Workplace barriers experienced by nurses in a tertiary level hospital during COVID-19 pandemic

Background: Nurses as frontline workers are experiencing barriers while discharging their duties. So, identifying workplace barriers experienced by nurses during COVID-19 is important because they are the most vital component of medical care. The present study aimed to identify the workplace barriers experienced by nurses in a tertiary-level hospital during the COVID-19 pandemic. Methods: This descriptive type of cross-sectional study was conducted among 200 nurses who were working in the non-COVID unit at Dhaka Medical College Hospital, Dhaka. Sampling was done by convenience sampling method. A semi-structured questionnaire was administered to the respondents to obtain information. Data were collected through a face-to-face interview. Results: The study found that 83% of respondents were females, and the mean age was 31.8�5. 52.5% completed a diploma in nursing, 61.5% of their working experience was 1-5 years, and 53% were working in the inpatient department. The major barriers identified were lack of guidelines, shortage of PPE, inadequate training coverage, lack of area for doffing and donning, and inadequate social distancing. Statistical analysis showed that different departments of work had a significant association (p<0.05) with inadequate training coverage. Conclusions: The barriers identified in this study should be overcome to improve nurses� experiences in the workplace and in turn the quality of patient care during the COVID-19 pandemic.

Therapeutic potential of Calotropis gigantea extract against invasive pulmonary aspergillosis: In vitro and in vivo study

Objective: To characterize the antifungal activity of methanolic leaf extract of Calotropis gigantea alone or in combination with amphotericin B against invasive pulmonary aspergillosis in mice. Methods: GC/MS was used for analysis of active constituents of Calotropis gigantea extract. Spore germination assay and broth micro-dilution method were used to determine antifungal potential of Calotropis gigantea/amphotericin B against Aspergillus fumigatus. Neutropenic mice were randomly assigned into 5 groups: group 1 was neutropenic (control); group 2 was infected with Aspergillus fumigatus; group 3 was infected with Aspergillus fumigatus, and treated with Calotropis gigantea extract; group 4 was infected with Aspergillus fumigatus and treated with amphotericin B; group 5 was infected with Aspergillus fumigatus and treated with both Calotropis gigantea extract and amphotericin B. Fresh lung tissues were histopathologically examined. Fungal burden and gliotoxin concentration were evaluated in lung tissues. Catalase, superoxide dismutase, and malondialdehyde content were determined in lung tissues. Myeloperoxidase, tumor necrosis factor-alpha, interleukin-1, and interleukin-17 were also estimated by the sandwich enzyme-linked immuno-sorbent assay. Results: Calotropis gigantea/amphotericin B had a minimum inhibitory concentration and minimum fungicidal concentration of 80 and 160 μg/mL, respectively, for Aspergillus fumigatus. Additionally, Calotropis gigantea/amphotericin B significantly reduced lung fungal burden by 72.95% and inhibited production of gliotoxin in lung tissues from 6 320 to 1 350 μg/g lung. Calotropis gigantea/amphotericin B reduced the oxidative stress of the lung via elevating the activity of antioxidant enzymes and decreasing the levels of lipid peroxidation. Myeloperoxidase activity and the production of pro-inflammatory cytokines were also significantly reduced. Scanning electron microscopy revealed deteriorations in the hyphae ultrastructure in Calotropis gigantea/amphotericin B treated Aspergillus fumigatus and leak of cellular components after damage of the cell wall. In vivo study revealed the suppression of lung tissue damage in mice of invasive pulmonary aspergillosis, which was improved with Calotropis gigantea/amphotericin B compared to the control group. Conclusions: Calotropis gigantea/amphotericin B is a promising treatment to reduce lung fungal burden and to improve the drugs' therapeutic effect against invasive pulmonary aspergillosis.

Therapeutic potential of Calotropis gigantea extract against invasive pulmonary aspergillosis: In vitro and in vivo study

