docking study against PDE-4B clarified that all the examined candidates achieved nearly similar binding modes with similar orientations to that of the native roflumilast ligand and showed higher docking scores than roflumilast., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Early-phase trials of venetoclax in children and teenagers/young adults with leukaemia have yielded promising results, but there remains a paucity of real-world data. To address this, we report a cohort of 41 children treated with venetoclax for a range of haematological malignancies, demonstrating complete remission in 43.6%, with most achieving minimal residual disease (MRD) negativity. Venetoclax was particularly effective as a bridge to transplant, with bridging successful in 75% of patients. Patients with MRD <1% at initiation of venetoclax were more likely to achieve MRD negativity (81.8% vs. 34.5%, p = 0.007) and had improved overall survival (54.5% vs. 17.9%, p = 0.004)., (© 2024 British Society for Haematology and John Wiley & Sons Ltd.)

Objective: To determine the factors associated with second attempt success and the risk of adverse events following a failed first attempt at neonatal tracheal intubation., Design: Retrospective analysis of prospectively collected data on intubations performed in the neonatal intensive care unit (NICU) and delivery room from the National Emergency Airway Registry for Neonates (NEAR4NEOS)., Setting: Eighteen academic NICUs in NEAR4NEOS., Patients: Neonates requiring two or more attempts at intubation between October 2014 and December 2021., Main Outcome Measures: The primary outcome was successful intubation on the second attempt, with severe tracheal intubation-associated events (TIAEs) or severe desaturation (≥20% decline in oxygen saturation) being secondary outcomes. Multivariate regression examined the associations between these outcomes and patient characteristics and changes in intubation practice., Results: 5805 of 13 126 (44%) encounters required two or more intubation attempts, with 3156 (54%) successful on the second attempt. Second attempt success was more likely with changes in any of the following: intubator (OR 1.80, 95% CI 1.56 to 2.07), stylet use (OR 1.65, 95% CI 1.36 to 2.01) or endotracheal tube (ETT) size (OR 2.11, 95% CI 1.74 to 2.56). Changes in stylet use were associated with a reduced chance of severe desaturation (OR 0.74, 95% CI 0.61 to 0.90), but changes in intubator, laryngoscope type or ETT size were not; no changes in intubator or equipment were associated with severe TIAEs., Conclusions: Successful neonatal intubation on a second attempt was more likely with a change in intubator, stylet use or ETT size., Competing Interests: Competing interests: VN serves as the President of the Society of Critical Care Medicine (SCCM) 2023–2024. The views expressed in this manuscript are his and not intended to represent the opinions of the SCCM., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction In Malaysia, orthodontic treatments are provided by general dental practitioners (GDPs) or specialist orthodontists. Evidence suggested that the public could be confused about clinicians providing orthodontic treatments. The objectives of this study were to assess the public understanding of the difference between a specialist orthodontist and a GDP who provides orthodontic treatment and to evaluate the factors that might influence the choice of a practitioner. Methods An online, dual-language survey comprising 185 Malaysian adults was completed. Thirteen questions regarding social demographics, knowledge of clinicians providing orthodontic treatment, and factors that influence the choice of a clinician were asked. Results Around 74% of Malaysian respondents knew the differences between a specialist orthodontist and a GDP providing orthodontic treatment. Being treated by a specialist orthodontist and the cost of treatment were identified as the most important factors in choosing an orthodontic service provider followed by recommendations from GDP, location, testimony, and lastly recommendations from friends/family. Conclusion The majority of Malaysian respondents could identify the difference between a specialist orthodontist and a GDP who provides orthodontic treatment. Being treated by a specialist orthodontist and cost were the main factors that influenced the choice of a clinician providing orthodontic treatment in Malaysia., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Jawatankuasa Etika Penyelidikan (Manusia) (JEPeM) Universiti Sains Malaysia (USM) issued approval USM/JEPeM/22040208. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ahmed Elagamy Moussa et al.)

Background: Based on the involvement of qualified educators in its design, the Learning-by-Concordance tool aims to promote the learning of reasoning in contexts of uncertainty. However, data are still scarce on the experience of educators in terms of sharing and exposing their reasoning processes using this tool., Purpose: This study sought to explore the beliefs and experiences of educators when involved in the design of a Learning-by-Concordance tool., Method: This research used a descriptive qualitative design. Four dialogue groups were conducted with educators with different roles and responsibilities while designing a Learning-by-Concordance tool. A descriptive interpretative analysis of educators' verbatim quotes was done., Findings: A total of 14 participants took part in the study. The results show the discomfort of educators despite their recognized expertise. Three themes emerged: 1- the need to be reassured by the opinions of colleagues; 2-feeling like impostors; and 3- concerns for the quality of instructional supports., Conclusions: The role taken by educators for teaching reasoning in contexts of uncertainty is to draw on practical experience where different types of knowledge intersect and are mobilized, to overcome feelings of insecurity, and to engage in close and authentic conversation with learners., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Crown Copyright © 2024. Published by Elsevier Inc. All rights reserved.)

