Association of postoperative delirium with hypotension in critically ill patients after cardiac surgery: a prospective observational study.

BACKGROUND: Postoperative delirium (POD), an acute and variable disturbance in cognitive function, is an intricate and elusive phenomenon that occurs after cardiac surgery. Despite progress in surgical techniques and perioperative management, POD remains a formidable challenge, imposing a significant burden on patients, caregivers, and healthcare systems. METHODS: This prospective observational study involved 307 patients who underwent cardiac surgery. Data on the occurrence of delirium, clinical parameters, and postoperative characteristics were collected. A multivariate analysis was performed to assess the relationship between POH and POD. RESULTS: Sixty-one patients (21%) developed delirium, with an average onset of approximately 5 days postoperatively and a duration of approximately 6 days. On multivariate analysis, POH was significantly associated with POD, and the adjusted odds ratios indicated that patients with POH were more likely to develop delirium (OR, 5.61; p = 0.006). Advanced age (OR, 1.11; p = 0.002), emergency surgery (OR, 8.31; p = 0.001), and on-pump coronary artery bypass grafting were identified as risk factors of POD. Patients who developed delirium were typically older, more likely to be male, and had higher morbidity rates than those who did not. CONCLUSION: POH is significantly associated with delirium in critically ill patients after cardiac surgery. Surgical complexity and advanced age contribute to the risk of developing POD and poor postoperative outcomes.

Diabetic Patient with CA-MRSA Pneumonia and Plasma Cell Neoplasm: A Case Report of Severe Complications and Prognosis.

BACKGROUND The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) has been increasing in recent years, becoming a cause of community-acquired infection. Interestingly, its role in malignancy recently started to be considered after a noticed increase in reported cases and studies discussing the potential association. CASE REPORT In the present case, the patient had known and uncontrolled diabetes mellitus and a history of multiple abscesses that were previously treated by incision and drainage. The patient received a diagnosis of severe pneumonia, and MRSA was found in blood cultures. Further tests for HIV, hemagglutinin type 1, and neuraminidase type 1 (H1N1) were negative. The D test was also performed for macrolide-inducible resistance and was negative, indicating the need for intravenous administration of clindamycin. An echocardiogram ruled out endocarditis. Subsequently, the patient experienced progressive back pain and weakness involving the lower limbs. A pathological fracture was discovered, along with nerve root compression. An urgent posterior spine fixation was then performed by a neurosurgeon. A biopsy was collected at the site of the pathological fracture, and histopathological tests indicated a plasma cell neoplasm. CONCLUSIONS MRSA is known to cause serious and dangerous infections, including necrotizing pneumonia. Furthermore, a link between MRSA and plasma cell dyscrasia has been considered in several reports. This necessitates the need for further studies to clarify this hidden association, which may help in the course and prognosis of these patients.

Remineralization effect of Er;Cr:YSGG laser irradiation with or without acidulated phosphate fluoride application on deciduous teeth enamel surface with induced white spot lesion. An in vitro study.

Background: This study aims to assess the efficacy of Er; Cr: YSGG laser operating under sub-ablative settings for the remineralization of artificially induced white spot lesions on the enamel of primary teeth, both as a standalone treatment and in conjunction with 1.23% acidulated phosphate fluoride (APF) gel. Material and Methods: Eighty primary posterior teeth were used to induce white spot lesions and were randomly divided into eight groups. The groups consisted of a negative control group (G1), a 0.75W laser irradiation group (G2), a 0.5W laser irradiation group (G3), a 0.25W laser irradiation group (G4), a positive control group with APF gel application (G5), and three groups that received laser irradiation of 0.75W, 0.5W, and 0.25W followed by APF gel application (G6, G7, and G8) respectively. Surface microhardness, SEM, and X-RD were used to evaluate the remineralization effect. Results: There was a notable enhancement in surface microhardness post-treatment with the laser, APF gel, and their combination compared to the negative control group. The most pronounced increase in surface microhardness was observed in the combination treatment groups (G6, G7, and G8). SEM analysis showed increased surface roughness in groups treated with 0.75W and 0.5W laser power. X-RD assessments indicated an augmentation in crystal intensity within groups G6 and G8. Conclusions: The combined application of Er; Cr: YSGG laser under sub-ablative parameters and APF gel demonstrated a superior potential for remineralizing primary teeth enamel affected by white spot lesions. Key words:Er;Cr:YSGG laser. Sub-ablative irradiation. Remineralization. White spot lesion. APF gel. SEM. X-RD.

