Spontaneous bilateral superficial femoral artery pseudoaneurysms and a unilateral posterior tibial artery aneurysm in an immunocompromised patient.

Key Clinical Message: The presence of multiple pseudoaneurysms in a patient should prompt investigations for the underlying etiologies including autoimmune and immunosuppressive disease processes. Treatment options include open repair and endovascular stenting. Abstract: Pseudoaneurysms (also known as false aneurysms) are atypical dilatations or outpouchings from a vessel which are not always contained by the three layers of a normal vessel wall, namely the intima, media, and adventitia. These are distinct from a true aneurysm which has a wall comprising all three layers. The underlying etiology for both true aneurysms and pseudoaneurysm can vary. We present the rare case of bilateral superficial femoral artery pseudoaneurysms, of unknown etiology and a concurrent posterior tibial artery saccular aneurysm in a patient with Human Immunodeficiency Virus (HIV) infection and multiple comorbidities. This was managed using a combination of endovascular covered stent grafts and open surgical repair technique. The patient is doing well on follow-up a year later with no post-operative infections. A literature review of the existing reports of superficial femoral artery pseudoaneurysms and posterior tibial artery aneurysms and their management is also reported.

Association of the gut microbiota with clinical variables in obese and lean Emirati subjects.

Background: Growing evidence supports the role of gut microbiota in obesity, yet exact associations remain largely unknown. Specifically, very little is known about this association in the Emirati population. Methods: We explored differences in gut microbiota composition, particularly the Firmicutes/Bacteroidetes (F/B) ratio, between 43 obese and 31 lean adult Emirate counterparts, and its association with obesity markers, by using V3-V4 regions of 16 S ribosomal RNA gene sequencing data. Furthermore, we collected anthropometric and biochemical data. Results: The two major phyla in obese and lean groups were Firmicutes and Bacteroidetes. We observed a significantly lower alpha diversity (Shannon index) in obese subjects and a significant difference in beta diversity and phylum and genus levels between the two groups. The obese group had higher abundances of Verrucomicrobia and Saccharibacteira and lower abundances of Lentisphaerae. Acidaminococcus and Lachnospira were more abundant in obese subjects and positively correlated with adiposity markers. No correlations were found between the gut microbiota and biochemical variables, such as fasting blood sugar, total cholesterol, HDL cholesterol, LDL cholesterol, and triglycerides. Conclusion: We reveal significant differences in the gut microbiota between obese and lean adult Emiratis and an association between certain microbial genera of the gut microbiota and obesity. A better understanding of the interactions between gut microbes, diet, lifestyle, and health is warranted.

Development and Validation of the Soft Skills Questionnaire for Nurses.

Introduction: Skills challenge has been given great attention for its impact on employees' performance. Various approaches have been put forward to design professional development programs that help in preparing nurses to work in the field and ongoing training programs to keep them up to each new method and technique at the interpersonal improvement level. Objective: To develop and validate a questionnaire that tests the communication and management skills, emotional intelligence, and confidentiality of nurses in Lebanon. Methods: The questionnaire, consisting of 25 statements, was generated and developed by experts in the field of nursing, soft skills, and questionnaire development. The items of the questionnaire were assessed using face, content, and construct validity and data validation was examined through psychometric properties at the final stage of the validation. Internal consistency and reliability were assessed through Cronbach alpha ( α ). Further analyses were carried out to decide on the number of factors to be extracted using Oblimin Rotation method. All statistical tests were performed using Statistical Package for the Social Sciences (SPSS 20.0). Results: Nineteen items of the 25-item scale had an I-CVI of 1.00 and the remaining six items had an I-CVI of 0.87. The S-CVI/UA was 0.76 and the S-CVI/Ave was 0.97, which meant that the items were good for the underlying construct. For the psychometric measures, the results were quite accepted and satisfactory. The Kaiser-Meyer-Oklin measure of sampling adequacy and the significance for the Bartlett's test for the whole questionnaire were quite acceptable with 0.680 and 0.000, respectively. Furthermore, the Cronbach alpha (α) value was 0.824 indicating a high internal consistency between the items of the questionnaire. While obtaining exploratory factor analysis for each section, results showed that Oblimin Rotation method should be applied to the last section in which three items were eliminated to maintain a simple factor structure. Conclusion: This study shows that the 25-item Soft Skills Questionnaire is a valid and reliable tool for evaluating the level of communication of nurses, their emotional intelligence, confidentiality, and management.

