Search results for: Yasmin M. Fayez

Authors: Yasmin Hussein Embaby

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Introduction: Athletic Training has its essentials, rules, and methods that help individual in reaching the maximum possible athletic level during the exercised physical activity, therefore; it is important for those working in athletic field to recognize and understand what is going on inside our bodies. This will show the close relationship between physiology and athletic training as the science that explains the various changes that happen to respond to the practice of physical activities. Swimming is one of the water sports that play a major role in influencing the full compatibility of body parts and its systems during the practice of different swimming methods, which uses aqueous to move. It is the initial nucleus in swimming learning and through which the beginner gain a sense of security, safety and the ability to move in aqueous by learning basic skills. Research Methodology: The researcher used the experimental methodology by using pre and post measurement on two equal groups (experimental – control) because it is appropriate for the research. Conclusions: Through the results and information found by the researcher, and in light of the related studies, theoretical readings and the statistical treatments of data; the researcher reached the following conclusions: 1. Muscle relaxation exercises have a positive effect on performance level in crawl swimming and on endorphin hormone as it helps in increasing its normal rater in body, the improvement percentage for experimental group in the relaxation ability, level of endorphin hormone exceeds those of control group. 2. The validity of muscle relaxation exercises proposed for the application, which achieved its objectives, namely increasing the level of endorphin hormone in the body; where research results showed a statistically significant difference in the level of endorphin hormone in favor of the experimental sample.

Keywords: beginners, endorphin hormone, relaxing exercises, swimming

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Authors: Hanan Fayez Hussein

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‘Due to increasing environmental challenges and security problems in the world such as global warming, storms, and terrorism’, humans have discovered new technologies and new materials in order to program daily life. As providing physical and psychological security is one of the primary functions of architecture, so in order to provide security, building must prevents unauthorized entry and harm to occupant and reduce the threat of attack by making building less attractive targets by new technologies such as; Nanotechnology, which has emerged as a major science and technology focus of the 21st century and will be the next industrial revolution. Nanotechnology is control of the properties of matter, and it deals with structures of the size 100 nanometers or smaller in at least one dimension and has wide application in various fields. The construction and architecture sectors were among the first to be identified as a promising application area for nanotechnology. The advantages of using nanomaterials in construction are enormous, and promises heighten building security by utilizing the strength of building materials to make our buildings more secure and get smart home. Access barriers such as wall and windows could incorporate stronger materials benefiting from nano-reinforcement utilizing nanotubes and nano composites to act as protective cover. Carbon nanotubes, as one of nanotechnology application, can be designed up to 250 times stronger than steel. Nano-enabled devices and materials offer both enhanced and, in some cases, completely new defence systems. In the addition, the small amount of carbon nanoparticles to the construction materials such as; cement, concrete, wood, glass, gypson, and steel can make these materials act as defence elements. This paper highlights the fact that nanotechnology can impact the future global security and how building’s envelop can act as a defensive cover for the building and can be resistance to any threats can attack it. Then focus on its effect on construction materials such as; Concrete can obtain by nanoadditives excellent mechanical, chemical, and physical properties with less material, which can acts as a precautionary shield to the building.

Keywords: nanomaterial, global warming, building security, smart homes

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Authors: Mohamed Anwar Hammad, Khaled Mohamed Al Akhali, Yasmin Elsobky

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Board certification is a voluntary process that confirms a pharmacist's capability, competency, education, skills, and proficiency beyond what is essential for licensure. This analysis was intended to investigate the prevalence of board-certified pharmacists in the Arab countries and compare the Board of Pharmacy Specialties (BPS) between Egypt, Saudi Arabia, and Canada. A cross-sectional study was conducted. The data were mined from the BPS website. Data were managed by IBM SPSS Statistics 23.0 and presented as descriptive statistics. Of 36918 Board certified pharmacists (BCPs) until February 2018, only 4038 (10.9%) were from the outside United States of America. From 4038 BCPs, about 1782 (44.1%) were from Arab nations. Egypt has the top prevalence of the BPS among the Arab countries 937 (52.6%) BCPs. However, the Kingdom of Saudi Arabia comes in the second position 442 (24.8%). Pharmacotherapy (BCPS), nutrition support pharmacy (BCNSP), critical care pharmacy (BCCCP) and oncology pharmacy (BCOP) are the highest specialties by 1474 (82.7%), 114 (6.4%), 61 (3.42%) and 60 (3.37%) respectively, while, infectious diseases pharmacy (AQID), cardiology pharmacy (AQCD) and nuclear pharmacy (BCNP) are the lowest prevalence of specialties by 7 (0.4%), 6 (0.3%) and 1 (0.06%) respectively. Added qualifications were canceled and became a new specialty in BPS as the rest of the specialties. Both infectious diseases and cardiology specialties exams are not conducted yet all over the world from the beginning of 2018. Egypt has the second prevalence 937 (2.54%), before Canada 920 (2.49%) and after United States of America 32880 (89.06%) in the worldwide in terms of BCPs. In conclusion the BCPS is the uppermost specialty; however, there is still a need for all the other specialties. In a short period, BCCCP jumped to the third position. Cardiology and infectious disease will be new specialties. Egyptian pharmacists are in the top of Arab countries, and 2nd in worldwide BCPs.

