Automotive Technology Revolutionized Restorative Dentistry Discovery of Alpha-diketone/Amine Catalyst: Part II -Reflections on Photopolymerization from Conception to Development of Composite Resin and Activator Light.

A full account of the preceded early research tribulation that led to the development of the first visible light activated composite resin and the first visible light activator source is documented. The events took place over four years since early 1974 when a raw industrial composite resin that was radiolucent, stiff paste, universal optically opaque white color, polymerized by exposure to a prototype visible light for 120 seconds was given to developed. Four years later, the developed restorative composite resin ended up as a radiopaque, optically translucent, universal color with an additional three shades that possessed the biologic, esthetic, mechanical and physical characteristics with proven efficacy be used for esthetic zone. This conservative account of early development of a technology that must count as one of a small number of inventions during the seventies, over the years has revolutionized restorative dental practice. We were privileged and very lucky to be associated with developmental stages, stumbling blocks, and final success of the first LC Composite resin that ignited the thought process worldwide and laid the foundation for modern esthetic restoratives practiced today.

Automotive Technology Revolutionized Restorative Dentistry Discovery of Alpha-diketone/Amine Catalyst: Part I.

A full account of early research that led to the discovery of the Alpha-diketone and Amine systems by two Imperial Chemical Industries (ICI) researchers. UK Chemists in the mid-sixties marked the beginning in the early development of a composite resin cured with visible light spectrum into a solid mass. Its incorporation into the newly developed Urethane based resin, led to conceiving the idea of developing the first light-activated restorative composite resin, which formed the prototype of modern composite restorative materials. How all that came about, and the ideas that were conceived and pursued in the development of these systems are discussed in detail.

Acute Kidney Injury Resulting From Hemoglobinuria After Pulsed-Field Ablation in Atrial Fibrillation: Is it Preventable?

BACKGROUND: High-voltage pulses can cause hemolysis. OBJECTIVES: The authors evaluated the occurrence of hemoglobinuria after pulsed-field ablation (PFA) and its impact on renal function in patients with atrial fibrillation (AF). METHODS: A consecutive series of patients with AF undergoing PFA were included in this analysis. The initial patients who did not receive postablation hydration immediately after the procedure were classified as group 1 (n = 28), and the rest of the study patients who received planned fluid infusion (0.9% sodium chloride ≥2 L) after the procedure were categorized as group 2 (n = 75). RESULTS: Of the 28 patients in group 1, 21 (75%) experienced hemoglobinuria during the 24 hours after catheter ablation. The mean postablation serum creatinine (S-Cr) was significantly higher than the baseline value in those 21 patients (1.46 ± 0.28 mg/dL vs 0.86 ± 0.24 mg/dL, P < 0.001). Of those 21 patients, 4 (19%) had S-Cr. >2.5 mg/dL (mean: 2.95 ± 0.21 mg/dL). The mean number of PF applications was significantly higher in those 4 patients than in the other 17 patients experiencing hemoglobinuria (94.63 ± 3.20 vs 46.75 ± 9.10, P < 0.001). In group 2 patients, no significant changes in S-Cr were noted. The group 2 patients received significantly higher amounts of fluid infusion after catheter ablation than did those in group 1 (2,082.50 ± 258.08 mL vs 494.01 ± 71.65 mL, P < 0.001). In multivariable analysis, both hydration (R2 = 0.63, P < 0.01) and number of PFA applications (R2 = 0.33, P < 0.01) were independent predictors of postprocedure acute kidney injury. CONCLUSIONS: On the basis of our findings, both the number of PFA applications and postablation hydration were independent predictors of renal insult that could be prevented using planned fluid infusion immediately after the procedure.

Safety and feasibility of same-day discharge following uncomplicated transvenous lead extraction.

