Real-world evidence of the effects of sodium-glucose co-transporter 2 inhibitors on the dosing of diuretics in patients with heart failure: a retrospective cohort study

Background: Heart failure (HF) was estimated to impact approximately 64 million individuals worldwide in 2017 and is predicted to rise in the coming years. Therefore, the aim of our study was to evaluate the effects of sodium-glucose transport protein 2 (SGLT2) inhibitors on the dosing of diuretics among individuals diagnosed with HF. Methods: A retrospective cohort study was conducted at Security Forces Hospital in Riyadh, Saudi Arabia, between January 2018 and August 2022. The study included adult patients who were diagnosed with heart failure and received dapagliflozin and/or diuretic. A descriptive analysis was conducted to identify significant differences between both groups by using the chi-square test for categorical variables and the Student's t-test for continuous variables. A logistic regression model was also run to identify the odds of each event. Statistical significance was indicated by p values less than .05. Results: Overall reduction in diuretics was reported in 68 patients in the SGLT2 inhibitors plus diuretic therapy group, while in the diuretic therapy group 25 patients reported overall reduction in diuretics (OR = 4.81, 95% [2.74-8.45]). The reduction of the loop dose level was reported by 58 patients in the SGLT2 inhibitors plus diuretic group and by 25 patients in the diuretic group (OR = 3.48, 95% [1.98-6.11]). The discontinuation of thiazide was reported by 16 patients in the SGLT2 inhibitors plus diuretic therapy group, but by only two patients in the diuretic group (OR = 9.04, 95% [2.03-40.19]). After 6 months, ejection fraction was increased by 2.74 in the SGLT2 inhibitors plus diuretic group (p = .0019) and decreased by 2.56 in the diuretic group (p = .0485), both of which were statistically significant. The mean dose changes were decreased by 14.52 in the SGLT2 inhibitors plus diuretic group (p < .0001), which was statistically significant. Conclusion: Treatment with SGLT2 inhibitors plus diuretic significantly reduced the patients' diuretic requirements. Therefore, our finding supports the theoretical concept of minimizing the level of diuretic upon the initiation of SGLT2 inhibitors.

Surveying Hematologists' Perceptions and Readiness to Embrace Artificial Intelligence in Diagnosis and Treatment Decision-Making

AIM

This study aims to explore the critical dimension of assessing the perceptions and readiness of hematologists to embrace artificial intelligence (AI) technologies in their diagnostic and treatment decision-making processes.

METHODS

This study used a cross-sectional design for collecting data related to the perceptions and readiness of hematologists using a validated online questionnaire-based survey. Both hematologists (MD) and postgraduate MD students in hematology were included in the study. A total of 188 participants, including 35 hematologists (MD) and 153 MD hematology students, completed the survey.

RESULTS

Major challenges include "AI's level of autonomy" and "the complexity in the field of medicine." Major barriers and risks identified include "lack of trust," "management's level of understanding," "dehumanization of healthcare," and "reduction in physicians' skills." Statistically significant differences in perceptions of benefits including resources (p=0.0326, p<0.05) and knowledge (p=0.0262, p<0.05) were observed between genders. Older physicians were observed to be more concerned about the use of AI compared to younger physicians (p<0.05).

CONCLUSION

While AI use in hematology diagnosis and treatment decision-making is positively perceived, issues such as lack of trust, transparency, regulations, and poor AI awareness can affect the adoption of AI.

Room-Temperature Magnetic Phase Transition in an Electrically Tuned van der Waals Ferromagnet

Finding tunable van der Waals (vdW) ferromagnets that operate at above room temperature is an important research focus in physics and materials science. Most vdW magnets are only intrinsically magnetic far below room temperature and magnetism with square-shaped hysteresis at room temperature has yet to be observed. Here, we report magnetism in a quasi-2D magnet Cr_{1.2}Te_{2} observed at room temperature (290 K). This magnetism was tuned via a protonic gate with an electron doping concentration up to 3.8×10^{21}  cm^{-3}. We observed nonmonotonic evolutions in both coercivity and anomalous Hall resistivity. Under increased electron doping, the coercivities and anomalous Hall effects (AHEs) vanished, indicating a doping-induced magnetic phase transition. This occurred up to room temperature. DFT calculations showed the formation of an antiferromagnetic (AFM) phase caused by the intercalation of protons which induced significant electron doping in the Cr_{1.2}Te_{2}. The tunability of the magnetic properties and phase in room temperature magnetic vdW Cr_{1.2}Te_{2} is a significant step towards practical spintronic devices.