Objective: To evaluate whether ECG monitoring impacts resuscitative steps during simulated neonatal resuscitation in the setting of pulseless electrical activity (PEA) in the delivery room., Design: This pilot, crossover randomised controlled trial recruited providers in teams of three who participated in two simulation scenarios (PEA with and without ECG monitoring). Teams were randomised to one scenario and then crossed over. All sessions were video-recorded. The primary outcome was time to pulse check once the manikin was programmed to become pulseless. The secondary outcomes were total pulse checks, time to positive pressure ventilation, intubation, chest compressions and administration of epinephrine, and teams' quotes and behaviours during resuscitation. The primary outcome was analysed using Kaplan-Meier survival curve. The secondary outcomes were compared with Wilcoxon signed-rank test. The quotes were analysed using content analysis with pattern coding., Results: Eighty-two healthcare providers were approached and 30 consented (10 teams). The mean time to check the pulse once the manikin was pulseless was 38.5 s (SD 30.1) without ECG vs 88.1 s (SD 46.1) with ECG (p<0.01). There was a significantly decreased number of pulse checks with the ECG compared with without (p<0.01). Time to intubation, chest compressions, start of positive pressure ventilation and epinephrine administration was not different between the groups. Quotes/behaviours revealed false reassurance and over-reliance on ECG monitoring, repeated pulse check errors and troubleshooting behaviours., Conclusions: ECG monitoring in simulated neonatal resuscitation results in delayed recognition of a pulseless state, decreased number of pulse checks and a possible false sense of security. Simulated resuscitation clinical endpoints are unaffected., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Mitigating spill pollution in the Nile River is crucial to protecting aquatic life, water quality, and public health. Extensive studies focused on the assessment of water quality and hydrodynamics of the Nile River, but there have been relatively few studies that have applied integrated hydrodynamic and water quality modeling approaches to simulate actual accidents in the Nile Fourth Reach. The goal of this study is to develop advanced computational models to simulate accidental spills in the Nile River and track the resulting impacts on water quality. Hydrodynamic and water quality simulations were performed using Delft3D software for 144 km of the Nile River, Egypt, from El-Menia to Assuit. Once the hydrodynamic and water quality models were calibrated, two phosphate spill scenarios were modeled under maximum and minimum flow conditions. The spatial distribution of the spill plume along the studied river section was visualized every 12 h following the spill occurrence for both scenarios. The results of the research were calibrated and validated against measured field data. In addition, various error and performance indicators were calculated to thoroughly assess the rigor and reliability of the results. The results demonstrated that flow velocity was the main factor influencing the spill plume characteristics and behavior. Initially, advection force plays a significant role after a spill occurs. After that, phosphate becomes mixed and diluted through dispersion. The spill plume took less time to reach downstream areas during the period of maximum flow compared to minimum flow. Additionally, the concentration of phosphate decreased as the water flowed downstream. The spatial distribution of the spill over time can assist water treatment facilities in developing mitigation strategies to address the spill impacts. However, complex Nile River dynamics demand extensive computational power. Therefore, the model was simplified for spill events, using the modeling capabilities to analyze hypothetical spills and contaminant spread in the absence of real data., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Simulation is an effective training method for neonatal resuscitation (NR). However, the limitations brought about by the COVID-19 pandemic, and other resource constraints, have necessitated exploring alternatives. Virtual reality (VR), particularly 360-degree VR videos, have gained attraction in medical training due to their immersive qualities. The primary objectives of the study were to produce a high quality 360-degree virtual reality (VR) video capturing NR simulation and to determine if it could be an acceptable adjunct to teach NR. The secondary objective was to determine which aspects of NR could benefit from the incorporation of such a video in training. This was an exploratory development study. The first part consisted of producing the video using a GoPro action camera, Adobe Premiere Pro, and Unity Editor. In the second part participants were recruited, based on level of experience, to watch the video and answer questionnaires to determine acceptability (user experience and cognitive load) and aspects of NR which could benefit from the video. The video was successfully developed. Forty-six participants showed a strong general appreciation. User experience revealed high means (> 6) in the positive subscales and low means (< 4) for immersion side effect, with no difference between groups. Cognitive load was higher than anticipated. Participants indicated that this video could be effective for teaching crisis resource management principles, human and environment interactions, and procedural skills. The 360-degree VR video could be a potential new simulation adjunct for NR. Future studies are needed to evaluate learning outcomes of such videos., (© 2024. The Author(s).)

