Optimization of colorectal cancer screening strategies: New insights

In this editorial,we discuss the article by Agatsuma et al.We concentrate specifically on the current routinely used screening tests recommended by society guidelines and delve into the significance of early diagnosis of colorectal cancer(CRC)and its substantial impact on both incidence and mortality rates.Screening is highly recommended,and an early diagnosis stands out as the most crucial predictor of survival for CRC patients.Therefore,it is essential to identify and address the barriers hindering adherence to screening measures,as these barriers can vary among different populations.Furthermore,we focus on screening strategy optimization by selecting high-risk groups.Patients with comorbidities who regularly visit hospitals have been diagnosed at an early stage,showing no significant difference compared to patients undergoing regular screening.This finding highlights the importance of extending screening measures to include patients with comorbidities who do not routinely visit the hospital.

Nasal flap preservation in endoscopic dacryocystorhinostomy for nasolacrimal duct obstruction

AIM:To compare surgical outcomes between the conventional endoscopic dacryocystorhinostomy(DCR)and a modified endoscopic DCR for the treatment of nasolacrimal duct obstruction(NLDO),and evaluate factors associated with the surgical success rate.METHODS:Medical records of patients who underwent primary DCR surgery between January 2016 and July 2020 at the Otorhinolaryngology Department of Eye and Ear International Hospital,Lebanon were reviewed.RESULTS:The study group consisted of 50 consecutive modified endoscopic DCR and the control group consisted of 138 consecutive conventional endoscopic DCR.The success rates at 1y were 98.0%(49 out of 50)for modified DCR,significantly higher compared to 84.8%(117/138)for the conventional DCR;there was no significant difference in the success rate throughout the years in terms of both surgical techniques.The modified surgery vs traditional[adjusted odds ratio(aOR)=14.96]and having an adjunctive septoplasty surgery vs not(aOR=3.99)were significantly associated with higher odds of success.CONCLUSION:Mucosal flap preservation and apposition shows significant improvement in the surgical success rate.Moreover,there is no statistically significant difference found in terms of complication rate and mean operative time between the conventional and the modified techniques.

Outpatient insulin use in type 2 diabetes mellitus and acute respiratory distress syndrome outcomes:A retrospective cohort study

BACKGROUND The impact of type 2 diabetes mellitus(T2DM)on acute respiratory distress syndrome(ARDS)is debatable.T2DM was suspected to reduce the risk and complications of ARDS.However,during coronavirus disease 2019(COVID-19),T2DM predisposed patients to ARDS,especially those who were on insulin at home.AIMTo evaluate the impact of outpatient insulin use in T2DM patients on non-COVID-19 ARDS outcomes.METHODS We conducted a retrospective cohort analysis using the Nationwide Inpatient Sample database.Adult patients diagnosed with ARDS were stratified into insulin-dependent diabetes mellitus(DM)(IDDM)and non-insulindependent DM(NIDDM)groups.After applying exclusion criteria and matching over 20 variables,we compared cohorts for mortality,duration of mechanical ventilation,incidence of acute kidney injury(AKI),length of stay(LOS),hospitalization costs,and other clinical outcomes.RESULTS Following 1:1 propensity score matching,the analysis included 274 patients in each group.Notably,no statistically significant differences emerged between the IDDM and NIDDM groups in terms of mortality rates(32.8%vs 31.0%,P=0.520),median hospital LOS(10 d,P=0.537),requirement for mechanical ventilation,incidence rates of sepsis,pneumonia or AKI,median total hospitalization costs,or patient disposition upon discharge.CONCLUSION Compared to alternative anti-diabetic medications,outpatient insulin treatment does not appear to exert an independent influence on in-hospital morbidity or mortality in diabetic patients with non-COVID-19 ARDS.