INTRODUCTION: Transvenous lead extraction (TLE), while mostly a safe procedure, has risk of serious periprocedural complications. As such, overnight hospitalization remains a routine practice. In our center, we routinely discharge patients on the same day following an uncomplicated TLE. METHODS: This is a retrospective study of 265 consecutive patients who underwent uncomplicated TLE in our center between 2019 and 2021. Same-day discharge (SDD) patients are compared with those who stayed at least overnight for observation after the TLE procedure (non-SDD group). To assess the safety of an SDD strategy after uncomplicated TLE, the main study endpoint was to compare the rate of major procedure-related complications at 1-, 7-, and 30-days. To identify the factors influencing the operator's decision to discharge the patient on the same day, the secondary endpoint was to analyze clinical and procedural predictors of SDD. RESULTS: A total of 153 patients were discharged the same day after uncomplicated TLE (SDD), while 112 stayed at least overnight after the procedure (non-SDD). There was no significant difference in major procedure-related complications at 1-day (SDD 0% vs. non-SDD 1.8%, p value = ns), while patients in the SDD group had a lower rate of 7- and 30-day complications when compared with those in the non-SDD group (2.1% vs. 8.2%, p value = .0308; and 3.5% vs. 16%, p value = .0049, respectively). Noninfectious indication for TLE (OR 16.1, 95% confidence interval [CI] 4.29-77.6) and procedure end time before 12:00 (OR 2.82, 95% CI 1.11-7.27) were the only independent predictors of SDD. CONCLUSION: SDD discharge following uncomplicated TLE in selected patients (i.e., those without device infection and when the TLE procedure is completed in the morning) is feasible and safe.

Pulsed-Field Ablation Does Not Worsen Baseline Pulmonary Hypertension Following Prior Radiofrequency Ablations.

BACKGROUND: Studies have reported development of pulmonary hypertension (PH) secondary to reduced LA compliance following AF ablation. OBJECTIVES: We aimed to compare the risk of worsening of baseline PH between non-paroxysmal AF patients undergoing pulsed-field ablation (PFA) and standard radiofrequency ablation (RFA). METHODS: This multicenter study included 28 nonparoxysmal AF patients with PH undergoing a PFA-based ablation procedure after >1 failed RFA. A cohort of 28 AF patients with PH, scheduled for repeat RFA, 1:1 propensity-score matched using a multivariable logistic model, were used as the comparator group. Right heart catheterization and echocardiography were performed before and after the procedure to assess the pulmonary artery pressure (PAP). PH was defined as resting mean PAP of >20 mm Hg. RESULTS: The baseline characteristics of the PFA and propensity-matched RFA groups were comparable. The mean PAP assessments at baseline, follow-up, and change from baseline were analyzed. The groups had comparable baseline mean pulmonary artery pressures (mPAP) (P = 0.177). After adjustment for baseline mPAP in an analysis of covariance model, the least-squares means change at 3 months after ablation was -1.71 ± 1.03 mm Hg and 19.67 ± 1.03 mm Hg in PFA and RFA, respectively (P <0.001). CONCLUSIONS: In this propensity-matched population, no worsening of mPAP was detected following pulsed-field ablation in patients with pre-existing PH undergoing a repeat procedure for recurrence.

Catheter ablation approach and outcome in HIV+ patients with recurrent atrial fibrillation.

INTRODUCTION: Earlier studies have shown a clear association between severity of human immunodeficiency virus (HIV) infection and incident atrial fibrillation (AF). We present the long-term outcome of catheter ablation (CA) and electrophysiological characteristics in HIV+ AF patients. METHODS: This study evaluated 1438 consecutive AF patients [31 (2.15%) with HIV and 1407 (97.8%) without HIV diagnosis] undergoing their first CA at our center. A total of 31 HIV patients and 31 controls were generated by propensity matching, based on calculated risk factor scores, using a logistic model. During first procedure, all received isolation of pulmonary vein (PV) + posterior wall and superior vena cava. Non-PV triggers, defined as ectopic triggers originating from sites other than PVs, were identified at the redo ablation with high-dose isoproterenol challenge. RESULTS: Clinical characteristics were not different between the groups. When compared to the control, by the end of 5 years after the first procedure, recurrence was significantly greater in HIV group [100% vs. 54%, p < .001]. Among patients that underwent redo ablation non-PV triggers were higher in HIV group [93.5% vs. 54%, p < .001], and most frequently originated from the coronary sinus [67.7% vs. 45.2%, p < .001] and left atrial appendage [41.9% vs. 25.8%, p < .001]. After focal ablation of non-PV trigger, no difference in arrhythmia recurrence between two groups [80.6% vs. 87.1%, p = .753] at 1-year follow up was found. CONCLUSION: Our findings suggest that non-PV triggers are highly prevalent in HIV+ AF patients resulting in higher rate of the mid- and long-term arrhythmia recurrence.

