COVID-19-induced immune thrombocytopenia management approach: A case report and literature review.

Key Clinical Message: Vincristine therapy can be effective in refractory Immune thrombocytopenia (ITP) following COVID-19 vaccination. Our case report highlights the need for further research to establish standard management guidelines for COVID-19-vaccine-associated ITP. Abstract: Adult immune thrombocytopenia (ITP) can occur as a rare complication following several viral infections or a rare adverse event or complication of vaccination. In this paper, we report a case of a 39-year-old male patient with severe refractory ITP that began 4-weeks after receiving his third (booster) dose of the COVID-19 vaccine (BNT162b2, Pfizer-BioNTech). He was given oral dexamethasone 40 mg daily for 4 days followed by prednisone at 1 mg/kg (85 mg daily) for 10 days. In the following weeks, we attempted several other lines of therapy to treat his ITP, including anti-RhD immunoglobulin, which, unfortunately, caused moderate hemolysis requiring packed red blood cell transfusion, intravenous immunoglobulin (given at a subtherapeutic dose of 0.4 g/kg for only 1 day since it was not available), rituximab, and eltrombopag. The patient, unfortunately, showed no response to any of these treatments. This was an indicator to initiate salvage therapy with vincristine 2 mg weekly for 3 weeks. The patient's platelet count started to increase remarkably during the third week of vincristine and normalized after 4 weeks. We review the findings, clinical characteristics, and management approaches that were reported in the literature regarding COVID-19-vaccine-induced ITP. More in-depth research is needed to delineate standard guidelines for the management of such cases. This report underscores the importance of resorting to vincristine and eltrombopag as great options for severe and refractory ITP related to the COVID-19 vaccine.

Tribological Characterization of a Novel Ceramic-Epoxy-Kevlar Composite.

This work aims to explore the effect of side load and rotational speed on the tribological behavior of a novel ceramic-epoxy composite in Kevlar matrix casing lining that is in contact with a rotating drillpipe tool joint (DP-TJ) coated with the same composite. Three rotational speeds (65, 115, and 154 rpm) and three side loads (500, 700, and 1000 N) were considered under water-based mud (WBM) lubrication. Wear depths, volumes, and specific casing wear rates (K) were determined for each combination of speed and load. The wear depth and K were found to increase with an increasing applied side load. However, the specific casing wear rate at the rotational speed of 115 rpm was found to be the lowest among the three speeds. This is mainly due to a probable lubrication regime change from boundary lubrication at 65 rpm to hydrodynamic lubrication with a thick lubricant film at 115 rpm. The digital microscope images were used to determine the wear mechanism, showing that at low speeds, the main mechanism was abrasive wear, but the increase in the speed brought about more adhesive wear. In contrast, the change in the side load does not affect the wear mechanism of the casing. Scanning electron microscopy and energy-dispersive spectroscopy (EDS) were used to analyze the surface and composition of the novel material before and after the wear tests.

Implementation of community-based management of severe acute malnutrition in conflict affected regions: a case of South Kordofan, Sudan.

Malnutrition is the major cause of mortality and morbidity globally with undernutrition contributing about 45% of all deaths of under five children. Besides the direct effects of protracted conflicts, the macroeconomic crisis that has greatly increased the national inflation rate hence devastating the purchasing power, the COVID-19 outbreak, flooding, and the Desert Locusts have contributed to a food security emergency. Besides being among the most under resourced states, South Kordofan has experienced years of conflict resulting in displacement of people and extensive infrastructure destruction with high rates of malnutrition. The state currently has 230 health facilities and out of these, only 140 are providing outpatient therapeutic programme centres with 28.6% (40) of these being operated by the state ministry of health and the rest by the international non-governmental organizations. Limited resources leading to donor dependence, limited accessibility due to insecurity and floods, poor referral system and gaps in continuity of care, lack of operational and implementation research data and limited integration of management of malnutrition in other health services have negatively affected effective implementation. Ensuring effective and efficient community based management of acute malnutrition, implementation needs action beyond the health sector with a multi-sectoral and integration approach. Federal and state development frameworks should ensure a comprehensive multi-sectoral nutrition policy with strong political commitment and allocation of adequate resources to ensure integrated and quality implementation.

