Postoperative atrial fibrillation (POAF) after cardiac surgery: clinical practice review.

Postoperative atrial fibrillation (POAF) after cardiac surgery is associated with elevated morbidity and mortality. Although current prediction models have limited efficacy, several perioperative interventions can reduce patients' risk of POAF. These begin with preoperative medications, including beta-blockers and amiodarone. Moreover, patients should be screened for preexisting atrial fibrillation (AF) so that concomitant surgical ablation and left atrial appendage occlusion can be performed in appropriate candidates. Intraoperative interventions such as posterior pericardiectomy can reduce mediastinal fluid accumulation, which is a trigger for POAF. Furthermore, many preventive strategies for POAF are implemented in the immediate postoperative period. Initiating beta-blockers, amiodarone, or both is reasonable for most patients. Overdrive atrial pacing, colchicine, and steroids have been used by some, although the evidence base is less robust. For patients with POAF, rate-control and rhythm-control strategies have comparable outcomes. Decision-making regarding anticoagulation should recognize that the stroke risk associated with POAF appears to be lower than that for general nonvalvular AF. The evidence that oral anticoagulation reduces stroke risk is less clear for POAF patients than for patients with general nonvalvular AF. Given that POAF tends to be shorter-lived and is associated with greater bleeding risks in the perioperative period, decisions regarding anticoagulation should be individualized. Finally, wearable technology and machine learning algorithms for better predicting and managing POAF appear to be coming soon. These technologies and a comprehensive clinical program could meaningfully reduce the incidence of this common complication.

Perceptions of health warnings on cigarette sticks among the adult population in Al-Madinah, Saudi Arabia: A cross-sectional survey.

INTRODUCTION: Health warnings on cigarette sticks are emerging as a tool to control tobacco consumption; hence, understanding how they are perceived is valuable in determining their effectiveness. Our study aimed to evaluate the perception of health-related messages and warnings on individual cigarette sticks. It also aimed to evaluate the perceptions of the effectiveness of cigarette packaging warnings and the acceptance level for the inclusion of health warnings on cigarette sticks. METHODS: This cross-sectional survey was conducted on 285 individuals in Al-Madinah, Saudi Arabia. The survey was distributed online using a non-probability convenience sampling technique. The chi-squared test and logistic regression analysis were used to determine the association of sociodemographic characteristics and smoking-related variables with participants' perceptions of health warnings on cigarette sticks and packaging. The responses were also assessed qualitatively using conceptual content analysis. RESULTS: In all, 18.6% of participants perceived that the package warnings were either 'quite effective' or 'very effective' in prompting smokers to quit. For health warnings on cigarette sticks, 28.1% of participants perceived that the theme of statistics on mortality was either 'quite effective' or 'very effective' in prompting smokers to quit, compared to 35.0 % for the theme of social and financial consequences. Respondents who had secondary education and lower were almost two times more likely to support the inclusion of health warnings than those who had a university education and higher (OR=1.9; 95% CI: 1.02-3.7, p=0.042). Most of the comments were positive for the inclusion of health warnings on cigarette sticks. CONCLUSIONS: Most participants perceived that package warnings were ineffective, but warnings on cigarette sticks were effective methods of dissuasion of cigarette use. Smokers were almost twice as likely to perceive as effective supportive messages to quit than non-smokers. The majority of participants 'agreed' or 'strongly agreed' to the inclusion of health warnings on cigarette sticks.

Molecular characterization of Canna yellow streak virus with divergent coat protein N-terminal fragment in Iraq.

BACKGROUND: Canna yellow streak virus (CaYSV, family Potyviridae) infects many canna cultivars, which have been widely cultivated in the Iraqi gardens for ornamental purposes. The genetic variability within multiple genomic regions of CaYSV population has been demonstrated in the 3' part, particularly in the coat protein (CP). This work was aimed to characterize CaYSV and investigate its variability from canna plants in Iraq. METHOD AND RESULTS: Leaves of canna plants grown in several gardens in Baghdad were tested by potyvirus group antibodies and RT-PCR. Analysis of the nucleotide (nt) sequences corresponding to the 3' part of the virus genome revealed the highest identity (81.6-90.6%) with known CaYSV isolates. Phylogenetic analysis of the coat protein (CP) gene sequence placed the Iraqi isolates in a separate clade with members of group A. This distinction was evidenced by unique amino acid changes found within the N-terminal motif of the CP. This is the first report of phylogenetically distinct CaYSV in Iraq. CONCLUSIONS: This is the first report of phylogenetically distinct CaYSV with divergent CP N-terminus in Iraq.

Mother-daughter communication about puberty in Egypt.