Objective: To characterize the antifungal activity of methanolic leaf extract of Calotropis gigantea alone or in combination with amphotericin B against invasive pulmonary aspergillosis in mice. Methods: GC/MS was used for analysis of active constituents of Calotropis gigantea extract. Spore germination assay and broth micro-dilution method were used to determine antifungal potential of Calotropis gigantea/amphotericin B against Aspergillus fumigatus. Neutropenic mice were randomly assigned into 5 groups: group 1 was neutropenic (control); group 2 was infected with Aspergillus fumigatus; group 3 was infected with Aspergillus fumigatus, and treated with Calotropis gigantea extract; group 4 was infected with Aspergillus fumigatus and treated with amphotericin B; group 5 was infected with Aspergillus fumigatus and treated with both Calotropis gigantea extract and amphotericin B. Fresh lung tissues were histopathologically examined. Fungal burden and gliotoxin concentration were evaluated in lung tissues. Catalase, superoxide dismutase, and malondialdehyde content were determined in lung tissues. Myeloperoxidase, tumor necrosis factor-alpha, interleukin-1, and interleukin-17 were also estimated by the sandwich enzyme-linked immuno-sorbent assay. Results: Calotropis gigantea/amphotericin B had a minimum inhibitory concentration and minimum fungicidal concentration of 80 and 160 μg/mL, respectively, for Aspergillus fumigatus. Additionally, Calotropis gigantea/amphotericin B significantly reduced lung fungal burden by 72.95% and inhibited production of gliotoxin in lung tissues from 6 320 to 1 350 μg/g lung. Calotropis gigantea/amphotericin B reduced the oxidative stress of the lung via elevating the activity of antioxidant enzymes and decreasing the levels of lipid peroxidation. Myeloperoxidase activity and the production of pro-inflammatory cytokines were also significantly reduced. Scanning electron microscopy revealed deteriorations in the hyphae ultrastructure in Calotropis gigantea/amphotericin B treated Aspergillus fumigatus and leak of cellular components after damage of the cell wall. In vivo study revealed the suppression of lung tissue damage in mice of invasive pulmonary aspergillosis, which was improved with Calotropis gigantea/amphotericin B compared to the control group. Conclusions: Calotropis gigantea/amphotericin B is a promising treatment to reduce lung fungal burden and to improve the drugs' therapeutic effect against invasive pulmonary aspergillosis.

Chemotherapeutic effect of Ulmus pumila leaves methanolic extract against N-methyl-N-nitrosourea-induced mammary carcinoma in female rats: An in vitro and in vivo study

Searching for a chemopreventive agent is an important approach for breast cancer management. The aim of the study was to evaluate the chemopreventive potential of Ulmus pumila (UP) leaves extract on breast tumorigenesis induced in experimental animals by N-methyl-N-nitrosourea. This target was undertaken through preparing several extracts from the fresh leaves of UP using different solvents against the breast adenocarcinoma cell line (MCF-7). Our in vitro results demonstrated that the methanolic extract of UP (UPME) showed the highest cytotoxic activity against the growth of MCF-7 cells. After determination of UPME safe dose (1/10) of a lethal dose, the in vivo results revealed that UPME treatment significantly decreased the activities of liver enzymes, kidney function, cancer antigen 15-3 (CA 15-3) level, urokinase plasminogen activator, heparanase, basic fibroblast growth factor, B-cell leukemia lymphoma 2, and cyclooxygenase-2. By contrast, total antioxidant capacity (TAC) was increased in therapeutic, protective, and prophylactic groups as compared to the tumor group. These improvements were supported with histopathological changes. These results indicated that the chemotherapeutic potential of UPME through stimulation of apoptosis and the suppression of angiogenesis, proliferation, and metastasis.

Development of an efficient in vivo cell-based assay system for monitoring hepatitis C virus genotype 4a NS3/4A protease activity

Background: Hepatitis C virus (HCV) represents a serious worldwide healthcare problem. No protective vaccines against HCV have been developed yet due to the fact that HCV is rapidly mutable, allowing the virus to escape from the neutralizing antibodies. Understanding of HCV was initially hampered by the inability to achieve viral replication in cell culture. Given its essential roles in viral polyprotein processing and immune evasion, HCV NS3/4A protease is a prime target for antiviral chemotherapy. We aimed to establish in vivo cell-based assay system for monitoring the activity of NS3/4A protease from HCV genotype 4a, the predominant genotype in Egypt, and the Middle East. Furthermore, the developed system was used to evaluate the inhibitory potency of a series of computer-designed chemically-synthesized compounds against NS3/4A protease from HCV genotype 4a. Materials and Methods: Native as well as mutant cleavage sites to NS3/4A protease were cloned in frame into ?-galactosidase gene of TA cloning vector. The target specificity of HCV NS3/4A was evaluated by coexpression of ?-galactosidase containing the protease cleavage site with NS3/4A protease construct in bacterial cells. The activity of ?-galactosidase was colorimetrically estimated in the cell lysate using orthonitro phenyl ?-D-galactopyanoside (ONPG) as a substrate. Results and Conclusions: We successfully developed an efficient cell-based system based on the blue/white selection of bacterial cells that are able to express functional/nonfunctional ?-galactosidase enzyme.