Bronchiolitis in Infants; Five Years' Experience of a Teaching Hospital

Background

Bronchiolitis is a clinical syndrome affecting the lower respiratory tract of infants and toddlers <2 years old. Variability in clinical profile and response to therapy in children with Bronchiolitis calls for studying the different clinical aspects of local patient population.

Aim

The goal of our study is to determine the clinical presentation, past medical history, hospitalization course and prognosis in children below two years of age who have been hospitalized in King Fahad University Hospital over the last five years.

Materials and Methods

A retrospective chart review based on electronic health records of all Bronchiolitis-related hospitalization of infants and toddlers below two years of age, covering the period between January 1, 2015, to April 26, 2020.

Results

Out of a total of 446 children <2 years of age, 202 were female (45.4%), and 243 were male (54.6%). Although the length of hospital stay was almost equal between the sexes, there was a significant (p-value=0.01) increase in length of intensive care unit stay among females compared to males. Furthermore, there was a significant prolongation in the duration of ventilator usage among females (p value = 0.062). Out of fifty-five patients admitted to the ICU, 83.63% of them were 12 months of age and below.

Conclusion

Our results show a significant increase in length of ICU and ventilator use among females compared to males. It also shows that infants younger than 12 months account for most ICU admissions. These findings, among many others, may help pediatricians formulate a better diagnostic and therapeutic pathways.

Irreversibility analysis through neural networking of the hybrid nanofluid for the solar collector optimization

Advanced techniques are used to enhance the efficiency of the energy assets and maximize the appliance efficiency of the main resources. In this view, in this study, the focus is paid to the solar collector to cover thermal radiation through optimization and enhance the performance of the solar panel. Hybrid nanofluids (HNFs) consist of a base liquid glycol (C3H8O2) in which nanoparticles of copper (Cu) and aluminum oxide (Al2O3) are doped as fillers. The flow of the stagnation point is considered in the presence of the Riga plate. The state of the solar thermal system is termed viva stagnation to control the additional heating through the flow variation in the collector loop. The inclusion of entropy generation and Bejan number formation are primarily conceived under the influence of physical parameters for energy optimization. The computational analysis is carried out utilizing the control volume finite element method (CVFEM), and Runge-Kutta 4 (RK-4) methods. (FEATool Multiphysics) software has been used to find the solution through (CVFEM). The results are further validated through a machine learning neural networking procedure, wherein the heat transfer rate is greatly upgraded with a variation of the nanoparticle's volume fraction. We expect this improvement to progress the stability of heat transfer in the solar power system.

Impact of perioperative chemotherapy on survival outcome of advanced colorectal cancer patients treated with cytoreduction and hyperthermic intraperitoneal chemotherapy: A retrospective study