Evaluation of orthobiological ozonized platelet-rich plasma therapy post-arthroscopic suturing and lone partial meniscectomy in the treatment of meniscal tears within degenerative knee osteoarthritis.

BACKGROUND: Knee joint osteoarthritis (OA)-related meniscal tears are still sometimes treated in centers by arthroscopic partial meniscectomy (APM), which is then followed by a solitary physical therapy regimen. OBJECTIVE: The present study was conducted to compare the efficacy of intra-articular injection of ozonized platelet-rich plasma (PRP) and hyaluronic acid following arthroscopic suturing, and APM to treat meniscal tear degenerative type. METHODS: In a randomized trial of prospective comparative research, 104 patients, all of whom had meniscal tears due to OA of the knee, were randomly divided into two groups. The participants in Group A (55 patients) were given intra-articular ozonized PRP and hyaluronate therapeutics, following arthroscopic suturing of meniscal tear treatment (ASMT) of degenerative knee joint OA. Group B (49 patients) was prepared for APM alone. Both groups were followed by physical therapy and a follow up visit throughout 12, 24, and 36 months. The WOMAC and Lequesne scores were evaluated. RESULTS: At every follow up visit for 6, 12, and 24, months, there was a significant decline in the mean of WOMAC and Lequesne scores in Groups A and B relative to baseline. Additionally, Group A significantly (P<0.0001) outperformed Group B at 12, 24, and 36 months for both Lequesne's and WOMAC scores. There were infection, stiffness, and widespread OA knee degeneration detected in Group B while no serious adverse effects were observed in Group A. CONCLUSION: The study's findings demonstrated that physical and intra-articular orthobiological ozonized PRP and hyaluronate therapies were more effective than APM in treating degenerative knee joint OA.

Prevalence and risk of hospitalization for depression in patients with heart failure.

BACKGROUND: Patients with heart failure could have a high prevalence of depression which may increase the risk of hospitalization. So this study is to estimate the prevalence of depression among patients attending heart failure clinics, and determine whether depression increases the risk of hospitalization in patients with heart failure. METHODS: In this analytical cross-sectional study, we interviewed patients with heart failure and identified those with depression; the Patient Health Questionnaire-9 was used to estimate the prevalence of depression and assess clinical outcomes, including the risk of hospitalization. RESULTS: A total of 200 patients with a mean age of 64,44±13,865 years were analyzed. The prevalence of depression among them was 36.5%. and it affected by factors like employment, education, and medical status, as Patients on diuretics were found to be greater at 41.1% than non-users at 19% (p=0,008). The majority of the patients with both heart failure and depression were hospitalized twice or more during the last year 54.8% (p=0,001). CONCLUSION: The prevalence of depression among patients with heart failure is high, which increases the risk of hospitalization.

Monoterpenoid synergy: a new frontier in biological applications.

Monoterpenoids, compounds found in various organisms, have diverse applications in various industries. Their effectiveness is influenced by the oil's chemical composition, which in turn is influenced by plant genotype, environmental conditions, cultivation practices, and plant development stage. They are used in various industries due to their distinctive odor and taste, serving as ingredients, additives, insecticides, and repellents. These compounds have synergistic properties, resulting in superior combined effects over discrete ones, potentially beneficial for various health purposes. Many experimental studies have investigated their interactions with other ingredients and their antibacterial, insecticidal, antifungal, anticancer, anti-inflammatory, and antioxidant properties. This review discusses potential synergistic interactions between monoterpenoids and other compounds, their sources, and biological functions. It also emphasizes the urgent need for more research on their bioavailability and toxicity, underlining the importance and relevance of this comprehensive study in the current scientific landscape.

Evaluating large language models for health-related text classification tasks with public social media data.

