Prevalence and prognosis of fulminant type 1 diabetes mellitus in The Middle East: a comparative analysis in a 5-year nationwide cohort.

PURPOSE: To analyze the prevalence and progression of fulminant type 1 diabetes (FT1D) in Qatar. METHODS: This retrospective study analyzed consecutive index- diabetic ketoacidosis (DKA) admissions (2015-2020) among patients with new-onset T1D (NT1D) in Qatar. RESULTS: Of the 242 patients, 2.5% fulfilled the FT1D diagnostic criteria. FT1D patients were younger (median-age 4-years vs.15-years in classic-T1D). Gender distribution in FT1D was equal, whereas the classic-T1D group showed a female predominance at 57.6% (n = 136). FT1D patients had a mean C-peptide of 0.11 ± 0.09 ng/ml, compared to 0.53 ± 0.45 ng/ml in classic-T1D. FT1D patients had a median length of stay (LOS) of 1 day (1-2.2) and a DKA duration of 11.25 h (11-15). The median (length of stay) LOS and DKA duration in classic-T1D patients were 2.5 days (1-3.9) and 15.4 h (11-23), respectively. The FT1D subset primarily consisted of moderate (83.3%) and severe 916.7%) DKA, whereas classic T1D had 25.4% mild, 60.6% moderate, and 14% severe DKA cases. FT1D was associated with a higher median white cell count (22.3 × 103/uL) at admission compared to classic T1D (10.6 × 103/uL). ICU admission was needed for 66.6% of FT1D patients, compared to 38.1% of classic-T1D patients. None of the patients in the FT1D group had mortality, while two died in the classic-T1D group. CONCLUSION: This is the first study establishing the existence of FT1D in ME, which presented distinctively from classic-T1D, exhibiting earlier age onset and higher critical care requirements. However, the clinical outcomes in patients with FT1D seem similar to classic T1D.

Integrating artificial intelligence techniques for advancements in colorectal cancer management: navigating past and predicting future direction.

Artificial Intelligence (AI) in the last few years has emerged as a valuable tool in managing colorectal cancer, revolutionizing its management at different stages. In early detection and diagnosis, AI leverages its prowess in imaging analysis, scrutinizing CT scans, MRI, and colonoscopy views to identify polyps and tumors. This ability enables timely and accurate diagnoses, initiating treatment at earlier stages. AI has helped in personalized treatment planning because of its ability to integrate diverse patient data, including tumor characteristics, medical history, and genetic information. Integrating AI into clinical decision support systems guarantees evidence-based treatment strategy suggestions in multidisciplinary clinical settings, thus improving patient outcomes. This narrative review explores the multifaceted role of AI, spanning early detection of colorectal cancer, personalized treatment planning, polyp detection, lymph node evaluation, cancer staging, robotic colorectal surgery, and training of colorectal surgeons.

Successful medical management of a pituitary macroadenoma with features of resistant acromegaly and hyperprolactinemia using pasireotide.

BACKGROUND: The somatostatin analog, pasireotide, is used for the treatment of acromegaly after the failure of surgery and/or first-line medical treatment. CASE PRESENTATION: A 48-year-old male reported that during a workup for obesity in his home country, hyperprolactinemia was diagnosed and a 3.5 × 3.5 cm pituitary macroadenoma was identified on pituitary MRI. He received cabergoline for 6 months; then he was lost to follow-up. He presented at our Endocrine clinic 2 years later for treatment of obesity (BMI 49.5 kg/m2). Biochemical workup revealed that in addition to hyperprolactinemia (7,237 [normal: 85-323 mIU/L), he had acromegaly, evident by elevated insulin-like growth factor 1 (IGF-1) level (450 [normal: 88-210 µg/L]), and a positive growth hormone suppression test, secondary hypothyroidism, and secondary hypogonadism. Pituitary MRI showed that the adenoma encased parts of the left and right internal carotid arteries and encroached on the optic chiasm. Surgical excision was therefore not feasible. He was treated with cabergoline and later, long-acting release (LAR) octreotide. Prolactin levels were reduced with cabergoline, but IGF-1 levels did not respond to octreotide, and it was discontinued. The patient abandoned radiotherapy after two sessions. He was started on LAR pasireotide 40 mg every 4 weeks and continued on cabergoline 0.5 mg per week. His biochemical response was dramatic, with a near normalization of IGF-1 levels in 3 months. After 6 months from starting pasireotide, we increased cabergoline dose from 0.5 mg/week to 3 mg/week. Three months later, IGF-1 level was normalized. The patient developed type 2 diabetes as a side effect of pasireotide; however, this was well-controlled with medications. CONCLUSIONS: The case suggests that pasireotide can provide marked biochemical improvement in acromegaly after the failure of both cabergoline monotherapy and cabergoline plus octreotide. This further confirms a potentially efficacious treatment regimen in treatment-resistant acromegaly with hyperprolactinemia.