A call to enhance transparency among Egyptian medical schools.

BACKGROUND: Making accreditation results easily accessible has become a worldwide essential issue, especially after international standards were created for medical education. The Egyptian Society for Medical Education (ESME) expects Egyptian medical schools to be more open about their accreditation results to build trust with students, families, and the community. This will help ensure newly graduated doctors are of high quality. Our literature review found almost no information on how transparent Egyptian medical school websites are with posting their accreditation results. Students and families use these websites to choose schools and be confident in the quality of education, so accreditation results should be easily accessible. METHODS: This study was conducted to estimate the information transparency of Egyptian medical colleges' websites regarding their accreditation process. Twenty-five official websites of Egyptian medical colleges, as well as official website of the National Authority for Quality Assurance and Accreditation of Education (NAQAAE) were reviewed. The websites' search considers two main criteria for transparency. Each criterion is further divided into several information items. Data was recorded and analyzed using Research Electronic Data Capture software (REDCap). The authors excluded, from the data analysis, newly established schools of less than five years of age that were not required to apply for accreditation yet. RESULTS: The results of the research showed that only thirteen colleges registered their credentials on their websites. However, the amount of data available about the process, dates, and documents was very limited. Accreditation information for these thirteen schools is confirmed by information on the NAQAAE website. Other information on other important elements such as accountability and future plans was almost completely missing. CONCLUSION: The authors concluded that due to the lack of basic information on the websites of Egyptian medical schools about their institutional accreditation status, serious steps should be taken by medical schools and the National Accreditation Authority to encourage openness and ensure transparency towards institutional accreditation.

Impact of Colchicine Monotherapy on the Risk of Acute Pericarditis Following Atrial Fibrillation Ablation.

BACKGROUND: Acute pericarditis is a known complication of ablation procedures for atrial fibrillation (AF). OBJECTIVES: This study aimed to evaluate the benefits of colchicine monotherapy in terms of reducing the risk of pericarditis and related hospitalization rate in AF patients undergoing catheter ablation. METHODS: Consecutive AF patients undergoing first catheter ablation were classified into 3 groups based on their colchicine use: Group 1: no colchicine; group 2: colchicine from 7 days before to 1 month after ablation; and group 3: colchicine from the day of the procedure to 1 month after. Standard institutional protocol was used to follow all patients for 1 year. RESULTS: A total of 1,075 patients were classified into groups 1 (n = 607), 2 (n = 213), and 3 (n = 255). Symptoms of acute pericarditis were reported in 129 patients (12%): group 1: n = 106 (17.5%); group 2: n = 4 (1.9%); and group 3: n = 19 (7.5%); P < 0.001. Rate of mild-moderate as well as severe pericarditis were significantly lower in group 2. In the multivariable regression analysis, pre- and post-ablation colchicine use was seen to be associated with significantly lower risk of acute pericarditis and related hospitalization compared with the other 2 groups. In addition, at 1-year follow-up, arrhythmia-free survival rate was significantly higher in paroxysmal AF patients receiving colchicine compared with the no-colchicine population. CONCLUSIONS: Colchicine therapy starting 7 days before to 1 month after the ablation procedure was associated with significantly lower risk of acute pericarditis and related hospitalization. In addition, paroxysmal AF patients receiving colchicine had a higher arrhythmia-free survival rate compared with those not receiving colchicine.

Best ablation strategy in patients with premature ventricular contractions with multiple morphology: a single-centre experience.