OBJECTIVES: Large language models (LLMs) have demonstrated remarkable success in natural language processing (NLP) tasks. This study aimed to evaluate their performances on social media-based health-related text classification tasks. MATERIALS AND METHODS: We benchmarked 1 Support Vector Machine (SVM), 3 supervised pretrained language models (PLMs), and 2 LLMs-based classifiers across 6 text classification tasks. We developed 3 approaches for leveraging LLMs: employing LLMs as zero-shot classifiers, using LLMs as data annotators, and utilizing LLMs with few-shot examples for data augmentation. RESULTS: Across all tasks, the mean (SD) F1 score differences for RoBERTa, BERTweet, and SocBERT trained on human-annotated data were 0.24 (±0.10), 0.25 (±0.11), and 0.23 (±0.11), respectively, compared to those trained on the data annotated using GPT3.5, and were 0.16 (±0.07), 0.16 (±0.08), and 0.14 (±0.08) using GPT4, respectively. The GPT3.5 and GPT4 zero-shot classifiers outperformed SVMs in a single task and in 5 out of 6 tasks, respectively. When leveraging LLMs for data augmentation, the RoBERTa models trained on GPT4-augmented data demonstrated superior or comparable performance compared to those trained on human-annotated data alone. DISCUSSION: The results revealed that using LLM-annotated data only for training supervised classification models was ineffective. However, employing the LLM as a zero-shot classifier exhibited the potential to outperform traditional SVM models and achieved a higher recall than the advanced transformer-based model RoBERTa. Additionally, our results indicated that utilizing GPT3.5 for data augmentation could potentially harm model performance. In contrast, data augmentation with GPT4 demonstrated improved model performances, showcasing the potential of LLMs in reducing the need for extensive training data. CONCLUSIONS: By leveraging the data augmentation strategy, we can harness the power of LLMs to develop smaller, more effective domain-specific NLP models. Using LLM-annotated data without human guidance for training lightweight supervised classification models is an ineffective strategy. However, LLM, as a zero-shot classifier, shows promise in excluding false negatives and potentially reducing the human effort required for data annotation.

Predictors and outcomes of genomic knowledge among nurses in a middle eastern country: A cross-sectional study.

BACKGROUND: Genomics has received significant attention in recent years. Nurses can uniquely contribute to the field of genomics and improve genomic healthcare. However, they lack the necessary knowledge to accomplish this, impacting their confidence, willingness, and ability to implement genomics healthcare negatively. Given Oman's unique healthcare context, its prospective genomics application, and the global trend toward genomic competency, it is essential to gauge nurses' genomic knowledge as basis for equipping them. AIM: This study assessed the genomic knowledge among nurses in the Sultanate of Oman. It also explored the predictors and outcomes of their genomic knowledge. DESIGN: This study used a quantitative, descriptive, cross-sectional design. SETTINGS: Nurses from four public hospitals in Muscat Governorate, Sultanate of Oman were recruited to participate in the study. METHODS: A total of 661 out of 700 nurses responded to the pen and paper self-report questionnaire (94 % response rate). Univariate, bivariate, and regression analyses were used for data analysis. RESULTS: Consistent with international studies, nurses in Oman had low to moderate genomic knowledge. Years of experience in genetics healthcare and working in either the surgical and maternity units were positively associated with higher genomic knowledge. Working in the bone marrow transplant unit and having a family history of consanguinity were associated with poorer genomic knowledge. Higher genomic knowledge was associated with an increased willingness to care for patients with genetic issues, higher confidence in providing genomic healthcare, and a lower intention to pursue continuing education on genomics. CONCLUSION: Strategies targeting variables, particularly those that are amenable to interventions, should be developed and implemented to foster genomic knowledge in nurses.

Evaluation of immunotoxicity of iron oxide nanoparticles on coelomocytes of Eisenia fetida.