Differential evolution of diabetic ketoacidosis in adults with pre-existent versus newly diagnosed type 1 and type 2 diabetes mellitus.

BACKGROUND: Diabetic ketoacidosis (DKA) was once known to be specific to type-1 diabetes-mellitus (T1D); however, many cases are now seen in patients with type-2 diabetes-mellitus (T2D). Little is known about how this etiology shift affects DKA's outcomes. METHODS: We studied consecutive index DKA admissions from January 2015 to March 2021. Descriptive analyses were performed based on pre-existing T1D and T2D (PT1D and PT2D, respectively) and newly diagnosed T1D and T2D (NT1D and NT2D, respectively). RESULTS: Of the 922 patients, 480 (52%) had T1D, of which 69% had PT1D and 31% NT1D, whereas 442 (48%) had T2D, of which 60% had PT2D and 40% NT2D. The mean age was highest in PT2D (47.6 ± 13.1 years) and lowest in PT1D (27.3 ± 0.5 years) (P < 0.001). Patients in all groups were predominantly male except in the PT1D group (55% females) (P < 0.001). Most patients were Arabic (76% in PT1D, 51.4% in NT1D, 46.6% in PT2D) except for NT2D, which mainly comprised Asians (53%) (P < 0.001). Patients with NT2D had the longest hospital length of stay (LOS) (6.8 ± 11.3 days) (P < 0.001), longest DKA duration (26.6 ± 21.1 h) (P < 0.001), and more intensive-care unit (ICU) admissions (31.2%) (P < 0.001). Patients with PT1D had the shortest LOS (2.5 ± 3.5 days) (P < 0.001), DKA duration (18.9 ± 4.2 h) (P < 0.001), and lowest ICU admissions (16.6%) (P < 0.001). CONCLUSIONS/INTERPRETATION: We presented the largest regional data on differences in DKA based on the type and duration of diabetes- mellitus (DM), showing that T2D is becoming an increasing cause of DKA, with worse clinical outcomes (especially newly diagnosed T2D) compared to T1D.

Feasibility of robotic platform to perform R0 resection for locally advanced multi-visceral pelvic malignancy: an institutional experience on outcomes of robotic pelvic exenteration.

BACKGROUND: Exenteration surgery for multi-visceral pelvic malignancy is a complex life-changing operation with high perioperative morbidity and mortality. Traditional open surgery has long been the standard approach for pelvic exenteration for achieving Ro resection which is the main aim of surgery. In the current era of minimally invasive surgery, robotic-assisted pelvic exenteration has provided a promising alternative, offering potential advantages in terms of improved oncological outcomes and enhanced postoperative recovery. This study aims to explore the feasibility of a robotic platform for locally advanced multi-visceral pelvic malignancy. METHODS: A retrospective review from the prospectively maintained robotic colorectal surgery database at University Hospital Coventry and Warwickshire (UHCW) Trust was performed. Demographic details and clinical and surgical details were documented from the case records. Data was analysed using SPSS version 22. RESULTS: Thirteen female patients diagnosed with primary or recurrent pelvic malignancy who underwent robotic pelvic exenteration at UHCW between February 2019 and April 2023 at UHCW were included. The mean age of our patients was 60.4 (± 10.1) years. Complete Ro resection was achieved in all 13 (100%) cases on final histopathology. The median length of hospital stay was 15 days after this extensive surgery. Grade 3 morbidity on Clavien-Dindo classification was observed in four (30.7%) patients, while zero percent 30-day mortality was experienced in this study. At a median follow-up of 21 (3-53) months, we observed tumor recurrence in three (23.7%) patients, while death in four (30.7%) patients. Only few studies have highlighted outcomes of robotic pelvic exenteration, and our results were quite comparable to them. CONCLUSION: Robotic-assisted pelvic exenteration for primary or recurrent pelvic malignancy is feasible with improved oncological and acceptable postoperative outcomes.

