Physicians' knowledge and practice concerning diagnosis and management of anaphylaxis: The situation in Egypt.

INTRODUCTION: Early recognition of an anaphylaxis event is crucial for instituting lifesaving management. We sought to explore knowledge and practice towards anaphylaxis in a sample of physicians from ten Egyptian governorates. METHODS: An eighteen question-based questionnaire was developed by expert allergists to evaluate the knowledge and practice towards anaphylaxis, based on the World Allergy Organization guidelines for the assessment and management of anaphylaxis. The questionnaires were distributed, and the answered forms collected via emails, and data were tabulated, and analysed. RESULTS: In this cross-sectional study, a total of 242 physicians completed the survey (183 (75.6%) paediatricians, 32 (13.2%) internists, 22 (9.1%) intensivists and five (2.1%) anaesthetists). Only 91 participants (37.6%) identified all the four proposed anaphylaxis clinical scenarios while 70, 45 and 36 identified three, two and one scenario, respectively. Loss of consciousness and abdominal symptoms were not recognised as possible presentations of anaphylaxis by 64.5% and 80.2% of the participants, respectively. Epinephrine was considered the first line treatment by 98 (40.5%), corticosteroids by 77 (31.8%) and antihistamines by 25 (10.3%). 75 (31%) responders identified the right dose of epinephrine while 119 (49.2%) identified the proper route. Concerning practice, 83 physicians (39.2%) used epinephrine for all cases of anaphylaxis, 88 (41.5%) used it for refractory cases only whereas 41 (19.3%) did not use epinephrine at all. DISCUSSION: Our survey shows that the knowledge of Egyptian physicians and their practice towards anaphylaxis are still inadequate. The current situation reinforces the need to disseminate and encourage the adoption of the international guidelines for anaphylaxis diagnosis and treatment.

Osteogenesis and cytotoxicity of a new Carbon Fiber/Flax/Epoxy composite material for bone fracture plate applications.

This study is part of an ongoing program to develop a new CF/Flax/Epoxy bone fracture plate to be used in orthopedic trauma applications. The purpose was to determine this new plate's in-vitro effects on the level of bone formation genes, as well as cell viability in comparison with a medical grade metal (i.e. stainless steel) commonly employed for fabrication of bone plates (positive control). Cytotoxicity and osteogenesis induced by wear debris of the material were assessed using Methyl Tetrazolium (MTT) assay and reverse transcription polymerase chain reaction (RT-PCR) for 3 osteogenesis specific gene markers, including bone morphogenetic proteins (BMP2), runt-related transcription factor 2 (Runx2) and Osterix. Moreover, the Flax/Epoxy and CF/Epoxy composites were examined separately for their wettability properties by water absorption and contact angle (CA) tests using the sessile drop technique. The MTT results for indirect and direct assays indicated that the CF/Flax/Epoxy composite material showed comparable cell viability with no cytotoxicity at all incubation times to that of the metal group (p≥0.05). Osteogenesis test results showed that the expression level of Runx2 marker induced by CF/Flax/Epoxy were significantly higher than those induced by metal after 48 h (p=0.57). Also, the Flax/Epoxy composite revealed a hydrophilic character (CA=68.07°±2.05°) and absorbed more water up to 17.2% compared to CF/Epoxy, which reached 1.25% due to its hydrophobic character (CA=93.22°±1.95°) (p<0.001). Therefore, the new CF/Flax/Epoxy may be a potential candidate for medical applications as a bone fracture plate, as it showed similar cell viability with no negative effect on gene expression levels responsible for bone formation compared to medical grade stainless steel.

Biomechanical fatigue analysis of an advanced new carbon fiber/flax/epoxy plate for bone fracture repair using conventional fatigue tests and thermography.

The current study is part of an ongoing research program to develop an advanced new carbon fiber/flax/epoxy (CF/flax/epoxy) hybrid composite with a "sandwich structure" as a substitute for metallic materials for orthopedic long bone fracture plate applications. The purpose of this study was to assess the fatigue properties of this composite, since cyclic loading is one of the main types of loads carried by a femur fracture plate during normal daily activities. Conventional fatigue testing, thermographic analysis, and scanning electron microscopy (SEM) were used to analyze the damage progress that occurred during fatigue loading. Fatigue strength obtained using thermography analysis (51% of ultimate tensile strength) was confirmed using the conventional fatigue test (50­55% of ultimate tensile strength). The dynamic modulus (E⁎) was found to stay almost constant at 47 GPa versus the number of cycles, which can be related to the contribution of both flax/epoxy and CF/epoxy laminae to the stiffness of the composite. SEM images showed solid bonding at the CF/epoxy and flax/epoxy laminae, with a crack density of only 0.48% for the plate loaded for 2 million cycles. The current composite plate showed much higher fatigue strength than the main loads experienced by a typical patient during cyclic activities; thus, it may be a potential candidate for bone fracture plate applications. Moreover, the fatigue strength from thermographic analysis was the same as that obtained by the conventional fatigue tests, thus demonstrating its potential use as an alternate tool to rapidly evaluate fatigue strength of composite biomaterials.