Iron oxide nanoparticles (Fe3O4 NPs) have gained considerable attention due to their diverse applications in various fields. However, concerns about their potential toxic effects on the environment and living organisms have also emerged. In this study, we synthesized and characterized Fe3O4 NPs and assessed their immunotoxicity on the coelomocytes of Eisenia fetida. The Fe3O4 NPs were synthesized using a co-precipitation method, and their physicochemical properties were determined using techniques such as X-ray diffraction (XRD), scanning electron microscopy-energy dispersive X-ray (SEM-EDX), transmission electron microscopy (TEM) and Fourier-transform infrared spectroscopy (FTIR). The synthesized Fe3O4 NPs exhibited a uniform size distribution with spherical morphology and the phase purity was confirmed from XRD analysis. To evaluate the immunotoxicity of Fe3O4 NPs, Eisenia fetida coelomocytes were exposed to various concentrations of Fe3O4 NPs for 14 days. Furthermore, we analyzed the impact of Fe3O4 NPs on the biochemical parameters, including superoxide dismutase (SOD), catalase (CAT), acid phosphatase (APs), alkaline phosphatase (ALP), and total protein content (TPC), as well as conducted a histological examination. Biochemical analysis revealed significant alterations in the activity levels of SOD, CAT, APs, ALP, and TPC in the coelomocytes, indicating immune system dysregulation upon exposure to Fe3O4 NPs. Moreover, histological examination demonstrated structural changes, suggesting cellular damage caused by Fe3O4 NPs. These findings provide valuable insights into the immunotoxic effects of Fe3O4 NPs on Eisenia fetida and underscore the need for further investigation into the potential environmental impact of nanoparticles.

Impact of COVID-19 on asthma control in Kirkuk City: an analysis of post-pandemic trends.

Bronchial asthma, a common chronic respiratory disease, should be managed and controlled correctly to prevent symptoms and maintain a good quality of life. Viral upper respiratory infections, especially the widespread COVID-19 virus, can exacerbate asthma. This study investigated the impact of COVID-19 severity (mild, moderate, severe) on asthma control compared to a control group without COVID-19. Asthma control was assessed using Asthma Control Test (ACT) scores and spirometry before and after COVID-19 infection. Statistical analysis revealed a significant decline (P = 0.001) in asthma control following mild to moderate COVID-19 recovery, evidenced by increased asthma symptoms, lower ACT scores, difficulty managing asthma, and increased need for asthma medication.

Correction: Association of SNPs within TMPRSS6 and BMP2 genes with iron deficiency status in Saudi Arabia.

[This corrects the article DOI: 10.1371/journal.pone.0257895.].

A Bibliometric analysis of scientific publication on Peri-Implantitis from 1990 to 2020.

Background: Peri-implantitis can involve about 13% of implants and 20% of patients, it has been reported that its incidence increases from about 0.4 to 43.9% in 3-5 years. The purpose was to analyze, using bibliometric indicators, the scientific efficiency of different organization, countries, and researchers that published articles on Peri-implantitis in various dental journals during the period from 1990 to 2020. Material and Methods: The search was carried out using Scopus database on publications related to Peri-implantitis from 1990 to 2020 using VOSviewer 1.6.15. The selected search encompassed title of article, citation count, year of publication, authors, institution, country and keywords. Data maps were obtained from VOS viewer based on number of papers, citation count, sources, countries and authors. A density visualization analysis was performed to interpret the data. Bibliometric analysis with reference to citation and documents, authors, journals and keywords was also evaluated. Results: An upsurge in number of cumulative papers published on Peri-implantitis from 1990 to 2020 was observed. The top three countries that published most research papers on Peri-implantitis included United States, Sweden and Switzerland respectively. The most productive organization in the field was Blekinge Institute of Technology, Karlskrona, Sweden. The maximum numbers of papers were published in "Clinical Oral Implants Research", while the most published and cited author was Niklaus P. Lang, with 50 papers, 5391 citations with 107.82 average citations per paper. Conclusions: There is a tremendous increase in number of publications on peri-implantitis through collaboration of authors, nations and institutes. Among the leading countries from where evidence is originating includes, USA, Sweden and Switzerland. The leading institutes whose work received most citations included, Kristiansand University (Sweden), Blekinge Institute of Technology (Sweden), Trinity college (Dublin) and University Of Bern (Switzerland). A positive trend of highly collaborative work was observed among the institutes and authors on peri-implantitis. Key words:Bibliometric analysis, Peri-Implantitis, Scopus, Dental implants.

Advances and Challenges in Spinal Cord Injury Treatments.