Effect of Iron Deficiency Anemia on Hba1c Levels in Controlled Plasma Glucose Levels

Anaemia is a major health issue that has a wide global impact involving approximately 1/3rd of patients with anaemia. HbA1C levels are not influenced by blood glucose levels alone. Studies suggest that conditions like IDA, haemolytic anaemia, alcohol ingestion, pregnancy, blood loss, and uraemia may alter HbA1C levels independent of glycaemic status. Methods: Totally 200 patients were included in the study.. 100 patients were controlled diabetics with iron deficiency anemia and 100 were controlled diabetics without iron deficiency anemia. Comparison of levels of HbA1c was done between the two groups. Results: Correlation between mcv and hba1c is -0.76716. Which is strongly negative correlated. P – Value for the correlation test is 0.000001. Conclusion: Iron deficiency anemia has role in elevating A1C in both the groups. Iron deficiency anemia elevates HbA1c levels in diabetic individuals with controlled plasma glucose levels. The elevation is more in patients having plasma glucose levels between 100 to 126 mg/dl. Hence, before altering the treatment regimen for diabetes, iron deficiency anemia should be treated first.

Comparative Assessment of Biological and Fisheries Productivity of Caspian Sturgeons Species

Based on the model describing the dynamics of the number of generations of fish during the life cycle, the influence of growth and maturity on the biological and commercial productivity of conditional populations of Caspian sturgeon, formed from 1.0 million specimens of yearlings, was studied. On the biomass of conditional sturgeon populations, their gross output and catch are influenced by the length of yearlings, the size and age of maturity, the periodicity of spawning, the rate of linear and weight growth of individuals, and the degree of stocks catching. The highest yield of biomass and catch, obtained from 1 million yearlings, is observed in Beluga (Huso huso), then Ship Sturgeon (Acipenser nudiventris), Russian sturgeon (Acipenser gueldenstaedtii), Stellate Sturgeon (Acipenser stellatus) and sterlet (Acipenser ruthenus).

Predictors for perioperative blood transfusion in elderly patients with extra capsular hip fractures treated with cephalo-medullary nailing / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>The aim of our study was to determine predictive factors and requirement for perioperative blood transfusion in elderly patients with extra capsular hip fractures treated with cephalo-medullary device.</p><p><b>METHODS</b>Seventy-nine patients with extra capsular hip fractures treated with cephalo-medullary nailing were included in the study. Age, sex, ASA grade, timing of surgery, preoperative and postoperative haemoglobin, length of hospital stay, fracture type, number of units transfused and 30-day mortality were recorded.</p><p><b>RESULTS</b>The mean age was 82.3 years. Forty-seven patients underwent a short nail and 32 patients a long nail; 53.4% patients required blood transfusion postoperatively. Transfusion was required in 71.8% of the long nails (p < 0.05), 65.8% patients above the age of 80 (p < 0.05), 100% of the patients with hemoglobin below 90 g/L and 20 patients with a ASA grade of 3 (p < 0.05). 78.5% patients with A2 fracture and 75% of A3 fractures needed blood transfusion (p > 0.05). Length of hospital stay in non-transfusion group was 13 days and in transfusion group was 19 days (p < 0.05). 55.1% operated within 36 h and 47.6% operated after 36 h of admission needed transfusion (p > 0.05). Thirty-day mortality in patients needing blood transfusion was 5% and in non-transfusion group was 3.7% (p > 0.05).</p><p><b>CONCLUSION</b>Patient age, ASA grade, preoperative haemoglobin and length of nail are reliable predictors for perioperative blood transfusion in extra capsular hip fractures in elderly patients treated with cephalo-medullary nailing and reinforce a selective transfusion policy.</p>

Medicinal and biological values of Callistemon viminalis extracts: History, current situation and prospects

Callistemon viminalis (C. viminalis) is a plant that has been reported to have various medicinal values such as antibacterial, antifungal, antioxidant activities and other pharmaceutical and insecticidal properties. This review covers the potentials, applications and properties of different extracts from different parts (branches, flowers, fruits, bark, leaves) of C. viminalis. Furthermore, the chemical structures of the bioactive compounds were reported for biological activities. All the results supported the traditional uses of C. viminalis in folk medicine. In addition, some researches supported the use of C. viminalis extracts for the preparation of metal oxide nanoparticles.