AIMS: This study aimed to examine the clinical benefits of targeted ablation of all Premature ventricular complex (PVC) morphologies vs. predominant PVC only. METHODS AND RESULTS: A total of 171 consecutive patients with reduced left ventricular ejection fraction (LVEF) and ≥2 PVC morphology with high burden (>10%/day) undergoing their first ablation procedure were included in the analysis. At the initial procedure, prevalent PVC alone was ablated in the majority. However, at the redo, all PVC morphologies were targeted for ablation. : At the first procedure, 152 (89%) patients received ablation of the dominant PVC only. In the remaining 19 (11%) patients, all PVC morphologies were ablated. At two years, high PVC burden was detected in 89 (52%) patients. Repeat procedure was performed in 78 of 89, where all PVC morphologies were ablated. At 5 years after the repeat procedure, 71 (91%) had PVC burden of <5% [3.8 ± 1.1% vs. 15.4 ± 4.3% in successful vs. failed subjects (P < 0.001)]. In patients with low PVC burden after the initial procedure, LVEF improved from 37.5% to 41.6% [mean difference (MD): 3.39 ± 2.9%, P < 0.001], whereas a reduction in LVEF from 39.8% to 34.5% (MD: 6.45 ± 4.7%, P < 0.001) was recorded in patients with high PVC burden. One year after the repeat procedure, LVEF improved from 36.2% to 41.7% (MD: 5.5 ± 4.3%, P < 0.001) in patients with successful ablation. CONCLUSION: In this observational series, ablation of all PVC morphologies was associated with significantly lower PVC burden and improvement of LVEF at long-term follow-up, compared with ablation of the dominant morphology only.

Correlation Between Pre-treatment Collateral Status and Short-Term Functional Outcome in Patients With Mild to Moderate Stroke After Reperfusion Therapy in a Local Primary Stroke Center in the Southwestern Part of Saudi Arabia.

Background Stroke is a substantial cause of disability and mortality worldwide and is characterized by the sudden onset of acute neurological deficit. During acute ischemia, cerebral collateral circulations are crucial in preserving blood supply to the ischemic region. Recombinant tissue plasminogen activator (r-tPA) and endovascular mechanical thrombectomy (MT) are the primary standards of care for acute recanalization therapy. Methodology From August 2019 through December 2021, we enrolled patients treated in our local primary stroke center with anterior circulation acute ischemic stroke (AIS) treated with intravenous thrombolysis (IVT) with or without MT. Only patients diagnosed with mild to moderate anterior ischemic stroke, as measured by the National Institutes of Health Stroke Scale (NIHSS), were included in the study. The candidate patients underwent non-contrast CT scanning (NCCT) and CT angiography (CTA) at admission. The modified Rankin scale (mRS) was used to assess the functional outcome of the stroke. The modified Tan scale, graded on a scale of 0-3, was used to determine the collateral status. Results This study comprised a total of 38 patients who had anterior circulation ischemic strokes. The mean age was 34. 8±13. All patients received IVT; eight patients (21.1%) underwent MT following r-tPA. In 26.3% of cases, hemorrhagic transformation (HT), both symptomatic and asymptomatic, was evident. Thirty-three participants (86.8%) had a moderate stroke, whereas five participants (13.2%) had a minor stroke. With a P-value of 0.003, a poor collateral status on the modified Tan score is substantially associated with a short, poor functional outcome. Conclusion In our study, patients with mild to moderate AIS with good collateral scores at admission had better short-term outcomes. Patients with poor collaterals tend to present with a disturbed level of consciousness more than patients with good collaterals.

Evaluation of postural stability and vestibulo-ocular reflex in adults with chronic suppurative otitis media.

