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Importance:. Optimal blood product transfusion strategies before tunneled central venous catheter (CVC) placement are required in critically ill coagulopathic patients with liver disease to reduce exposure to allogeneic blood products and mitigate bleeding and thrombotic complications. Objectives:. This study evaluated the safety and efficacy of a thromboelastography-guided transfusion strategy for the correction of coagulopathy in patients with liver disease compared with a conventional transfusion strategy (using international normalized ratio, platelet count, and fibrinogen) before tunneled CVC insertion. Design, Setting, and Participants:. A retrospective propensity score-matched single-center cohort study was conducted at a quaternary care academic medical center involving 364 patients with liver disease (cirrhosis and acute liver failure) who underwent tunneled CVC insertion in the ICU. Patients were stratified into two groups based on whether they received blood product transfusions based on a thromboelastography-guided or conventional transfusion strategy. Main Outcomes and Measures:. Primary outcomes that were evaluated included the volume, units and cost of blood products (fresh frozen plasma, cryoprecipitate, and platelets) when using a thromboelastography-guided or conventional approach to blood transfusions. Secondary outcomes included the frequency of procedure-related bleeding and thrombotic complications. Results:. The total number of units/volume/cost of fresh frozen plasma (12 U/3,000 mL/$684 vs. 32 U/7,500 mL/$1,824 [p = 0.019]), cryoprecipitate (60 U/1,500 mL/$3,240 vs. 250 U/6,250 mL/$13,500 [p < 0.001]), and platelets (5 U/1,500 mL/$2,610 vs. 13 units/3,900 mL/$6,786 [p = 0.046]) transfused were significantly lower in the thromboelastography-guided transfusion group than in the conventional transfusion group. No differences in the frequency of bleeding/thrombotic events were observed between the two groups. Conclusions and Relevance:. A thromboelastography-guided transfusion strategy for correction of coagulopathy in critically ill patients with liver disease before tunneled CVC insertion, compared with a conventional transfusion strategy, reduces unnecessary exposure to allogeneic blood products and associated costs without increasing the risk for peri-procedural bleeding and thrombotic complications.

AbstractThis study investigates the specific requirements for training and enhancing digital collections management for library professionals in Pakistan. The approach is centered around three primary objectives: ascertaining the professional training prerequisites for library professionals overseeing digital collections; assessing the extent of progress in digital collections within university libraries; and pinpointing the obstacles encountered by librarians and library professionals in this domain. The findings indicate a significant deficiency in resources and training for professionals, highlighting the need for specialized training in areas such as digital copyright and preservation techniques. Recommendations for enhancing digital library services encompass more financial resources and targeted training programs. This study addresses significant subjects such as misunderstandings regarding digital libraries, inadequate technological infrastructure, a shortage of skilled workers, copyright difficulties, cultural and digital obstacles, and financial constraints. Resolving these challenges not only has the potential to expedite the establishment of digital libraries in Pakistan but also has the capacity to serve as a model for other developing countries. [ABSTRACT FROM AUTHOR]

Objective: To determine the association between chronic statin use and mortality in patients hospitalized with coronavirus disease 2019 (COVID-19). Patients and Methods: We identified a retrospective cohort of patients requiring admission at the Mayo Clinic using our enterprise-wide COVID-19 registry from March 1, 2020, through September 30, 2020. Available information included age, sex, use of statins, medical comorbidities, and 30-day mortality. We estimated the association of statins with 30-day mortality using odds ratios and 95% CIs from logistic regression modeling. Results: Patients (N=1295) between the ages of 30 and 80 years tested positive for COVID-19 and required admission during the study period, of whom 500 (38.6%) were taking statins at admission. Patients taking statins were older and more likely to have diabetes mellitus or congestive heart failure. Within 30 days of diagnosis, 59 (4.6%) died. In multivariable analysis, statin users did not have statistically different odds of death within 30 days with an odds ratio of 1.14 (95% CI, 0.64 to 2.03; P=.67) compared to nonusers. Conclusion: Patients with COVID-19 taking statins had similar 30-day mortality to those not taking statins after adjusting for relevant covariates. Although this is partly influenced by a higher prevalence of risk factors for more severe COVID-19 presentation not entirely adjusted for by the Charlson comorbidity index, these data would not support statins as a likely therapeutic intervention for COVID-19 in the hospital setting.