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Background: Colorectal cancer (CRC) with peritoneal carcinomatosis (PC) is generally associated with poor prognosis. The present study aims to assess potential value of perioperative systemic chemotherapy in patients treated with cytoreductive surgery with HIPEC (CRS/HIPEC) in a single institute in Saudi Arabia. Methods: We included CRC with PC who underwent CRS/ HIPEC from January 2012 till December 2019. Different clinicopathological, treatment-related factors and dates of relapse/death, were retrospectively assessed. We checked the distribution of these factors in addition to survival outcome in those who received perioperative chemotherapy vs. none. Results: We recruited 127 eligible patients (79 patients [62.2%] received systemic chemotherapy). Patients with no perioperative chemotherapy were more likely to have grade 1 tumours (62.5% vs. 25.3%, p < 0.0001), mucinous adenocarcinoma (41.7% vs. 12.7%, p = 0.002), normal CEA ≤5 ng/dl (70.2% vs. 47.4%, p = 0.016) and peritoneal-only metastasis (66.7% vs. 45.6%, p = 0.021). Median PFS and OS were 34 and 62.2 months, respectively. Patients with no perioperative systemic chemotherapy had significantly better PFS and OS (median PFS: not reached vs. 19 months, HR = 0.29, 95% CI = 0.15-0.59, p < 0.0001, OS :HR = 4.3, 95% CI 1.3-14.3, p = 0.009). After adjustment of different prognostic factors, there was no significance difference in OS between the two groups (HR = 3.8, 95% CI = 0.98-14.71, p = 0.053), while PFS was still significantly better in the no chemotherapy group (HR = 2.52, 95% CI = 1.13-5.63, p = 0.024). Conclusions: CRS/HIPEC provided favourable survival outcome in our study cohort especially in patients with more favourable prognostic features. No survival benefit with perioperative chemotherapy could be demonstrated.

Peripheral Neuropathy in Diabetes: Burden, Lifestyle and Pharmacological Interventions for Prevention and Treatment

Diabetes mellitus (DM) is a very common comorbidity worldwide, and it is associated with a wide variety of complications. Diabetic peripheral neuropathy (DPN) is one of these complications that increases the morbidity and mortality of these patients. Multiple studies indicated that lifestyle modifications are very beneficial for these patients in terms of decreasing the symptoms or preventing the progression of the disease. Therefore, a thorough search was conducted to study and shed light on the effects of lifestyle interventions, such as physical exercise, and pharmacological treatment on DPN. A total of 100 studies were found and 32 were selected based on whether or not they support the aim of the study. It was concluded that lifestyle interventions such as regular exercise, healthy diet and weight loss, which will all in turn improve the patient’s glycemic control, play a major role in controlling the disease and preventing its complications. Moreover, the aim of pharmacological interventions is a 30% reduction in pain intensity, however pharmacological interventions are limited in DPN, up till now the FDA approved only three medications that help in the reduction of the pain intensity. These medications are antidepressant duloxetine, anticonvulsant pregabalin, and the opioid-like analgesic tapentadol.

Spin-Momentum Locking Induced Anisotropic Magnetoresistance in Monolayer WTe2

Monolayer WTe₂ is predicted to be a quantum spin Hall insulator (QSHI), and its quantized edge transport has recently been demonstrated. However, one of the essential properties of a QSHI, spin-momentum locking of the helical edge states, has yet to be experimentally validated. Here, we measure and observe gate-controlled anisotropic magnetoresistance (AMR) in monolayer WTe₂ devices. Electrically tuning the Fermi energy into the band gap, a large in-plane AMR is observed and the minimum of the in-plane AMR occurs when the applied magnetic field is perpendicular to the current direction. In line with the experimental observations, the theoretical predictions based on the band structure of monolayer WTe₂ demonstrate that the AMR effect originates from spin-momentum locking in the helical edge states of monolayer WTe₂. Our findings reveal that the spin quantization axis of the helical edge states in monolayer WTe₂ can be precisely determined from AMR measurements.

Transformational Leadership Style on Nursing Job Satisfaction Amongst Nurses in Hospital Settings: Findings From Systematic Review

