Background The effect of awake prone positioning on intubation rates is not established. The aim of this trial was to investigate if a protocol for awake prone positioning reduces the rate of endotracheal intubation compared with standard care among patients with moderate to severe hypoxemic respiratory failure due to COVID-19. Methods We conducted a multicenter randomized clinical trial. Adult patients with confirmed COVID-19, high-flow nasal oxygen or noninvasive ventilation for respiratory support and a PaO2/FiO2 ratio ≤ 20 kPa were randomly assigned to a protocol targeting 16 h prone positioning per day or standard care. The primary endpoint was intubation within 30 days. Secondary endpoints included duration of awake prone positioning, 30-day mortality, ventilator-free days, hospital and intensive care unit length of stay, use of noninvasive ventilation, organ support and adverse events. The trial was terminated early due to futility. Results Of 141 patients assessed for eligibility, 75 were randomized of whom 39 were allocated to the control group and 36 to the prone group. Within 30 days after enrollment, 13 patients (33%) were intubated in the control group versus 12 patients (33%) in the prone group (HR 1.01 (95% CI 0.46–2.21), P = 0.99). Median prone duration was 3.4 h [IQR 1.8–8.4] in the control group compared with 9.0 h per day [IQR 4.4–10.6] in the prone group (P = 0.014). Nine patients (23%) in the control group had pressure sores compared with two patients (6%) in the prone group (difference − 18% (95% CI − 2 to − 33%); P = 0.032). There were no other differences in secondary outcomes between groups. Conclusions The implemented protocol for awake prone positioning increased duration of prone positioning, but did not reduce the rate of intubation in patients with hypoxemic respiratory failure due to COVID-19 compared to standard care. Trial registration ISRCTN54917435. Registered 15 June 2020 (https://doi.org/10.1186/ISRCTN54917435).

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The present study examines the relationship among emotional intelligence, achievement, and gender. The sample consists of 121 participants at a public university in North Upper Egypt called Minia University. The Wong & Law's (2002) emotional intelligence scale has been used in this study. Confirmatory factor analysis has been adopted to verify the structure validity of the EI scale. Results of confirmatory factor analysis showed that the four-factor model fits well and its results meet the criteria for goodness of fit indices (> 0.90) and root mean score residual (< 0.05). Cronbach Alpha indicated high reliability of the scale. Positive correlation was found between academic achievement and self emotional appraisal, regulation of emotion, use of emotions, and total emotional intelligence score. There was no significant difference between males and females in emotional intelligence in the total score of EI scale and its subscales. Only two dimensions (regulation of emotions & self emotions appraisal) predicted academic achievement.

BackgroundIt has been shown that certain hematological conditions, such as lymphopenia and thrombocytopenia, are associated with increased severity and mortality from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, a majority of the previous data came from large institutional centers with high academic output. We aimed to explore the association between patient's characteristics, hematological parameters, and outcomes in admitted persons with coronavirus disease 2019 (COVID-19) at our community hospital in an inner city. MethodsThis study is a retrospective chart review designed to evaluate the potential associations between demographic and clinical characteristics of our patient population and their outcomes when testing positive for SARS-CoV-2. The study population included patients hospitalized in the Saint Francis Medical Center from January 2020 to September 2020. This pilot study included 50 out of the 275 hospitalized patients with a confirmed SARS-CoV-2 infection during this timeframe. Data collection from the patient's chart included age, sex, comorbidities, admission complete blood cell count, and use of Remdesivir, steroids, and plasma. The primary outcome was all-cause in-hospital mortality. Secondary outcomes included the need for mechanical ventilation and ICU admission. ResultsIn this pilot study, there was an overall mortality rate of 32% (16 out of 50 patients). Charlson Comorbidity Index (CCI) of 3 points or above was present in 87.5% of the patients in the mortality group versus 41.1% in patients who survived (p = 0.0021). There was no statistically significant difference in mortality between males and females after adjusting for other variables with an odds ratio (OR) of 0.19 (95% CI 0.02-1.80, p = 0.09). There were no statically significant differences in mortality between Caucasians, non-Hispanic, Black, and Latinx patients (p = 0.466). Admission platelets were lower in the mortality group with a mean of 157.7 ± 43.23 (Thou/ul) versus 250.06 ± 93.95 (Thou/ul) in the survivors (p = 0.0005). Admission white blood cell count in the mortality group was lower than the survivor group with an average of 5.93 ± 2.58 (Thou/ul) versus 9.3 ± 4.14 (Thou/ul) (p = 0.0039), respectively. The plasma D-dimer level of 3 mg/L fibrinogen equivalent unit (FEU) or higher was associated with increased mortality. There was no association of Creactive protein (CRP) with mortality (p = 0.93 and p = 0.54, respectively); however, the CRP level revealed an association with ICU admission (p = 0.03). The use of steroids, Remdesivir, and plasma did not have a statistically significant effect on mortality, ICU admission, or sepsis in our study. ConclusionIn this study, older age, higher CCI, and plasma D-dimer level of 3 mg/L FEU or higher were associated with higher mortality among COVID-19 patients. White blood cell count and platelet count were significantly lower in the mortality group in comparison to the survivor group. However, there was no statistical difference in lymphocyte count b...

