Determinants of Healthcare Workers’ Willingness to Receive COVID-19 Vaccination

@#Introduction: The expedited COVID-19 vaccine has challenged people’s belief and perception of its effectiveness. The purpose of this study was to identify whether knowledge related to Covid-19 and perception of effectiveness of Covid-19 vaccine would predict health-care workers’ willingness to take the vaccine. Methods: A cross-sectional design using a convenience sampling technique was used to collect data from 302 HCWs. HCWs targeted included all those working at healthcare settings in Jordan. Data collected regarding knowledge related Covid-19 and perception of effectiveness of Covid-19 vaccine. Data collected using a self-administered questionnaire. Results: HCWs have moderate to high level of knowledge related to vaccines of Covid-19 and its effectiveness. High level of willingness to take the vaccine was also observed among HCWs. Those with higher level of knowledge and positive perception of effectiveness of Covid-19 vaccine are more likely to take the vaccine (p < .05); however, not highly influential (R2 = 27%). Demographic characteristics have not been found to influence HCWs’ decision to take the vaccine. Conclusion: There is a need to enhance positive perception of effectiveness of Covid-19 vaccine among health professionals through appropriate education and procedures.

Suicidality and its Relationship to Psychological and Sociodemographic Factors among Individuals with Obsessive Compulsive Disorders in Jordan

@#Introduction: Obsessive Compulsive Disorder (OCD) is a chronic mental disorder causing severe social and occupational dysfunction leading to high risk of suicidal ideas and behaviours. The purpose of the study was to investigate the prevalence of suicidality and its relationship to psychological (depressive and anxiety symptoms) and sociodemographic factors among individuals with Obsessive Compulsive Disorder in Jordan. Methods: this is a descriptive correlational study. Data was collected using self-reported questionnaire from 90 individuals diagnosed with OCD from outpatient departments receiving care at public and private health institutions in Jordan. Data were collected regarding suicidality, anxiety, and depressive symptoms. Results: Suicidal risk was detected in 34.4% % (N= 31) of the individuals with OCD, 90% had mild to severe depressive symptoms, 70% had mild to severe anxiety symptoms. Significant positive correlation found between suicidality, anxiety and depressive symptoms (p<.05). Individuals with OCD and suicidality had significantly lower educational level, contamination, trichotillomania, and sexual obsessions. Depressive symptoms and type of OCD were significant predictors for suicidality among individuals known to have OCD. Conclusion: Individuals with OCD have high risk for suicidality and should be carefully monitored. Health care professionals in the outpatients’ clinics are recommended to actively investigate suicidality risk as part of OCD comprehensive assessment per visit.

Community versus Hospital Acquired Pressure Injuries: An Assessment of Predisposing Risk Factors

@#Introduction: Pressure injuries are a common problem in acute and chronic healthcare settings with critical morbidity and mortality consequences on patients and healthcare systems. The objective of this study was to assess the predisposing risk factors associated with patients with community acquired pressure injuries and hospital acquired pressure injuries. Methods: Data were drawn from patients' electronic medical records from two hospitals with a total of 784 beds in the North Texas area and 94 records of HAPI and 206 records of CAPI patients were assessed. The measures examined included patients' socio-demographic variables, admission diagnosis, and Braden scale measures. Results: Scores for Albumin, weight, body mass index, length of stay and Braden measures were significantly higher for HAPI than CAPI patients at α < 0.05. Higher total Braden scores (OR=1.25, 95%CI: 1.15, 1.41), friction (OR=2.44, 95%CI: 1.39, 4.27), and longer length of stay (OR=1.13, 95%CI: 1.09, 1.18) were associated with a higher likelihood of HAPI. Conclusions: Interventions aimed at prevention of pressure injuries should target reducing friction and length of stay at care facilities.