BACKGROUND: The nursing shortage is a common problem in Saudi Arabia with multi-factorial causes. In addition to the low supply of Saudi graduate nurses from training facilities, job satisfaction remains a significant determinant of nurse turnover and intention to leave that contribute to the shortage of nursing workforce. The higher number of expatriate nurses who have a short stay compared to Saudi nurses compounds this problem. Therefore, effective strategies for making the nursing profession attractive and increasing nurse retention in Saudi Arabia are required. OBJECTIVE: The general objective was to examine the impact of transformational leadership style on job satisfaction amongst nurses in hospital settings. Specifically, the appraisal examined how transformational leadership style improves nursing job satisfaction in hospital settings, determined the mediating factors of the relationship between transformational leadership style and nurses&rsquo; job satisfaction, and investigated nurses&rsquo; perceptions of transformational leadership style compared with other leadership styles. METHODOLOGY: This study was used systematic review design with eight selected quantitative nursing research published between 2012 and 2017. A systematic search of the recent literature was conducted on PubMed, Scopus, Wiley Online, and Web of Science databases using search terms developed a priori to identify the articles that met the inclusion criteria. The quality of the included studies was evaluated by McMaster Critical Review Form for Quantitative Studies. Extracted data were summarised, explored and correlated using narrative synthesis. FINDINGS: Eight studies of cross-sectional design were appraised. Transformational leadership style was positively related to nurses&rsquo; job satisfaction. Transactional leadership also had a positive correlation while passive-avoidant or laissez-faire style had a negative relationship. Transformational leadership improved nursing job satisfaction through its dimensions (idealised influence, inspirational motivation, intellectual stimulation and individualised consideration). Nurse empowerment and workplace support mediated the relationship between transformational leadership and nurse job satisfaction. Nurses had a higher perception of transformational style compared to other leadership styles, and job satisfaction was found to improve nurse and patient outcomes. CONCLUSION: Transformational leadership appears to improve job satisfaction of nurses working in a hospital setting that leads to higher nursing retention. Hospital administrators and managers should practice transformational leadership to improve job satisfaction of staff nurses for better nursing outcomes, and leadership skills should be incorporated in the nursing education curriculum. However, further evaluation of transformational leadership in relation to its influencing factors is required.

It's About Everything: Validation and Optimization of 96-Well Tray Flow Cytometry Crossmatch

Flow cytometric crossmatch (FCXM) is widely used in many centers as part of pretransplant risk assessment to detect donor-specific anti-HLA antibodies. The limited number of crossmatches that can be performed during on-call work-up for deceased donors within reasonable time remains the main obstacle to accommodating the majority of highly sensitized listed patients to be tested by the standard tube FCXM method. This limitation often directs the organs to nonsensitized patients and deprives highly sensitized patients who could be compatible if their sera were included in the crossmatch test. The goal of this study is to optimize a 96-well tray FCXM protocol that allows more sera to be crossmatched without prolonging the overall procedural time while maintaining quality and sensitivity of the assay. The new method was validated against use of the standard tube method and included total of 63 crossmatches performed simultaneously by both methods using 20 donors' cells with patients' sera, pooled positive controls tested on different dilutions, and commercial negative control. In the new protocol we modify various assay parameters including tube platform, incubation time, amount of reagent antibody cocktail, and cell volumes. An overall concordance of 98% was achieved with the protocols with slight improvement in sensitivity (2 negative B-cell reactions converted to positive in presence of weak donor-specific antibodies and mild T-cell reactivity could be picked up at 1:80 diluted positive control by the tray method only). The median channel fluorescence values of the 2 methods were essentially equivalent for both T and B crossmatches (r² of 0.98 and 0.97, respectively). In conclusion, 96-well tray assay has the potential to increase the probability of highly sensitized patients receiving transplants by allowing increased number of crossmatches to be performed with significant reduction in turnaround time and assay cost. Furthermore, the enhanced sensitivity of the assay will provide more accurate information about sensitization status and strength of donor-specific antibodies to treating physicians, allowing them to choose the best therapeutic option and to provide better patient care.