PURPOSE: To evaluate the vestibulospinal reflex and vestibulo-ocular reflex (VOR) in patients with chronic suppurative otitis media (CSOM) using posturography and the video head impulse test (vHIT). METHODS: Sixty-five patients with CSOM and 65 healthy participants as controls were included. Patients with CSOM were instructed to complete the dizziness handicap inventory (DHI). All participants underwent otoscopy, pure-tone audiometry, posturography sensory organization test (SOT), and vHIT. RESULTS: Patients with CSOM exhibited a high prevalence of dizziness. The CSOM group had poor SOT vestibular scores compared to the control group. Patients with CSOM had worse sways in the antero-posterior and mediolateral planes. The CSOM group was divided into two subgroups according to the type of hearing loss. SOT vestibular scores were significantly poorer in the mixed hearing loss group than those in the conductive hearing loss group. We found a positive correlation between disease duration and poor SOT vestibular scores. Moreover, poor SOT vestibular scores correlated with high DHI scores. We found abnormalities in the vHIT results in the CSOM group in the form of low VOR gain and corrective saccades. CONCLUSION: Our study provides clinical evidence of dizziness, poor postural control, and VOR abnormalities in patients with CSOM. The presence of sensory elements of hearing loss in patients with CSOM appears to be positively associated with vestibular dysfunction.

Prevalence of atrial fibrillation and procedural outcome in patients undergoing catheter ablation for premature ventricular complexes.

INTRODUCTION: Atrial fibrillation (AF) and premature ventricular complexes (PVC) are common arrhythmias. We aimed to investigate AF prevalence in patients with PVC and its impact on PVC ablation outcomes. METHODS: Consecutive patients undergoing PVC ablation at a single institution between 2016 and 2019 were included and prospectively followed for 2 years. Patients with severe valvular heart disease, hyperthyroidism, malignancy, alcohol use disorder and advanced renal/hepatic diseases were excluded. Twelve-lead electrocardiograms were used to diagnose AF and assess PVC morphology. All PVCs were targeted for ablation using 4-mm irrigated-tip catheters at standardized radiofrequency power guided by 3-D mapping and intracardiac echocardiography. Patients were followed with remote monitoring, device interrogations and office visits every 6 months for 2 years. Detection of any PVCs in follow-up was considered as recurrence. RESULTS: A total of 394 patients underwent PVC ablation and 96 (24%) had concurrent AF. Patients with PVC and AF were significantly older (68.2 ± 10.8 vs. 58.3 ± 15.8 years, p < .001), had lower LV ejection fraction (43.3 ± 13.3% vs. 49.6 ± 12.4%, p < .001), higher CHA2 DS2 -VASc (2.8 ± 1.3 vs. 2.0 ± 1.3, p < .001) than those without. PVCs with ≥2 morphologies were detected in 60.4% and 13.7% patients with vs without AF (p < .001). At 2-year follow-up, PVC recurrence rate was significantly higher in patients with vs without AF (17.7% vs. 9.4%, p = .02). CONCLUSION: AF was documented in 1/4 of patients undergoing PVC ablation and was associated with lower procedural success at long-term follow-up. This was likely attributed to older age, worse LV function and higher prevalence of multiple PVC morphologies in patients with concurrent AF.

Three-dimensional intracardiac echocardiography for left atrial appendage sizing and percutaneous occlusion guidance.

AIMS: Left atrial appendage (LAA) imaging is critical during percutaneous occlusion procedures. 3D-intracardiac echocardiography (ICE) features direct visualization of LAA from multiple cross-sectional planes at a time. We aimed at reporting procedural success of 3D-ICE-guided LAA occlusion and the correlation between pre-procedural transoesophageal echocardiography (TEE) and intraprocedural 3D-ICE for LAA sizing. METHODS AND RESULTS: Among 274 patients undergoing left atrial appendage occlusion (LAAO) with a Watchman FLX, periprocedural ICE guidance was achieved via a commercially available 2D-ICE catheter (220 patients) or a novel (NUVISION™) 3D-ICE one (54 patients). Primary endpoint was a composite of procedural success and LAA sealing at follow-up TEE. Secondary endpoint was a composite of periprocedural device recapture/resizing plus presence of leaks ≥ 3 mm at follow-up TEE. 3D-ICE measurements of maximum landing zone correlated highly with pre-procedural TEE reference values [Pearson's: 0.94; P < 0.001; bias: -0.06 (-2.39, 2.27)]. The agreement between 3D-ICE-based device selection and final device size was 96.3% vs. 79.1% with 2D-ICE (P = 0.005). The incidence of the primary endpoint was 98.1% with 3D-ICE and 97.3% with 2D-ICE (P = 0.99). 2D-ICE patients had a trend towards a higher incidence of periprocedural device recapture/redeployment (31.5% vs. 44.5%; P = 0.09). The secondary endpoint occurred in 31.5% of 3D-ICE patients vs. 45.9% of 2D-ICE ones (P = 0.065). CONCLUSION: Intracardiac echocardiography-guided LAAO showed a very high success, with no major adverse events. A very high level of agreement for LAA sizing was found between pre-procedural TEE and periprocedural 3D-ICE. 3D-ICE performed significantly better than 2D-ICE for FLX size selection and may provide better guidance during device deployment.