Does country risk impact the banking sectors’non‑performing loans?Evidence from BRICS emerging economies

This study aims to fill the gap in the literature by specifically investigating the impact of country risk on the credit risk of the banking sectors operating in Brazil,Russia,India,China,and South Africa(BRICS),emerging countries.More specifically,we explore whether the country-specific risks,namely financial,economic,and political risks significantly impact the BRICS banking sectors’non-performing loans and also probe which risk has the most outstanding effect on credit risk.To do so,we perform panel data analysis using the quantile estimation approach covering the period 2004–2020.The empirical results reveal that the country risk significantly leads to increasing the banking sector’s credit risk and this effect is prominent in the banking sector of countries with a higher degree of non-performing loans(Q.25=−0.105,Q.50=−0.131,Q.75=−0.153,Q.95=−0.175).Furthermore,the results underscore that an emerging country’s political,economic,and financial instabilities are strongly associated with increasing the banking sector’s credit risk and a rise in political risk in particular has the most positive prominent impact on the banking sector of countries with a higher degree of non-performing loans(Q.25=−0.122,Q.50=−0.141,Q.75=−0.163,Q.95=−0.172).Moreover,the results suggest that,in addition to the banking sectorspecific determinants,credit risk is significantly impacted by the financial market development,lending interest rate,and global risk.The results are robust and have significant policy suggestions for many policymakers,bank executives,researchers,and analysts.

Disruption of biofilms from sewage pipes under physical and chemical conditioning

Biofilms grown inside two sewage collecting pipes located in industrial and residential areas are studied. Bacterial biomass inside three layers of biofilms was evaluated. Biofilm cohesion under different mixing rate and ionic strength was also investigated. Effects of physical and chemical parameters in the biofilms were evaluated by monitoring turbidity, chemical and biochemical oxygen demands. Extracted organic matter from biofilms was partitioned to polar, aromatic and saturated fractions using activated silica column chromatography. Results revealed that bacterial biomass growth depending on biofilm thickness and stratification. The most loaded stratum in bacteria/biomass was the sewage-biofilm interface stratum that represented 51% of the total bacteria/biomass. Stirring rate and ionic strength of mono- and bivalent salts showed a major influence in biofilm disruption. The stirring time enhanced the exchange dynamic and matter capture between biofilm fragments at the critical stirring rate 90 r/min. Sodium chloride showed the dispersing effect on biofilms in suspension, and decreased the BOD5 （biochemical oxygen demand） beyond the physiological salt concentration.

Coronary artery aneurysm:A review

Coronary artery aneurysm(CAA)is a clinical entity defined by a focal enlargement of the coronary artery exceeding the 1.5-fold diameter of the adjacent normal segment.Atherosclerosis is the main cause in adults and Kawasaki disease in children.CAA is a silent progressive disorder incidentally detected by coronary angiography,but it may end with fatal complications such as rupture,compression of adjacent cardiopulmonary structures,thrombus formation and distal embolization.The pathophysiological mechanisms are not well understood.Atherosclerosis,proteolytic imbalance and inflammatory reaction are involved in aneurysmal formation.Data from previously published studies are scarce and controversial,thereby the management of CAA is individualized depending on clinical presentation,CAA characteristics,patient profile and physician experience.Multiple therapeutic approaches including medical treatment,covered stent angioplasty,coil insertion and surgery were described.Herein,we provide an up-to-date systematic review on the pathophysiology,complications and management of CAA.

Assessment of the Socio-Demographic Factors Associated with the Satisfaction Related to the Childbirth Experience

Assessment of the socio-demographic factors associated with the satisfaction is related to the childbirth experience. Objective: A mother’s satisfaction with the childbirth experience may have instant and lasting effects on her wellbeing, and on the bonding with her infant. The main aim of the study was to assess which socio-demographic factors are associated with this satisfaction. Most factors that authors agree on are: Pain intensity, personal control, self-efficacy, length of labor, method of delivery and numerous other demographic factors. Design: A cross-sectional study. Data was collected using a self-reported survey. Settings: The sample consisted of 100 women, selected from St Georges Hospital and CHU-NDS, who had to speak Arabic and had given birth in the past three days prior to interview. Methods: The multiple linear regressions and the mean test were used to assess which factors were associated with a positive childbirth experience. The Mackey childbirth satisfaction scale, three items from the Wijma delivery Expectancy/Experience questionnaire, a seven item mastery scale developed by Pearlin and Schooler and a background questionnaire were filled by women. Findings: Factors that were linked to a positive birth experience were: Higher age, multiparous women, higher education, high monthly income, unemployment, childbirth preparation, high personal control and self-efficacy, high childbirth and labor pain, fulfilled expectations, shorter period of labor and instrumented delivery. Conclusion: This study demonstrates that satisfaction with the childbirth experience is multi-dimensional with diverse factors foreseeing diverse dimensions of satisfaction.