Testing The Effectiveness Of Integrated Elderly Care Model On Quality Of Care And Health Outcomes Among Hospitalized Elderlies In West Bank

@#The rapid increase in the ageing population and health conditions are imposing a higher challenge to the health care system that requires multidisciplinary teamwork utilizing coordinated care approach. This study examined the effects of integrated care model on quality of care received by older hospitalized patients in West Bank. A quantitative interrupted time series design (pretest and posttest multiple time series, quasi-experiment design) was used. The study examined the effects of integrated care model on admitted older patients (n=32) in the West Bank measuring ten dimensions of quality of care and four health indicators. There was a significant improvement in the dimensions of quality of care: dimensions: nurses’ communications with patients, physicians’ communications with patients, staff response to patients’ needs, pain management, explanations on medications, amount of information given on discharge plan, patients' area cleanliness, patients' area quietness, rating of the hospital, and willingness to recommend the hospital. Incidence of falls and incidence of pressure ulcer improved after implementing the model, while readmission rate and average length of stay did not improve. This study contributed to the limited body of knowledge related to the effect of integrated care model on hospitalized older patients’ quality of care in Palestine/ West Bank. Integrated care has the potential to improve care outcomes among hospitalized older patients.

Molecular and Bacteriological Diagnosis of Mycoplasma Species Infection in Camels at Taif Governorate, Saudi Arabia

Aims: We designed this work to confirm if the PCR technique is more rapid and specific than traditional diagnostic method by culture. Study Design: In vitro experimental and molecular study. Place and Duration of Study: Genetic engineering and biotechnology unit, Taif University, Saudi Arabia from October, 2016 to September, 2017. Methodology: Ninety three nasal and tracheal swabs and lung samples were collected from camel in Taif slaughterhouse, Saudi Arabia. All samples were tested by culture and PCR method using universal primer of 16S rRNA gene. Results: There was no positive result obtained by culture method, but 30 (32.2%) of nasal swabs were positive using PCR method. Moreover, we used species-specific primers for Mycoplasma arginine, M. bovis and M. mycoides subspecies mycoides to identify the isolates at species level, but no positive results obtained with specific primers. These positive samples could be other Mycoplasma species. Conclusion: These results indicate that PCR technique is a specific molecular detection technique for Mycoplasma identification, and more sensitive test. These techniques are simple and fast methods to detect and isolate infected animals.

Sildenafil reduces ischemia/reperfusion testicular injury after torsion/detorsion in rats.

This study was conducted to investigate the protective effects of sildenafil citrate on testicular injury after testis torsion/detorsion (T/D) in rats. Forty adult male Wistar rats were randomly allocated into four equal groups of ten rats each. Group 1 (Sham-operated); Group 2 (torsion for 2 hours and detorsion for 2 hours); Group 3, (torsion for 2 hours, sildenafil injection and detorsion for 2 hours), and Group 4 (sildenafil injection, torsion for 2 hours and detorsion for 2 hours).The levels of lipid peroxidation (P<0.001) and nitric oxide (P < 0.01) were significantly increased in in the testis of group 2 rats. Testicular reduced glutathione and serum inhibin B levels were decreased significantly (P<0.001) after T/D. Administration of sildenafil either before or after torsion prevented the increase in lipid peroxidation and nitric oxide, and alleviated glutathione and inhibin B levels. Sildenafil also prevented ischemia/reperfusion cellular damage and histological alterations in testicular tissue. These results suggest that treatment with sildenafil citrate 2 hours before or after torsion could induce protective effects against ischemia/reperfusion injury.

Neurocysticercosis: A case report and brief review

Neurocysticercosis (NCC) is one of the seven neglected endemic zoonoses targeted by the World Health Organization. It is considered a common infection of the nervous system caused by the Taenia solium and is known to be the primary cause of preventable epilepsy in many developing countries. NCC is commonly resulted by the ingestion of Taenia solium eggs after consuming undercooked pork, or contaminated water. The parasite can grow in the brain and spinal cord within the nervous system, causing severe headache and seizures beside other pathological manifestations. Immigration and international travel to endemic countries has made this disease common in the United States. NCC can be diagnosed with computed tomography and magnetic resonance imaging of the brain. The treatment of the NCC including cysticidal drugs (e.g., albendazole and praziquantel), and neurosurgical procedure, depending upon the situation. A patient of Asian origin came to our clinic with complaints of dizziness, headaches and episodes seizures for the past twelve years without proper diagnosis. The computed tomography and magnetic resonance imaging scans indicated multilobulated cystic mass in the brain with the suspicion of neurocysticercosis.