Thoracic Fluid Content in Neonates Presented with Respiratory Distress as a Predictive Tool for Transient Tachypnea of Newborn.

INTRODUCTION: Respiratory conditions are the most common reason for admission of newborns to a neonatal care unit. The index of contractility (ICON) can be used to measure the thoracic fluid content (TFC) in neonates which is a significant parameter in cases presented with transient tachypnea of newborn (TTN). OBJECTIVE: The objective was to compare TFC between newborn infants with TTN compared with other causes of respiratory distress (RD). We tested the hypothesis that TFC would be higher in infants with TTN. STUDY DESIGN: In total, 105 newborns were enrolled at the delivery room and were categorized into three groups: TTN, other causes of RD, and control, according to physical examination and Chest X-Ray. TFC was measured within the first 6 hours for all infants and at 24 and 48 hours for the first two groups. RESULTS: Demographic data showed higher male participants and use of antenatal steroid therapy in RD groups. TFC within the first 6 hours was higher in RD groups. However, TFC at 24 hours of ≤24 mL/kg, and TFC drop rate at 24 hours of >12% are statistically significant discriminators of TTN from non-TTN, with sensitivity and specificity of 97.1 and 47.1%, and 60 and 82.4%, respectively (Fig 1 and 2). CONCLUSION: ICON can be used in conjunction with clinical parameters and CXR as a tool for differentiation between TTN and other causes of RD within the first 24 hours of life by using the cutoff value of TFC at 24 hours and TFC drop rate. This will allow earlier and optimum management of different causes of RD. KEY POINTS: · Thoracic fluid content. · Neonatal respiratory distress. · Newborn.

Continuing professional development system for health-care professions, Egypt.

While the regulatory framework for medical education in Egypt has rapidly evolved, the progress of developing a system for continuing professional development has been slow. In 2018 the government approved legislation establishing a regulatory authority for continuing professional development and added expectations for continuing professional development as a condition of relicensure for physicians in Egypt. The new authority has deployed a provider-accreditation model that sets criteria for educational quality, learning outcomes, independence from industry, and tracking of learners. Only accredited providers can submit continuing professional development accredited activities. Despite regulatory and administrative support there have been several barriers to the implementation of the system including limited availability of funding, lack of suitable training venues and equipment for hands-on training, and resistance from the profession. As of March 2022, 112 continuing professional development providers have achieved accreditation, and deployed 154 accredited continuing professional development activities. The majority of accredited providers were medical associations (64%) and higher education institutions (18%), followed by medical foundations and nongovernmental organizations (13%) and health-care facilities (5%). One electronic learning platform has been accredited. Any entity with commercial interests cannot be accredited as a continuing professional development provider. Funding of continuing professional development activities can be derived from provider budgets, programme registration fees or appropriate sponsors. Funding from industry is limited to unrestricted educational grants. The foundations for an effective continuing professional development system have been established in Egypt with the aim of achieving international recognition.