Association of Sociodemographic Factors with Tuberculosis Outcomes in Mississippi.

Tuberculosis (TB) is one of the leading causes of death worldwide. In the US, the national incidence of reported TB cases was 2.16 per 100,000 persons in 2020 and 2.37 per 100,000 persons in 2021. Furthermore, TB disproportionately affects minorities. Specifically, in 2018, 87% of reported TB cases occurred in racial and ethnic minorities in Mississippi. Data from TB patients from the Mississippi Department of Health (2011-2020) were used to examine the association between sociodemographic subgroups (race, age, place of birth, gender, homelessness, and alcohol use) with TB outcome variables. Of the 679 patients with active TB cases in Mississippi, 59.53% were Black, and 40.47% were White. The mean age was 46 ± ten years; 65.1% were male, and 34.9% were female. Among patients with previous TB infections, 70.8% were Black, and 29.2% were White. The rate of previous TB cases was significantly higher among US-born (87.5%) persons compared with non-US-born persons (12.5%). The study suggested that sociodemographic factors play a significant role in TB outcome variables. This research will help public health professionals to develop an effective TB intervention program that addresses sociodemographic factors in Mississippi.

Casing Wear and Wear Factors: New Experimental Study and Analysis.

To understand and quantify casing wear during drilling operations, an experimental setup with real drill pipe joints (DPJ) and casings was designed and used to carry out wear tests, simulating various operating conditions and environments. P110 steel casing samples were tested under dry and wet conditions. Actual field oil- and water-based fluids were utilized to lubricate the contact area at two different side loads (1000 N and 1400 N) and DPJ speeds (115 and 207 rpm). The results show that for the same testing conditions, the casing wear volume and wear factor under water-based lubrication were more than twice those obtained under oil-based fluid testing. As expected, the wear volume and wear factor were highest under dry conditions. Moreover, it was noticed that, as the normal load was increased at a constant rotational speed (rpm), the wear factor increased. On the other hand, raising the rotational speed at the same applied load reduced the casing wear factor, due to the observed absence of adhesive wear and possible localized softening effects at higher speeds. SEM analyses of the worn areas showed that under dry conditions, the main wear mechanisms were abrasion and delamination. However, both adhesive wear and abrasive wear mechanisms were observed under oil-based lubrication. The energy dispersive spectroscopy (EDS) analysis of the worn surface revealed that at higher loads and speeds, a heavy transfer of particles from the oil-based lubricant took place. On the other hand, some contaminants of the water-based lubricant were observed on the worn surfaces.

Detection of Cytomegalovirus Infection in Infants with Biliary Atresia: A Meta-analysis.

Objectives Biliary atresia (BA) is the most common indication of liver transplantation in children. Several reports attributed BA to both prenatal and perinatal etiologies, including a viral infection-induced autoimmune response that targets the bile ducts. Cytomegalovirus (CMV) remains the most common virus being linked to BA. This meta-analysis aimed to estimate to what extent CMV infection is detected in patients with BA. Methods This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The databases of MEDLINE, Embase, Scopus, WHO-Virtual Health Library (VHL), ScienceDirect, and Google Scholar were used for the systematic search. The risk of bias was assessed using the Newcastle-Ottawa scale. Random effects model was used to estimate the pooled prevalence estimate with the corresponding 95% confidence interval (CI) using Comprehensive Meta-Analysis Software version 3.3. Results A total of 19 studies that fulfilled the eligibility criteria were included in the meta-analysis. The total number of infants with BA was 630 patients, and the pooled overall prevalence of CMV infection among them was 25.4% (95% CI: 15.9%-38.0%). There was high heterogeneity among studies (I 2 = 85.1%, p < .001), and subgroup analyses showed significant regional differences (X 2 = 48.9, p <.001). Data on the prognosis of CMV-associated BA were scarce and obtainable from few studies that suggested an association between detection of CMV infection and poor prognosis of BA. Conclusions The limited available data demonstrates that the rate of detection of CMV infection is high in infants with BA. There is still a need for large studies with appropriate controls for obtaining more reliable results about the various aspects of the association between CMV infection and BA.