Standarized Tribulus terrestris extract protects against rotenone-induced oxidative damage and nigral dopamine neuronal loss in mice

Strong evidence proposes that brain oxidative DNA damage and microglia activation contribute to Parkinson's disease (PD) pathogenesis. Traditional therapeutic regimens for PD can only relieve the symptoms. Tribulus terrestris (T. terrestris), a flowering plant from family Zygophyllaceae, is used in traditional medicine for treating different disorders and exerts neuroprotective and antioxidant effects in experimental models. The current study attempted to test whether treatment with T. terrestris standardized extract (TTE) can improve motor dysfunction and alleviate rotenone induced oxidative DNA damage and neurotoxicity in mice. Six groups of male Swiss albino mice were utilized. Group (1) was the vehicle (oil) group, group 2 was the rotenone control group (1 mg/kg/48 hours, subcutaneously) for 9 times, groups 3 and 4 were injected with rotenone and treated with TTE (5 or 10 mg per kg, by oral gavage) for 17 days, groups 5 and 6 served as TTE (5 or 10 mg per kg) per se groups. Motor function was measured by the pole and the open-field tests. Then, mouse brains were dissected, one hemisphere was employed for biochemical assays and the other one was used in histopathological studies. Results demonstrated that TTE ameliorated the motor dysfunctions induced by rotenone as well as markers of inflammation and DNA damage (8-OHdG and MTH1 expression). Indicators of oxidative stress and upregulation of the microglia marker (CD₁₁b) were suppressed by the higher dose of TTE (10 mg per kg). Finally, the higher dose of TTE improved the Cresyl violet staining and tyrosine hydroxylase immunostaining in the substantia nigra. In summary, TTE ameliorated the locomotor dysfunction and dampened the DNA damage and oxidoinflammatory stress in rotenone-parkinsonian mice. These results suggest TTE as a potential candidate for neurodegenerative diseases.

Understanding the public temper through an evaluation of rumours: an ethnographical method using educational technology

The power of rumours is that they can be broadly exchanged, generating a 'public temper' (which is everybody's temper without being anybody's temper in particular). This article, therefore, describes an approach to measuring the public temper, examining particularly the public temper of an Arab society, namely Saudi Arabia. It addresses the following research question: is it possible to analyse existing (scholarly) rumours to see if they can be used as informants of the public temper of the culture in which they exist? This question is answered ethnographically by analysing 579 Arabic online rumours collected by students as part of their critical engagement with educational technology. Having analysed the data, four categories emerged: the concerns, interests, attitudes and values of Saudi Arabia. According to the literature, these four categories, taken together, constitute the emotional domain (i.e., the public temper) of a society. Thus, a theoretical proposition (and contribution to the existing literature regarding sociology) is that rumours mirror the public temper of a culture, reflecting a range of emotions from simple to complex (from concerns, interests and attitudes to values). Simpler emotions (e.g., concerns) appear to be more easily affected by rumours than more complex emotions (e.g., values). An implication of this study is that rumours have 'biographies', which detail public tempers across space and time. Rumours are 'records' of public tempers that should be read in the same way archaeologists read landscapes and remains. Although rumours entail ill-defined information, it is feasible to well define society through such ill-defined information, meaning that something can come out of its opposite. This study offers ethnographers a new method of understanding public tempers through rumours, alongside conventional meaning-making symbols (e.g., poems).

Pharmacological activities of a novel plant species, Huernia Sp. Nov. aff. Boleana growing in the high mountains of southwest Saudi Arabia

Huernia Sp. Nov. aff. Boleana, Apocynaceae, grows in the high mountains of southwest Saudi Arabia and is widely used as a remedy for the treatment of diabetes. The present study investigated the anti‑inflammatory, wound healing and inhibitory effects on migration of Huernia Sp. Nov. aff. Boleana. The anti‑inflammatory effect was assessed in mice using formalin‑induced edema. Wound healing effects were assessed in rats using a circular excision wound model. An in vitro 'scratch' test was used to investigate the inhibitory effects on melanoma cell (B16‑F10) migration. The anti‑inflammatory effects of total extract, hexane and chloroform fractions were greater or equal to indomethacin (control). The relatively non‑polar fractions (hexane and chloroform) exhibited higher anti‑inflammatory activities compared with the aqueous fraction. The percentage of wound contraction among animals treated with the plant extract was higher compared with the control; however, this difference was not statistically significant (P>0.05). The total plant extract increased wound healing by inhibiting the inflammatory response, promoting angiogenesis, and significantly promoting the proliferation of fibroblasts, particularly on days 7 and 14 post‑wounding. Furthermore, the plant extract promoted wound repair via the enhancement of collagen synthesis, and complete epithelization with well‑formed and differentiated epithelial tissues. The in vitro 'scratch' test indicated the inhibitory effects of this plant on melanoma cell migration in a dose‑dependent manner. The present study indicated that Huernia Sp. Nov. aff. Boleana may have potential as an anti‑inflammatory, wound-healing and migration-inhibiting ethno medicine.