Determinants of Infant Young Child Feeding Among Mothers of Malnourished Children in South Punjab, Pakistan: A Qualitative Study.

Inadequate feeding is one of the most critical underlying determinants of child malnutrition. In this study, we explore infant young child feeding (IYCF) and deconstruct breastfeeding barriers in mothers of severely malnourished children in one of the most marginalized districts of Punjab province of Pakistan. Using purposive sampling, 20 lactating mothers are recruited for open-ended semi-structured interviews. Results reveal that barriers to immediate and exclusive breastfeeding include the introduction of pre-lacteal, butter, and cow or formula milk by mothers and grandmothers. Birthing difficulties and ritualizing prelacteal to transfer religion and culture cause the delay of early initiation of breastmilk. The colostrum is also discarded based on its weird physical look. Moreover, household circumstances, limited diet, extra workload, and mental stress associated with marital relationships are other significant barriers. Mothers perceive their breastmilk as thin, impotent, and of bad quality and often complain against breastmilk insufficiency due to general weakness. Furthermore, poor mothers reduce breastfeeding when the fertility burden is high, especially if a female baby is in their womb. Alternatively, outer milk is recommended but washing bottles with detergents often becomes frequent. In conclusion, immediacy, exclusivity, frequency, and duration of breastfeeding are circumscribed owing to multiple social, cultural, and economic causes. Therefore, a holistic approach combining cultural and structural causes might be more relevant for successful IYCF practices in marginalized communities of Pakistan.

Posterior Reversible Encephalopathy Syndrome Onset Within 24 Hours Following Moderna mRNA Booster COVID-19 Vaccination: Vaccine Adverse Event Vs. Hypertension?

We present a case of a female who presented with the acute onset of neurological changes within 24 hours of receiving her third, or booster, dose of the mRNA Moderna (Cambridge, Massachusetts) coronavirus disease 2019 (COVID-19) vaccination. Her clinicoradiological findings were most consistent with posterior reversible encephalopathy syndrome (PRES). Although PRES has been reported with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, this raised suspicion of a possible vaccine-induced PRES with her only confounder being hypertension managed with a beta-blocker. Extensive workup for other entities associated with PRES, including infection, autoimmune, paraneoplastic syndrome, and alcohol were unrevealing. Thus far, there have not been any reports of PRES post mRNA vaccination. We encourage providers to report similar cases with neurological manifestations post mRNA vaccination to the vaccine adverse event reporting system (VAERS). Timely diagnosis and treatment of PRES may help minimize any irreversible neurological sequelae.

The Association between Peptide Hormones with Obesity and Insulin Resistance Markers in Lean and Obese Individuals in the United Arab Emirates.

Peptide hormones play a crucial role in body weight and glucose homeostasis. In this study, we aimed to explore this association and recruited 43 obese and 31 age- and sex-matched lean participants. We assessed their body mass index (BMI), waist circumference (WC), waist-to-height ratio (WtHR), percentage body fat (PBF), fasting blood levels of peptide hormones (GLP-1, GLP-2, insulin, leptin, ghrelin, CCK, and PYY), fasting blood sugar (FBS), and Homeostatic Model Assessment of Insulin Resistance (HOMA-IR). We tested the associations between peptide hormones and markers of obesity and insulin resistance (IR) by using the Independent-Samples t-test and Mann-Whitney U test, partial correlation, and logistic regression. FBS, insulin, HOMA-IR, GLP-1, GLP-2, and leptin were significantly higher in the obese group; ghrelin and CCK were significantly higher in lean participants, and no difference was seen for PYY. Controlling for BMI, GLP-1 was positively correlated with WtHR, while ghrelin was inversely correlated with WtHR. GLP-1 was correlated with HOMA-IR. GLP-1 was associated with obesity and IR markers in the regression model. Our results show that obese and lean adults display significant differences in plasma peptide hormone levels. GLP-1 levels were independently associated with markers of obesity and IR. Restoring the appetite hormone balance in obesity may represent a potential therapeutic target.