Incidental discovery of right ventricular lipoma in a young female associated with ventricular hyperexcitability: An imaging multimodality approach

BACKGROUND Cardiac lipomas are rare benign tumors commonly found in the right atrium or left ventricle.Patients are usually asymptomatic,and clinical presentation depends on location and adjacent structures impairment.Right ventricle lipomas are scarce in the literature.Moreover,the previous published cases were reported in over 18-year-old patients.CASE SUMMARY We report a giant right ventricle lipoma discovered incidentally in a 17-year-old female while performing preoperative work-up.The diagnosis was confirmed by histopathological examination,and a conservative approach was performed.CONCLUSION Multimodal cardiac imaging and histopathological examination are required for a definitive diagnosis.The therapeutic approach depends on clinical presentation.

33% Classification Accuracy Improvement in a Motor Imagery Brain Computer Interface

A right-hand motor imagery based brain-computer interface is proposed in this work. Such a system requires the identification of different brain states and their classification. Brain signals recorded by electroencephalography are naturally contaminated by various noises and interferences. Ocular artifact removal is performed by implementing an auto-matic method “Kmeans-ICA” which does not require a reference channel. This method starts by decomposing EEG signals into Independent Components;artefactual ones are then identified using Kmeans clustering, a non-supervised machine learning technique. After signal preprocessing, a Brain computer interface system is implemented;physiologically interpretable features extracting the wavelet-coherence, the wavelet-phase locking value and band power are computed and introduced into a statistical test to check for a significant difference between relaxed and motor imagery states. Features which pass the test are conserved and used for classification. Leave One Out Cross Validation is performed to evaluate the performance of the classifier. Two types of classifiers are compared: a Linear Discriminant Analysis and a Support Vector Machine. Using a Linear Discriminant Analysis, classification accuracy improved from 66% to 88.10% after ocular artifacts removal using Kmeans-ICA. The proposed methodology outperformed state of art feature extraction methods, namely, the mu rhythm band power.

Flu Vaccine Coupled to Vitamin D Decrease the Frequency of Lower Respiratory Tract Infections (Randomized Controlled Trial)

Introduction: Influenza disease is one of the major health concerns in pediatrics. One of the most recently suggested effects of vitamin D is preventing infectious diseases. The aim of our study was to compare flu vaccine effect to flu vaccine associated to vitamin D (100,000 UI per OS) in reducing respiratory tract infections in children. Patients and Methods: 347 healthy children aged 2 to 5 years randomly selected during fall 2012 and the following season fall 2013 were included;upper and lower respiratory tract infections following vaccination were noted. Our results were analyzed using SPSS program (Chi-square and T-test). Results: Out of a total of 347 children included, 150 received flu vaccine and 197 received flu vaccine plus vitamin D. 88 children from both groups manifested upper respiratory tract infections and 64 had lower respiratory tract infections. The statistical analysis revealed no significant difference between the two groups concerning the upper respiratory tract infection (p = 0.207) and a significant difference between groups for the lower respiratory tract infection (p = 0.001). Conclusion: Coupling vitamin D to flu vaccine provides no protection against upper respiratory infections but provides an effective strategy to decrease the rate of lower respiratory infections in children 2 - 5 years of age.

Transplantation of CD34+cells for myocardial ischemia

CD34+cells are multipotent hematopoietic stem cells also known as endothelial progenitor cells and are useful in regenerative medicine.Naturally,these cells are mobilized from the bone marrow into peripheral circulation in response to ischemic tissue injury.CD34+cells are known for their high proliferative and differentiation capacities that play a crucial role in the repair process of myocardial damage.They have an important paracrine activity in secreting factors to stimulate vasculogenesis,reduce endothelial cells and cardiomyocytes apoptosis,remodel extracellular matrix and activate additional progenitor cells.Once they migrate to the target site,they enhance angiogenesis,neovascularization and tissue regeneration.Several trials have demonstrated the safety and efficacy of CD34+cell therapy in different settings,such as peripheral limb ischemia,stroke and cardiovascular disease.Herein,we review the potential utility of CD34+cell transplantation in acute myocardial infarction,refractory angina and ischemic heart failure.