Objective: To systematically review the literature and to estimate the risk of chloroquine (CQ) and hydroxychloroquine (HCQ) cardiac toxicity in patients with coronavirus disease 2019 (COVID-19). Methods: We searched multiple data sources including PubMed/MEDLINE, Ovid Embase, Ovid EBM Reviews, Scopus, and Web of Science and medrxiv.org from November 2019 through May 27, 2020. We included studies that enrolled patients with COVID-19 treated with CQ or HCQ, with or without azithromycin, and reported on cardiac toxic effects. We performed a meta-analysis using the arcsine transformation of the different incidences. Results: A total of 19 studies with a total of 5652 patients were included. The pooled incidence of torsades de pointes arrhythmia, ventricular tachycardia, or cardiac arrest was 3 per 1000 (95% CI, 0-21; I2=96%) in 18 studies with 3725 patients. Among 13 studies of 4334 patients, the pooled incidence of discontinuation of CQ or HCQ due to prolonged QTc or arrhythmias was 5% (95% CI, 1-11; I2=98%). The pooled incidence of change in QTc from baseline of 60 milliseconds or more or QTc of 500 milliseconds or more was 9% (95% CI, 3-17; I2=97%). Mean or median age, coronary artery disease, hypertension, diabetes, concomitant QT-prolonging medications, intensive care unit admission, and severity of illness in the study populations explained between-studies heterogeneity. Conclusion: Treatment of patients with COVID-19 with CQ or HCQ is associated with an important risk of drug-induced QT prolongation and relatively higher incidence of torsades de pointes, ventricular tachycardia, or cardiac arrest. Therefore, these agents should not be used routinely in the management of COVID-19 disease. Patients with COVID-19 who are treated with antimalarials for other indications should be adequately monitored.

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a rapidly spreading disease causing increased morbidity and mortality across the globe. There is limited available knowledge regarding the natural history of the SARS-CoV-2 infection. Other factors that are also making this infection spread like a pandemic include global travelers, lack of proven treatment, asymptomatic carriers, potential reinfection, underprepared global health care systems, and lack of public awareness and efforts to prevent further spread. It is understood that certain preexisting medical conditions increase the risk of mortality with COVID-19; however, the outcome of this disease in traditionally vulnerable chronic illnesses such as end-stage renal disease is not well documented. We present a case of a 56-year-old African American lady with end-stage renal disease on the peritoneal dialysis who presented predominantly with nausea, vomiting, and subsequently found to have COVID-19. We use this case to illustrate an atypical presentation of the COVID-19 in a vulnerable patient and discuss the literature.

Lyme disease is a tick-borne infection caused by Borrelia burgdorferi. Cardiac manifestations are rare, occurring in 0.5% to 10% of patients. Lyme carditis and atrioventricular block are established manifestations of Lyme disease. Endocarditis caused by Borrelia has been reported only twice previously, and in both cases, these were species (Borrelia afzelii and Borrelia bissettii) not present in North America. We report a unique case of mitral valve endocarditis caused by B burgdorferi.

With the advent of new technological transformations in libraries and information centres, library professionals have experienced major challenges with changes in the generation, creation, dissemination, and preservation of knowledge in libraries. The objectives of the present study are to find out the hindrances to implementing ICT, and incorporation in libraries has a prominent place in fulfilling the needs of users, but one must not ignore the fact that ICT is not only the factor responsible for achieving the goals of libraries; it is also the library professional's positive attitude that endorses the implementation of the same. There are many factors that can help library professionals develop a positive attitude, including prior knowledge, proper training, and continuing education like in-service courses, workshops, and seminars. If the staff of the library shows a positive attitude towards the adoption of ICT in their organisation, it will raise their self-confidence, thereby increasing productivity, while also raising their morale and motivation among colleagues. On the other hand, a negative attitude will raise high levels of anxiety, lower levels of self-efficacy, technophobia, cyberphobia, and fear of losing their jobs. The negative attitudes of library professionals are the main hindrance to the implementation of ICT in libraries. The present study's findings can advance our understanding of ICT adoption in libraries and provide practical recommendations for maximizing the use of ICT resources in library services. The study concluded that the major objectives have been accomplished by those in the library industry who adopt a critical stance toward the adoption and rejection of new technologies. [ABSTRACT FROM AUTHOR]

