Viral infections and chronic rhinosinusitis.

Viral infections are the most common cause of upper respiratory infections; they frequently infect adults once or twice and children 6 to 8 times annually. In most cases, these infections are self-limiting and resolve. However, many patients with chronic rhinosinusitis (CRS) relay that their initiating event began with an upper respiratory infection that progressed in both symptom severity and duration. Viruses bind to sinonasal epithelia through specific receptors, thereby entering cells and replicating within them. Viral infections stimulate interferon-mediated innate immune responses. Recent studies suggest that viral infections may also induce type 2 immune responses and stimulate the aberrant production of cytokines that can result in loss of barrier function, which is a hallmark in CRS. The main purpose of this review will be to highlight common viruses and their associated binding receptors and highlight pathophysiologic mechanisms associated with alterations in mucociliary clearance, epithelial barrier function, and dysfunctional immune responses that might lead to a further understanding of the pathogenesis of CRS.

Vaginal pessary: a culprit for intraperitoneal bladder perforation.

Vaginal pessaries are widely considered to be a safe and effective non-surgical management option for women with pelvic organ prolapse. Complications may occur, and are more frequent with improper care and certain device designs and materials. It is imperative to provide information to patients about potential complications. We present the case of a woman in her 70s who presented to the Emergency Department with increasing groin and abdominal pain following a vaginal pessary insertion 2 days prior for grade 3 vaginal vault prolapse. On presentation, her abdomen was markedly distended with guarding. Laboratory investigations showed a significant acute kidney injury with a metabolic acidosis. An initial non-contrast CT showed fluid and inflammatory changes surrounding the bladder, and bladder perforation was suspected. A subsequent CT cystogram showed extravasation of contrast from the bladder into the peritoneal cavity, in keeping with an intraperitoneal bladder rupture. The patient underwent an emergency bladder repair in theatre.

Experimental Research on the Wear Behavior of Materials Used in the Manufacture of Components for Cement Concrete Mixers.

Mixers used in the production of cement concrete operate under special conditions such as mechanical stresses, abrasive-erosive friction phenomena, and corrosive working environments. In this paper, the authors aimed to establish a correlation between the chemical composition of mixer blade materials and their wear behavior. Three types of alloyed (chromium) cast iron were used for an experimental program that included three sets of tests in accelerated wear conditions which replicated the actual working environment (mixture of mineral aggregate, sand, cement, and water). The tribological tests were carried out using a Baroid tribometer. The results indicated that regardless of the test environment, cast iron with the highest chromium content exhibited the best wear resistance. However, it cannot be concluded that the wear resistance of the studied cast iron materials increases as a direct result of an increase in chromium content. For a chromium content of less than 25%, a better tribological behavior was observed for cast iron with a lower chromium content (of about 4%) than for cast irons with a higher chromium content (of about 9%).

Additive Manufacturing Post-Processing Treatments, a Review with Emphasis on Mechanical Characteristics.

Additive manufacturing (AM) comes in various types of technologies and comparing it with traditional fabrication methods provides the possibility of producing complex geometric parts directly from Computer-Aided Designs (CAD). Despite answering challenges such as poor workability and the need for tooling, the anisotropy of AM constructions is the most serious issue encountered by their application in industry. In order to enhance the microstructure and functional behavior of additively fabricated samples, post-processing treatments have gained extensive attention. The aim of this research is to provide critical, comprehensive, and objective methods, parameters and results' synthesis for post-processing treatments applied to AM builds obtained by 3D printing technologies. Different conditions for post-processing treatments adapted to AM processes were explored in this review, and demonstrated efficiency and quality enhancement of parts. Therefore, the collected results show that mechanical characteristics (stress state, bending stress, impact strength, hardness, fatigue) have undergone significant improvements for 3D composite polymers, copper-enhanced and aluminum-enhanced polymers, shape memory alloys, high-entropy alloys, and stainless steels. However, for obtaining a better mechanical performance, the research papers analyzed revealed the crucial role of related physical characteristics: crystallinity, viscosity, processability, dynamic stability, reactivity, heat deflection temperature, and microstructural structure.