Environmental threatening concern and efficient removal of pharmaceutically active compounds using metal-organic frameworks as adsorbents.

An alarming number of contaminants of emerging concern, including active residues from pharmaceuticals and personal care products (PPCPs), are increasingly being introduced in water systems and environmental matrices due to unavoidable outcomes of modern-day lifestyle. Most of the PPCPs based contaminants are not completely eliminated during the currently used water/wastewater treatment processes. Therefore, highly selective and significant removal of PPCPs from environmental matrices remains a scientific challenge. In recent years, a wide range of metal-organic frameworks (MOFs) and MOF-based nanocomposites have been designed and envisioned for environmental remediation applications. MOF-derived novel cues had shown an adsorptive capability for the extraction and removal of an array of trace constituents in environmental samples. Noteworthy features such as substantial surface area, size, dispersibility, tunable structure, and repeated use capability provide MOFs-derived platform a superiority over in-practice conventional adsorptive materials. This review provides a comprehensive evaluation of the efficient removal or mitigation of various categories of PPCPs by diverse types of MOF-derived adsorbents with suitable examples. The growing research investigations in this direction paves the way for designing more efficient porous nanomaterials that would be useful for the elimination of PPCPs, and separation perspectives.

Vehicle Make and Model Recognition using Bag of Expressions.

Vehicle make and model recognition (VMMR) is a key task for automated vehicular surveillance (AVS) and various intelligent transport system (ITS) applications. In this paper, we propose and study the suitability of the bag of expressions (BoE) approach for VMMR-based applications. The method includes neighborhood information in addition to visual words. BoE improves the existing power of a bag of words (BOW) approach, including occlusion handling, scale invariance and view independence. The proposed approach extracts features using a combination of different keypoint detectors and a Histogram of Oriented Gradients (HOG) descriptor. An optimized dictionary of expressions is formed using visual words acquired through k-means clustering. The histogram of expressions is created by computing the occurrences of each expression in the image. For classification, multiclass linear support vector machines (SVM) are trained over the BoE-based features representation. The approach has been evaluated by applying cross-validation tests on the publicly available National Taiwan Ocean University-Make and Model Recognition (NTOU-MMR) dataset, and experimental results show that it outperforms recent approaches for VMMR. With multiclass linear SVM classification, promising average accuracy and processing speed are obtained using a combination of keypoint detectors with HOG-based BoE description, making it applicable to real-time VMMR systems.

When abusive supervision affects creative idea sharing: Understanding the role of employee cheating and organizational justice.

Getting employees to share their creative ideas has long been recognized as a vital source of organizational effectiveness. This research uses the conservation of resources theory to investigate how employee's creative idea sharing is affected by abusive supervision. Data for this research was collected from 209 employees and their immediate supervisors of generic nurses and medical dispensers of Southern Punjab public sector hospitals working under the Ministry of national health services regulation and Coordination. Data were then analyzed with the AMOS software package for simple regression and moderated mediation. This study found that with the increase in abusive supervision, employees develop cheating behavior, diminishing probability of sharing their creative ideas with coworkers. Along these lines, organizational justice moderates this relationship and attenuates the negative indirect effect of abusive supervision on creative idea sharing. The researchers recommended that organizations should develop training programs or coaching sessions for leaders to make them equip with essential interpersonal skills that can eradicate abusive supervision. Research implications, limitations, and future research directions are also discussed.

A systematic review of the clinical characteristics and course of atrioventricular blocks in hyperthyroidism.