This research reviews well cited United Arab Emirates Research Journals as per journal bibliometric quality indicators and scientometric protocols. Complex algorithms and trustworthy databases were used in judging journals quality ranking level. The main objective of this research work is to assess currently employed (2015) scientific journal quality indices with emphasis on recognised indicators that include: Journal Impact Factor (JIF), Eigenfactor Score (ES), SCImago Journal Rank indicator (SJR) and H5-index. United Arab Emirates Research Journals were chosen from their category within Web of Science. JIFs and ESs are acquired from Journal Citation Report and the SJR from the SCImago Journal and country rank website(Cantin, Munoz, & Roa, 2015). The thirty-nine (39) selected United Arab Emirates Research Journals were recorded and their associated data records and information documents retrieved from their primary locations, in Web of Science (WoS) and Scopus, in relating JIF, SJR, ES and H5 quality indicators for ranking purposes and rationales. Correlations amongst indicators were signified through Pearson's and Spearman's statistical correlations, calculated by means of SPSS software. Inspected JIFs fluctuated between 3.753 and 0.59; ES ranged between 0.03069 and 0.00028, while JSR extended between 1.605 and 0.207 and H5 varied between 59 and 9. Bivariate correlation between the four indicators (JIF, ES, SJR and H5) for ranking of the nominated United Arab Emirates Research Journals revealed a high Pearson's (r) statistical correlation between JIF and SJR indicators (r = 0.841) and a rather low statistical correlation between JIF and H5 indicators for journals in the selected category (r = 0.761). This correlation is lowest between JIF and ES values (r = 0.527). Spearman's rho statistical correlation showed a high correlation between JIF and SJR indicator for United Arab Emirates Research Journals (coefficient value of 0.871). A rather low correlation was noted among JIF and each of ES and H5 rankings (coefficient value = 0.728 for both indicators). Keywords: Journal Rank, Bibliometric Indicators, Impact Factor, SCImago Indicator, Eigenfactor Score, H5-Index, United Arab Emirates Research Journals, 1) Introduction Research findings and conclusions usually are published in eminent scientific journals to accredited outcomes, citation associations and work recognition. This is of value to experts, professionals, research groups, [...]

Background: Polycythaemia is defined as an increase in the hemoglobin above normal. This increase may be real or only apparent because of a decrease in plasma volume (spurious or relative polycythaemia) and the real polycythaemia can be because of primary due to genetic mutations or secondary due to increased erythropoietin production. The dominant symptoms from an increased red cell mass are related to hyper viscosity and thrombosis (both venous and arterial), because the blood viscosity increases logarithmically at hematocrits >55%. The present study aimed to characterize the different clinical presentations and to find out the complications associated with polycythaemia. Aim and objectives: To identify different clinical presentations of polycythaemia and to evaluate various etiologies of polycythaemia. Materials and methods: Patients with polycythaemia presented to OPD or in patient in the Department of General Medicine in Malllareddy Institute of Medical Sciences, Suraram from June 2020 to January 2022 were included. This was a descriptive observational study in which total of 24 patients were analyzed. Patients with polycythaemia (male Hb >16.5g/dl and females Hb>16.0g/dl) were included. Patients admitted with acute dehydration, sepsis and shock and other conditions leading to spurious polycythaemia and patient on diuretics were excluded. All the patients included who were found to have increased RBC mass not including patients from exclusion criteria. A detailed clinical history and physical examination was performed to identify clinical patterns of presentation and look for any complications, and necessary lab investigations were sent accordingly, to evaluate for the cause of polycythaemia. Results: A total of 24 patients were included in the study out of which 16 were males, and 8 were females. Polycythaemia Vera was found in 33% while secondary causes were seen in 67%, patients with polycythaemia vera were found to have more thrombotic complications and the mean age of presentation was in between 30-40 years. Amongst the secondary causes COPD was the most common cause and smoking was the most common risk factor. Conclusion: Polycythaemia presents wide and varied clinical manifestations. polycythaemia rubra vera is a not an uncommon finding in patients presenting with symptoms of arterial or venous thrombosis, polycythaemia rubra vera is more commonly associated with thrombotic tendencies when compared to secondary causes of polycythaemia, when evaluating a case of polycythaemia it is necessary to look for signs and symptoms of secondary causes, to especially look for erythropoietin secreting tumors an high index clinical suspicion is required in such cases. [ABSTRACT FROM AUTHOR]