Burnout among ICU Healthcare Workers at Two Tertiary Care Hospitals in Makkah during the Hajj Season.

Background: The Hajj season results in increased workload and longer shift hours for healthcare workers at the intensive care units (ICUs), which may result in burnout. Objective: To determine the point prevalence of professional burnout and its predictors among healthcare workers at the ICUs of two tertiary care hospitals in Makkah during the Hajj season. Methods: This cross-sectional descriptive study included all healthcare professionals working at the ICU departments of two of the largest tertiary care hospitals in the Makkah region during the 1439/2018 Hajj season. The original Maslach Burnout Inventory (MBI) questionnaire was used to measure burnout. Logistic regression models were fitted to estimate the effect size of the associated risk factors. Results: A total of 354 participants completed the questionnaire. Moderate to severe burnout was found in each of the three subscales: emotional exhaustion, 56%; depersonalization, 82%, and impaired personal achievement, 72%. Nurses were significantly more likely to experience burnout compared with physicians (P = 0.017). Independent predictors of moderate or severe burnout were being aged ≤40 years (odds ratio [OR]: 2.1, 95% CI: 0.395-4.002; P = 0.045), female gender (OR: 2.2, 95% CI: 0.242-4.346; P = 0.037); work having a negative impact on family (OR: 3, 95% CI: 0.164-5.504; P = 0.019); unsatisfaction with salary (OR: 2.8, 95% CI: 0.28-5.056; P = 0.025); and working at the cardiac critical care unit (OR: 2.6, 95% CI: 0.440-4.467; P = 0.035). Conclusion: This study revealed that the point prevalence of burnout is common among ICU healthcare workers during the Hajj season. These findings can be used by policymakers to devise strategies to mitigate the risks of burnout during the Hajj season.

Efficacy and Safety of Rifaximin in the Prevention of Recurrent Episodes of Hepatic Encephalopathy: A Systematic Review and Meta-analysis.

BACKGROUND: Rifaximin is an oral antimicrobial drug with a broad-spectrum effect. It locally regulates the function and structure of intestinal bacteria and decreases intestinal endotoxemia. We aimed to investigate the preventive role of rifaximin in recurrent episodes of hepatic encephalopathy in cases with a history of hepatic diseases. METHODS: We searched PubMed, Scopus, and Web of Science for the relevant studies using the following search strategy: "(Rifaximin) OR (Xifaxan) AND (cirrhosis) OR (encephalopathy)." We assessed the risk of bias using Cochrane's risk of bias tool. We included the following outcomes: recurrence of hepatic encephalopathy, adverse events, mortality rate, and time to the first episode of hepatic encephalopathy from the time of randomization (days). We performed the analysis of homogeneous data under the fixed-effects model, while analysis of heterogeneous data was performed under the random-effects model. RESULTS: We analyzed data obtained from 999 patients from 7 included trials. The overall risk ratio proved that the rifaximin group was associated with a lower recurrence rate than the control group (risk ratio [RR] = 0.61[0.50, 0.73], P = .001). We found no significant variation in both groups regarding adverse events (RR = 1.08 [0.89, 1.32], P = .41), and mortality rates (RR = 0.98 [0.61, 1.57], P = .93). The overall risk of bias results was low. CONCLUSION: The meta-analysis showed that in patients allocated to the rifaximin group, the incidence rate of hepatic encephalopathy was significantly lower when compared with those in the control group with no difference in both groups regarding adverse events and mortality rates.

Advancements in Fiber-Reinforced Polymer Composites: A Comprehensive Analysis.