Medicinal and biological values of Callistemon viminalis extracts: History, current situation and prospects

Callistemon viminalis (C. viminalis) is a plant that has been reported to have various medicinal values such as antibacterial, antifungal, antioxidant activities and other pharmaceutical and insecticidal properties. This review covers the potentials, applications and properties of different extracts from different parts (branches, flowers, fruits, bark, leaves) of C. viminalis. Furthermore, the chemical structures of the bioactive compounds were reported for biological activities. All the results supported the traditional uses of C. viminalis in folk medicine. In addition, some researches supported the use of C. viminalis extracts for the preparation of metal oxide nanoparticles.

Cheiloscopy as an additional forensic parameter : a review

@#Criminal activities involving human life always puts lives at stake. Newer advances in other fields especially medicine and dentistry is essential in solving the mysteries of death. Different disciplines insert a part of the puzzle until it is complete. Fingerprints, DNA profiling, Forensic anthropology are commonly employed in personnel identification, mass disasters and others. Investigators may also rely on lip prints to identify possible suspects or to support evidence gained in specific investigations. A lip print at scene of crime can be the basis for inference as to the number of people involved, gender, habits, occupational traits, and others, based on the pathological changes present. This review deals with lip prints and their possible acquisition and usage.

Durazo technique is beneficial in Egyptian liver transplant programs

For nearly four decades, the American people have partnered with the people of Egyptto promote an environment where all groups in Egyptian society - including women and minorities - can lead healthy, productive lives. USAID's program in Egypt, helped scientists and researchers collaborate with American universities aiming to learn about modern Americans cientific innovations. I was lucky that I have collaborated with one of the most premier USA universities in Hepatology and Liver surgery; UCLA, where I can apply all the liver new techniques I have learned in UCLA in Egypt. Durazo technique is one of very interesting method-post liver transplant, would decrease morbidities and mortalities not only in USA and Egypt, but also Globally

Dieulafoy's lesion: new diagnosis usinghigh? definition endoscopy and treatment withisoamyl 2 cyanoacrylate [Amcrylate]

Dieulafoy's lesion [DL] is a rare but important cause of gastrointestinal [GI] bleeding, accountingfor up to 6% of the cases of nonvariceal bleeding in the upper GI tract and 1-2% of all GIhemorrhages. Mortality rates are similar to those of other causes for GI bleeding. Following ourstrategy, an expert endoscopist with a skilled assistant should have a high rate of successful DL diagnosis when an obscured GI lesion is suspected. In our seven case study, we thinkit was feasible to use high?definition Fujinon intelligent chromoendoscopy to diagnose DL. Isoamyl 2 cyanoacrylate [Amcrylate] was effective and safe for treating DL as well as wereother strategies, including ethanolamine oleate, band ligation, and nebutyle 2 cyanoacrylate. Surgical wedge resection of the lesion should be considered as a therapeutic option if endoscopic therapy fails

Noninvasive prediction of HCV 4 SVR by 2D US: a randomizedstudy using data mining algorithm

Objective and aim :Hepatitis C virus [HCV] can cause both acute and chronic hepatitis. Antiviral therapy is thecornerstone for the treatment of chronic HCV infection once diagnosis is confirmed by PCR. Thegoal of antiviral therapy is to eradicate HCV RNA or attain sustained virological response [SVR]. In many countries worldwide, including Egypt, HCV infection is treated with a combination of pegylated interferon [and ribavirin [RBV]. Liver fibrosis/cirrhosis stage influences theresponse to pegylated interferon [and RBV. Even with new oral the rapies such as Sovaldimany patients have to continue to be on combination regimens of interferon/RBV or RBV alone. In the current study, we aimed to use data mining analysis to determine sonographic picturesthat can successfully predict SVR in HCV-4 patients before the antiviral therapy

Methods: Eighty-two patients were enrolled in this study and they underwent two-dimensional ultrasound examination before the antiviral therapy. The sonographic data obtained were analyzed with Rapidminer version 4.6 to create a decision tree algorithm for the prediction of SVR

Results: The absence of significant liver fibrosis was a predictive parameter of SVR mainly in those patients without a sonographic picture of cirrhosis. The resulting tree yielded an accuracy, sensitivity, and specificity of 85.82 +/- 10.79, 68.75, and 96.00%, respectively, upon 10-foldcross-validation

Conclusion: In the current study we used decision tree algorithm, one of the most important computational methods and tools for data analysis and predictive modeling in applied medicine, to predict SVR in HCV-infected patients. Two-dimensional ultrasound can give predictive information regarding the treatment outcome before interferon therapy for HCV-4

