Emerging Axonal Variants of Guillain Barré Syndrome “ AMAN and AMSAN “ as a Part of COVID-19 Sequalae

Background: Guillain-Barré syndrome (GBS) is an immune-mediated peripheral nerve disease. Its frequency was noticed to have increased during the COVID-19 period. Based on electrophysiological studies, the most common type of this disease is the demyelinating type. However, axonal types have also been seen. Methods: A large, analytical, cross-sectional study involving 2523 patients over a one-year period was conducted in Basrah, southern Iraq, to evaluate the neurophysiological changes for peripheral neuropathies following COVID-19 infection using nerve conduction studies and needle electromyography. The current study aims to evaluate the prevalence, clinical, and neurophysiological characteristics of patients with axonal variants of GBS. Results and conclusions: The study found that the axonal variants of GBS represent about 10% of the total reported GBS in the governorate, and they are developed in about 1 in 1000 patients attending the neurology and neurophysiology clinics who had a history of COVID-19 infectio

Clinical and Neurophysiological Evidence of Mononeuritis Multiplex During the COVID-19 Era

Infection with the novel coronavirus that causes coronavirus disease 2019 (COVID-19) results in a variety of clinical symptoms, including various neurological abnormalities. Peripheral nervous system symptoms, such as peripheral neuropathies, were often recorded in the medical literature, primarily as Guillain-Barré syndrome. Mononeuropathy multiplex is a multifocal axonal neuropathy commonly associated with vasculitis or connective tissue disease. Recent evidence about its associations with severe COVID-19 infection and intensive care unit hospitalization is being considered. A 58-year-old man with clinical and electrophysiological confirmation of mononeuropathy multiplex was reported during the peri-COVID-19 illness. He was treated with steroids and achieved a satisfactory response. Therefore, clinical and neurophysiological evaluation is recommended for any patient presenting with neurological manifestations following COVID-19 infection

Myographic evidence of polymyositis and dermatomyositis in COVID-19 patients

Idiopathic inflammatory myopathies, commonly known as myositis, are a diverse group of disorders defined clinically by persistent muscle weakness and reduced muscle endurance, as well as inflammatory cell infiltrates inside the muscle tissue. Myositis as a complication of coronavirus disease 2019 (COVID-19) has been described in an increasing number of reports. An analytical and cross-sectional study was undertaken in Basrah to analyze nerve conduction studies (NCS) and electromyographic (EMG) data in a COVID-19-affected patient. During the evaluation of 2240 patients, three cases of myositis were reported among the COVID-19 population, two of them with new clinical and EMG evidence of inflammatory myositis after the onset of COVID-19 infection, and one patient had a history of polymyositis before the COVID-19 pandemic, but a relapse was triggered by COVID-19, resulting in respiratory failure and death. The study found that the prevalence of myositis among the COVID-19 population was equal to 0.22%, which is 44 times higher than the prevalence of myositis (0.005%) worldwide before the onset of COVID-19 (P < 0.001)

Statistical modeling of monthly streamflow using time series and artificial neural network models: Hindiya Barrage as a case study

Autoregressive Integrated Moving Average (ARIMA) Box-Jenkins models combine the autoregressive and moving average models to a stationary time series after the appropriate transformation, while the nonlinear autoregressive (N.A.R.) or the autoregressive neural network (ARNN) models are of the kind of multi-layer perceptron (M.L.P.), which compose an input layer, hidden layer and an output layer. Monthly streamflow at the downstream of the Euphrates River (Hindiya Barrage) /Iraq for the period January 2000 to December 2019 was modeled utilizing ARIMA and N.A.R. time series models. The predicted Box-Jenkins model was ARIMA (1,1,0) (0,1,1), while the predicted artificial neural network (N.A.R.) model was (M.L.P. 1-3-1). The results of the study indicate that the traditional Box-Jenkins model was more accurate than the N.A.R. model in modeling the monthly streamflow of the studied case. Performing a one-step-ahead forecast during the year 2019, the forecast accuracy between the forecasted and recorded monthly streamflow for both models was as follows: the Box-Jenkins model gave root mean squared error (RMSE = 48.7) and the coefficient of determination R2 = 0.801), while the (NAR) model gave (RMSE = 93.4) and R2 = 0.269). Future projection of the monthly stream flow through the year 2025, utilizing the Box-Jenkins model, indicated the existence of long-term periodicity