Composites made from fiber-reinforced polymers (FRPs) are a crucial and highly adaptable category of materials widely utilized in numerous fields. Their flexibility and the range of criteria for classification enable the creation of tailored solutions to address distinct requirements in sectors such as civil engineering, aerospace, automotive, and marine, among others. The distinguishing characteristics of FRP composites include the type of reinforcing fiber used, the composition of the matrix material, the employed manufacturing process, the orientation of the fibers, and the specific end-use application. These classification variables offer engineers a versatile structure to determine and select the most appropriate materials and production techniques for their specific needs. Furthermore, the present study aims to reunite the criteria of classification for FRPs and specific manufacturing technologies of FRPs, such as conventional ones (matched die molding, contact molding), automated ones (filament winding, tape lay-up, and fiber placement), and advanced ones (electrospinning and additive manufacturing),with the chronological development of FRPs, insights on material characteristics, and comprehensive design guidelines based on their behavior in different environments of use.

Evaluation of the Safety and Efficacy of Dual Therapy Perindopril/Amlodipine in the Management of Hypertension. A Systematic Review and Meta-Analysis.

INTRODUCTION: Hypertension represent the commonest cause of death in 2017. Hypertension is classified into two types which are primary or essential hypertension and secondary hypertension. The perindopril-amlodipine combination showed a significant effect in reduction of the elevated BP and the cardiovascular complications. AIM: To evaluate the efficacy and safety of a fixed-dose single-pill combination of perindopril-amlodipine in hypertensive patients. METHODS: We searched PubMed, Medline, SCOPUS, and Web of Science for relevant clinical trials. Quality appraisal was evaluated according to GRADE and we assessed the risk of bias using Cochrane's risk of bias tool. We included the following outcomes: systolic blood pressure, diastolic blood pressure, pulse pressure, mean blood pressure, heart rate, cough, dizziness, headache, and peripheral edema. We performed the analysis of homogeneous data under the fixed-effects model, while analysis of heterogeneous data was analyzed under the random-effects model. We conducted a meta-regression according to the dose. RESULTS: We included ten clinical trials. The pooled analysis showed that there was a significant reduction of the systolic blood pressure, diastolic blood pressure, pulse plessure, mean blood pressure, and heart rate after the the perindopril-amlodipine combination (MD = 18.96 [14.32, 23.60], P < 0.0001), (MD = 11.90 [8.45, 15.35], P < 0.0001), (MD = 8.44 [6.91, 9.97], P = 0.0001), (MD = 13.07 [5.86, 20.29], P = 0.0004), and (MD = 2.93 [0.89, 4.96], P = 0.005), respectively. The results of the meta-regression revealed that the efficacy is increased by increasing the dose (P < 0.001) CONCLUSION: The use of the perindopril-amlodipine combination had a significant effect on the reduction of SBP, DBP, mean blood pressure, pulse pressure, and HR.

Screening for metabolic liver diseases crucial to increase SVR to patients with CHC.

Liver diseases and its complications is common health problem worldwide. The emergence of metabolic disorders as a cause after exclusion of viral hepatitis nowadays is important. This is retrospective study on 200 patient's age range from 6months to 18 years old (50 females and 150 males). The patients divided into 2 groups according to age < 5 years & >5 years and all investigations done was collected and statistically processed. Abdominal enlargement was observed in 166/200 of all patients, 48/166 (67.6%) in patients <5 years old and 118/166 (91.5%) in patients >5 years old with statistical significant, jaundice was present in 34/200 of patients, 23/34 (32.4%) in patients <5 years old and 11/34(8.5%) in patients >5 years old, with statistical significant difference, CBC was normal in 58/200 of all age groups. 10/58 (14.1%) in patients <5 years old, 48/58 (73.2%) in patients <5 years old, with statistical significant difference and abnormal CBC in 142/200 (61/142, 62.8%) in age group > 5 years old, 81/142 (85.9%) in age group <5 years. Metabolic disorders was normal in 124/200 of all age groups, 23/124 (32.4%) in patients <5 years old. Metabolic disorders was abnormal in 76/200 of all, 48/76(67.6%) in patients >5 years old and 28/76 (21.7%) in patients < 5 years old, with statistical significant difference & for both age groups. The sensitivity of modalities used in the diagnosis of liver disease was as follow for US, study of metabolic profile, abnormal liver functions and abnormal CBC, 83.1%, 65.2%, 61.6% and 66.1% consequently.