Background: Using the sandwich osteotomy technique in the posterior mandible is delicate. This study aimed to assess the safety and the amount of bone gain using a full digital workflow versus the conventional procedure., Patients and Methods: This split mouth study included 10 patients with bilateral vertically deficient posterior mandible. One side received conventional sandwich interpositional bone grafting (control group), while the other side received the same protocol using two patient-specific guides. The first guide (cutting guide) was used to place the osteotomies safely and accurately according to the predetermined dimensions and locations, and the second guide was used to fix the mobilized bony segment, leaving the desired gap to be filled with a particulate xenogenic bone graft., Results: Full neurosensory recovery was documented at 2 months postoperative for all patients and bilaterally. After 4 months, there was a statistically significant difference in vertical bone gain between both groups (p = 0.001), measuring an average of 3.76 ± 0.72 mm in the study group and 2.69 ± 0.37 mm in the control group. No statistically significant difference was found between the planned vertical augmentation (3.85 ± 0.58 mm) and the obtained vertical bone gain (3.76 ± 0.72 mm) in the study group (p = 0.765) proving the accuracy of the guided procedure., Conclusion: Computer-guided sandwich interpositional grafting is predictable regarding the execution of the osteotomies and the accuracy of fixation of the transport segment., (© 2024 Wiley Periodicals LLC.)

Competing Interests: Competing interests: None declared.

Over the past three decades, a notable rise in the occurrence of enteric protozoan pathogens, especially Giardia and Cryptosporidium spp., in drinking water sources has been observed. This rise could be attributed not only to an actual increase in water contamination but also to improvements in detection methods. These waterborne pathogens have played a pivotal role in disease outbreaks and the overall escalation of disease rates in both developed and developing nations worldwide. Consequently, the control of waterborne diseases has become a vital component of public health policies and a primary objective of drinking water treatment plants (DWTPs). Limited studies applied real-time PCR (qPCR) and/or immunofluorescence assay (IFA) for monitoring Giardia and Cryptosporidium spp., particularly in developing countries like Egypt. Water samples from two conventional drinking water treatment plants and two compact units (CUs) were analyzed using both IFA and qPCR methods to detect Giardia and Cryptosporidium. Using qPCR and IFA, the conventional DWTPs showed complete removal of Giardia and Cryptosporidium, whereas Mansheyat Alqanater and Niklah CUs achieved only partial removal. Specifically, Cryptosporidium gene copies removal rates were 33.33% and 60% for Mansheyat Alqanater and Niklah CUs, respectively. Niklah CU also removed 50% of Giardia gene copies, but no Giardia gene copies were removed by Mansheyat Alqanater CU. Using IFA, both Mansheyat Alqanater and Niklah CUs showed a similar removal rate of 50% for Giardia cysts. Additionally, Niklah CU achieved a 50% removal of Cryptosporidium oocysts, whereas Mansheyat Alqanater CU did not show any removal of Cryptosporidium oocysts. Conventional DWTPs were more effective than CUs in removing enteric protozoa. The contamination of drinking water by enteric pathogenic protozoa remains a significant issue globally, leading to increased disease rates. Infectious disease surveillance in drinking water is an important epidemiological tool to monitor the health of a population., (© 2023. The Author(s).)

The results of gene expression analysis based on p -value can be extracted and sorted by their absolute statistical significance and then applied to multiple similarity scores of their gene ontology (GO) terms to promote the combination and adjustment of these scores as essential predictive tasks for understanding biological/clinical pathways. The latter allows the possibility to assess whether certain aspects of gene function may be associated with other varieties of genes, to evaluate regulation, and to link them into networks that prioritize candidate genes for classification by applying machine learning techniques. We then detect significant genetic interactions based on our algorithm to validate the results. Finally, based on specifically selected tissues according to their normalized gene expression and frequencies of occurrence from their different biological and clinical inputs, a reported classification of genes under the subject category has validated the abstract (glomerular diseases) as a case study., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Ettetuani, Chahboune and Moussa.)