Enterocutaneous fistula in patients with peritoneal malignancy following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: Incidence, management and outcomes

BACKGROUND

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is an effective treatment for peritoneal carcinomatosis (PC) from multiple origins, however is associated with increased complications compared to conventional gastrointestinal surgery. The aetiology of enterocutaneous fistulas (ECF) in most cases is a result of various contributing factors and therefore remains a major clinical problem, occurring in 4-34% of patients post-CRS. The aim of this study was to analyze the incidence and outcome of ECF following CRS/HIPEC.

METHOD

From April 1999 to September 2015, 53 patients of 918 CRS/HIPEC procedures developed an ECF. Patient, operative and postoperative data were retrospectively analyzed to determine aetiology, classification outcome and possible contributing factors were reviewed on univariate and multivariate analysis.

RESULTS

We report a 5.8% ECF rate, diagnosed at a median of 13 days. The mortality rate was 5.7% and other morbidity was significantly increased (p = 0.0001). Twenty-five (47.2%), 8 (15.1%) and 20 patients (37.7%) had low, moderate and high output ECF respectively. Patients that had a CC2 cytoreduction, abdominal VAC or smoked had a higher risk of fistula (p = 0.004, p < 0.0001, p = 0.008). Spontaneous closure was achieved in 49.2% with conservative treatment (median 29 days) and 33.9% underwent surgical intervention. Preoperative serum albumin <35 g/L (p = 0.04), PCI>17 (p = 0.025) and operation >8.6 h s (p = 0.001) were independent risk factors on multivariate analysis. Overall and 5-year survival was significantly reduced (p < 0.0001,p = 0.016).

CONCLUSION

CRS/HIPEC remains an effective treatment modality for PC in selected patients with a comparable ECF incidence to reported elective gastrointestinal surgery rates. This study identifies multiple risk factors that should be considered in patients undergoing CRS/HIPEC.

Peritonectomy and hyperthermic intraperitoneal chemotherapy as treatment for desmoplastic small round cell tumour

INTRODUCTION

The St George Hospital specialises in peritonectomy and hyperthermic intraperitoneal chemotherapy (HIPEC) for treatment of intra-abdominal malignancies. Despite performing around 800 peritonectomy and HIPEC procedures, we have rarely encountered desmoplastic small round cell tumours (DSRCT). We present our experiences with DSRCT, and propose peritonectomy and HIPEC as a treatment option for DSRCT.

PRESENTATION OF CASE

This is a case series of 3 cases. The first case was a 26-year-old male who presented with appendicitis which we diagnosed as DSRCT and treated with peritonectomy and HIPEC. The second case was a 14-year-old male referred to our centre for peritonectomy and HIPEC after initial presentation with a pelvic mass and treatment with chemotherapy. The third case was a 21-year-old male referred to our centre for peritonectomy and HIPEC for recurrent DSRCT after previously being treated with neoadjuvant chemotherapy and surgery without HIPEC.

DISCUSSION

DSRCT is a rare, almost exclusively intra-abdominal malignancy, which predominantly affects young males. Survival prognosis remains poor in DSRCT despite conventional treatment with surgery, chemotherapy and radiotherapy; however, HIPEC has offered promising survival results. Our recurrences with peritonectomy and HIPEC at 6 months and 15 months are comparable with the literature of 8.85 months.

CONCLUSION

In our experience, patients with DSRCT who present with nodal involvement or recurrent disease tend to recur early despite treatment with peritonectomy and HIPEC. Longer term follow up of our patients and future studies involving HIPEC in DSRCT would be useful in assessing long-term clinical outcomes and survival.