Neurocysticercosis: A case report and brief review

Neurocysticercosis (NCC) is one of the seven neglected endemic zoonoses targeted by the World Health Organization. It is considered a common infection of the nervous system caused by the Taenia solium and is known to be the primary cause of preventable epilepsy in many developing countries. NCC is commonly resulted by the ingestion of Taenia solium eggs after consuming undercooked pork, or contaminated water. The parasite can grow in the brain and spinal cord within the nervous system, causing severe headache and seizures beside other pathological manifestations. Immigration and international travel to endemic countries has made this disease common in the United States. NCC can be diagnosed with computed tomography and magnetic resonance imaging of the brain. The treatment of the NCC including cysticidal drugs (e.g., albendazole and praziquantel), and neurosurgical procedure, depending upon the situation. A patient of Asian origin came to our clinic with complaints of dizziness, headaches and episodes seizures for the past twelve years without proper diagnosis. The computed tomography and magnetic resonance imaging scans indicated multilobulated cystic mass in the brain with the suspicion of neurocysticercosis.

Ruta graveolens and its active constituent rutin protect against diethylnitrosamine-induced nephrotoxicity through modulation of oxidative stress.

The current study was designed to evaluate the possible protective effects of Ruta graveolens (Rue) and its active phenolic constituent rutin against diethylnitrosamine (DEN)-induced nephrotoxicity in rats. A single dose of DEN (200 mg/kg body weight) was intraperitoneally injected. Two-weeks after DEN administration, rats received 0.05 % phenobarbital in drinking water for 12 weeks. Ruta graveolens (50 mg/kg) and rutin (50 mg/kg) were orally administered from the first day of experiment. DEN administration induced kidney injury evidenced by histological alterations as well as significant increase in serum urea (P<0.01), creatinine (P<0.001) and uric acid (P<0.001), and renal lipid peroxidation levels. On the other hand, renal glutathione content and activity of superoxide dismutase, glutathione peroxidase and glutathione-s-transferase were significantly declined. Concomitant supplementation with either R. graveolens extract or rutin markedly alleviated the altered biochemical and histopathological features. In conclusion, the current findings provide evidence that R. graveolens and its active phenolic component rutin could protect against DEN-induced renal damage through abolishment of oxidative stress and potentiation of the antioxidant defense system.

Biochemical and histological impacts of high doses of local and imported Nigella sativa administered to female rats

This study was conducted to compare between Syrian and Egyptian Nigella sativa [NS] seeds for some chemical characteristics, total phenolic contents; the percentage of the antioxidant activity and to evaluate the effect of high doses of NS crushed seeds or their extracted oils on some blood biochemical parameters as well as the architecture of liver and kidney tissues. The following results [on a dry- weight basis] were obtained for Syrian and Egyptian variety respectively, ash 3.21 and 4.57%, protein 22.3 and 22.4%, fixed oil 35.0 and 36.0%, carbohydrates 32.8 and 34.05% and essential oil 0.3 and 0.9%. The major unsaturated acids in the crude fixed oil extract of NS seeds were linoleic acid followed by oleic acid while palmitic acid was the main saturated fatty acid. The compositions of the essential oils, of the two examined samples contain the same constituents with different concentrations. Thymoquinone is more abundant in the Egyptian variety meanwhile, alpha-pinene, beta-pinene, carvacrol, alpha- terpineol, eugenol, beta-caryophillene and cavone are more abundant in the Syrian variety. The blood biochemical results revealed that the supplementation of NS crushed seeds of the two varieties or their extracted oils, with high doses showed some changes on liver functions [ which evaluated by the hepatic enzymes activity assay of ALT and AST], lowering cholesterol and triglycerides levels and displayed no effect on albumin, total protein and urea levels. A significant increase in ALP enzymatic activity was obtained that could be attributed to the effect of progesterone hormone, whereas female rats were employed to conduct the biochemical study. Meanwhile, the histological examinations for liver and kidney tissues revealed pathological changes that could be attributed to the presence of high amount of thymoquinone, this finding could explain the significant increase in lipid proxidative index as evaluated in the term of plasma malondialdehyde [MDA] especially after the administration of the Egyptian variety of NS

Shifting from traditional lecturing to interactive learning in Saudi dental schools: how important is staff development?