Medicinal plants and management of diabetes mellitus: a review

Diabetes is a metabolic disorder characterized by chronic hyperglycemia and associated with dysfunction and failure of various body organs. Alarming increase in prevalence rate has made this disorder a major health problem globally. The available treatment modalities are not sufficient to combat diabetes and associated complications. A number of medicinal plants have a significant antidiabetic potential against diabetes mellitus. We have listed the use of important medicinal herbs for the treatment and management of diabetes in this review

Role of focused ultrasound in the diagnosis of acute appendicitis in pediatric population. selection of a standard diagnostic criterion

To evaluate the diagnostic role of focused ultrasound of right iliac fossa in clinically suspected cases of acute appendicitis in pediatric population and its value as a standard diagnostic tool in that age group. A retrospective, cohort study was conducted at radiology department of Agha Khan University involving 239 children less than 16 years with clinically suspected appendicitis referred to radiology department from January 2009 to October 2011 were included. Medical records were reviewed for patient demographics, presenting signs and symptoms, sonographic, surgical findings and histopathological results. Two hundred and thirty nine patients with clinical suspicion of appendicitis were referred for focused ultrasound for appendix. Ultrasound examination showed 59 cases [24.6%] positive for appendicitis and thus they were operated. All of these were positive on histopathology. The remaining 180 cases [75.4%] that were negative on U/S were managed conservatively. Out of these 180 cases, 13 patients with negative findings on imaging studies were later operated due to clinical decision and/or CT examination. Acute appendicitis was proven in 10 out of the 13 cases. Focused ultrasound has high sensitivity in acute appendicitis for the assessment of clinically equivocal cases of pediatrics population. It can be used as an initial screening modality especially in pediatric population, thus reducing additional cost and radiation risk associated with CT scans and also reducing rate of negative surgery

Noncompaction cardiomyopathy: a new mechanism for mitral regurgitation with distinct clinical, echocardiographic features and pathological correlations

Noncompaction cardiomyopathy [NCCM] is a primary, genetic cardiomyopathy with variable clinical manifestations that include mitral regurgitation [MR]. This study comprised patients diagnosed with NCCM and MR in two cardiac centers [King Abdul-Aziz Cardiac Center, Riyadh, Kingdom of Saudi Arabia and Sudan Heart Institute, Khartoum, Sudan], and seen in the period between 2002 and 2013. The study describes follow up, clinical, echocardiographic, and histopathological findings. Nineteen cases [85% females] were identified. Ten percent of the cases had relapses and remissions of heart failure. Echocardiographic features included leaflet retraction in all patients, characteristic malcoaptation, and a zigzag deformity of anterior leaflet in 57% of patients. Ruptured chordae were found in 15% of the patients. One patient had pathological examination of the mitral valve which showed myxomatous degeneration, and sclerotic and calcific changes. We describe and discuss a new mechanism for MR caused by NCCM with identifiable clinical and echocardiographic features, and pathological correlations

Soluble CD14-subtype [prespsin] and hepcidin as diagnostic and prognostic markers in early onset neonatal sepsis

The clinical picture and laboratory markers of Early-onset neonatal sepsis [EONS] are nonspecific, however a variety of different molecules have been suggested as clinical biomarkers in sepsis. Presepsin [soluble CD14-subtype] has been identified as a protein whose level increases significantly in the blood of septic patients. Hepcidin, an iron homeostasis regulator, it can be used in diagnosis of neonatal sepsis. The aim of this study is to evaluate the role of new markers namely presepsin and hepcidin in diagnosis of EONS compared to CRP before and after antibiotic therapy. The study enrolled 62 neonates, 28 of them fulfilled the criteria of EONS, and 34 healthy neonates as a control group. Serum levels of presepsin, hepcidin, CRP, complete blood picture, blood gases, and serum iron parameters for all neonates and blood cultures were done for 28 of neonates with clinical picture of sepsis. Serum levels of presepsin, hepcidin, and CRP were significantly higher in neonates with sepsis than in healthy neonates. The presepsin was more sensitive and specific than hepcidin and CRP for diagnosis of EONS. After antibiotic therapy, the serum level of presepsin was dramatically decreased as compared to its pretreatment level. The same results was noted, but to a lesser degree for hepcidin and CRP. Additionally, the presepsin level was significantly correlated to blood culture results and CRP levels. Presepsin is considered a promising biomarker for early diagnosis of EONS with higher sensitivity and specificity rather than hepcidin and CRP. Its correlation to sepsis markers and response to treatment is more informative. Future large scale studies are needed to understand the role of hepcidin and presepsin in development of sepsis in other pediatric age groups