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Background Chronic kidney disease (CKD) coexisting with atrial fibrillation (AF) increases the risk of hemorrhage and ischemia. The study aimed to determine the relationship between different CKD stages and clinical outcomes of patients suffering from both CKD and AF and to determine the predictors of outcome. Methods The data was derived from multicenter CRAFT trial (NCT02987062). We have conducted a retrospective analysis of hospital records of 2663 AF patients divided in three groups according to their estimated glomerular filtration rate (eGFR) which was

Summary: Background: In patients with idiopathic inflammatory myopathies (IIM), autoantibodies are associated with specific clinical phenotypes suggesting a pathogenic role of adaptive immunity. We explored if autoantibody profiles are associated with specific HLA genetic variants and clinical manifestations in IIM. Methods: We included 1348 IIM patients and determined the occurrence of 14 myositis-specific or –associated autoantibodies. We used unsupervised cluster analysis to identify autoantibody-defined subgroups and logistic regression to estimate associations with clinical manifestations, HLA-DRB1, HLA-DQA1, HLA-DQB1 alleles, and amino acids imputed from genetic information of HLA class II and I molecules. Findings: We identified eight subgroups with the following dominant autoantibodies: anti-Ro52, -U1RNP, -PM/Scl, -Mi2, -Jo1, -Jo1/Ro52, -TIF1γ or negative for all analysed autoantibodies. Associations with HLA-DRB1∗11, HLA-DRB1∗15, HLA-DQA1∗03, and HLA-DQB1∗03 were present in the anti-U1RNP-dominated subgroup. HLA-DRB1∗03, HLA-DQA1∗05, and HLA-DQB1∗02 alleles were overrepresented in the anti-PM/Scl and anti-Jo1/Ro52-dominated subgroups. HLA-DRB1∗16, HLA-DRB1∗07 alleles were most frequent in anti-Mi2 and HLA-DRB1∗01 and HLA-DRB1∗07 alleles in the anti-TIF1γ subgroup. The HLA-DRB1∗13, HLA-DQA1∗01 and HLA-DQB1∗06 alleles were overrepresented in the negative subgroup. Significant signals from variations in class I molecules were detected in the subgroups dominated by anti-Mi2, anti-Jo1/Ro52, anti-TIF1γ, and the negative subgroup. Interpretation: Distinct HLA class II and I associations were observed for almost all autoantibody-defined subgroups. The associations support autoantibody profiles use for classifying IIM which would likely reflect underlying pathogenic mechanisms better than classifications based on clinical symptoms and/or histopathological features. Funding: See a detailed list of funding bodies in the Acknowledgements section at the end of the manuscript.

Shwan sub-Basin is one of the substantial groundwater sources in northern Iraq. Along with an increase in population, agricultural and industrial activities synced with the change in climate conditions, all could have a negative impact on the hydrochemistry of groundwater. Therefore, it becomes crucial to investigate the different processes that could affect hydrochemistry and water quality. Thirty-two groundwater samples were collected from wells distributed in the study area, and one surface water sample from Lesser Zab River, all water samples were gathered during two seasons. Hydrogeochemical model was performed on physiochemical analysis results by using PHREEQC software to understand the geochemical reactions occurring in groundwater. The results of the Saturated Index showed supersaturated values for calcite, aragonite and dolomite in groundwater samples during the first season in a percent of 84%. While the second season samples were supersaturated in percent of 40.6%, 37.5% and 46.8% for aragonite, calcite and dolomite minerals respectively. The Saturated Index shows supersaturated values of quartz mineral in most groundwater samples, which are sourced from the abundance of silicate minerals that are primarily included within the ambient rock materials of the tertiary and quaternary clastic aquifer system in the study region. The saturated index showed undersaturated values with most minerals of feldspar, halide and sulfate. However, these minerals were in a dissolution state, releasing significant amounts of Ca2+, Na+, Mg2+, HCO3−, Cl⁻ and SO42− ions into the solution. Most of the groundwater samples were classified as earth-alkaline water with an increased portion of alkali with prevailing bicarbonate for two seasons, except the groundwater sample W2 was classified as earth-alkaline water with an increased portion of alkali with prevailing SO42⁻ and Cl⁻. The water quality for human drinking was evaluated using the water quality index (WQI). The values of WQI were from 51.9 to 99.2 and from 53.9 to 88.5 for the first and the second seasons respectively. WQI revealed that most of the samples were classified as poor to very poor water quality, except the Lesser Zab River sample for the second season was good water quality and the sample W2 for the first season was unsuitable for drinking purposes.