Staff development is one of the main challenges when planning to introduce new educational methods into existing curricula. The aim of this study was to ascertain whether conducting a workshop prior to the implementation of new educational methods would help to enhance the participants' awareness of new educational strategies and motive them to use those strategies. A comprehensive workshop was developed and delivered to staff members at the Taibah University College of Dentistry, Almadinah Almunawwarah, KSA, during November 2014. The workshop explained the concepts of the flipped classroom and problem-based learning methods and provided exercises and simulation of actual classroom sessions. A questionnaire including closed- and open-ended questions was electronically distributed to participants after the workshop. Of the 27 participants, 89% thought that the workshop was a useful experience [p <0.01]. Similarly, responses to questions concerning the relevance, comprehensiveness and ease of the workshop were generally positive. The staff was now aware of these new methods and enjoyed the participation and interaction the workshop provided. However, concerns arose about the applicability of the proposed methods in real-life settings. This was mainly attributed to time constraints. Dental staff at Taibah University gave positive feedback about the workshop on interactive learning. Although staff awareness of the concepts was increased, scepticism and concerns related to the applicability of interactive learning methods to real-life settings were noted

Human leukocyte antigen DRB1 and the response to pegylated interferon/ribavirin therapy with chronic hepatitis C in children

Background: Egypt has the highest prevalence of hepatitis C virus [HCV] infection in the world [15%-25%] and the main [90%] genotype is type 4. Prevalence in Egyptian children was found to be 3% in Upper Egypt and 9% in Lower Egypt. Various human leucocytic antigen [HLA] alleles have been linked either persistence or clearance of the hepatitis C virus [HCV]. Several studies have aimed to identify the involvement of HLA with different outcomes of HCV infection, but the results have not been consistent

Aim of the work: To identify HLA association with different outcomes as regard treatment of chronic HCV [CHC] in Egyptian children with pegylated interferon-alpha2b [Peg-IFN-alpha-2b] and ribavirin [RBV]

Patients and methods: Forty clinically and laboratorial children diagnosed as CHC genotype 4 [ages 3-18 years, 14 females and 26 males]. Patients were treated using Peg-IFN-alpha 2b [Peg Intron] at a dosage of 60 ug/m[2] per week subsutaneously and RBV 15 mg/kg per day orally for 48 weeks. Serum HCV ribonucleic acid [RNA] was measured at the baseline, at the 12[th], 24[th] and 48[th] weeks during treatment, and after 24 weeks of post-treatment [study weeks 72]. Sustained virologic responders [SVR] were defined as patient with undetectable HCV-RNA in the serum at 24 weeks post-treatment, while non-responders defined as HCV-RNA remains detectable throughout the treatment phase. Genomic DNA was extracted from 1 ml peripheral blood in tubes containing EDTA. HLA typing was performed by polymerase chain reaction followed by detection using sequence-specific oligonucleotides probes

Results: Twenty-nine out of forty patients [72.5%] showed a sustained virological responders to Peg-IFN/RBV therapy, whereas eleven [27.5%] non-responders did not. The frequencies of DRB1[asterisk]11 was significantly higher in sustained virological responders than non-responders. On the other hand, DRB1[asterisk] 07 allele was significantly higher in non-responders than SVR. We also found that no statistically significant difference between SVR and non-responders as regards the demographic, laboratory and liver histopathology characteristics of patients

Conclusion: There is a trend of association between certain HLA alleles and the response to Peg-IFN/RBV in HCV infected children and a study on large number of patients to confirm this association is worthy