Objective: To assess if simulation-based just-in-time training (JITT, short video and simulation) is superior to video training (5-minute video) in acquiring skill in neonatal endotracheal intubation (ETI)., Study Design: A Canadian multicenter randomized trial recruited junior residents who performed neonatal ETI from July 2017 to June 2021. The primary outcomes were overall and first attempt ETI success rate. Secondary outcomes included number of attempts, duration of attempts, ETI-related complications, and residents' confidence level. Statistical analysis included generalized estimating equations, mixed model analysis, Mann-Whitney test, and χ² tests., Results: Sixty-five residents performed 139 ETI. The overall success rate was similar for both groups (67% vs 70%, P = .71). However, the first attempt success rate was higher for the simulation-based JITT group (54% vs 41%, P = .035). The mean duration of attempts was shorter (35 [SD, 9] vs 62 [SD, 9] seconds, P = .048) and the median number of attempts had a tendency to be lower for the simulation-based JITT group (1 [IQR, 1; 1] vs 1 [IQR, 1; 2], P = .02). There were more mucosal trauma events in the simulation-based JITT group (P = .02). Residents in both groups reported similar confidence level in performing ETI., Conclusions: Compared with video training, simulation-based JITT for neonatal ETI did not improve overall success rate. However, simulation-based JITT improved first attempt success rate and decreased the number and the duration of ETI attempts. With its positive clinical impact, simulation-based JITT can become an educational adjunct to neonatal ETI training for residents., Trial Registration: ClinicalTrials.gov: NCT02809924., Competing Interests: Declaration of Competing Interest This project was funded by the Canadian Pediatric Society Neonatal Resuscitation Program Research Grant and a Medical Education Grant from the Education Department of Centre Hospitalier Universitaire Sainte-Justine. The authors declare no conflicts of interest., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objectives: Aim of the study was to translate the International Female Coital Incontinence Questionnaire (IFCI-Q) into Arabic (Egyptian) and validate it into among Egyptian population complaining of coital urinary incontinence (CI)., Methods: Original questionnaire has been translated and back-translated by an expert panel, to produce the Arabic version. A pilot study was performed to make sure the questionnaire was understandable. Sixty patients included in the study were divided into two groups: Group A comprised patients with CI, and Group B comprised females who attended the urology clinic for other complaints, without CI. Reliability of the Arabic IFCI-Q was evaluated for internal consistency using Cronbach alpha coefficient. Test-retest reliability was determined using the Weighted Cohen's k-test. Discrimination validity was evaluated by comparing scores of patients with those of healthy females not complaining of CI using Mann-Whitney test., Results: 83.3% of women of both groups (mean age: 43.1 ± 10.6 yrs [Group A], 38.9 ± 8 [Group B] yrs) reported OAB symptoms, 73.3% had stress urinary incontinence and 46.7% reported mixed urinary incontinence. Regarding Group A, 10 patients had CI during penetration, 12 during orgasm and 8 had both forms of CI. The comparison of the responses between Group A and Group B demonstrated a statistically difference ( p  < 0.00). The content validity was assessed by a panel of expert functional urologists. The Cronbach's alpha coefficients for the total score were high (0.9-1), indicating high internal consistency. The difference between the two groups revealed an internal consistency of IFCI-Q of 0.563-0.851. The test-retest procedure revealed that the k-values of each item are very good., Conclusions: The Arabic version will allow utilizing this tool in a large population of Arabic-speaking countries, with different ethnic and demographic backgrounds., Competing Interests: No potential conflict of interest was reported by the author(s)., (© 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

Introduction and Objectives: Data on the use of single step dilatation technique during pediatric percutaneous nephrolithotomy (PCNL) in the literature is sparse. In this prospective randomized study, we aimed to compare the safety, efficacy, and perioperative complications of single step versus serial tract dilatation using Alken metal telescopic dilators during pediatric PCNL., Methods: Patients undergoing PCNL were randomized into two groups according to the dilatation technique used. In group A, Alken telescopic serial metal dilatation was utilized, and in group B, single step dilatation was performed. Inclusion criteria included children < 18 years with stone burden from 2 to 4 cm, located in the renal pelvis ± one calyx, who were candidates for PCNL. The primary outcomes were access time and complications' rate. The secondary outcomes were dilatation fluoroscopy time, operative duration, stone free rate, postoperative hospital stay, hemoglobin deficit, and need for blood transfusion. Both outcomes were evaluated and compared between both treatment groups., Results: A total of 70 patients were randomized into group A (35 patients) and group B (35 patients). Access was successfully obtained in all procedures. All the procedures were performed through a single tract. Access time and dilatation fluoroscopy time were shorter in group B (statistically significant). Patients in group A had higher rate of complications (statistically significant). Intraoperative bleeding requiring blood transfusion was less in single track dilatation than serial metal track dilatation., Conclusions: Compared to serial metal track dilatation, single step dilatation showed comparable operative time and stone free rate, with significantly reduced access time and dilatation fluoroscopy time., (© 2022. The Author(s).)