Workplace violence against healthcare workers during the COVID-19 pandemic in Sudan: A cross-sectional study.

Background: Workplace violence (WPV) against healthcare workers (HCWs) is a growing global issue. During the coronavirus diseases-2019 (COVID-19) pandemic, violent attacks on HCWs have been documented worldwide. This study aimed to investigate the magnitude and pattern of WPV among HCWs in Sudan during the COVID-19 pandemic. Methods: A web-based cross-sectional study of WPV was conducted among registered medical and health workers (pharmacists, physicians, dentists, nurses, laboratory technicians, and administrative and paramedical staff) during the COVID-19 pandemic in Sudan. Data were collected from August to December 2021 using a self-administered questionnaire distributed through social media platforms. Results: A total of 792 HCWs returned the online questionnaire. The mean age was 33.5 ± 8.6 years, where more than half were females (54.9%) and working during the day shift (58.8%). During the COVID-19 pandemic, three out of every four participants (78.3%) reported experiencing violence, with 65.8 % experiencing it more than three times. The common types of violence experienced were verbal (91.6%), physical (50.0%), and sexual abuse (11.0%). The emergency department reported the highest number of violent incidents (46.9%). Half of these violent events were not reported (50.3%), primarily due to a lack of a reporting system. The demographic factors that were significantly associated with exposure to violence were participants' occupation (p < 0.001), age (p = 0.001), marital status (p = 0.002), and years of working experience (p = 0.020). Conclusion: WPV was rampant among the HCWs in Sudan during the COVID-19 pandemic. The current findings are presented to draw the attention of policy leaders and stakeholders in Sudan to this alarming problem prompting the pressing need for policy and system interventions.

Performance of roof-mounted misting fans to regulate heat stress in dairy cows.

Heat stress can negatively affect cow's physiology, behavior, and milk production. This study evaluates the effectiveness of roof mounting misting fans to improve heat and humidity index which reduces heat stress in a cowshed. Local climatic conditions were monitored and cooling system ability to control heat stress were assessed. Measurements were conducted at different cooling zones and levels comparing with shaded and open zones. The temperature and humidity index measurements outside the cowshed THIout showed that animals exposed to high degrees of heat stress during most of the day. The average value of THIout was 87.49, whereas the average value of adjusted outside temperature and humidity index THIadj was greater than THIout by 10% when solar radiation was considered. The maximum difference of hourly averages for temperature and humidity indices THIadj and THI occurred at noon when the intensity of solar radiation was highest. The average value for temperature and humidity index under misting fans THIfan was 82.27 whereas inside the cowshed under shade THIshade was 85.20. This conclude that the misting fans was able to reduce heat stress in a limited degree. Further improvement in terms of the cowshed design aspects and an increase of cooling efficiency is needed.

Clinical profile of carpal tunnel syndrome in a teaching hospital.

OBJECTIVES: The aim of this study was to review the clinical characteristics and demography of Carpel Tunnel Syndrome (CTS) cases presented to a university hospital. METHODOLOGY: A retrospective study was done for 336 consecutive patients (290 females and 46 males), referred with a clinical diagnosis of CTS to the Neuro-diagnostic laboratory at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, between January 2007 and December 2010. All subjects had clinical evaluation and standardized nerve conduction studies (672 hands) performed by the same examiner. RESULTS: Carpal tunnel syndrome was confirmed in 640 hands (95.23%) with female predominance (86.3%). The mean age was 52.4 in females and 54.4 years in males with overall highest occurrence among the age group 45- < 55 years. Bilateral CTS was confirmed in the majority of the patients, i.e., 304(90.5%), and remaining were unilateral. Among unilateral pattern, 22 (68.8%) had right CTS and others had left CTS. Most of the patients were treated conservatively 85.4% while the rest had surgical decompression 14.6%. CONCLUSION: Overall predominant age group was 45-<55 years with female dominancy. Majority of subjects had bilateral CTS as well as conservative treatment was frequent.