Keywords: AQCD, AQID, Arab countries, BCACP, BCCCP, BCGP, BCNP, BCNSP, BCOP, BCPPS, BCPS, BCPP, Board of Pharmacy Specialties (BPS), Canada, Egypt, Saudi Arabia, USA

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Authors: Yasmin Begum Mohammed

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Ketorolac tromethamine (KTM) is a non-steroidal anti-inflammatory drug with a potent analgesic and anti-inflammatory activity due to prostaglandin related inhibitory effect of drug. It is a non-selective cyclo-oxygenase inhibitor. The drug is currently used orally and intramuscularly in multiple divided doses, clinically for the management arthritis, cancer pain, post-surgical pain, and in the treatment of migraine pain. KTM has short biological half-life of 4 to 6 hours, which necessitates frequent dosing to retain the action. The frequent occurrence of gastrointestinal bleeding, perforation, peptic ulceration, and renal failure lead to the development of other drug delivery strategies for the appropriate delivery of KTM. The ideal solution would be to target the drug only to the cells or tissues affected by the disease. Drug targeting could be achieved effectively by liposomes that are biocompatible and biodegradable. The aim of the study was to develop a parenteral liposome formulation of KTM with improved efficacy while reducing side effects by targeting the inflammation due to arthritis. PEG-anchored (stealth) and non-PEG-anchored liposomes were prepared by thin film hydration technique followed by extrusion cycle and characterized for in vitro and in vivo. Stealth liposomes (SLs) exhibited increase in percent encapsulation efficiency (94%) and 52% percent of drug retention during release studies in 24 h with good stability for a period of 1 month at -20°C and 4°C. SLs showed about maximum 55% of edema inhibition with significant analgesic effect. SLs produced marked differences over those of non-SL formulations with an increase in area under plasma concentration time curve, t₁/₂, mean residence time, and reduced clearance. 0.3% of the drug was detected in arthritic induced paw with significantly reduced drug localization in liver, spleen, and kidney for SLs when compared to other conventional liposomes. Thus SLs help to increase the therapeutic efficacy of KTM by increasing the targeting potential at the inflammatory region.

Keywords: biodistribution, ketorolac tromethamine, stealth liposomes, thin film hydration technique

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Authors: Naila Safdar, Faria Riasat, Azra Yasmin

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Lychee is an emerging fruit crop in Pakistan. Two famous cultivars of lychee, Gola and Surakhi, were collected from Khanpur Orchard, Pakistan and their whole fruit (including peel, pulp and seed) was investigated for pomological features and therapeutic activities. Both cultivars differ in shape and size with Gola having large size (3.27cm length, 2.36cm width) and more flesh to seed ratio (8.65g). FTIR spectroscopy and phytochemical tests confirmed presence of different bioactive compounds like phenol, flavonoids, quinones, anthraquinones, tannins, glycosides, and alkaloids, in both lychee fruits. Atomic absorption spectroscopy indicated an increased amount of potassium, magnesium, sodium, iron, and calcium in Gola and Surakhi fruits. Small amount of trace metals, zinc and copper, were also detected in lychee fruit, while heavy metals lead, mercury, and nickel were absent. These two lychee cultivars were also screened for antitumor activity by Potato disc assay with maximum antitumor activity shown by aqueous extract of Surakhi seed (77%) followed by aqueous extract of Gola pulp (74%). Antimicrobial activity of fruit parts was checked by agar well diffusion method against six bacterial strains Enterococcus faecium, Enterococcus faecalis, Staphylococcus aureus, Bacillus subtilis, Bacillus sp. MB083, and Bacillus sp. MB141. Highest antimicrobial activity was shown by methanolic extract of Gola pulp (27mm ± 0.70) and seed (19.5mm ± 0.712) against Enterococcus faecalis. DPPH scavenging assay revealed highest antioxidant activity by aqueous extract of Gola peel (98.10%) followed by n-hexane extract of Surakhi peel (97.73%). Results obtained by reducing power assay also corroborated with the results of DPPH scavenging activity.