Objectives: Vaccines are one of the best interventions developed for eradicating COVID-19. This study aimed to provide evidence on Sinopharm COVID-19 vaccine side effects. Methods: A cross-sectional survey study was conducted between January and April 2021 to collect data on the effects of the COVID-19 vaccine among individuals in the United Arab Emirates. Demographic data, vaccination and the response of people unwilling to take the COVID-19 vaccine were reported. Results: Side effects post first vaccine dose of normal injection site pain, fatigue and headache were more common in participants aged ≤49 years versus >49 years, while pain at the vaccination site, fatigue, lethargy, headache and tenderness were the most common side effects post second dose in both groups. All side effects for both doses were more prevalent among participants aged ≤49 years. Side effects were more common in females compared with males for both doses. The most common reason for being unwilling to take the COVID-19 vaccine was that vaccines are not effective. Conclusion: Post-vaccination side effects for the first and second doses were mild and predictable, and there were no hospitalization cases; this data will help reduce vaccine hesitancy.

Purpose: Near visual acuity is an essential measurement during an oculo-visual assessment. Short duration continuous text reading charts measure reading acuity and other aspects of reading performance. There is no standardized version of such chart in Arabic. The aim of this study is to create sentences of equal readability to use in the development of a standardized Arabic continuous text reading chart. Methods: Initially, 109 Arabic pairs of sentences were created for use in constructing a chart with similar layout to the Colenbrander chart. They were created to have the same grade level of difficulty and physical length. Fifty-three adults and sixteen children were recruited to validate the sentences. Reading speed in correct words per minute (CWPM) and standard length words per minute (SLWPM) was measured and errors were counted. Criteria based on reading speed and errors made in each sentence pair were used to exclude sentence pairs with more outlying characteristics, and to select the final group of sentence pairs. Results: Forty-five sentence pairs were selected according to the elimination criteria. For adults, the average reading speed for the final sentences was 166 CWPM and 187 SLWPM and the average number of errors per sentence pair was 0.21. Childrens’ average reading speed for the final group of sentences was 61 CWPM and 72 SLWPM. Their average error rate was 1.71. Conclusions: The reliability analysis showed that the final 45 sentence pairs are highly comparable. They will be used in constructing an Arabic short duration continuous text reading chart.

Introduction and objectives: Primary percutaneous coronary intervention infarction became the preferred method of treatment for myocardial ST segment elevation. Improved safety was reported in transradial access (radial) compared to transfemoral access (femoral). The aim of this study was to compare the cost between the two access points in ST segment elevation myocardial infarction. Methods: This is a subanalysis of the OCEAN RACE trial in which 103 myocardial infarction patients were randomized to either the radial (n=52) or femoral (n=51) groups. The clinical safety and efficacy were recorded during the hospital stay. The procedural metrics were meticulously logged, and costs were evaluated using the micro-cost method. The indirect costs were estimated using the human capital approach. Results: Clinical success was numerically higher in the radial group (90.4 vs. 80.4%, p=0.123). There were no differences in major adverse cardiac events (9.6% vs. 11.8%, p=0.48) and death (2.0% vs. 6.0%, p=0.31). The average in-hospital cost per patient was 2,740 ± 1,092 EUR. The cost of therapeutic success was lower in the radial group at 3,060 EUR vs. 3,374 EUR. The indirect costs related to absence at work were 138 EUR per patient, which were lower in the radial group compared to the femoral group. Conclusions: The total in-hospital costs were similar between the study groups. The indirect costs were lower in the radial group. Introduction of radial access as the default approach in all centers may significantly reduce the overall financial burden from a social perspective.

Aim: (a) To determine the spatial distributions and levels of major and minor elements, as well as heavy metals, in water, sediment, and biota (plant and fish) in Al-Hammar Marsh, southern Iraq, and ultimately to supply more comprehensive information for policy-makers to manage the contaminants input into the marsh so that their concentrations do not reach toxic levels. (b) to characterize the seasonal changes in the marsh surface water quality. (c) to address the potential environmental risk of these elements by comparison with the historical levels and global quality guidelines (i.e., World Health Organization (WHO) standard limits). (d) to define the sources of these elements (i.e., natural and/or anthropogenic) using combined multivariate statistical techniques such as Principal Component Analysis (PCA) and Agglomerative Hierarchical Cluster Analysis (AHCA) along with pollution analysis (i.e., enrichment factor analysis) Methods: Water, sediment, plant, and fish samples were collected from the marsh, and analyzed for major and minor ions, as well as heavy metals, and then compared to historical levels and global quality guidelines (WHO guidelines). Then, multivariate statistical techniques, such as PCA and AHCA, were used to determine the element sourcing. Results: Water analyses revealed unacceptable values for almost all physio-chemical and biological properties, according to WHO standard limits for drinking water. Almost all major ions and heavy metal concentrations in water showed a distinct decreasing trend at the marsh outlet station compared to other stations. In general, major and minor ions, as well as heavy metals exhibit higher concentrations in winter than in summer. Sediment analyses using multivariate statistical techniques revealed that Mg, Fe, S, P, V, Zn, As, Se, Mo, Co, Ni, Cu, Sr, Br, Cd, Ca, N, Mn, Cr, and Pb were derived from anthropogenic sources, while Al, Si, Ti, K, and Zr were primarily derived from natural sources. Enrichment factor analysis gave results compatible with multivariate statistical techniques findings. Analysis of heavy metals in plant samples revealed that there is no pollution in plants in Al-Hammar Marsh. However, the concentrations of heavy metals in fish samples showed that all samples were contaminated by Pb, Mn, and Ni, while some samples were contaminated by Pb, Mn, and Ni. Discussion and conclusions: Decreasing of Tigris and Euphrates discharges during the past decades due to drought conditions and upstream damming, as well as the increasing stress of wastewater effluents from anthropogenic activities, led to degradation of the downstream Al-Hammar Marsh water quality in terms of physical, chemical, and biological properties. As such properties were found to consistently exceed the historical and global quality objectives. However, element concentration decreasing trend at the marsh outlet station compared to other stations indicate that the marsh plays an important role as a natural filtration and bioremediation system. Higher element concentrations in winter were due to runoff from the washing of the surrounding Sabkha during flooding by winter rainstorms. Finally, the high concentrations of heavy metals in fish samples can be attributed to bioaccumulation and biomagnification processes.