Parental communication during puberty can be a protective factor for adolescents. In Egypt, girls have poor access to sexual and reproductive health services and there is a lack of information on puberty in school curricula. Yet little is known about girls' other sources of information about puberty, including communication with mothers. We analysed 29 in-depth interviews with young mothers of girls in Greater Cairo to better understand mother-daughter communication about puberty. We examine respondents' motivations for communication with their daughters, the type of messages they provided or expected to provide, and barriers to mother-daughter communication, paying particular attention to intergenerational dynamics with respect to how women learn about puberty. We found that while mothers wanted to, and did, play a primary role in communicating with girls about puberty, discussions were constrained by lack of information and embarrassment. Mothers were more open to discussing some aspects of puberty, such as hygiene, than others. Conversations may also be delayed due to social norms about what is appropriate for girls to know and when. Messages were often fear-based and embedded in norms that stigmatised girls' sexuality. Programmes and interventions targeting mothers' knowledge and communication skills around puberty should be adapted and tested in the context of Egypt.

Prognostic value of systematic lymphadenectomy in patients with ovarian cancer: A systematic review and meta-analysis.

OBJECTIVE: To appraise clinical outcomes of systematic lymphadenectomy in women with ovarian cancer based on stage, control group and type of chemotherapy. STUDY DESIGN: A literature search was conducted on SCOPUS, PUBMED, COCHRANE, MEDLINE, and WEB OF SCIENCE databases. All comparative studies that assess outcomes of systematic lymphadenectomy in patients with ovarian cancer were eligible. Overall survival was analyzed by pooling log hazard ratio (HR) and standard error of multivariable Cox regression models. MOGGE Meta-analysis Matrix is a novel illustration tool that was used to demonstrate multiple subgroup analyses of included studies. RESULTS: Twenty-two studies were eligible. Systematic lymphadenectomy was associated with better overall survival, that was close to significance, compared to control group (HR 0.93, 95 %CI 0.86-1.00). Among women treated with adjuvant chemotherapy, overall survival improved in women with stage IIB-IV who underwent systematic lymphadenectomy (HR 0.91, 95 %CI 0.84-0.99) and was most significant among patients with stage III to IV (HR 0.85, 95 %CI 0.73-0.99). Systematic lymphadenectomy did not improve survival in women who received neoadjuvant chemotherapy (HR 0.97, 95 %CI 0.73-1.29). Systematic lymphadenectomy was associated with improved progress-free survival compared to control group (HR 0.88, 95 %CI 0.79-0.99). CONCLUSION: Although data from clinical trials do not support role of systematic lymphadenectomy in advanced ovarian cancer, overall data conveys stage-specific survival benefit. Further clinical trials may be warranted to assess substage survival outcomes in women with advanced stages.

Medical Community Perspectives Regarding the Egyptian Medical Licensing Exam: A Mixed-Method Study.

BACKGROUND: Although national licensing examinations (NLEs) may be a costly process, they can predict performance of medical practitioners for many years following graduation. The current licensing requirements do not fulfill this function as there are no clear performance criteria for them. Therefore, new requirements should be developed and announced. OBJECTIVE:  The study aims to develop a framework for the Egyptian Medical Licensing Exam (EMLE) by exploring the opinions and perceptions of Egyptian health practitioners and medical educators. METHODS: This study is a two-phase exploratory mixed-method study. An online discussion forum was conducted with medical practitioners and educators concerning the development of the EMLE. Then, an online survey was distributed to explore the opinions of medical practitioners and educators about the EMLE. RESULTS: Fifty medical practitioners and educators participated in the discussion forum about the development of the EMLE, while 266 participants responded to the online survey. The responses of the participants contributed to the development of a framework for the EMLE that is divided into two main sections, the exam logistics and the exam set up. The exam logistics included the exam committee, prerequisites for the exam, the admission criteria and fees, and validity of the license. The exam set up included exam setting, structure, pass marks, and exam retake policy. CONCLUSION: The study concluded that medical practitioners and educators could contribute greatly to the planning for the EMLE. Their opinions are based on their experiences and include the timing of the exam, blueprinting, assessment methods, psychometrics and retake.

Complete Genome Sequence of Mycobacteriophage Fulbright.

Mycobacteriophage Fulbright was isolated from soil in central Oklahoma using Mycobacterium smegmatis mc2115. The genome of phage Fulbright is 42,396 bp long and contains 70 open reading frames (ORFs), with 33 having predicted functions and 37 having hypothetical proteins. It belongs to cluster N and shares 99% nucleotide identity with mycobacteriophage Phloss.

High-intensity focused ultrasound in management of placenta accreta spectrum: A systematic review.