Keywords: antimicrobial evaluation, antitumor assay, gola, phytoconstituents, reactive oxygen species, Surakhi

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Authors: Rumana Keyani, Haleema Sadia, Asia Nosheen, Rabia Naz, Humaira Yasmin, Sidra Zahoor

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Tomato is a significant crop of the world and is one of the staple foods of Pakistan. A vast number of plant pathogens from simple viruses to complex parasites cause diseases in tomatoes but fungal infection in our country is quite high. Sometimes the symptoms are too harsh destroying the crop altogether. Countries like our own with continuously increasing massive population and limited resources cannot afford such an economic loss. There is an array of morphological, genetic, biochemical and molecular processes involved in plant resistance mechanisms to biotic stress. The study of different metabolic pathways like Jasmonic acid (JA) pathways and most importantly signaling molecules like ROS/RNS and their redoxin enzymes i.e. TRX and NRX is crucial to disease management, contributing to healthy plant growth. So, improving tolerance in crop plants against biotic stresses is a dire need of our country and world as whole. In the current study, fungal pathogenic strains Alternaria solani and Rhizoctonia solani were used to inoculate tomatoes to check the defense responses of tomato plant against these pathogens at molecular as well as phenotypic level with jasmonic acid and spermidine pretreatment. All the growth parameters (root and shoot length, dry and weight root, shoot weight measured 7 days post-inoculation, exhibited that infection drastically declined the growth of the plant whereas jasmonic acid and spermidine assisted the plants to cope up with the infection. Thus, JA and Spermidine treatments maintained comparatively better growth factors. Antioxidant assays and expression analysis through real time quantitative PCR following time course experiment at 24, 48 and 72 hours intervals also exhibited that activation of JA defense genes and a polyamine Spermidine helps in mediating tomato responses against fungal infection when used alone but the two treatments combined mask the effect of each other.

Keywords: fungal infection, jasmonic acid defence, tomato, spermidine

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Authors: Yasmin Nanabhay

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The paper scrutinizes the literature on accountability and non-accountability, and then presents an analysis of a South African case which demonstrated consequences of a lack of accountability. Ethical conduct displayed by members of the public sector is integral to creating a sustainable democratic government, which upholds the constitutional tenets of accountability, transparency and professional ethicality. Furthermore, a true constitutional democracy emphasises and advocates the notion of service leadership that nurtures public participation and engages with citizens in a positive manner. Ethical conduct and accountability in the public sector earns public trust; hence these are key principles in good governance. Yet, in the years since the advent of democracy in South Africa, the government has been plagued by rampant corruption and mal-administration by public officials and politicians in leadership positions. The control measures passed by government in an attempt to ensure ethicality and accountability within the public sector include codes of ethics, rules of conduct and the enactment of legislation. These are intended to shape the mindset of members of the public sector, with the ultimate aim of an efficient, effective, ethical, responsive and accountable public service. The purpose of the paper is to analyse control systems and accountability within the public sector and to present reasons for non-accountability by means of a selected case study. The selected case study is the corruption trial of Jackie Selebi, who served as National Commissioner of the South African Police Service but was dismissed from the post. The reasons for non-accountability in the public sector as well as recommendations based on the findings to enhance accountability will be undertaken. The case study demonstrates the experience and impact of corruption and/or mal-administration, as a result of a lack of accountability, which has contributed to the increasing loss of confidence in political leadership in the country as elsewhere in the world. The literature is applied to the erstwhile National Commissioner of the South African Police Service and President of Interpol, as a case study of non-accountability.