Spinal cord injury (SCI) is a debilitating condition that is associated with long-term physical and functional disability. Our understanding of the pathogenesis of SCI has evolved significantly over the past three decades. In parallel, significant advances have been made in optimizing the management of patients with SCI. Early surgical decompression, adequate bony decompression and expansile duraplasty are surgical strategies that may improve neurological and functional outcomes in patients with SCI. Furthermore, advances in the non-surgical management of SCI have been made, including optimization of hemodynamic management in the critical care setting. Several promising therapies have also been investigated in pre-clinical studies, with some being translated into clinical trials. Given the recent interest in advancing precision medicine, several investigations have been performed to delineate the role of imaging, cerebral spinal fluid (CSF) and serum biomarkers in predicting outcomes and curating individualized treatment plans for SCI patients. Finally, technological advancements in biomechanics and bioengineering have also found a role in SCI management in the form of neuromodulation and brain-computer interfaces.

Findings of a Community Health Needs Assessment Survey in Al Najaf Governorate Iraq: A Snapshot of Al Marashda's Health Status.

BACKGROUND: Community health assessment (CHA) is a well-known method for identifying and analyzing community health needs. This CHA survey aimed to identify and analyze community health needs and assets to prioritize these needs and to plan and act upon significant unmet community health needs. METHODS: The CHA was planned based on the suggested standard of the North Carolina Guide including eight phases from July to December 2023. The CHA survey was performed among Al-Marashda region residents in the Al-Manathera district. The sample size of our study was 184 interviews of 12536 population. The primary data, which included demographic information, quality of life statements, and community improvement, were collected from the community using a questionnaire through opinion surveys and focus groups, while the secondary data which included the social, health, and economic status of Al-Marashda region residents were obtained from district and governorate sources. Analysis of whole data sources allowed 10 areas of community concern to be identified. RESULTS: Findings from the CHA survey showed that diabetes and high blood pressure, poverty and unemployment, and air pollution were the most common public health problems as priorities. CONCLUSIONS: The high-priority problems of Al-Marashda are in common with the noncommunicable diseases (NCDs) priority in Al Najaf. However, poverty and air pollution are specific to the Al-Marashda region. Public health authorities and the city governorate are advised to consider, support, and develop community diagnosis documents to implement appropriate interventions.

Machine learning-based cluster analysis identifies four unique phenotypes of patients with degenerative cervical myelopathy with distinct clinical profiles and long-term functional and neurological outcomes.

BACKGROUND: Degenerative cervical myelopathy (DCM), the predominant cause of spinal cord dysfunction among adults, exhibits diverse interrelated symptoms and significant heterogeneity in clinical presentation. This study sought to use machine learning-based clustering algorithms to identify distinct patient clinical profiles and functional trajectories following surgical intervention. METHODS: In this study, we applied k-means and latent profile analysis (LPA) to identify patient phenotypes, using aggregated data from three major DCM trials. The combination of Nurick score, NDI (neck disability index), neck pain, as well as motor and sensory scores facilitated clustering. Goodness-of-fit indices were used to determine the optimal cluster number. ANOVA and post hoc Tukey's test assessed outcome differences, while multinomial logistic regression identified significant predictors of group membership. FINDINGS: A total of 1047 patients with DCM (mean [SD] age: 56.80 [11.39] years, 411 [39%] females) had complete one year outcome assessment post-surgery. Latent profile analysis identified four DCM phenotypes: "severe multimodal impairment" (n = 286), "minimal impairment" (n = 116), "motor-dominant" (n = 88) and "pain-dominant" (n = 557) groups. Each phenotype exhibited a unique symptom profile and distinct functional recovery trajectories. The "severe multimodal impairment group", comprising frail elderly patients, demonstrated the worst overall outcomes at one year (SF-36 PCS mean [SD]: 40.01 [9.75]; SF-36 MCS mean [SD], 46.08 [11.50]) but experienced substantial neurological recovery post-surgery (ΔmJOA mean [SD]: 3.83 [2.98]). Applying the k-means algorithm yielded a similar four-class solution. A higher frailty score and positive smoking status predicted membership in the "severe multimodal impairment" group (OR 1.47 [95% CI 1.07-2.02] and 1.58 [95% CI 1.25-1.99, respectively]), while undergoing anterior surgery and a longer symptom duration were associated with the "pain-dominant" group (OR 2.0 [95% CI 1.06-3.80] and 3.1 [95% CI 1.38-6.89], respectively). INTERPRETATION: Unsupervised learning on multiple clinical metrics predicted distinct patient phenotypes. Symptom clustering offers a valuable framework to identify DCM subpopulations, surpassing single patient reported outcome measures like the mJOA. FUNDING: No funding was received for the present work. The original studies were funded by AO Spine North America.