Sustainability assessment of wastewater treatment techniques in urban areas of Iraq using multi-criteria decision analysis (MCDA)

Sustainable development is based on environmental, social, economic, and technical dimensions. In this study, the sustainability of wastewater treatment techniques in urban areas of Iraq was assessed using a multi-criteria decision analysis (MCDA)/the weighted sum model (WSM). The analysis was performed on 13 operating wastewater treatment plants in 10 provinces, Iraq, using a questionnaire sheet with the assistance of 52 specialists in the Ministry of Municipalities and Public Works, Iraq. Four types of wastewater treatment techniques (Conventional Treatment, Oxidation Ditches, Aeration Lagoons, and membrane bio-reactor (MBR)) were assessed. The environmental, social, economic, and technical dimensions were represented by 11, 5, 7, and 4 indicators, respectively. The main results of this study indicate that the sustainability of MBR recorded the highest total importance; the order of the total importance from the highest to the lowest was: MBR > Oxidation Ditches > Aeration Lagoons > Conventional Treatment. The environmental dimension proved its dominance in the four studied treatment techniques' sustainability as it recorded the maximum contribution to sustainability. While the technical dimension recorded the least contribution to sustainability, the order from the highest to the lowest was: Environmental Dimension > Economic Dimension > Social Dimension > Technical Dimension

The Phase Space as a New Representation of the Dynamical Behaviour of Temperature and Enthalpy in a Reefer monitored with a Multidistributed Sensors Network

The study of temperature gradients in cold stores and containers is a critical issue in the food industry for the quality assurance of products during transport, as well as forminimizing losses. The objective of this work is to develop a new methodology of data analysis based on phase space graphs of temperature and enthalpy, collected by means of multidistributed, low cost and autonomous wireless sensors and loggers. A transoceanic refrigerated transport of lemons in a reefer container ship from Montevideo (Uruguay) to Cartagena (Spain) was monitored with a network of 39 semi-passive TurboTag RFID loggers and 13 i-button loggers. Transport included intermodal transit from transoceanic to short shipping vessels and a truck trip. Data analysis is carried out using qualitative phase diagrams computed on the basis of Takens?Ruelle reconstruction of attractors. Fruit stress is quantified in terms of the phase diagram area which characterizes the cyclic behaviour of temperature. Areas within the enthalpy phase diagram computed for the short sea shipping transport were 5 times higher than those computed for the long sea shipping, with coefficients of variation above 100% for both periods. This new methodology for data analysis highlights the significant heterogeneity of thermohygrometric conditions at different locations in the container

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Pooled analysis of who surgical safety checklist use and mortality after emergency laparotomy

Background: The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods: In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results: Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89⋅6 per cent) compared with that in countries with a middle (753 of 1242, 60⋅6 per cent; odds ratio (OR) 0⋅17, 95 per cent c.i. 0⋅14 to 0⋅21, P &lt; 0⋅001) or low (363 of 860, 42⋅2 percent; OR 0⋅08, 0⋅07 to 0⋅10, P &lt; 0⋅001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference −9⋅4 (95 per cent c.i. −11⋅9 to −6⋅9) per cent; P &lt; 0⋅001), but the relationship was reversed in low-HDI countries (+12⋅1 (+7⋅0 to +17⋅3) per cent; P &lt; 0⋅001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0⋅60, 0⋅50 to 0⋅73; P &lt; 0⋅001). The greatest absolute benefit was seen for emergency surgery in low-and middle-HDI countries. Conclusion: Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries