Rebellion against resilience? The experience of women entrepreneurs in the context of poly-crisis

Utilising a qualitative approach, this article draws on the experiences of 20 women entrepreneurs operating in a constrained context who were already adapting to ongoing adversity when an acute disaster, the 2020 Beirut blast, occurred. The article expands the study of entrepreneurial resilience under prolonged adversity to reveal new insights on resilience fatigue, rebellion against resilience, and entrepreneurial rebellion. The findings indicate that in the context of poly-crisis marked by a lack of governmental and external support amid an acute event, established women entrepreneurs can act as change agents, transforming negative feelings of prolonged frustration, mistrust, hopelessness and denial into rebellion against the dysfunctional system. In so doing, they create transformational opportunities that enable their businesses and the surrounding ecosystem to thrive and flourish.</p

If current inhibitor ivabradine in patients with idiopathic dilated cardiomyopathy: Impact on the exercise tolerance and quality of life

Background: Evidence supported a beneficial effect of ivabradine on clinical outcome of patients with systolic heart failure, and a sinus heart rate (HR) ≥ 70 bpm. We explored the effect of ivabradine, vs. placebo, added to evidence-based treatment on exercise tolerance and quality of life in patients with idiopathic dilated cardiomyopathy. Methods: We enrolled 43 consecutive patients with dilated cardiomyopathy of no apparent cause, a left ventricular ejection fraction (LVEF) &lt; 40%, New York Heart Association class ≥ II, sinus HR ≥ 70 bpm, and background evidence-based anti-failure medications. Ischemic heart disease was ruled out. Patients were randomized (1:1) to receive ivabradine or placebo. Ivabradine was titrated up gradually till 7.5 mg twice daily, or a HR &lt; 60 bpm, and continued for 3 months. Symptom-limited exercise tolerance test was performed, and quality of life was assessed by the Minnesota Living With Heart Failure Questionnaire at 0, and 3 months. Results: Forty-three patients were randomized to ivabradine (n = 20), or placebo (n = 23). Mean age was 50.8 ± 14.5 years (53.5% males). Mean HR was 85 ± 12 bpm, and mean LVEF was 32 ± 6%. Mean dose of carvedilol was 31.2% of the target dose. Baseline HR, blood pressure, exercise tolerance, Minnesota questionnaire score, and left ventricular systolic function were comparable between the two groups (p &gt; 0.05 for all). At 3 months, mean dose of ivabradine was 6.8 mg bid. Ivabradine-treated patients had a lower HR, and improved left ventricular dimensions and systolic function, versus placebo-treated ones (p &lt; 0.05 for all). HR dropped by a mean of 14 bpm in the ivabradine group, corrected for placebo. Both exercise tolerance, and Minnesota questionnaire score were better in the ivabradine group (p &lt; 0.05 both). Ivabradine was well-tolerated. Conclusions: In symptomatic patients with idiopathic dilated cardiomyopathy, the addition of ivabradine, vs. placebo, to evidence-based treatment, reduced HR, and improved functional capacity, at short-term follow-up

Retrospective Radiographic Survey of Unconventional Ectopic Impacted Teeth in Al-Madinah Al-Munawwarah, Saudi Arabia

OBJECTIVES: Ectopic unconventional impacted teeth are rare. These teeth erupt in an unusual direction with limited unconventional access and have increased surgical risks. AIM: This study aimed to investigate and assess the prevalence and distribution of rare ectopic impacted teeth at the Taibah University Dental College and Hospital (TUDCH), Al-Madinah Al-Munawwarah, Saudi Arabia. METHODS: The study designed through a retrospective radiographic cross-sectional survey involving the review and examination of 9000 archived digital orthopantomograms of patients who visited the (TUDCH) in the period from January 2014 to December 2019 and to analyze any associated factors. RESULTS: There were 63 ectopically impacted teeth, with an incidence of 0.7%. The age of the patients ranged from 18 to 68 years, with a mean of 32.4 ± 13 years. Regarding patient nationality, 68.3% were Saudis. The most common ectopically impacted teeth were the extra impacted premolars, with an incidence of 0.2%, followed by the inverted molars, impacted first or second molars, and buccoversion or lingoversion third molars, with incidences of 0.16%, 0.13%, and 0.12%, respectively. The mandible was affected with ectopic impaction more than the maxilla, with an incidence of 55.6%. There was no difference between the right and left sides. Impacted teeth in the sinus were the least common. CONCLUSION: The prevalence of ectopic impacted teeth was 0.7% among the surveyed patients at TUDCH, Al-Madinah Al-Munawwarah, Saudi Arabia. Hence, the oral surgeon must have readiness for such a challenging, increasing situation

The inverted syringe technique for management of inverted nipples in breastfeeding women: a pilot randomized controlled trial

Background: Women with inverted nipples may struggle with breastfeeding and may stop exclusive breastfeeding before six months. The use of an inverted syringe to evert the nipples was successful in achieving high rates of infant latching and exclusive breastfeeding in case series but has not been tested in clinical trials. This open label, parallel group, randomized clinical trial investigated whether the use of the inverted syringe technique in women with inverted nipples would increase exclusive breastfeeding rate at one month, as compared to standard care. Methods/Design: Between June 2018 and January 2020, healthy pregnant women (N=54) with grades 1 or 2 inverted nipples were randomly allocated to standard care or to an experimental group that used the inverted syringe technique to evert the inverted nipple prior to every breastfeeding. The primary outcome measure was the rate of exclusive breastfeeding at one month. Secondary outcomes included the rates of exclusive breastfeeding at three and six months, any breastfeeding at one, three, and six months, nipple eversion, successful infant latching, breastfeeding-associated complications, maternal satisfaction with breastfeeding, maternal quality of life, and adverse events. Descriptive and bivariate analyses were conducted according to the intention to treat principle. Results: Participants in the experimental group were less likely to be exclusively breastfeeding at one (RR = 0.65, 95% CI: 0.44, 0.95; n = 47), and at three months (RR = 0.66, 95% CI: 0.47, 0.91; n = 45), or to practice any breastfeeding at six months (RR = 0.54, 95% CI: 0.34, 0.87; n = 44). Only 14.3% of women in the experimental group complied with the use of the inverted syringe during the first month. Breast pump and breastfeeding-associated complications were more commonly reported in the control group (p < 0.05 for both). Both groups had similar rates of nipple eversion, successful infant latching, and similar satisfaction with breastfeeding and quality of life issues. Conclusion: The inverted syringe technique was not associated with improvement in breastfeeding outcomes of women with inverted nipples. Larger clinical trials are needed to confirm our findings. Trial registration: ClinicalTrials.gov NCT03529630; Registered May 8, 2018. © 2022, The Author(s)

Breastfeeding success with the use of the inverted syringe technique for management of inverted nipples in lactating women: A study protocol for a randomized controlled trial

Background: Breastfeeding provides ideal infant nutrition, conferring several health benefits to children and their mothers. Women with inverted nipples, however, face difficulties that force them to prematurely terminate breastfeeding. Whereas available conservative measures for the correction of inverted nipples are of limited success, the use of an inverted syringe may be effective in achieving high rates of infant latching and exclusive breastfeeding. This technique, however, has not been investigated in a clinical trial. Methods/design: This open-label randomized controlled trial aims to investigate whether, in women with inverted nipples, the use of an inverted syringe increases the rate of exclusive breastfeeding at one month compared to standard care. One-hundred healthy women with grade 1 or 2 inverted nipples will be recruited as of 37 weeks of gestation. They will be randomly allocated to standard care (control group) or to an intervention group. The intervention consists of using an inverted syringe to evert the nipple before every breastfeed, starting with the first feed after delivery. The primary outcome measure is the rate of exclusive breastfeeding at 1 month. Secondary outcome measures include exclusive breastfeeding rates at 3 and 6 months, nipple eversion rate, successful latching rate, rates of any breastfeeding at 1, 3, and 6 months, breastfeeding-associated complications, maternal satisfaction with breastfeeding, maternal quality of life, and adverse events. Descriptive and regression analysis will be conducted under the intention to treat basis. Discussion: The use of the inverted syringe to evert inverted nipples is a simple, inexpensive, and safe technique that can be performed by mothers with inverted nipples. Findings of this trial, if positive, will provide much needed evidence for a safe, affordable, readily available, and simple intervention to treat inverted nipples, and improve breastfeeding practice among affected women. Trial registration: ClinicalTrials.gov, NCT03529630. Registered May 8, 2018. © 2019 The Author(s)

Synthesis of long-wavelength-absorbing photosensitizer/nanoparticle conjugates and their in vitro PDT evaluation on colorectal cancer cell lines

Starting from purpurin-18, a stable purpurin-18 imide derivative with intensive absorption in the near infrared has been synthesized. The opening of the exocycle anhydride by a primary alkylamine bearing an adamantyl group, allows after cyclization the formation of an imide function. This reaction led to the purpurinimide adamantane derivative (PIA) which enables the inclusion of a photosensitizer in the cavity of cationic cyclodextrin coupled to cellulose nanocrystals (CNCs/β-CD+). Preliminary in vitro results showed that CNCs/β-CD+ complexes improved internalization of photosensitizers into HCT116 and HT-29 colorectal cancer cell lines. Moreover, MTT (3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide) assay of CNCs/β-CD+/PIA complexes showed significant dose-dependent phototoxicity after illumination with red light, with IC50 values of 2.5 and 8.7 nM, for HT 116 and HT-29, respectively, and very low dark toxicity. The current results suggest that these nanoparticle/photosensitizer complexes are promising and useful tools for photodynamic therapy (PDT)

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10&nbsp;years; 78.2% included were male with a median age of 37&nbsp;years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Echocardiographic pearl a rare complication of infective endocarditis one of the rarest complication of infective endocarditis being diagnosed by echocardiography

Our patient is a 41 years old male, born and living in Cairo, working as a constructor worker and has 3 children the older of which is 13 years old. He was admitted to the internal medicine department by fever and shortness of breath for about 1 week associated with weakness of his right upper limb for 12h before his presentation which made him sought medical advice. He was not known to be hypertensive nor diabetic.He was a heavy Cigarette and Shesha smoker for about 17 years .He denied history of any substance abuse. He has no family history of any cardiac disease O/E: The patient appeared pale, toxic, orthopenic, a little confused however he was oriented to time, place and persons.There was mild weakness of his right upper limb with intact sensation. BP: 100/70 bilaterally, HR: 110, regular, of average volume, peripherally felt, Temp: 38.8°C, RR: 20/min. Bilateral fine basal rales on deep inspiration, Normal abdominal examination.Cardiac examination: The cardiac impulse was hyperdynamic at the 5th intercostal space just outside the mid-clavicular line with no palpable thrill. Auscultation revealed S3 gallop apically with grade III–IV pan systolic murmur radiating to the anterior axillary line.InvestigationsHgb: 11.2,WBC’s: 13,000, Platelet count: 270,000. Total billirubin: 1.1, BUN: 17, Creat: 1.4, Na: 135, K: 3.9, SGOT: 45, SGPT: 37.DiscussionLeft atrial dissection (LAD) is a rare complication and the literature reveals only a small number of cases. LAD is by Gallego et al. as a gap from the mitral or tricuspid annular area to interatrial septum or left atrial wall, creating a new chamber with or without communications into the true left or right atrium. The most common etiology of LAD is mitral valve surgery.Debridement of much calcified valves annulus, improper suturing of the annulus to the prosthetic cuff, excessive traction on sutures in the posterior annulus, and the hemodynamic influence of the paraprosthetic leak extended the dissection into the left atrial wall, developing a false cavity. Also left atrial thrombectomy can be associated with injury to the left atrial endocardium as a mechanism of primary tear.A rare case of left atrial dissection as a consequence of infectious endocarditis was reported. They present a patient with infectious endocarditis with involvement of mitral and aortic valves; in whom the trans-esophageal echocardiography was able to visualize the left atrial dissection.The LA has a venous component that receives the PVs, a fingerlike atrial appendage, and shares the septum with the right atrium. The major part of the atrium, including the septal component, is relatively smooth-walled whereas the appendage is rough with pectinate muscles. The smoothest parts are the superior and posterior walls that make up the pulmonary venous component, and the vestibule. Seemingly uniform, the walls are composed of one to three or more overlapping layers of differently aligned myocardial fibers, with marked regional variations in thickness. Why the posterior wall of the left atrium:A sagittal section through the left atrium of a cadaver shows the proximity of the esophagus to the posterior wall of the left atrium The wall is particularly thin at the level of the superior pulmonary veins. Clinical presentation may be the appearance of a new systolic murmur, associated with or without symptoms of heart failure and low-output manifestations, hours to days after the operation but there were patients in whom clinical onset occurs years after surgery. Rarely, LAD can be an incidental finding on TEE in an asymptomatic patient.LA dissection typically appears as a hypoechoic space from the mitral/tricuspid origin extending along the interatrial septum or LA wall. M-mode is excellent at distinguishing subtle movement of the intima or the endocardium in relation to the cardiac cycle. Similar to what is seen in aortic dissections, the false cavity is compressed during systole as the LA is being filled.Other entities that should be considered when an LA mass is visualized are:Thrombi most common left atrial myxoma, cysts, coronary aneurysms. Pericardial blood impinging on the LA wall may mimic these findings.Color flow Doppler can be used to examine the endocardium for a tear and point of communication with the chamber. Pulsed wave Doppler can also be used to identify flow across a tear. TEE is the diagnostic modality of choice for LAD.No definitive criteria exist to help guide management of LAD. Prompt surgical repair is usually required because of coexistent significant mitral regurgitation, intra-cardiac shunt, mycotic aneurysm, pseudo aneurysm or fistulous communication. However, in the absence of these findings, surgery may not always be necessary and occasionally successful repair has been performed years after diagnosis