Silencing sensory neuron membrane protein RferSNMPu1 impairs pheromone detection in the invasive Asian Palm Weevil.

The red palm weevil (RPW), Rhynchophorus ferrugineus (Olivier), also known as the Asian palm weevil, is an invasive pest that causes widespread damage to palm trees around the globe. As pheromone communication is crucial for their mass attack and survival on palm trees, the olfactory concept of pest control strategies has been widely explored recently. We aim to understand the molecular basis of olfaction in RPW by studying one of the key olfactory proteins in insect pheromone communication, sensory neuron membrane proteins (SNMPs). SNMPs belong to the CD36 (cluster of differentiation 36) family that perform two distinct olfactory roles in insects, either in pheromone (odorant) transfer to the odorant receptors (SNMP1) or in the pheromone clearing process (SNMP2). In this study, we performed antennal transcriptomic screening and identified six SNMPs, mapping them on the R. ferrugineus genome, and confirmed four distinct SNMPs. Both SNMP1 proteins in RPW, viz., RferSNMPu1 and RferSNMPu2, were mapped onto the same scaffold in different loci in the RPW genome. To further understand the function of these proteins, we first classified them using phylogenetic analysis and checked their tissue-specific expression patterns. Further, we measured the relative transcript abundance of SNMPs in laboratory-reared, field-collected adults and pheromone-exposure experiments, ultimately identifying RferSNMPu1 as a potential candidate for functional analysis. We mapped RferSNMPu1 expression in the antennae and found that expression patterns were similar in both sexes. We used RNAi-based gene silencing to knockdown RferSNMPu1 and tested the changes in the RPW responses to aggregation pheromone compounds, 4-methyl-5-nonanol (ferrugineol) and 4-methyl-5-nonanone (ferrugineone), and a kairomone, ethyl acetate using electroantennogram (EAG) recordings. We found a significant reduction in the EAG recordings in the RferSNMPu1 knockdown strain of adult RPWs, confirming its potential role in pheromone detection. The structural modelling revealed the key domains in the RferSNMPu1 structure, which could likely be involved in pheromone detection based on the identified ectodomain tunnels. Our studies on RferSNMPu1 with a putative role in pheromone detection provide valuable insight into understanding the olfaction in R. ferrugineus as well as in other Curculionids, as SNMPs are under-explored in terms of its functional role in insect olfaction. Most importantly, RferSNMPu1 can be used as a potential target for the olfactory communication disruption in the R. ferrugineus control strategies.

Pathology as a Basic Medical Subject: Its Relevance and Application During Clinical Practice in Jordanian MD Programs, Interns' and Residents' Perspectives.

Aim: Medical literature revealed that there is a lack of information about the opinions of medical interns and residents about curricula provided to them during their undergraduate programs, either in a group of detached subjects or an incorporated and efficacious topic (ie, pathology). Purpose: To assess and compare the interns' and residents' perspectives towards Pathology as a subject. To recognize their opinions toward the relevance and application of Pathology while practicing clinically. Methods: This study was a cross-sectional online, self-administered questionnaire targeting interns and residents. The questionnaire consisted of 30 questions, enquiring about the demographic data, subject strength, teaching duration, interest in the subject, and usefulness of Pathology as a subject in clinical practice. Results: Overall, 103 participants completed the survey. The female and male percentage was 59.2% and 40.8% respectively. 86.4% of participants were interns, while 13.6% were residents. 87% of participants agreed that applying pathology during clinical practice is a skill that should be strengthened in the early stages of preclinical education of Medicine. A modest percentage believed that a practitioner could efficiently treat the majority of patients with no need to know the specifics of the pathological mechanisms involved. Most of the participants believed that pathology courses helped them in making a differential diagnosis, analysis of normal and pathological constituents, and dissection and identification of structures. Conclusion: This study highlights the positive perceptions of Jordanian interns and residents toward pathology courses. It also demonstrates that participants prefer an active and dynamic educational model with an emphasis on better integration of pathology courses and clinical experiences that fit their needs in clinical practice. Thus, we recommend future studies to compare the competencies of interns and residents enrolled in the courses with integrated medical curricula, of pathology versus those who studied the conventional medical curricula of pathology, as well as to evaluate their perceptions of medical education.