BACKGROUND: Atrioventricular block (AVB) is rare in hyperthyroidism (HTH). Little is known about the true prevalence, clinical course, optimal management, and outcomes of different types of AVBs in patients with HTH. To address these uncertainties, we aimed to conduct a systematic review by combining the available literature to provide more meaningful data regarding AVBs in HTH. METHODS: We systematically searched PubMed, Scopus, Embase, and Google Scholar for articles reporting patients who developed AVB in the context of HTH. Data were analysed in STATA 16. The main outcomes included types of AVB, frequency of pacemaker insertion, and resolution of AVB. The systematic review is registered with the International Prospective Register of Systematic Reviews (PROSPERO) with the identification number CRD42022335598. RESULTS: A total of 56 studies (39 case reports, 12 case series, 3 conference abstracts, 1 retrospective study, and 1 prospective observational study) with 87 patients were included in the analysis, with a mean age of 39.1 ± 17.6 years. Females constituted 65.7% (n = 48) of the cohort. Complete heart block (CHB) was the most commonly reported AVB (N = 45, 51.7%), followed by first-degree AVB (16.1%) and second-degree AVB (14.9%). Overall, 21 patients underwent pacing. A permanent pacemaker was inserted in one patient with second-degree AVB and six patients with CHB. Mortality was reported in one patient with CHB. The clinical course and management of HTH and AVBs did not differ in patients with CHB or lower-degree blocks. Apart from lower rates of goitre and more use of carbimazole in those who underwent pacing, no differences were found when compared to the patients managed without pacing. CONCLUSION: Current data suggest that CHB is the most common type of AVB in patients with HTH. Most patients can be managed with anti-thyroid management alone. Additionally, whether pacemaker insertion alters the clinical outcomes needs further exploration.

A systematic review of literature on Insulin-like growth factor-2-mediated hypoglycaemia in non-islet cell tumours.

INTRODUCTION: Insulin-like growth factor-2 (IGF-2)-mediated hypoglycemia is a rare yet clinically significant entity with considerable morbidity and mortality. Existing literature is limited and fails to offer a comprehensive understanding of its clinical trajectory, management and prognostication. METHODS: Systematic review of English-language articles reporting primary patient data on IMH was searched using electronic databases (PubMed, Scopus and Embase) from any date up to 21 December 2022. Data were analysed in STATA-16. RESULTS: The systematic review contains 172 studies, including 1 Randomised controlled trial, 1 prospective observational study, 5 retrospective observational studies, 150 case reports, 11 case series and 4 conference abstracts. A total of 233 patients were analysed, averaging 60.6 ± 17.1 years in age, with comparable proportions of males and females. The commonest tumours associated with Insulin-like Growth Factor-2-mediated hypoglycaemia were fibrous tumours (N = 124, 53.2%), followed by non-fibrous tumours originating from the liver (N = 21, 9%), hemangiopericytomas (N = 20, 8.5%) and mesotheliomas (N = 11, 4.7%). Hypoglycaemia was the presenting feature of NICT in 42% of cases. Predominant clinical features included loss of consciousness (26.7%) and confusion (21%). The mean IGF-2 and IGF-1 levels were 882.3 ± 630.6 ng/dL and 41.8 ± 47.8, respectively, with no significant correlation between these levels and patient outcomes. Surgical removal was the most employed treatment modality (47.2%), followed by medication therapy. The recovery rate was 77%, with chronic liver disease (CLD) significantly associated with a poor outcome (OR: 7.23, P: 0.03). Tumours originating from fibrous tissues were significantly associated with recovery (p < .001). In the logistic regression model, CLD remained a significant predictor of poor outcomes. CONCLUSION: This systematic review highlights that most non-islet-cell tumour-hypoglycaemia (NICTH) is due to fibrous tumours. NICTs demonstrate a variable prognosis, which is fair if originating from fibrous tissue. Management such as octreotide, corticosteroids, diazoxide, embolization, radiotherapy and surgical resection have disparate success rates.

Dietary inclusion of Withania somnifera and Asparagus racemosus induces growth, activities of digestive enzymes, and transcriptional modulation of MyoD, MyoG, Myf5, and MRF4 genes in fish, Channa punctatus.