Keywords: corruption, internal control, maladministration, non-compliance, oversight mechanisms, public accountability, public sector

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Authors: Noor Taleb Ismael, Areej Abd Al Kareem Al Titi, Ala'a Fayez Jaber

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Objectives: To investigate self-perceived functional performance among adults with IDD who are Jordanian residential care and rehabilitation centers residents. Also, to investigate their functional abilities (i.e., motor, and cognitive). In addition, to determine the motor and cognitive predictors of their functional performance. Methods: The study utilized a cross-sectional descriptive design; the sample included 180 individuals with IDD (90 males and 90 females) aged 18 to 75 years. The inclusion criteria encompassed: 1) Adults with a confirmed IDD by their physician’s professional and 2) residents in Jordanian Residential Care and Rehabilitation Centers affiliated with the Jordanian Ministry of Social Development. The exclusion criteria were: 1) bedridden or totally dependent on their care providers; 2) who had an accident or acquired neurological conditions. Researchers conducted semi-structured interviews to complete the outcome measures that include the Canadian Occupational Performance Measure (COPM), the Functional Independence Measure (FIM), the Montreal Cognitive Assessment (MoCA), the Mini-Mental Status Examination (MMSE), and the sociodemographic questionnaire. Data analyses consisted of descriptive statistics, analysis of frequencies, correlation, and regression analyses. Result: Individuals with IDD showed low functional performance in all daily life areas, including self-care, productivity, and leisure; there was severe cognitive impairment and poor independence and functional performance. (COPM Performance M= 1.433, SD±.57021, COPM Satisfaction M= 1.31, SD±.54, FIM M= 3.673, SD± 1.7918). Two predictive models were validated for the COPM performance and FIM total scores. First, significant predictors of high self-perceived functional performance on COPM were high scores on FIM Motor sub scores, FIM cognitive sub scores, young age, and having a high school educational level (R2=0.603, p=0.012). Second, significant predictors of high functional capacity on FIM were a high score on the COPM performance subscale, a high MMSE score, and having a cerebral palsy (CP) diagnosis (R2=0.671, p<0.001). Conclusions: Evaluating functional performance and associated factors is important in rehabilitation to provide better services and improve health and QoL for individuals with IDD. This study suggested conducting future studies targeting integrated individuals with IDD who live with their families in the communities.

Keywords: functional performance, intellectual and developmental disabilty, cognitive abilities, motor abilities

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Authors: Natasha Yasmin Felles, Gerard Riley

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Background and Aims: Relationship breakdown is typical when one partner lives with an acquired brain injury caused by issues like a stroke. Research has found that the perception of relationship satisfaction decreases following such an injury among non-injured partners. Non-injured partners also are found to experience caregiver stress/burden as they immediately have to take the role of a caregiver along with being a partner of the injured. Research has also found that the perception of a continuous relationship, i.e. the perception of the relationship to be essentially the same as it was before the injury, also changes among those caregiving partners. However, there is a lack of available intervention strategies that can help those partners with both individual and relationship difficulties. The aim of this case study was to conduct a pilot test of an intervention aimed to explore whether it is possible to support a partner to experience greater continuity within the relationship poststroke, and what benefits such a change might have. Method: A couple, where one partner experienced an acquired brain injury poststroke were provided with Integrated Behavioural Couples Therapy for 3-months. The intervention addressed goals identified as necessary by the couple and by the formulation of their individual and relationship difficulties, alongside the goal of promoting relationship continuity. Before and after measures were taken using a battery of six questionnaires to evaluate changes in perceptions of continuity, stress, and other aspects of the relationship. Results: Both quantitative and qualitative data showed that relationship continuity was improved after the therapy, as were the measures of stress and other aspects of the relationship. The stress felt by the person with the acquired brain injury also showed some evidence of improvement. Conclusion: The study found that perceptions of relationship continuity can be improved by therapy and that improving these might have a beneficial impact on the stress felt by the carer, their satisfaction with the relationship and overall levels of conflict and closeness within the relationship. The study suggested the value of further research on enhancing perceptions of continuity in the relationship after an acquired brain injury. Currently, the findings of the study have been used to develop a pilot feasibility study to collect substantive evidence on the impact of the intervention on the couples and assess its feasibility and acceptability, which will help in further developing a specific generalized relationship continuity intervention, that will be beneficial in preventing relationship breakdown in the future.