Fabrication and characterization of novel biomimetic PLLA/cellulose/hydroxyapatite nanocomposite for bone repair applications.

The purpose of this research is to develop and characterize a novel biomimetic nanocomposite that closely mimics the properties of real bone such as morphology, composition and mechanical characteristics. This novel porous nanocomposite is composed of cotton-sourced cellulose microcrystals, hydroxyapatite nanoparticles and poly l-lactide acid. A unique combination of commonly used fabrication procedures has been developed including pre-treatment of particles using a coupling agent. The effect of various weight ratios of the reinforcing agents was evaluated to assess their influence on the chemical, thermal, and mechanical properties of the nanocomposites. The prepared nanocomposites were characterized using Fourier transform infrared spectroscopy, scanning electron microscopy, differential scanning calorimetry and compression testing. Our results indicated the presence of molecular interactions between all components leading to an increase of the crystallinity of the polymer from 50% to 80%. Compression test results revealed that increasing the weight ratio of microcrystalline cellulose/poly l-lactide acid and hydroxyapatite/poly l-lactide acid from 0.1 to 0.5 enhanced the compressive yield stress from 0.127 to 2.2MPa and The Young's modulus from 6.6 to 38MPa, respectively. It was found that the fabricated nanocomposites are comparable with the trabecular bone from compositional, structural, and mechanical point of view.

Biomechanical fatigue analysis of an advanced new carbon fiber/flax/epoxy plate for bone fracture repair using conventional fatigue tests and thermography.

The current study is part of an ongoing research program to develop an advanced new carbon fiber/flax/epoxy (CF/flax/epoxy) hybrid composite with a "sandwich structure" as a substitute for metallic materials for orthopedic long bone fracture plate applications. The purpose of this study was to assess the fatigue properties of this composite, since cyclic loading is one of the main types of loads carried by a femur fracture plate during normal daily activities. Conventional fatigue testing, thermographic analysis, and scanning electron microscopy (SEM) were used to analyze the damage progress that occurred during fatigue loading. Fatigue strength obtained using thermography analysis (51% of ultimate tensile strength) was confirmed using the conventional fatigue test (50-55% of ultimate tensile strength). The dynamic modulus (E(⁎)) was found to stay almost constant at 47GPa versus the number of cycles, which can be related to the contribution of both flax/epoxy and CF/epoxy laminae to the stiffness of the composite. SEM images showed solid bonding at the CF/epoxy and flax/epoxy laminae, with a crack density of only 0.48% for the plate loaded for 2 million cycles. The current composite plate showed much higher fatigue strength than the main loads experienced by a typical patient during cyclic activities; thus, it may be a potential candidate for bone fracture plate applications. Moreover, the fatigue strength from thermographic analysis was the same as that obtained by the conventional fatigue tests, thus demonstrating its potential use as an alternate tool to rapidly evaluate fatigue strength of composite biomaterials.

Biomechanical properties of an advanced new carbon/flax/epoxy composite material for bone plate applications.

This work is part of an ongoing program to develop a new carbon fiber/flax/epoxy (CF/flax/epoxy) hybrid composite material for use as an orthopaedic long bone fracture plate, instead of a metal plate. The purpose of this study was to evaluate the mechanical properties of this new novel composite material. The composite material had a "sandwich structure", in which two thin sheets of CF/epoxy were attached to each outer surface of the flax/epoxy core, which resulted in a unique structure compared to other composite plates for bone plate applications. Mechanical properties were determined using tension, three-point bending, and Rockwell hardness tests. Also, scanning electron microscopy (SEM) was used to characterize the failure mechanism of specimens in tension and three-point bending tests. The results of mechanical tests revealed a considerably high ultimate strength in both tension (399.8MPa) and flexural loading (510.6MPa), with a higher elastic modulus in bending tests (57.4GPa) compared to tension tests (41.7GPa). The composite material experienced brittle catastrophic failure in both tension and bending tests. The SEM images, consistent with brittle failure, showed mostly fiber breakage and fiber pull-out at the fractured surfaces with perfect bonding at carbon fibers and flax plies. Compared to clinically-used orthopaedic metal plates, current CF/flax/epoxy results were closer to human cortical bone, making the material a potential candidate for use in long bone fracture fixation.