Si le cadre réglementaire de l'enseignement médical en Égypte a rapidement évolué, la progression de l'élaboration d'un système de développement professionnel continu a été lente. En 2018, le gouvernement a approuvé la législation établissant une autorité de réglementation en faveur du développement professionnel continu et a ajouté des attentes en matière de développement professionnel continu comme condition de renouvellement du permis d'exercer pour les médecins en Égypte. Cette nouvelle autorité a diffusé un modèle d'accréditation des prestataires qui fixe des critères de qualité éducative, de résultats d'apprentissage, d'indépendance vis-à-vis du secteur et de suivi des apprenants. Seuls les prestataires accrédités peuvent présenter des activités agréées de développement professionnel continu. Malgré un soutien réglementaire et administratif, plusieurs obstacles ont entravé la mise en œuvre de ce système, notamment la disponibilité limitée de fonds, le manque de lieux de formation et d'équipements adaptés à une formation pratique, ainsi que la résistance de la part de la profession. En mars 2022, 112 prestataires de formation professionnelle continue avaient obtenu leur accréditation et mis en place 154 activités de formation professionnelle continue agréées. La majorité des prestataires accrédités étaient des associations médicales (64%) et des établissements d'enseignement supérieur (18%), suivis par des fondations médicales et des organisations non gouvernementales (13%) et des établissements de soins de santé (5%). Une plateforme d'apprentissage électronique a été accréditée. Toute entité ayant des intérêts commerciaux ne peut être accréditée en tant que prestataire de services de développement professionnel continu. Le financement des activités de développement professionnel continu peut provenir des budgets des prestataires, des frais d'inscription aux programmes ou de sponsors appropriés. Le financement par le secteur se limite à des subventions éducatives sans restriction. Les bases d'un système efficace de développement professionnel continu ont été établies en Égypte dans le but d'obtenir une reconnaissance internationale.

Mientras que el marco regulatorio para la educación médica en Egipto ha evolucionado con rapidez, el progreso del desarrollo de un sistema para el desarrollo profesional continuo ha sido lento. En 2018, el gobierno aprobó la legislación que establece una autoridad reguladora para el desarrollo profesional continuo y añadió las expectativas de desarrollo profesional continuo como condición para la renovación de la licencia de los médicos en Egipto. La nueva autoridad ha desplegado un modelo de acreditación de proveedores que establece criterios de calidad educativa, resultados de aprendizaje, independencia del sector y seguimiento de los estudiantes. Solo los proveedores autorizados pueden presentar actividades acreditadas de desarrollo profesional continuo. A pesar del apoyo normativo y administrativo, ha habido varios obstáculos para la aplicación del sistema, como la escasa disponibilidad de fondos, la falta de centros de formación y equipos adecuados para la formación práctica, y la resistencia de la profesión. En marzo de 2022, 112 proveedores de desarrollo profesional continuo han logrado la acreditación y han desplegado 154 actividades de desarrollo profesional continuo acreditadas. La mayoría de los proveedores autorizados eran asociaciones médicas (64 %) e instituciones de enseñanza superior (18 %), seguidas de fundaciones médicas y organizaciones no gubernamentales (13 %) y centros de atención sanitaria (5 %). También se ha acreditado una plataforma de aprendizaje electrónico. Las entidades con intereses comerciales no pueden ser acreditadas como proveedores de formación profesional continua. La financiación de las actividades de desarrollo profesional continuo se puede obtener de los presupuestos de los proveedores, de las cuotas de inscripción en los programas o de los patrocinadores correspondientes. La financiación obtenida del sector se limita a subvenciones educativas sin restricciones. En Egipto, se han establecido las bases de un sistema eficaz de desarrollo profesional continuo con el objetivo de lograr el reconocimiento internacional.

Impact of digital monitoring on compliance and outcome of lifestyle-change measures in patients with coexistent atrial fibrillation and obesity.