The present study explores growth potential of two medicinal herbs, Withania somnifera (Ashwagandha or 'A') and Asparagus racemosus (Shatavari or 'S') after their dietary inclusion in fish, Channa punctatus (13.5 ± 2 g; 11.5 ± 1 cm). Three hundred well-acclimatized fish were distributed into 10 groups- C (Control), S1 (1% S), S2 (2% S), S3 (3% S), A1 (1% A), A2 (2% A), A3 (3% A), AS1 (1% A and S), AS2 (2% A and S), and AS3 (3% A and S), each having 10 specimens. Fish were fed with these diets for 60 days. The study was performed in triplicate. Growth indices- weight gain (WG), specific growth rate percentage (SGR%), feed intake (FI), and condition factor (CF), after 30 and 60 days, were found significantly (p < 0.05) up-regulated in all the groups, except S1, when compared to the C. A significant (p < 0.05) increase in final body weight (FBW) was noticed in all the groups, except S1, after 60 days. Relative to the control group, activities of lipase and amylase in the gut tissue were elevated in all groups, at both sampling times, with the exception of lipase in S1 at 60 days, and amylase in S1 at day 30 and day 60 and S2 at day 60. The mRNA expression of myogenic regulatory factors (MRFs) was also found to be significantly (p < 0.05) up-regulated with the highest fold changes recorded in AS3 for myoD (3.93 ± 0.91); myoG (6.71 ± 0.30); myf5 (4.40 ± 0.33); MRF4 (4.94 ± 0.21) in comparison to the C.

Clinical characteristics and outcomes of patients with TSH-secreting pituitary adenoma and Graves' disease - a case report and systematic review.

BACKGROUND: Coexistence of TSH-secreting pituitary adenoma (TSHoma) and Graves' disease (GD) is rare and complicates the management decision. METHODS: We present a case of the co-existence of TSHoma and GD. In addition, we systematically searched articles describing TSHoma and GD in the same patient published until 20th March 2023, using Pubmed, Scopus and Embase. CASE PRESENTATION: A 46-year-old man presented with symptoms of thyrotoxicosis. His thyroid function tests showed serum TSH 3.35 (reference range 0.3-4.2) mIU/L, FT3 19.7 (3.7-6.4) pmol/L, and FT4 68.9 (11-23.3) pmol/L. The serum TSH receptor antibody was 11.5 mIU/L (positive at ≥ 1.75 mIU/L). Pituitary magnetic resonance imaging showed macroadenoma compressing the optic chiasm. The patient underwent trans-sphenoidal resection of pituitary adenoma. Postoperatively, he remained on maintenance carbimazole and octreotide. RESULTS: Fourteen articles comprising 15 patients were identified from the systemic search. A total of 16 patients (including the current case) were included in the systematic review. The mean (± SD) age at diagnosis was 41 ± 13.6 years. The majority were females (75%). The median (IQR) TSH was 1.95 (0.12-5.5) mIU/L, the median (IQR) free T3 was 11.7 (7.6-19.7) pmol/L and the median (IQR) free T4 level was 47.6 (33.3-64.4) pmol/L. Ten (76.9%) patients had positive TSH receptor antibody levels. 84.6% had pituitary macroadenoma. Pituitary surgery was performed in 12 (75%) patients. At the last follow-up, 4 (25%) patients had complete resolution of symptoms after pituitary surgery, 3 (18.7%) were on maintenance treatment with thionamides for GD, 1 (6.25%) on beta-blockers and 1 (6.25%) on somatostatin analog. CONCLUSION: TSHoma and GD can co-exist, and it is essential to identify this rare association as it can significantly impact treatment strategies.

Oxidative stress, inflammation, and steatosis elucidate the complex dynamics of HgCl2 induced liver damage in Channa punctata.