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In view of the lack of a short scale for the direct measurement of English language learning anxiety developed in the Egyptian context, this study aims to develop and validate a brief scale. Exploratory factor analysis (EFA) was employed using (362) EFL learners enrolled in first year at college of education, Minia University. Results of EFA proved that the scale consisted of four subscales: (speaking anxiety, (8) items, =.84, writing anxiety (8) items, =.84, reading anxiety (8) items, =.84, listening anxiety, (8) items, =.83). Confirmatory factor analysis (CFA) was conducted on 46 items to examine the structure validity. Results of confirmatory factor analysis showed that the fourfactor model fitted well and results met the criteria for goodness of fit indices (>.90) and root mean score residual (RMR < .05) which means the (ELAS) has a four factor structure in the Egyptian university students sample. The brief scale has good reliability and adequate validity and results of the analysis supported the conclusion that it is a reliable and valid measurement instrument.

Background Heavy menstrual bleeding (HMB) is a common clinical finding in patients with uterine leiomyomas that can negatively impact their quality of life. Recently, a novel oral GnRH-antagonist (elagolix) has emerged as a possible therapeutic agent for this ailment. Herein data was pooled from clinical trials assessing the safety and efficacy of elagolix with and without add-back therapy. Main text PubMed and Cochrane library were systematically searched for RCTs that measured the efficacy and safety of elagolix for the treatment of uterine fibroid-associated HMB. All safety and efficacy endpoints were compared between elagolix-alone, elagolix w/add-back therapy, and placebo. The primary efficacy endpoint was defined as the number of women who achieved menstrual blood loss (MBL) < 80 ml and a reduction in MBL from baseline of > 50% at the end of treatment. Secondary outcomes assessed included change in hemoglobin levels, incidence suppression of bleeding and amenorrhea, and the incidence of adverse events. The random effects model was used to pool data, and heterogeneity was assessed using I2. Our search identified 4 clinical trials meeting our PICO criteria, with a total of 916 patients. Analysis of the primary outcome revealed that elagolix-alone was the most effective treatment compared to both placebo (LOR = 3.47, CI = 3.03–3.91, p = 0.000, I2 = 0.0%) and add-back therapy (LOR = 0.64, CI = 0.12–1.16, p = 0.016, I2 = 43.1%). Furthermore, both elagolix groups (irrespective of add-back therapy) observed a significant improvement in post-treatment hemoglobin levels as compared to the placebo group (elagolix-alone vs PBO: LOR = 1.44, CI = 0.66–2.22, I2 = 66.0%, p = 0.000; elagolix-w/add-back therapy vs PBO: LOR = 1.22, CI = 0.78–1.66, I2 = 0.0%, p = 0.000). Concerning safety, while elagolix without add-back therapy had the highest overall incidence of adverse effects (elagolix-alone vs placebo LOR = 0.84, CI = 0.48–1.20, I2 = 7.8%, p = 0.000; elagolix-alone vs elagolix-w/add-back LOR = 0.68, CI = 0.09–1.26, p = 0.024, I2 = 64.6%), the incidence of serious (life threatening) adverse events between all 3 treatment groups was not statistically different. The inclusion of add-back therapy with elagolix made the treatment noticeably safer (elagolix-w/add-back vs placebo: LOR = 0.19, CI = − 0.10 to 0.48, I2 = 0.0%, p = 0.194) without seriously compromising its efficacy. Conclusion High-quality evidence from 4 trials suggests that elagolix is an effective treatment for leiomyoma-associated HMB, with a marked improvement in all efficacy endpoints. Furthermore, the inclusion of add-back therapy in the treatment regimen should be considered as it mitigates the hypoestrogenic effects of elagolix.

Aim Acute appendicitis (AA) is the most common abdominal surgical emergency in the UK and traditionally, operative management is the mainstay of treatment. However, during the first wave of the COVID-19 pandemic, ACPGBI discouraged laparoscopy, due to potential risks of aerosol viral transmission. We aimed to review clinical outcomes of patients treated for AA at our DGH prior to and after the change in ACPGBI guidance. Method The first 30 patients treated for AA prior to (Group A) and following the update in ACPGBI guidance (Group B), were identified. Results Group A: 7% managed conservatively vs 93% operative management. Group B: 74% managed conservatively vs 26% operative management. No statistically significant difference was seen in the rate of post-operative complications, or readmission. In Group B, of those managed conservatively and then readmitted, 75% underwent an operation (RR &lt; 1.00). The average length of stay (LOS) of those managed conservatively in Group A was 3.5 days vs 2.4 days in Group B (p &lt; 0.05). Statistically significant differences in LOS were also observed in patients who underwent surgery - Group A 5.5 day vs 8.25 days in Group B (p &lt; 0.001). Conclusions In conclusion, the change in ACPGBI guidance in the early stages of the COVID-19 pandemic, saw statistically significant differences in LOS at our DGH. A shorter LOS in those conservatively managed in Group B could be explained by hospital bed pressures. An increase in LOS for Group B patients with operative management is understandable, as only cases of complicated AA, or those readmitted underwent emergency surgery.