Introduction: Obesity, a known risk factor for atrial fibrillation (AF), is potentially reversible through lifestyle changes, including diet and physical activity. However, lack of compliance is a major obstacle in attaining sustained weight loss. We investigated the impact of patient engagement using a digital monitoring system on compliance for lifestyle-change measures and subsequent outcome. Methods: A total of 105 consecutive patients with coexistent AF and obesity (body mass index ≥28) were classified into 2 groups based on the monitoring method: group 1, use of digital platform (n = 20); group 2, conventional method (n = 85). Group 1 used the RFMx digital monitoring platform (smartphone app) that sets weekly goals for exercise and weight loss, tracks patient compliance data continuously, and sends regular text reminders. Conventional method included monitoring patients' adherence to diet and change in weight during in-person clinic visits or monthly phone calls from staff. Results: Baseline characteristics of groups 1 and 2 were comparable. At 6 months of follow-up, 12 (60%) and 28 (33%) from group 1 and 2, respectively, were compliant with the physician instructions regarding diet and exercise (P = .025). Weight loss was observed in 9 of 12 (75%) from group 1 and 11 of 28 (39%) from group 2 (P = .038) and mean reduction in weight was 9.9 ± 8.9 lb and 4.0 ± 2.1 lb (P = .042). Conclusion: In this series, continuous digital monitoring was seen to be associated with significant improvement in compliance through better patient engagement, resulting in more weight loss compared to the conventional method.

Clinical and neurophysiological risk factors of learning disabilities in different types of idiopathic focal epilepsy.

Objectives: Academic difficulties are common in epileptic children. A learning disability (LD) is a reduction in the learning capacity of children or the intellectual ability of adults, which is different from mental retardation or dementia. Materials & Methods: The participants were 56 patients, of whom 35 were males (62.5%), and 21 were females (37.5%). The participants attended the Neurology Outpatient Clinic, the Sohag University Hospital, between December 2016 and May 2017. Children with chronological age between 7 and 16 years with idiopathic focal and normal mental and motor developmental history were enrolled in this cross-sectional study. The Revised Quick Neurological Screening Test was used to assess different types of LD. Results: LDs were present in 67.9% of our participants with a statistically significant association between LDs in one arm and younger age, earlier age of onset of epilepsy, frequent seizures, and seizure semiology, particularly of temporal lobe origin, in the other arm. In addition, left epileptic focus on EEG, prolonged treatment duration with antiepileptic drugs (AED), and polytherapy were significantly correlated with LDs. Conclusion: Many factors are significantly correlated with LDs in children with idiopathic focal epilepsy, like age of the patient, age of epilepsy onset, seizure semiology, prolonged AED treatment, and polytherapy.

Transesophageal Echocardiography Following Left Atrial Appendage Electrical Isolation: Diagnostic Pitfalls and Clinical Implications.

BACKGROUND: Following left atrial appendage (LAA) electrical isolation, the decision on whether to continue oral anticoagulation after successful atrial fibrillation ablation is based on the study of its mechanical function on transesophageal echocardiography (TEE). In this cohort, LAA contraction is absent and the incorrect interpretation of emptying flow velocities can lead to unwanted clinical sequelae. METHODS: One hundred and sixty consecutive TEE exams performed to evaluate the LAA mechanical function following its electrical isolation were reviewed by an experienced operator blinded to the original diagnosis of LAA dysfunction. The rate of diagnostic discrepancy in the assessment LAA dysfunction and its clinical implications were evaluated. RESULTS: Diagnostic discrepancy with misclassification of the LAA mechanical function occurred 36% (58/160) of TEE exams. In most cases (57/58), such discrepancy was observed in the setting of an incorrect original diagnosis of a normal LAA mechanical function despite absent/reduced or inconsistent LAA contraction. This main source of this wrong diagnosis was the wrong interpretation of passive LAA flows (34/57; 60%), followed by failure to identify dissociated firing (15/57; 26%). In rare cases (8/57; 14%), velocities of surrounding structures were interpreted as LAA flow due to misplacement of the pulsed-wave Doppler sample volume. Following LAA isolation, the proportion of patients who experienced a cerebrovascular event while off oral anticoagulation due to the misclassification of their LAA mechanical function was 70% (7/10 [95% CI, 40%-89%]). CONCLUSIONS: Underdiagnosis of LAA mechanical dysfunction is common in TEEs performed following LAA electrical isolation, and it is associated with an increased risk of cerebrovascular events owing to oral anticoagulation discontinuation despite absent/reduced LAA contraction. Careful review of the TEE exam by an operator with specific expertise in LAA imaging and familiar with the functional implications of LAA isolation is necessary before interrupting oral anticoagulation in this cohort.