Water bodies are highly pollution-prone areas in which mercury (Hg) is considered as a major menace to aquatic organisms. However, the information about the toxicity of mercuric chloride (HgCl2) in a vital organ such as the liver of fish is still inadequate. This study aimed to assess the impact of mercuric chloride (HgCl2) exposure on the liver of Channa punctata fish over 15, 30, and 45 days, at two different concentrations (0.039 mg/L and 0.078 mg/L). Mercury is known to be a significant threat to aquatic life, and yet, information regarding its effects on fish liver remains limited. The results of this study demonstrate that exposure to HgCl2 significantly increases oxidative stress markers, such as lipid peroxidation (LPO) and protein carbonyls (PC), as well as the levels of serum glutamic-oxaloacetic transaminase (SGOT) and serum glutamic pyruvic transaminase (SGPT) in the fish. Additionally, the transcriptional and protein analysis of specific genes and molecules associated with necroptosis and inflammation, such as ABCG2, TNF α, Caspase 3, RIPK 3, IL-1ß, Caspase-1, IL-18, and RIPK1, confirm the occurrence of necroptosis and inflammation in the liver. Histopathological and ultrastructural examinations of the liver tissue further reveal a significant presence of liver steatosis. Interestingly, the upregulation of PPARα suggests that the fish's body is actively responding to counteract the effects of liver steatosis. This study provides a comprehensive analysis of oxidative stress, biochemical changes, gene expression, protein profiles, and histological findings in the liver tissue of fish exposed to mercury pollution in freshwater environments.

Discrimination of Xylene Isomers by Precisely Tuning the Interlayer Spacing of Reduced Graphene Oxide Membrane.

Separating xylene isomers is a challenging task due to their similar physical and chemical properties. In this study, we developed a molecular sieve incorporating a reduced graphene oxide (rGO) membrane for the precise differentiation of xylene isomers. We fabricated GO membranes using a vacuum filtration technique followed by thermal-induced reduction to produce rGO membranes with precisely controllable interlayer spacing. Notably, we could finely tune the interlayer spacing of the rGO membrane from 8.0 to 5.0 Å by simply varying the thermal reduction temperature. We investigated the reverse osmosis separation ability of the rGO membranes for xylene isomers and found that the rGO membrane with an interlayer spacing of 6.1 Å showed a high single component permeance of 0.17 and 0.04 L m-2 h-1 bar-1 for para- and ortho-xylene, respectively, exhibiting clear permselectivity. The separation factor reached 3.4 and 2.8 when 90:10 and 50:50 feed mixtures were used, respectively, with permeance 1 order of magnitude higher than that of current state-of-the-art reverse osmosis membranes. Additionally, the membrane showed negligible permeance and selectivity decay even after continuous operation for more than 5 days, suggesting commendable membrane resistance to solvent swelling and operating pressure.

Comparing Anesthesia and Surgery Controlled Time for Primary Total Knee and Hip Arthroplasty Between an Academic Medical Center and a Community Hospital: Retrospective Cohort Study.

BACKGROUND: Osteoarthritis is a significant cause of disability, resulting in increased joint replacement surgeries and health care costs. Establishing benchmarks that more accurately predict surgical duration could help to decrease costs, maximize efficiency, and improve patient experience. We compared the anesthesia-controlled time (ACT) and surgery-controlled time (SCT) of primary total knee (TKA) and total hip arthroplasties (THA) between an academic medical center (AMC) and a community hospital (CH) for 2 orthopedic surgeons. OBJECTIVE: This study aims to validate and compare benchmarking times for ACT and SCT in a single patient population at both an AMC and a CH. METHODS: This retrospective 2-center observational cohort study was conducted at the University of Colorado Hospital (AMC) and UCHealth Broomfield Hospital (CH). Cases with current procedural terminology codes for THA and TKA between January 1, 2019, and December 31, 2020, were assessed. Cases with missing data were excluded. The primary outcomes were ACT and SCT. Primary outcomes were tested for association with covariates of interest. The primary covariate of interest was the location of the procedure (CH vs AMC); secondary covariates of interest included the American Society of Anesthesiologists (ASA) classification and anesthetic type. Linear regression models were used to assess the relationships. RESULTS: Two surgeons performed 1256 cases at the AMC and CH. A total of 10 THA cases and 12 TKA cases were excluded due to missing data. After controlling for surgeon, the ACT was greater at the AMC for THA by 3.77 minutes and for TKA by 3.58 minutes (P<.001). SCT was greater at the AMC for THA by 11.14 minutes and for TKA by 14.04 minutes (P<.001). ASA III/IV classification increased ACT for THA by 3.76 minutes (P<.001) and increased SCT for THA by 6.33 minutes after controlling for surgeon and location (P=.008). General anesthesia use was higher at the AMC for both THA (29.2% vs 7.3%) and TKA (23.8% vs 4.2%). No statistically significant association was observed between either ACT or SCT and anesthetic type (neuraxial or general) after adjusting for surgeon and location (all P>.05). CONCLUSIONS: We observed lower ACT and SCT at the CH for both TKA and THA after controlling for the surgeon of record and ASA classification. These findings underscore the efficiency advantages of performing primary joint replacements at the CH, showcasing an average reduction of 16 minutes in SCT and 4 minutes in ACT per case. Overall, establishing more accurate benchmarks to improve the prediction of surgical duration for THA and TKA in different perioperative environments can increase the reliability of surgical duration predictions and optimize scheduling. Future studies with study populations at multiple community hospitals and academic medical centers are needed before extrapolating these findings.