BACKGROUND: High-intensity focused ultrasound (HIFU) is a non-invasive procedure that has been studied in the management of placenta accreta spectrum (PAS). OBJECTIVE: To appraise HIFU in the management of PAS and highlight the restrictions on converting uterus-preserving studies into evidence-based practice. SEARCH STRATEGY: A search on Scopus, Cochrane, PubMed and Web of Science was conducted from date of inception to January 2020. SELECTION CRITERIA: Studies on using HIFU in the management of PAS were eligible. Review articles, conference papers, and case reports were excluded. DATA COLLECTION: A standardized sheet was used to abstract data from eligible studies. CON-PAS registry was used to include studies on other conservative modalities. RESULTS: Four studies were eligible (399 patients). Average residual placental volume was 61.74 cm3 (6.01-339 cm3 ). Treatment was successful in all patients. Normal menstruation recovered after 48.8 days (15-150 days). No major complications were encountered. Sixty-one studies were retrieved from the CON-PAS registry; uterine artery embolization (23 studies), balloon placement (15 studies), compression sutures (10 studies), placenta in situ (7 studies), and uterine resection (6 studies) were successful in 83.7%, 92.9%, 87.9%, 85.2%, and 79.3% of cases, respectively. CONCLUSIONS: HIFU may fit certain clinical situations in the management of PAS. A global research strategy is recommended to incorporate conservative approaches within a comprehensive management protocol.

Algorithm for automatic recognition of PSK and QAM with unique classifier based on features and threshold levels.

In this paper, we present a unique modulation classification method that is based on determining an attractive relation between higher-order cumulants (HOCs) using a decision tree-classifier to improve the extracted features employed for the recognition of modulation schemes, such as phase shift keying (PSK) and quadrature amplitude modulation (QAM). A threshold algorithm is applied to the proposed classifier, which consists of sub-classifiers, each comprising a single feature, and each being capable of distinguishing the modulation types individually. In this work, a high-accuracy classifier system is utilized to recognize modulation schemes, such as QAM (16, 32, 64, 128, and 256) and (2, 4, and 8) PSK at a low signal-to-noise ratio (SNR). In this study, 1000 signals are studied for each SNR of -5 dB to 30 dB. The most prominent results of the classifier decisions range from 88% to 100% with regard to distinguishing the same types of PSK and QAM. In the long run, the proposed classifier module will be advantageous in terms of accuracy and computational complexity relative to the other classifiers in the literature. The results demonstrate that the proposed algorithm has a significantly better classification accuracy in comparison with the previously proposed ones.

Identification of congenital rubella syndrome in Sudan.

BACKGROUND: Epidemiological data about congenital rubella syndrome (CRS) are scarce and rubella vaccine is not yet included in the childhood immunization schedule in Sudan. This study aimed to identify and describe CRS cases among Sudanese infants with congenital eye or heart defects. METHODS: Between February and September 2010, paired oral fluid and dried blood spot samples were collected from 98 infants aged up to 12 months. These infants were enrolled during their visits to five hospitals in Khartoum, Sudan. Clinical samples were screened for rubella IgM and for ≥ 6 months old infants also for IgG antibodies by ELISA. The oral fluid of IgM and/or IgG positive patients was tested for rubella RNA by reverse transcriptase PCR. RESULTS: Our findings revealed that two children (2.0%) were IgM positive and another five children (5.1%) were positive for IgG antibodies. None of the five infants of which enough oral fluid was available for RNA investigation was PCR positive. CONCLUSIONS: This study documented the presence of CRS in Sudan and highlighted the importance of rubella vaccine introduction for preventing future CRS cases in the country.

Distinctive effects of the Epstein-Barr virus family of repeats on viral latent gene promoter activity and B-lymphocyte transformation.

The Epstein-Barr virus (EBV), a human B-lymphotropic gamma herpesvirus, contains multiple repetitive sequences within its genome. A group of repetitive sequences, known as the family of repeats (FR), contains multiple binding sites for the viral trans-acting protein EBNA-1. The FR sequences are important for viral genome maintenance and for the regulation of the promoter involved in viral latent gene expression. It has been reported that a palindromic sequence with a putative secondary structure exists at the 3' end of the FR in the genome of the EBV B95-8 strain and that this palindromic sequence has been deleted from the FR of the commonly used EBV miniplasmids. For the first time, we cloned an EBV B95-8 DNA fragment containing the full-length FR, which enabled us to examine the functional difference between full-length and deleted FRs. The full-length FR, like the deleted FR, functioned as a transcriptional enhancer of the viral latent gene promoter, but that transactivation was significantly attenuated in the case of the full-length FR. No significant enhancement of replication was observed when the deleted FR was replaced with the full-length FR in an EBV miniplasmid. By contrast, when the same set of FR sequences were tested in the context of the complete EBV genome, the full-length FR resulted in more-efficient B-cell transformation than the deleted FR. We propose that the presence of the full-length FR contributes to the precise regulation of the viral latent promoter and increases the efficiency of B-cell transformation.