Guided Botulinum Toxin Injections for Limbs Spasticity:The Winning Duets

Botulinum toxin found its way into a lot of medical treatments improving the quality of life in many clinical situations.When treating spasticity,this toxin is injected in the affected muscle to decrease its tension and hyperactivity.The isolation of the affected muscles for injection is done either by anatomical palpation of the muscle which is also known as non-guided injection technique,or by using the ultrasound or the electromyography also known guided injection technique.In this study which is a prospective observational study that included patients over a 6 months period,28 patients aged between 2 and 78 years,with spasticity na?ve to botulinum toxin injections or had already been injected more than 3 months ago,were injected using guided injection technique.The optimal doses of botulinum toxin were administered based on the age,the severity of the condition,and affected muscle groups.In pediatric population these were also calculated according to the body weight.All patients were evaluated pre and 4 weeks post injection using the MAS Score(Modified Ashworth Scale).Statistical analysis showed a very significant response to treatment as compared to the pre-injection condition,for upper limbs,lower limbs,and all muscle groups with almost absent significant local or systemic side effects(with a p value less than 0.001).Conclusion:guided techniques for botulinum toxin injections showed a great efficacy in the treatment of spasticity along with no regional or systemic side effects and are relatively well tolerated by patients.This finding leads to a better management of spasticity and to a decrease in oral medication intake and secondarily a decrease in their possible side effects.

Adaptive overheating cover for a solar water heater

Solar water heating systems have been widely used around the world.However,exposure to sunlight can overheat the device,affecting the efficiency and durability of the system.This article proposes an adaptive deck controller that protects the system from overheating without compromising the availability of domestic hot water.Solar water heaters are considered one of the most effective ways to reduce a home’s carbon footprint.They are a renewable energy source that reduces reliance on fossil fuels and saves money.Thus,this paper aims to develop a dynamic cover for solar water heaters that prevent overheating using an artificial neural network to optimize the design of control systems.Based on a self-organizing map network,the controller automatically adjusts the temperature of the solar collector through a fabric screen covering the main subsystems,depending on many parameters such as weather conditions,collector temperature and domestic hot water depending on demand.A suggested technique of four different shade percentages(0%,20%,25%or 32%)can avoid overheating and maintain the amount of hot water the home needs.Although renewable energy is free,proper controls are required to ensure maximum efficiency or proper use.In addition,the control of renewable energy leads to longer service life.

Association of problematic internet use with depression,impulsivity,anger,aggression,and social anxiety:Results of a national study among Lebanese adolescents

Importance:Several studies conducted worldwide(mostly in Western countries)highlighted the negative effects of problematic internet use,particularly among adolescents aged 12 to 17,including depression,impulsivity,aggression,and social fear and avoidance.In Lebanon,literature on the prevalence and impact of problematic internet use among adolescents is limited.Objective:This study aim was to study the association between problematic internet use and depression,impulsivity,anger,aggression and social phobia among Lebanese adolescents.Methods:A cross-sectional study was performed on 1103 young adolescents(14-17 years),recruited from October 2017 till April 2018.The Internet Addiction Test(IAT)was used to evaluate the level of problematic internet use.Data were analyzed using the MANCOVA analysis.The main independent variable of interest was the IAT,while the dependent variables included the psychological scales.Results:The multivariate analysis taking the psychological scales as the dependent variables and the problematic internet use(IAT score)as an independent variable,showed that problematic internet use was associated with higher depression,impulsivity,aggression,anger,hostility and social anxiety.Interpretation:Problematic internet use has become an important health issue that should not be overlooked,particularly because of the increased use of the internet by adolescents.Educational programs on early exposure to the internet should be developed.