A retrospective study comparing the results of continuous glucose monitoring to self-blood glucose monitoring for pregnant women with type 1 diabetes mellitus.

BACKGROUND: Type 1 diabetes mellitus (T1DM) is associated with adverse maternal and fetal outcomes. Continuous glucose monitoring (CGM) during pregnancy is associated with better glycemic control in women with T1DM. However, no clear benefits have been demonstrated in reducing adverse feto-maternal outcomes in pregnant women with T1DM. DESIGN AND METHODS: This is a retrospective, single-center study of pregnant women with T1DM to evaluate the impact of CGM use on glycemic control and feto-maternal outcomes in pregnant women with T1DM. RESULTS: Of 265 women with T1DM, 92 (34.7%) used CGM, and 173 (65.3%) were managed with capillary blood glucose (CBG) monitoring. The mean (SD) age and BMI at the first visit were 29.4 (4.7) years and 27.2 (5.2) kg/m2, respectively. The mean (SD) HbA1c at the first-trimester visit was 63 (1) mmol/mol, and in the last trimester was 51 (1%). There was no difference in the mean changes in HbA1c between the two groups. Women using CGM had lower insulin requirements (1.02 + 0.37 vs. 0.87 + 0.04 units/kg, p = 0.01). The two groups had no significant differences in maternal or fetal outcomes. CONCLUSION: CGM use in pregnant T1DM women is not associated with improved fetomaternal outcomes.

The role of Da Vinci Xi robotic simulation curriculum in enhancing skills in robotic colorectal surgery.

Robotic surgery in comparison to open and laparoscopic surgery allows better ergonomics, three-dimensional vision, and seven-degree freedom of movement. This ensures fast recovery, fewer postoperative complications, and safe oncological resections. Robotic surgery has revolutionized the field of colorectal surgery, providing surgeons with enhanced precision, dexterity, and visualization. To ensure safe and successful outcomes, surgeons must acquire competency and proficiency in robotic surgical techniques. Robotic simulation exercises have emerged as a valuable tool for training and skill development in robotic colorectal surgery. This research paper explores the importance and relationship between robotic simulation exercises and the acquisition of skills and competency required for carrying out safe colorectal surgery using a robotic platform. The authors discuss the benefits of virtual simulation-based training using the Da Vinci Xi skill simulator, and the evidence supporting its effectiveness in colorectal surgery. In this article, emphasis has been made on some important Da Vinci Xi skill simulator exercises for enhancing skills in robotic colorectal surgery.

Leaders' ambition and followers' cheating behavior: The role of performance pressure and leader identification.