Background: The major cause of morbidity and mortality in patients with portal hypertension is due to oesophageal varices. Upper gastrointestinal endoscopy is considered best to detect varices earlier. It's an invasive tool which is expensive and increased financial burden among patients. Hence this study is undertaken to find non-invasive indicators of oesophageal varices in cirrhosis patients with portal hypertension and to establish the role of portal vein diameter determined by ultrasonography in predicting the oesophageal varices. Aim and objectives: To detect non-invasive indicators of oesophageal varices in chronic liver disease, to determine the relation between oesophageal varices on upper gastrointestinal endoscopy and portal vein diameter, to determine other non-invasive parameters to identify oesophageal varices. Materials and methods: A cross sectional study on 45 patients, who were diagnosed to have chronic liver disease and are being presented to outpatient department and were admitted in Malla Reddy Institute of Medical Sciences, Suraram over a period of one year under department of general medicine. All the patients with chronic liver disease who underwent upper gastrointestinal endoscopy are included in the study. Results: 45 patients with cirrhosis of liver were included in the study, among which 32 were males and 13 were females with a mean age group of 46 years. On upper gastrointestinal endoscopy 87% of patients had oesophageal varices while other 13% of patients were normal. Mean portal vein diameter was 13.8 mm and has a positive linear correlation with p<0.01 and positive predictive value of 95.25%. Majority of patients belonged to the platelet count group of 50,000 to 1lakh and its inversely co related to the severity of varices. Majority of patients with oesophageal varices had moderate splenomegaly. Conclusion: Ultrasonography of portal vein diameter and spleen size along with thrombocytopenia are reliable, inexpensive and easily reproducible non-invasive tool in predicting the presence of oesophageal varices and hence can identify the patients who require endoscopy on a prophylactic basis. [ABSTRACT FROM AUTHOR]

Introduction Electronic publishing has been revolutionizing the format of the recorded knowledge. Electronic information services are attracting readers' attention in today's networked environment. E-journals and E-databases bring new challenges before [...]

Present work studies the role of bibliometric indicators and scientometric instruments for checking the qualities of journals published in the area of construction and building technology. Journal quality review targeted comparisons between indicators of significance and merit from reputable databases. Likewise, present work stressed on performance of well cited journals and their informational correlations as predicted by selected indicators complex algorithms. Main research objective focused on review of scientific journal quality indices that included: Journal Impact Factor (JIF), Eigenfactor Score (ES), SCImago Journal Rank indicator (SJR) and H5 index. Dependable construction and building technology journals were chosen from their category within Web of Science. JIFs and ESs are obtained from Journal Citation Report and the SJR from the SCImago Journal and country rank website. Sixty one construction and building technology journals were selected for this work and their related data records and information documents retrieved from their primary sites in relating designated quality indicators (JIF, SJR, ES and H5). Correlations between indicators were elucidated by means of Pearson's and Spearman's statistical correlations produced by SPSS software. All reclaimed journals are indexed in Web of Science and Scopus citation database. [ABSTRACT FROM AUTHOR]

Objective. This paper investigated the possibility of SCImago Journal Rank (SJR), Eigenfactor Score (ES) and H5 Index indicators as alternatives to the Journal Impact Factor (JIF) in the field of water resources. Method. The SJR, ES, H5 index and JIF scores and ranking of water resources journals were downloaded from the relevant websites. Pearson and Spearman correlation coefficients were calculated to test hypotheses for association between the four journal quality metrics. Result. Strong positive correlations were found between the scores and rank order based on the SJR, ES, H5 and JIF of selected journals. Hence, academics and researchers in water resources can use the SJR, ES and H5 indicators as alternatives to JIF for evaluation and judgment of scientific journals in the area. [ABSTRACT FROM AUTHOR]

The effectiveness of electronic resources and services in select campuses of Fiji National University Library on the basis of users' satisfaction is evaluated. A survey method was employed to conduct this research. Out of sixteen campus libraries of FNU, the researcher selects eight libraries from different division of Fiji in the user's survey. 150 well-structured questionnaires were distributed to gather information related to uses of electronic resources and services. The 140 filled questionnaireswere collected from students and faculty members and analysed, classified and tabulated by employing simple statistical methods. The study reveals that majority of the users of FNU libraries keep themselves abreast of developments in electronic resources, services and their proper utilisation in the field of academic and research. The result showed a growing interest in e-resources among the users and also found that slow downloading and blockage of website is the hurdle in proper utilisation of electronic resources. The survey further reveals that the majority of respondents are aware of the usage of e-resources and services. [ABSTRACT FROM AUTHOR]