Background: Chlamydia trachomatis is an obligate intracellular gram-negative pathogen, responsible for diverse affections, mainly trachoma and sexually transmitted diseases. Antibiotics are the commonly used drugs to tackle chlamydiae infections. However, when overused or wrongly used this may lead to strains' resistance to antibiotics, this phenomenon represents a real health problem worldwide. Numerous studies showed the association of Chlamydia trachomatis resistance with mutations in different genes; these mutations could have a deleterious or neutral impacts on the encoded proteins. The aim of this study is to perform an in silico analysis of C. trachomatis rpoB-encoded proteins using numerous bioinformatics tools and to identify the functional and structural-related effects of the mutations and consequently their impact on the bacteria sensitivity to antibiotics., Results: The analysis revealed that the prediction of the damaging impact related to the mutations in rpoB-encoded proteins showed eight mutations: V136F, Q458K, V466A, A467T, H471N, H471Y, H471L, and I517M with big deleterious effects. Among them, six mutations, V136F, Q458K, V466A, A467T, H471N, and I517M, are located in a highly conserved regions decreasing the protein's stability. Furthermore, the structures analysis showed that the mutations A467T, H471N, I517M, and V136F models had a high deviation compared to the wild type. Moreover, the prediction of protein-protein network indicated that rpoB wild type interacts strongly with 10 proteins of C. trachomatis, which are playing different roles at different levels., Conclusion: As conclusion, the present study revealed that the changes observed in the encoded proteins can affect their functions and structures, in addition to their interactions with other proteins which impact the bacteria sensitivity to antibiotics. Consequently, the information revealed through this in silico analysis would be useful for deeper exploration to understand the mechanisms of C. trachomatis resistance and enable managing the infection to avoid its complications. We recommend further investigations and perform deeper experimental analysis with collaboration between bioinformaticians, physicians, biologists, pharmacists, and chemistry and biochemistry scientists., (© 2022. The Author(s).)

Objective: To determine the relationship between number of attempts and adverse events during neonatal intubation., Study Design: A retrospective study of prospectively collected data of intubations in the delivery room and NICU from the National Emergency Airway Registry for Neonates (NEAR4NEOS) in 17 academic centers from 1/2016 to 12/2019. We examined the association between tracheal intubation attempts [1, 2, and ≥3 (multiple attempts)] and clinical adverse outcomes (any tracheal intubation associated events (TIAE), severe TIAE, and severe oxygen desaturation)., Results: Of 7708 intubations, 1474 (22%) required ≥3 attempts. Patient, provider, and practice factors were associated with higher TI attempts. Increasing intubation attempts was independently associated with a higher risk for TIAE. The adjusted odds ratio for TIAE and severe oxygen desaturation were significantly higher in TIs with 2 and ≥3 attempts than with one attempt., Conclusion: The risk of adverse safety events during intubation increases with the number of intubation attempts., (© 2022. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Objective: We hypothesized that videolaryngoscope use for tracheal intubations would differ across NICUs, be associated with higher first attempt success and lower adverse events., Study Design: Data from the National Emergency Airway Registry for Neonates (01/2015 to 12/2017) included intubation with direct laryngoscope or videolaryngoscope. Primary outcome was first attempt success. Secondary outcomes were adverse tracheal intubation associated events and severe desaturation., Results: Of 2730 encounters (13 NICUs), 626 (23%) utilized a videolaryngoscope (3% to 64% per site). Videolaryngoscope use was associated with higher first attempt success (p < 0.001), lower adverse tracheal intubation associated events (p < 0.001), but no difference in severe desaturation. After adjustment, videolaryngoscope use was not associated with higher first attempt success (OR:1.18, p = 0.136), but was associated with lower tracheal intubation associated events (OR:0.45, p < 0.001)., Conclusion: Videolaryngoscope use is variable, not independently associated with higher first attempt success but associated with fewer tracheal intubation associated events., (© 2022. The Author(s), under exclusive licence to Springer Nature America, Inc.)