Transforming growth factor beta one and non alcoholic fatty liver disease

Background and study aim: Hepatic steatosis reflects an imbalance between the uptake and synthesis of fatty acids by the liver and their oxidation and export. The mechanism of cell injury remains unclear. Transforming growth factor ­ beta 1 (TGF-ß1) as a proinflammatory cytokine has become an important issue in the context of pathogenesis and progression of non alcoholic fatty liver disease (NAFLD). This study was planned to assess the value of TGF-ß1 in different forms of NAFLD.Patients and methods:This study included 62 patients; 20 patients with benign steatosis (group 1), 20 patients with non alcoholic steatohepatitis (NASH) (group 2) and 22 patients with cirrhosis (group 3), as well as 7 healthy subjects who served as a control group. Each group was subclassified according to the presence of obesity, type 2 diabetes mellitus and hypertriglyceridemia. All participants were subjected to abdominal ultrasound, ultrasound guided needle liver biopsy and routine laboratory investigations e.g. complete blood picture, liver function tests, fasting and 2 hours postprandial blood glucose and serum triglycerides.Results : Serum TGF-ß1 in the benign steatosis group was insignificantly different from the control group, while NASH and cirrhosis groups had significantly higher levels compared to control and benign steatosis groups (P<0.001). TGF-ß1 in NASH group was significantly higher than in cirrhosis group (428.78 ± 117.15 vs 260.42 ± 110.22 ng/ml, P=0.032). In benign steatosis group, TGF-ß1 was insignificantly different among subgroups. In NASH and cirrhotic patients, TGF-ß1 was significantly higher in dyslipidemic subgroups.Conclusion : Serum level of TGF-ß1 was higher in patients with severe forms of NAFLD (NASH and cirrhosis) than in patients with benign steatosis

Cyclooxygenase-2 expression is associated with elevated AST level in hepatocellular carcinoma

Cyclooxygenase-2, the inducible rate-limiting enzyme of prostaglandins biosynthesis, has been reported to be involved in the pathogenesis of a variety of chronic inflammation-related human malignancies including Hepatocellular Carcinoma [HCC]. However, its clinical significance in HCC remains obscure. Our objectives were to evaluate COX-2 expression in HCC and correlate its expression to the different clinicopathological parameters and to assess its impact on patient survival. The present study was conducted on 17 HCC and 21 adjacent non-tumor liver tissues obtained from 22 HCC patients underwent curative hepatectomy at the National Cancer Institute, Cairo University, Egypt. Eight normal liver tissues taken from normal donors and HepG2 cell line were used as controls. Total RNA from tissues and cells was extracted and COX-2 mRNA was detected by RT- PCR and correlated to the clinicopathological criteria as well as to patient's survival. COX-2 mRNA was detected in 58.8% of the HCC tissues and in 28.6% of the adjacent non-tumor liver tissues. COX-2 expression was significantly associated with elevated levels of serum aspartate aminotransferase [AST] with high specificity for the detection of the disease. However, there was no significant correlation between COX-2 expression and any of the histopathological criteria. COX-2 expression may be involved in HCC carcinogenesis with high specificity for the detection of the disease It was significantly associated with elevated AST levels indicating disease severity. However cox2 expression seems to be an independent factor with no correlation to any of the clinicopathological data or patient's survival

Molecular characterization of Listeria species isolated from frozen fish

The objective of this study was to investigate the molecular characterization of Listeria species isolated from frozen raw fish. A total of 219 samples consisting of 104 mackerel, 52 horse mackerel, 51 catfish and 12 herring were collected and analyzed by bacteriological, serological, antimicrobial and molecular methods. Overall, 29[56.9%] and 1[0.96%] of catfish samples and mackerel samples respectively were positive for Listeria spp. No Listeria was detected in herring and horse mackerel. In catfish, L. welshimeri [13.7%] was the most commonly isolated species followed by L. monocytogenes [11.8%], L. innocua [9.8%], L. grayi subsp. murrayi [9.8%], L. grayi subsp. grayi [7.8%], and L. ivanovii [3.9%]. In mackerel, only L. monocytogenes was detected in one sample.L. monocytogenes isolates serotyped as type 1 and type 4 [3 isolates each] and one non-typeable.Antimicrobial resistance profiling showed all L. monocytogenes isolates were resistant to ampicillin and tetracycline. Two were resistant to erythromycin. However, they were susceptible to rifampicin, vancomycin, chloramphenicol and streptomycin. Four virulence-associated genes [prfA, hlyA, actA and inlA] in addition to the genus gene [prs] were investigated using multiplex PCR. All the isolates were positive for prs gene but, onlyL. monocytogenes isolates were positive for all tested virulence genes. Our study indicates that imported raw catfish can represent a significant source of L. monocytogenes and potential health risk for listeriosis