There have been numerous and extensive studies into the visual requirements for reading in adults with low vision. There are far fewer studies involving children with low vision. This article compares the studies on children which do exist with the findings in adults. Acuity reserve (magnification), contrast reserve and visual field requirements are considered. We also review the literature which compares the efficacy of large print with optical magnification for children. From the few studies that exist, there are indications that the requirements for children are not the same as for adults. Therefore, we suggest that one cannot directly apply the results from adults to children and that there is a gap in the literature (and therefore our understanding) of the visual requirements for reading in children.

Ambulatory ECG (AECG) is very commonly employed in a variety of clinical contexts to detect cardiac arrhythmias and/or arrhythmia patterns which are not readily obtained from the standard ECG. Accurate and timely characterization of arrhythmias is crucial to direct therapies that can have an important impact on diagnosis, prognosis or patient symptom status. The rhythm information derived from the large variety of AECG recording systems can often lead to appropriate and patient-specific medical and interventional management. The details in this document provide background and framework from which to apply AECG techniques in clinical practice, as well as clinical research., (Copyright © 2017 International Society for Holter and Noninvasive Electrocardiology, Heart Rhythm Society, and Wiley Periodicals, Inc. Published by Elsevier Inc. All rights reserved.)

Purpose: Pulmonary vein isolation is a well established method of definite treatment of atrial fibrillation (AF). Periprocedural onset of AF usually terminates spontaneously within minutes, but not in all cases. Antazoline is an antihistaminic agent with antiarrhythmic properties. The aim of our retrospective study was to evaluate the efficacy of antazoline in termination of AF in patients undergoing pulmonary vein isolation., Materials and Methods: Consecutive 141 patients who received antazoline to terminate AF during pulmonary vein isolation were analyzed. The antazoline was administered at the rate of 30-50mg/min (max. 500mg) after the circumferential ablation in the ostia of pulmonary veins and before confirmation of isolation. Success was defined as restoration of sinus rhythm within 20min after antazoline infusion., Results: The efficacy of antazoline was 83.6% in paroxysmal and 31.1% in persistent AF patients. Clinical variables that were independently predictive of antazoline ineffectiveness were female (odds ratio [OR]: 4.35; 95% confidence interval [CI]: 1.26-14.3; p=0.018) and AF at the beginning of procedure (OR 28.4; 95% CI 3.89-208.0; p=0.001). Due to antazoline related side effects infusion was discontinued in 7 patients (5%)., Conclusions: Antazoline seems to be safe agent in termination of AF in patients undergoing pulmonary vein isolation. We also observed satisfying efficacy, which needs to be proved in a randomized clinical trial., (Copyright © 2015 Medical University of Bialystok. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.)

The effect of dopaminergic drugs on the timing of conditioned keypecking in ring doves was studied in two experiments. Subjects were given pairings of a keylight with food and the temporal distribution of keypecks was obtained during unreinforced probe trials. Experiment 1 demonstrated that injections of pimozide before each session immediately decreased response rates but shifted timing distributions gradually to the right over several days of treatment. Experiment 2 showed similar results using a longer interstimulus interval (ISI). No shifts were observed when the drug was injected after training sessions, or when a delay, identical to each subject's average latency to eat during the drug condition, was inserted between keylight offset and food presentation. Consequently, the shifts in timing were mediated neither by mere accumulation of the drug nor a delay from keylight offset to food presentation resulting from the drug's ability to slow motor processes. The results suggest that pimozide modulates response rate through its effect on motor processes or incentive value, and response timing through a conditioned response (CR) to injection-related cues established via their repeated pairings with the drug.