Keywords: acquired brain injury, couples therapy, relationship continuity, stroke

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Authors: T. Yasmin, M. A. Farrelly, B. C. Rogers

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Urban water governance in developing countries faces numerous challenges arising from uncontrolled urban population expansion, water pollution, greater economic push and more recently, climate change impact while undergoing transitioning towards a sustainable system. Sustainability transition requires developing adaptive capacities of the socio-ecological and socio-technical system to be able to deal with complexity. Adaptive capacities deliver strategies to connect individuals, organizations, agencies and institutions at multiple levels for dealing with such complexity. Understanding the level of adaptive capacities for sustainability transformation thus has gained significant research attention within developed countries, much less so in developing countries. Filling this gap, this article develops a conceptual framework for analysing the level of adaptive capacities (if any) within a developing context. This framework then applied to the chronological development of urban water governance strategies in Bangladesh for almost two centuries. The chronological analysis of governance interventions has revealed that crisis (public health, food and natural hazards) became the opportunities and thus opened the windows for experimentation and learning to occur as a deviation from traditional practices. Self-organization and networks thus created the platform for development or disruptions to occur for creating change. Leadership (internal or external) is important for nurturing and upscaling theses development or disruptions towards guiding policy vision and targets as well as championing ground implementation. In the case of Bangladesh, the leadership from the international and national aid organizations and targets have always lead the development whereas more often social capital tools (trust, power relations, cultural norms) act as disruptions. Historically, this has been evident in the development pathways of urban water governance in Bangladesh. Overall this research has shown some level of adaptive capacities is growing for sustainable urban growth in big cities, nevertheless unclear regarding the growth in medium and small cities context.

Keywords: adaptive capacity, Bangladesh, sustainability transformation, water governance

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Authors: Jabulani Mtshiya, Yasmin Sultana-Muchindu

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Technical and Vocational Education (TVE) is the platform on which developed nations have built their economic foundations, which have led them to attain high standards of living. Zambia has put up educational systems aimed at empowering the citizens and building the economy. Nations such as China, the United States America, and several other European nations are such examples. Despite having programs in Technical and Vocations Education, the Zambian economy still lags, and the industries contributing merger to Gross Domestic Product. This study addresses the significance of Technical and Vocational Education and how it can improve the livelihood of citizens. It addresses aspects of development and productivity and highlights the problems faced by learners in Lusaka and Southern provinces in Zambia. The study employed qualitative research design in data collection and a method of descriptive data analysis was used in order to bring out the description of the prevailing state of affairs in TVE in the perspective of learners. This meant that the respondents indicated their views and thoughts toward TVE. The study collected information through research questionnaires. The findings showed that TVE is regarded important by government and various stakeholders and that it is also regarded important by learners. The findings also showed that stakeholders and society need to pay particular attention to the development of TVE in order to improve the livelihood of citizens and to improve the national economy. Just like any other developed nation that used TVE to develop their industries, Zambia also has the potential to train its youth and to equip them with the necessary skills required for them to contribute positively to the growth of industries and the growth of the economy. Deliberate steps need to be taken by the government and stakeholders to apply and make firm the TVE policies that were laid. At the end of the study recommendations were made; that government should put in the right measures in order to harness the potential at hand. Further on, recommendations were made to carry out this research at the national level and also to conduct it using the quantitative research method, and that government should be consistent to its obligations of funding and maintaining TVE institutions in order for them to be able to operate effectively.

Keywords: education, technical, training, vocational

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Authors: Mohammed Fayez Al Rez

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Nowadays, there is an unmet clinical need for new small-diameter vascular grafts to overcome the drawbacks of traditional methods used for treatment of widespread cardiovascular diseases. Vascular tissue engineering (VTE) is a promising approach that can be utilized to develop viable vascular grafts by in vitro seeding of functional cells onto a scaffold allowing them to attach, proliferate and differentiate. To achieve this purpose, the scaffold should provide cells with the initial necessary extracellular matrix environment and structure until being able to reconstruct the required vascular tissue. Therefore, producing scaffolds with suitable features is crucial for guiding cells properly to develop the desired tissue-engineered vascular grafts for clinical applications. The main objective of this work is fabrication and characterization of tubular small-diameter ( < 6 mm) bilayered scaffolds for VTE. The scaffolds were prepared via mixing electrospinning approach of biodegradable poly(ε-caprolactone) (PCL) polymer – due to its favorable physicochemical properties – to mimic the natural environment-extracellular matrix. Firstly, tubular nanofibrous construct with inner diameter of 3, 4 or 5 mm was electrospun as inner layer, and secondly, microfibrous construct was electrospun as outer layer directly on the first produced inner layer. To improve the biological properties of PCL, a group of the electrospun scaffolds was immersed in type-1 collagen solution. The morphology and structure of the resulting fibrous scaffolds were investigated by scanning electron microscope. The electrospun nanofibrous inner layer contained fibers measuring 219±35 nm in diameter, while the electrospun microfibrous outer layer contained fibers measuring 1011 ± 150 nm. Furthermore, mechanical, thermal and physical tests were conducted with both electrospun bilayered scaffold types where revealed improved properties. Biological investigations using endothelial, smooth muscle and fibroblast cell line showed good biocompatibility of both tested electrospun scaffolds. Better attachment and proliferation were obviously found when cells were cultured on the scaffolds immersed with collagen due to increasing the hydrophilicity of the PCL. The easy, inexpensive and versatile electrospinning approach used in this work was able to successfully produce double layered tubular elastic structures containing both nanofibers and microfibers to imitate the native vascular structure. The PCL – as a suitable and approved biomaterial for many biomedical and tissue engineering applications – can ensure favorable mechanical properties of scaffolds used for VTE. The VTE approach using electrospun bilayered scaffolds offers optimal solutions and holds significant promises for treatment of many cardiovascular diseases.

Keywords: electrospinning, poly(ε-caprolactone) (PCL), tissue-engineered vascular graft, tubular bilayered scaffolds, vascular cells

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Authors: Fayez Hanna, Viet Tran

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A 20 years old lady- primigravida 6 weeks pregnant with unremarkable past history, presented to the emergency department at the Royal Hobart Hospital, Tasmania, Australia, with hyperemesis gravidarum associated with, dehydration and complicated with hematemesis and chest pain resistant. Accordingly, we conducted laboratory investigations which revealed: FBC: WBC 23.9, unremarkable U&E, LFT, lipase and her VBG showed a pH 7.4, pCo2 36.7, cK+ 3.2, cNa+ 142. The decision was made to do a chest X-ray (CXR) after explaining the risks/benefit of performing radiographic investigations during pregnancy and considering the patient's plan for the termination of the pregnancy as she was not ready for motherhood for shared decision-making and consent to look for pneumoperitoneum to suggest perforated viscus that might cause the hematemesis. However, the CXR showed pneumomediastinum but no evidence of pneumoperitoneum or pneumothorax. Consequently, a decision was made to proceed with CT oesophagography with imaging pre and post oral contrast administration to identify a potential oesophageal tear since it could not be excluded using a plain film of the CXR. The CT oesophagography could not find a leak for the administered oral contrast and thus, no oesophageal tear could be confirmed but could not exclude the Mallory-Weiss tear (lower oesophageal tear). Further, the CT oesophagography showed an extensive pneumomediastinum that could not be confirmed to be pulmonary in origin noting the presence of bilateral pulmonary interstitial emphysema and pneumothorax in the apex of the right lung that was small. The patient was admitted to the Emergency Department Inpatient Unit for monitoring, supportive therapy, and symptomatic management. Her hyperemesis was well controlled with ondansetron 8mg IV, metoclopramide 10mg IV, doxylamine 25mg PO, pyridoxine 25mg PO, esomeprazole 40mg IV and oxycodone 5mg PO was given for pain control and 2 litter of IV fluid. The patient was stabilized after 24 hours and discharged home on ondansetron 8mg every 8 hours whereas the patient had a plan for medical termination of pregnancy. Three weeks later, the patient represented with nausea and vomiting complicated by a frank hematemesis. Her observation chart showed HR 117- other vital signs were normal. Pathology showed WBC 14.3 with normal U&E and Hb. The patient was managed in the Emergency Department with the same previous regimen and was discharged home on same previous regimes. Five days later, she presented again with nausea, vomiting and hematemesis and was admitted under obstetrics and gynaecology for stabilization then discharged home with a plan for surgical termination of pregnancy after 3-days rather than the previously planned medical termination of pregnancy to avoid extension of potential oesophageal tear. The surgical termination and follow up period were uneventful. The case is considered rare as pneumomediastinum is a very rare complication of hyperemesis gravidarum where vomiting-induced barotrauma leads to a ruptured oesophagus and air leak into the mediastinum. However no rupture oesophagus in our case. Although the combination of pneumothorax and pneumomediastinum without oesophageal tear was reported only 8 times in the literature, but none of them was due to hyperemesis gravidarum.

Keywords: Pneumothorax, pneumomediastinum, hyperemesis gravidarum, pneumopericardium

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Authors: Tiffanie-Marie Borg, Yasmin Zeinolabediny, Nima Heidari, Ali Noorani, Mark Slevin, Angel Cullen, Stefano Olgiati, Alberto Zerbi, Alessandro Danovi, Adrian Wilson

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Knee Osteoarthritis (OA) is a critical cause of disability globally. In recent years, there has been growing interest in non-invasive treatments, such as intra-articular injection of micro-fragmented fat (MFAT), showing great potential in treating OA. Mesenchymal stem cells (MSCs), originating from pericytes of micro-vessels in MFAT, can differentiate into mesenchymal lineage cells such as cartilage, osteocytes, adipocytes, and osteoblasts. Secretion of growth factor and cytokines from MSCs have the capability to inhibit T cell growth, reduced pain and inflammation, and create a micro-environment that through paracrine signaling, can promote joint repair and cartilage regeneration. Here we have shown, for the first time, data supporting the hypothesis that women respond better in terms of improvements in pain and function to MFAT injection compared to men. Historically, women have been underrepresented in studies, and studies with both sexes regularly fail to analyse the results by sex. To mitigate this bias and quantify it, we describe a technique using reproducible statistical analysis and replicable results with Open Access statistical software R to calculate the magnitude of this difference. Genetic, hormonal, environmental, and age factors play a role in our observed difference between the sexes. This observational, intention-to-treat study included the complete sample of 456 patients who agreed to be scored for pain (visual analogue scale (VAS)) and function (Oxford knee score (OKS)) at baseline regardless of subsequent changes to adherence or status during follow-up. We report that a significantly larger number of women responded to treatment than men: [90% vs. 60% change in VAS scores with 87% vs. 65% change in OKS scores, respectively]. Women overall had a stronger positive response to treatment with reduced pain and improved mobility and function. Pre-injection, our cohort of women were in more pain with worse joint function which is quite common to see in orthopaedics. However, during the 2-year follow-up, they consistently maintained a lower incidence of discomfort with superior joint function. This data clearly identifies a clear need for further studies to identify the cell and molecular biological and other basis for these differences and be able to utilize this information for stratification in order to improve outcome for both women and men.

Keywords: gender differences, micro-fragmented adipose tissue, knee osteoarthritis, stem cells

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Authors: Salima R. Rajwani, Tazeen Ali, Rubina Barolia, Yasmin Parpio, Nasreen Alwani, Salima B. Virani

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Introduction: Nurses and physicians have a critical role in initiating lifesaving interventions during cardiac arrest. It is important that timely delivery of high quality Cardio Pulmonary Resuscitation (CPR) with advanced resuscitation skills and management of cardiac arrhythmias is a key dimension of code during cardiac arrest. It will decrease the chances of patient survival if the healthcare professionals are unable to initiate CPR timely. Moreover, traditional training will not prepare physicians and nurses at a competent level and their knowledge level declines over a period of time. In this regard, simulation training has been proven to be effective in promoting resuscitation skills. Simulation teaching learning strategy improves knowledge level, and skills performance during resuscitation through experiential learning without compromising patient safety in real clinical situations. The purpose of the study is to evaluate the effectiveness of simulation training in Advanced Cardiac Life Support Courses by using the selfefficacy tool. Methods: The study design is a quantitative research design and non-randomized quasi-experimental study design. The study examined the effectiveness of simulation through self-efficacy in two instructional methods; one is Medium Fidelity Simulation (MFS) and second is Traditional Training Method (TTM). The sample size was 220. Data was compiled by using the SPSS tool. The standardized simulation based training increases self-efficacy, knowledge, and skills and improves the management of patients in actual resuscitation. Results: 153 students participated in study; CG: n = 77 and EG: n = 77. The comparison was done between arms in pre and post-test. (F value was 1.69, p value is <0.195 and df was 1). There was no significant difference between arms in the pre and post-test. The interaction between arms was observed and there was no significant difference in interaction between arms in the pre and post-test. (F value was 0.298, p value is <0.586 and df is 1. However, the results showed self-efficacy scores were significantly higher within experimental group in post-test in advanced cardiac life support resuscitation courses as compared to Traditional Training Method (TTM) and had overall (p <0.0001) and F value was 143.316 (mean score was 45.01 and SD was 9.29) verses pre-test result showed (mean score was 31.15 and SD was 12.76) as compared to TTM in post-test (mean score was 29.68 and SD was 14.12) verses pre-test result showed (mean score was 42.33 and SD was 11.39). Conclusion: The standardized simulation-based training was conducted in the safe learning environment in Advanced Cardiac Life Suport Courses and physicians and nurses benefited from self-confidence, early identification of life-threatening scenarios, early initiation of CPR, and provides high-quality CPR, timely administration of medication and defibrillation, appropriate airway management, rhythm analysis and interpretation, and Return of Spontaneous Circulation (ROSC), team dynamics, debriefing, and teaching and learning strategies that will improve the patient survival in actual resuscitation.