Comparative study between two-port and four-port laparoscopic cholecystectomy

Laparoscopic cholecystectomy has become the standard of care for patients requiring removal of the gallbladder. Traditional laparoscopic cholecystectomy is performed using the four-port technique. The aim of this study was to compare two-port with four-port laparoscopic cholecystectomy and to determine whether there are extra benefits with two-port laparoscopic cholecystectomy. Patients and methods Between March 2010 and March 2012, 70 adult patients with symptomatic cholelithiasis were enrolled into this study, which was carried out at New Dameitta University Hospital. They were randomly divided into two equal groups: group A underwent four-port laparoscopic cholecystectomy and group B underwent two-port laparoscopic cholecystectomy. The mean follow-up time was 13.18 months [range 6-23 months]. The mean operative time was 36.285 min for group A and 39.142 min for group B. As regards group A, the severity of postoperative pain was mild in 11 patients [31.42%], moderate in 19 patients [54.28%], and severe in five patients [14.28%]. As regards group B, the severity of postoperative pain was mild in 22 patients [62.85%], moderate in 12 patients [34.28%], and severe in one patient [2.85%]. As regards cosmetic appearance and patient satisfaction for the scar, for group B they were excellent in 31 patients [88.57%] and good in four patients [11.42%]; however, for group A they were excellent in 22 patients [62.85%] and good in 13 patients [37.14%]. In our study, we found that the use of two-port laparoscopic cholecystectomy did not affect the procedure's safety and conversion rate. Two-port laparoscopic cholecystectomy patients needed less analgesia and had a shorter hospital stay. Other advantages include fewer scars, more patient satisfaction, and cost effectiveness

Laparoscopic transabdominal preperitoneal repair versus open preperitoneal mesh repair for inguinal hernia

The surgical history of inguinal hernias dates back to ancient Egypt, from Bassini's repair to today's mesh-based open and laparoscopic repairs. The aim of this study was to compare laparoscopic transabdominal preperitoneal [TAPP] repair with open preperitoneal polypropylene mesh repair for treatment of inguinal hernia. From June 2010 to June 2012, 40 adult patients with primary inguinal hernia were included in this study, which was carried at New Damietta University Hospital. The patients were randomly divided into two equal groups: Group A underwent laparoscopic TAPP polypropylene mesh repair and group B underwent open preperitoneal polypropylene mesh repair. The mean follow-up time was 14.8 months. The mean operative time was 66.8 min for group A and that for group B was 47 min. The mean hospital stay was 1.475 days for group A and that for group B was 1.575 days. Contralateral clinically occult inguinal hernia was discovered and repaired in nine patients [45%] in the TAPP group. As regards group A, the severity of postoperative inguinal pain was mild in 12 patients [60%], moderate in seven patients [35%], and severe in one patient [5%]. As regards group B, the severity of postoperative inguinal pain was mild in six patients [30%], moderate in 10 patients [50%], and severe in four patients [20%]. The TAPP technique is an excellent tool for laparoscopic treatment of inguinal hernias. A prerequisite for excellent results is the strict application of a standardized technique. In experienced hands, all types of inguinal hernias, including large scrotal hernias, can be operated upon with low morbidity and recurrence rates. However, to achieve favorable results, a strong educational program on laparoscopy is recommended