Purpose: We seek to understand why and how leaders' actions that are positive from organizational perspectives, drive to engage employees in cheating behaviors. Design/methodology/approach: The proposed mediated moderation model was tested in two separate studies, study 1 and study 2, with data collected from police officers and employees of Islamic banking respectively, and then analyzed with Mplus for random coefficient models for direct effects, indirect effects, and for mediated moderation. Findings: It was found that leaders' ambitions may enhance performance pressure on the subordinates, which in turn promotes their cheating behavior. Overall, we found that the traditional view of ambition theory only emphasizes good mechanisms such as motivation. However, to integrate with a social identity perspective, ambition would also cause pressure and pressure rather than motivation. Additionally, leaders' ambitions are more strongly and positively related to the performance pressure and cheating behaviors of employees when subordinates also have high leader identification. The findings of this research suggested that leaders' positive workplace behavior could also spawn subordinates' unethical behaviors. Practical implications: Through this research, we can help policymakers understand that leaders' positive desire in general and ambition, in particular, may not be necessarily associated with subordinates' positive behaviors. Our results revealed that internalized with performance pressure, the leaders' ambition is associated with subordinates' cheating behavior. The findings of this research will help policymakers understand what might be promoting unethical behavior of employees. The cheating behavior of employees is not a singular level phenomenon of subordinates, it could also be triggered by contextual factors. Therefore, in developing policies for reducing the chance of cheating at work, the policymakers should also focus on the contextual factors that might be promoting cheating. Originality/value: Ambitious leaders tend to demonstrate high performance, also, performance pressure literature focuses efforts of the employees toward high performance. The dark side of these lines of researches is still underexplored. We shifted the conventional focus of understanding to the positive side of ambition and performance pressure by explaining the potential cost in the form of employees' enhanced cheating behavior. The interplay between the relationship between leaders' ambition and subordinates' perception of leader identification also enhanced our understating about the boundary condition of the relationship between leaders' ambition, performance pressure, and cheating behavior of subordinates.

Construct validity of the physical activity neighborhood environment scale-Oman.

Aims: This study aims to examine the construct validity of Physical Activity Neighborhoods Environment Scales, Oman (PANES-O), and compare the subjective perceptions with objective measures in Muscat, the capital area of Oman. Methods: Walkability index scores using GIS maps were calculated for 35 study areas in Muscat based on which five low and 5 high walkable study areas were randomly selected. A community survey was then conducted in November 2020 in each study area using the 16-item PANES-O instrument to measure the participants' perception of neighborhood density, land use mix, infrastructure, safety, aesthetics, and street connectivity. Due to pandemic restrictions, a social media-based purposive sampling strategy was utilized to reach community-based networks and complete digital data collection. Results: Significant differences between the low and high walkablehigh-walkable neighborhoods were observed for 2 of 3 macroenvironment subscales, density and land use. Respondents in high walkable neighborhoods perceived their areas as having more twin villas (P = 0.001) and apartment buildings (P < 0.001), greater access to destinations (like more shops, and places to go within walking distance; P < 0.001), easy access to public transport (P < 0.001), and more places to be active (P < 0.001); than their counterparts in low walkable neighborhoods. In terms of microenvironmental attributes, respondents in high walkablehigh-walkable neighborhoods perceived their areas to have better infrastructure, better aesthetic qualities, and better social environment than their counterparts in low walkablelow-walkable neighborhoods. Significant differences in perceptions across 12 of the 16-item PANES tool confirmed that 6 of the 7 subscales were significantly sensitive to built environment attributes between the low and high walkable study areas. Respondents in high walkable neighborhoods perceived their areas as having greater access to destinations (like more shops, places to go within walking distance; P ≤ 0.001), easy access to public transport (P ≤ 0.001), more places to be active (P ≤ 0.001), better infrastructure (like more sidewalks, facilities to bicycle; P ≤ 0.001), and better aesthetic qualities (P ≤ 0.001). PANES-O also was able to rate high walkable neighborhoods to be higher in residential density and land-use mix compared to the low walkable neighborhoods demonstrating its sensitivity to the GIS maps' objective measures. Conclusions and recommendations: These results provide preliminary strong support for the construct validity of PANES-O, suggestingconfirming that it is a promising tool for assessing macroenvironmental perceptions related to physical activity in Oman. Further research using objective measures of microenvironments and device-based physical activity scores is needed to confirm the criterion validity of the 10 micro-environmental attributes of PANES-O using objective measures for the microenvironment. PANES-O could be used to generate and develop the needed evidence on the most appropriate approaches to improving the built environment to promote physical activity and urban planning in Omanthe country.