Delaying Cardiac Catheterization in Favor of Endoscopy in Non-ST Elevation Myocardial Infarction Patients Is Associated with Worse Outcomes: A Nationwide Analysis.

BACKGROUND: Non-variceal upper gastrointestinal bleeding (NVUGIB) in non-ST-elevation myocardial infarction (NSTEMI) is associated with substantial morbidity and mortality. We evaluated inpatient outcomes of esophagogastroduodenoscopy (EGD) before cardiac catheterization in patients with NSTEMI and NVUGIB. METHODS: We utilized the National Readmission Database (2016-2019) to identify all index hospitalizations with a primary diagnosis of NSTEMI and a secondary diagnosis of NVUGIB that underwent EGD before cardiac catheterization (cases). A matched comparison cohort of similar hospitalizations that undergo EGD after cardiac catheterization were identified (controls) after 1:1 propensity score matching for age, gender, cardiac comorbidities, causes, and severity of bleeding. RESULTS: A total of 796 cases were matched with 796 controls. There was a higher median length of hospital stay (8 vs. 5 days, P = 0.01) and median hospital charges ($111,218 vs. $99,115, P = 0.002) for cases compared to controls. There was a higher all-cause inpatient mortality in cases compared to controls (5.5% vs. 3.9%, P = 0.26). Furthermore, there was a higher proportion of patients with ICU admission (7% vs. 3%, P < 0.001), septic shock (7.1% vs. 5.8%, P = 0.41), atrial fibrillation (27.1% vs. 19.8%, P < 0.001) and acute kidney injury (42.8% vs. 29.1%, P < 0.001) for cases compared to controls. CONCLUSION: Delaying cardiac catheterization in favor of EGD is associated with increased hospital stay, costs, and cardiac complications. Further studies are warranted to establish our findings.

In Situ Testing of Polymers Immersed in Aging Fluids at Elevated Temperature and Pressure.

A novel elevated-temperature and high-pressure in situ punch-shear-test cell was developed to qualify materials for reliable service in harsh environments representative of those typically encountered in oil and gas operations. The proposed modular and compact test device is an extension of the ASTM D 732 punch-shear method. Conventionally, materials are first exposed to harsh environments, then removed from the aging environment for mechanical testing. This practice can lead to the generation of unrealistic (often optimistic) mechanical properties. This is especially true in the case of materials for which fluid ingress is reversible. The present contribution elaborates on the developed in situ punch-shear device that has been successfully used to realistically assess the tensile yield strength and modulus properties of in-service polymer materials based on experimentally established correlations between shear and tensile tests.

Psychological Impact of the COVID-19 Pandemic on Healthcare Professionals in Tunisia: Risk and Protective Factors.

Background: Our study aimed to evaluate the magnitude of different psychological outcomes among Tunisian healthcare professionals (HCPs) during the first wave of the coronavirus disease 2019 (COVID-19) pandemic, and to identify the associated factors. Methods: Healthcare professionals completed a cross-sectional questionnaire during a 3-week period in the first wave of the COVID-19 pandemic in Tunisia. The survey collected demographic information, factors that may interfere with the psychological outcomes, behavioral changes, and mental health measures. Mental health was assessed using three scales: the Seven-Item Insomnia Severity Index, the Two-Item Patient Health Questionnaire, and the Two-Item Generalized Anxiety Disorder instrument. Multivariable logistic regression was conducted to identify factors associated with psychological outcomes. Results: A total of 503 HCPs successfully completed the survey, and 493 agreed to enroll in the study: 411 (83.4%) physicians, 323 (64.2%) women, and 271 (55%) with a second-line work position. A significant proportion of HCPs had anxiety (35.7%), depression (35.1%), and insomnia (23.7%). Women, those with a psychiatric history, and those using public transportation had higher proportions for overall symptoms compared with other groups, for example, depression in 44.9% of female participants vs. 18.2% of male participants (p = 0.00). Those with a previous medical history and nurses had more anxiety and insomnia compared with other groups, for example, anxiety in 45.1% of nurses, 36.1% of interns/residents, and 27.5% of attending physicians (p = 0.04). Multivariable logistic regression showed that female gender was a risk factor for all psychological outcomes, whereas psychiatric history was a risk factor for both anxiety and insomnia [odds ratio (OR) = 2.86, 95% CI 1.78-4.60, p = 0.00 for insomnia]. Using protective equipment was associated with a lower risk for depression (OR = 0.41, 95% CI 0.27-0.62, p = 0.00) and anxiety. Physical activity was also protective against depression and anxiety (OR = 0.41, 95% CI 0.25-0.67, p = 0.00). Conclusion: Psychological symptoms are usually overlooked or dismissed by HCPs, although the COVID-19 pandemic played a major role in exacerbating this burden. Prompt psychological support should be endorsed and simple measures, such as physical activity and ensuring the availability of personal protective equipment, are paramount to improve mental health outcomes and the quality of care provided to patients.

Assessment of anthropogenic inputs in the surface waters of the southern coastal area of Sfax during spring (Tunisia, Southern Mediterranean Sea).

The coastal marine area of Sfax (Tunisia), which is well-known for its high productivity and fisheries, is also subjected to anthropogenic inputs from diverse industrial, urban and agriculture activities. We investigated the spatial distribution of physical, chemical and biogeochemical parameters in the surface waters of the southern coastal area of Sfax. Pertinent tracers of anthropogenic inputs were identified. Twenty stations were sampled during March 2013 in the vicinity of the coastal areas reserved for waste discharge. Phosphogypsum wastes dumped close to the beaches were the main source of PO4(3-), Cl(-) and SO4(2-) in seawater. The high content in total polyphenolic compounds was due to the olive oil treatment waste water released from margins. These inorganic and organic inputs in the surface waters were associated with elevated COD. The BOD5/COD (<0.5) and COD/BOD5 (>3) ratios highlighted a chemical pollution with organic load of a low biodegradability.

[Ureteral injuries in gynaecologic surgery]. / Les traumatismes de l'uretère d'origine gynécologique.

Surgical injury to the ureter is an important problem that confronts the urologist, the gynaecologist and the general surgeon. We report 38 cases of iatrogenic ureteral injuries observed after gynaecological surgery between January 1972 and December 2004. Hysterectomy accounted for 22 injuries. Injuries were intra-operatively recognized in 3 cases and were treated immediately. In the case of lesions identified secondarily, a ureter-vesical implantation was performed in 66% of cases with a good result in 84% of them. Four patients required nephrectomy. We discuss the cicumstances of development, diagnosis approach and treatment of this lesion and review the literature about this subject.

[Association of benign prostatic hyperplasia and hernia inguinale. A report of 55 cas]. / Association hypertrophie bénigne de la prostate et hernie inguinale. Cure simultanée à propos de 55 cas.

THE AIM: of this study is to evaluate the results of combined surgery of prostatic disease and inguinal hernia repair. METHODS: We report a retrospective study of 55 patients operated in the same operating time for benign prostatic hyperplasia and hernia inguinale, and present our criteria for patient selection, operative technique, and postoperative results. RESULTS: The mean age of our patient was 69 years with a range of 56 to 85 years. Open suprapubic prostatectomy was done in 53% of cases, transurethral prostatic resection in 47% of cases and prothetic hernioplasty in 60% of cases. The incidence of postoperative wound infection and recurrent hernia was 5,4 % and 6% respectively, witch compares favorably to results of herniorraphy and prostatectomy performed separately. Simultaneous repair of inguinal hernias and surgery of prostatic disease is effective and technically feasible.