Acute effects of cigarette smoking on the cardiac diastolic functions

Smoking is an independent risk factor for coronary heart diseases and it increases all causes of cardiovascular morbidity and mortality. To assess the acute effect of cigarette smoking on ventricular diastolic functions [LV and RV] in healthy, young, and slim smokers. Thirty volunteers who had recently commenced smoking [less than one year] and who smoked 1-2 cigarettes per day, underwent ECG, 2D and M-mode echocardiography, standard Doppler echocardiography, pulsed TDI [tissue Doppler imaging] on septal and lateral side of mitral annulus and lateral tricuspid annulus. Vp values were measured. The investigator asked them to hold smoking for at least two days after which echocardiographic examination was conducted before smoking one cigarette and the second examination conducted immediately after smoking one cigarette containing at least 0.4 mg of nicotine. Doppler findings over the mitral valve showed the E wave was significantly reduced from 82.7 +/- 10.4 to 74.6 +/- 10.4 after smoking; the A wave increased; the E/A ratio was reduced from 1.5 +/- 0.3 to 1.2 +/- 0.2; the E' septal significantly decreased [15.3 +/- 2.4 vs. 11.2 +/- 1.1] after smoking, and the E/E' ratio increased from 5.5 +/- 1.1 to 6.7 +/- 1.1. Doppler findings over the tricuspid valve showed the E wave was reduced from 60.6 +/- 9.7 to 52.7 +/- 9.6; the A wave increased from 42.2 +/- 6.5 to 50.1 +/- 6.6; and the E/A ratio decreased [1.45 +/- 0.25 vs. 1.06 +/- 0.19]. The E' significantly decreased from 14.1 +/- 1.8 to 10.9 +/- 2.4, while the A' increased [10.2 +/- 2.4 vs. 12.7 +/- 3.6] after smoking; and the IVRT of the RV was significantly prolonged from 62.9 +/- 7.5 to 68.7 +/- 7.9 after smoking. The Vp was markedly reduced from 67.8 +/- 8 to 55.2 +/- 3.5 after smoking. These findings reflected on the LV filling pressure [LVFvp] which increased from 9.8 +/- 1.4 to 10.5 +/- 1.3 after smoking. All changes were statistically significant at P < 0.001. Our study reveals that cigarette smoking can result in significant acute alteration in the diastolic functions of both ventricles

Laparoscopic crural repair with simultaneous sleeve gastrectomy: a way in gastroesophageal reflux disease treatment associated with morbid obesity

Laparoscopic sleeve gastrectomy [LSG] has become popular both as a definitive and a staged procedure for morbid obesity. Gastroesophageal reflux disease [GERD] is a common co-morbid disease in bariatric patients. The aim of this study was to evaluate the efficacy of LSG and hiatal hernia repair [HHR] to treat obesity, complicated by hiatus hernia [HH]. The participants in the study were twenty patients, 14 women and 6 men, with a mean body mass index of 43.4 +/- 1.9 kg/m[2] and mean age of 47 years. All the subjects were eligible for LSG and eight were found to have esophagitis at pre-operative endoscopy. Patients with Barrett's esophagus were excluded. GERD symptom questionnaire, 24-hour esophageal pH-metry, and manometry were employed as Pre-and post-procedure assessments. The mean follow-up period was eight months. Clinical outcomes were also evaluated in terms of GERD symptoms improvement or resolution, interruption of antireflux medication, and X-ray evidence of HH recurrence. Symptomatic HH was diagnosed preoperatively in 18 patients. In the other two patients, HH was asymptomatic and was diagnosed intra-operatively. Prosthetic reinforcement of crural closure was performed in two symptomatic cases with an HH > 5 cm. Mortality was nil and no complications occurred. After a mean follow-up of seven months, GERD symptoms resolution occurred in nine patients, while the other patients reported an improvement of reflux. Body mass index had fallen from 43.4 to 36.2 kg/m[2]. A laparoscopic hiatal repair with or without commercially available onlay reinforcement biologic mesh and a sleeve gastrectomy performed at the same time, was successful in controlling the reflux symptoms and reducing body weight

Hypertension control at a nephrology clinic at Jordan university hospital

To determine the degree of control of hypertension in hypertensive patients attending the nephrology clinic. A cross sectional study carried out by examining the records of patients with hypertension attending the nephrology clinic. There were 335 subjects included with mean age of 58.8 +/- 13.4 years and 189 [56.4%] were women. The mean systolic BP was131 +/- 13 and mean diastolic BP was 79 +/- 7. Two hundred seventy three subjects [81.5%] had BP