Keywords: advanced cardiac life support, cardio pulmonary resuscitation, return of spontaneous circulation, simulation

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Authors: Yasmin A. M. Ferreira, Ana C. K. Pelissari, Sofia De C. F. Vicente, Raquel M. Da S. Campos, Deborah C. L. Masquio, Lian Tock, Lila M. Oyama, Flavia C. Corgosinho, Valter T. Boldarine, Ana R. Dâmaso

Abstract:

The prevalence of overweight and obesity is growing around the world and currently considered a global epidemic. Food and nutrition are essential requirements for promoting health and protecting non-communicable chronic diseases, such as obesity and cardiovascular disease. Specific dietary components may modulate the inflammation and oxidative stress in obese individuals. Few studies have investigated the dietary Inflammation Factor Rating (IFR) in obese adolescents. The IFR was developed to characterize an individual´s diet on anti- to pro-inflammatory score. This evaluation contributes to investigate the effects of inflammatory diet in metabolic profile in several individual conditions. Objectives: The present study aims to investigate the effects of a multidisciplinary weight loss therapy on inflammation factor rating and cardiometabolic risk in obese adolescents. Methods: A total of 26 volunteers (14-19 y.o) were recruited and submitted to 20 weeks interdisciplinary therapy allied to health education website- Ciclo do Emagrecimento®, including clinical, nutritional, psychological counseling and exercise training. The body weight was monitored weekly by self-report and photo. The adolescents answered a test to evaluate the knowledge of the topics covered in the videos. A 24h dietary record was applied at the baseline and after 20 weeks to assess the food intake and to calculate IFR. A negative IFR suggests that diet may have inflammatory effects and a positive IFR indicates an anti-inflammatory effect. Statistical analysis was performed using the program STATISTICA version 12.5 for Windows. The adopted significant value was α ≤ 5 %. Data normality was verified with the Kolmogorov Smirnov test. Data were expressed as mean±SD values. To analyze the effects of intervention it was applied test t. Pearson´s correlations test was performed. Results: After 20 weeks of treatment, body mass index (BMI), body weight, body fat (kg and %), abdominal and waist circumferences decreased significantly. The mean of high-density lipoprotein cholesterol (HDL-c) increased after the therapy. Moreover, it was found an improvement of inflammation factor rating from -427,27±322,47 to -297,15±240,01, suggesting beneficial effects of nutritional counselling. Considering the correlations analysis, it was found that pro-inflammatory diet is associated with increase in the BMI, very low-density lipoprotein cholesterol (VLDL), triglycerides, insulin and insulin resistance index (HOMA-IR); while an anti-inflammatory diet is associated with improvement of HDL-c and insulin sensitivity Check index (QUICKI). Conclusion: The 20-week blended multidisciplinary therapy was effective to reduce body weight, anthropometric circumferences and improve inflammatory markers in obese adolescents. In addition, our results showed that an increase in inflammatory profile diet is associated with cardiometabolic parameters, suggesting the relevance to stimulate anti-inflammatory diet habits as an effective strategy to treat and control of obesity and related comorbidities. Financial Support: FAPESP (2017/07372-1) and CNPq (409943/2016-9)

Keywords: cardiometabolic risk, inflammatory diet, multidisciplinary therapy, obesity

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