Challenges to establishing and maintaining kidney transplantation programs in developing countries: What are the coping strategies?

Kidney transplantation (KT) is the optimal form of renal replacement therapy for patients with end-stage renal diseases. However, this health service is not available to all patients, especially in developing countries. The deceased donor KT programs are mostly absent, and the living donor KT centers are scarce. Single-center studies presenting experiences from developing countries usually report a variety of challenges. This review addresses these challenges and the opposing strategies by reviewing the single-center experiences of developing countries. The financial challenges hamper the infrastructural and material availability, coverage of transplant costs, and qualification of medical personnel. The sociocultural challenges influence organ donation, equity of beneficence, and regular follow-up work. Low interests and motives for transplantation may result from high medicolegal responsibilities in KT practice, intense potential psychosocial burdens, complex qualification protocols, and low productivity or compensation for KT practice. Low medical literacy about KT advantages is prevalent among clinicians, patients, and the public. The inefficient organizational and regulatory oversight is translated into inefficient healthcare systems, absent national KT programs and registries, uncoordinated job descriptions and qualification protocols, uncoordinated on-site investigations with regulatory constraints, and the prevalence of commercial KT practices. These challenges resulted in noticeable differences between KT services in developed and developing countries. The coping strategies can be summarized in two main mechanisms: The first mechanism is maximizing the available resources by increasing the rates of living kidney donation, promoting the expertise of medical personnel, reducing material consumption, and supporting the establishment and maintenance of KT programs. The latter warrants the expansion of the public sector and the elimination of non-ethical KT practices. The second mechanism is recruiting external resources, including financial, experience, and training agreements.

Independent Risk Factors of Failed Extubation among Adult Critically Ill Patients: A Prospective Observational Study from Saudi Arabia.

Background: Mechanical ventilation provides essential support for critically ill patients in several diagnoses; however, extubation failure can affect patient outcomes. From Saudi Arabia, no study has assessed the factors associated with extubation failure in adults. Methods: This prospective observational study was conducted in the intensive care unit of a tertiary care hospital in Riyadh, Saudi Arabia. Adult patients who had been mechanically ventilated via the endotracheal tube for a minimum of 24 hours and then extubated according to the weaning protocol were included. Failed extubation was defined as reintubation within 48 hours of extubation. Results: A total of 505 patients were included, of which 72 patients had failed extubation (14.3%, 95% CI: 11.4%-17.7%). Compared with the failed extubation group, the successfully extubated group had significantly shorter duration of mechanical ventilation (mean difference: -2.6 days, 95% CI: -4.3 to -1; P = 0.001), a slower respiratory rate at the time of extubation (mean difference: -2.3 breath/min, 95% CI: -3.8 to -1; P = 0.0005), higher pH (mean difference: 0.02, 95% CI: 0.001-0.04; P = 0.03), and more patients with strong cough (percent difference: 17.7%, 95% CI: 4.8%-30.5%; P = 0.02). Independent risk factors of failed extubation were age (aOR = 1.02; 95% CI: 1.002-1.03; P = 0.03), respiratory rate (aOR = 1.06, 95% CI: 1.01-1.1; P = 0.008), duration of mechanical ventilation (aOR = 1.08, 95% CI: 1.03 - 1.1; P < 0.001), and pH (aOR = 0.02, 95% CI: 0.0006-0.5; P = 0.02). Conclusion: Older age, longer duration of mechanical ventilation, faster respiratory rate, and lower pH were found to be independent risk factors that significantly increased the odds of extubation failure among adults.