Can surgical skills be taught using technological advances online? A comparative study of online and face-to-face surgical skills training.

INTRODUCTION: Online teaching has rapidly emerged as a viable alternative to traditional face-to-face education. How to teach surgical skills in the online environment, however, has not yet been fully established nor evaluated. METHODS: An international 1-day online surgical skills course consisting of lectures, pre-recorded virtual workshops, live demonstrations and along with surgical skills teaching in breakout rooms was organised. Based on existing learning theories, new methods were developed to deliver skills teaching online. Simultaneously, traditional in-person surgical skills teaching was also conducted and used as a benchmark. Skills development was assessed by trained demonstrators and self-reported competency scores were compared between the online and face-to-face event. RESULTS: 553 delegates from 20 different countries attended the online course. Of these, 64 were trained in breakout rooms with a 1:5 demonstrator-to-delegate ratio whilst the remaining 489 delegates participated in didactic skills development sessions. In a separate face-to-face course, 20 delegates were trained with traditional methods. Demonstrators rated the competency of delegates for suturing, tendon repair and vascular anastomosis. There was no significant difference in the competency ratings of delegates receiving online teaching or face-to-face teaching (p = 0.253, p = 0.084, p = 1.00, respectively). The development of the same skills to "articulation" were not different between formats (p = 0.841, p = 0.792, p = 1.00, respectively). Post course self-rated competency scores improved for all technical skills (p < 0.001). Small group sessions, both online and face-to-face, received higher satisfaction ratings compared to large group sessions in terms of clarity of instructions, answers to questions and demonstrator feedback. Overall feedback on teaching quality, however, was equivalent across both groups. DISCUSSION: Online teaching of surgical skills for early training years is an appropriate alternative to face-to-face teaching.

Sexual discrimination in neurosurgery: a questionnaire-based nationwide study amongst women neurosurgeons in Bulgaria.

BACKGROUND: The aim of this qualitative, descriptive, cross-sectional study was to identify potential factors influencing the progression of female neurosurgeons in Bulgaria. METHODS: The study was conducted nationally, by sending out an online (SurveyMonkey®) questionnaire with 30 questions over a 3-month period to 15 registered female neurosurgeons in practice including residents/trainees and specialists from state universities, private universities and regional hospitals in Bulgaria. The questionnaire covered basic demographics, level of academic achievement and aspects of personal and professional experience, along with questions on the perceived barriers that female neurosurgeons nationally encountered during their clinical and academic career. These results were compared with similar studies conducted in other countries following a literature search on PubMed. RESULTS: Eleven out of fifteen respondents returned the completed survey, covering 10 institutions which included 8 university clinics and two regional clinics, achieving a response rate of 73.3%. No questionnaires were excluded. The factors negatively influencing the clinical and academic professional development and progression in the field included lack of mentors and other female role models, perceived bias regarding remuneration and leave, as well as a lack of support with regards to work-life balance and difficulty progressing in the academic fields. CONCLUSIONS: Although there is an ever increasing and growing awareness of the factors negatively impacting women progression in neurosurgery worldwide, there are still significant gaps and biases that hinder career progression amongst female neurosurgical communities and highlight a need for potential practices to be established in the workplace to counteract this.

Addressing Mass Shootings in a New Light.

Locations change, casualties change, but the choice of weapon remains the same: firearms. With mass shootings gaining continuous limelight, we aim through this article to provide the readers an overview of the perpetrator's profile, along with various opinions proposed by the media, government, National Rifle Association (NRA), and health professionals. With mental health linked as a common factor for such incidents, we need to explore the different stances to eliminate such events. This article also provides a collaborative approach to alter the narrative and view it in a new light.