Double Decker anterior cruciate ligament avulsion.

Distal anterior cruciate ligament avulsion from tibial side is an unusual injury. It can be either bony avulsion, which is more common, or rarely a soft tissue peeling of tibial spine with no bone injury. This case report represents a very infrequent injury of combined soft tissue peeling of distal anterior cruciate ligament along with bony avulsion of tibial spine in a 12-years-old boy after falling from his bike.

Novel paper-based potentiometric combined sensors using coumarin derivatives modified with vanadium pentoxide nanoparticles for the selective determination of trace levels of lead ions.

Novel miniaturized Pb(II) paper-based potentiometric sensors are described using coumarin derivatives I and II as electroactive ionophores and nano vanadium pentoxide as a solid contact material for the sensitive and selective monitoring of trace lead ions. Density functional theory (DFT) confirms optimum geometries, electronic properties, and charge transfer behaviors of 1:2 Pb(II): coumarin complexes. The sensors are prepared by using two strips of 20 × 5 mm filter paper with two circular orifices. One orifice is coated with vanadium pentoxide (V2O5) nanoparticles in colloidal conductive carbon as a solid-contact, covered by a PVC membrane containing coumarin ionophore to act as a sensing probe. The other orifice is treated with Ag/AgCl in a polyvinyl butyral (PVB) film, to act as a reference electrode. Sensors with ionophores (I) and (II) exhibit Nernstian slopes of 27.7 ± 0.2 and 30.2 ± 0.2 mV/decade over the linear concentration range 4.5 × 10-7 to 6.2 × 10-3 M and 8.5 × 10-8 to 6.2 × 10-3 M, with detection limits of 1.3 × 10-7 M (26.9 ppb) and 2.1 × 10-8 M (4.4 ppb), respectively. The sensors are satisfactorily used for accurate determination of lead ions in drinking water, lead-acid battery wastewater, and electronic waste leachates. The results compare favourably well with data obtained by flameless atomic absorption spectrometry.

Impact of targeted drug administration and intermittent preventive treatment for forest goers using artesunate-pyronaridine to control malaria outbreaks in Cambodia.

INTRODUCTION: The national malaria programme of Cambodia targets the rapid elimination of all human malaria by 2025. As clinical cases decline to near-elimination levels, a key strategy is the rapid identification of malaria outbreaks triggering effective action to interrupt local transmission. We report a comprehensive, multipronged management approach in response to a  2022 Plasmodium falciparum outbreak in Kravanh district, western Cambodia. METHODS: The provincial health department of Pursat in conjunction with the Center for Parasitology, Entomology and Malaria Control (CNM) identified villages where transmission was occurring using clinical records, and initiated various interventions, including the distribution of insecticide-treated bed nets, running awareness campaigns, and implementing fever screening with targeted drug administration. Health stations were set up at forest entry points, and later, targeted drug administrations with artesunate-pyronaridine (Pyramax) and intermittent preventive treatment for forest goers (IPTf) were implemented in specific village foci. Data related to adherence and adverse events from IPTf and TDA were collected. The coverage rates of interventions were calculated, and local malaria infections were monitored. RESULTS: A total of 942 individuals were screened through active fever surveillance in villages where IPTf and TDA were conducted. The study demonstrated high coverage and adherence rates in the targeted villages, with 92% (553/600) coverage in round one and 65% (387/600) in round two. Adherence rate was 99% (551/553) in round one and 98% (377/387) in round two. The study found that forest goers preferred taking Pyramax over repeated testing consistent with the coverage rates: 92% in round one compared to 65% in round two. All individuals reachable through health stations or mobile teams reported complete IPTf uptake. No severe adverse events were reported. Only six individuals reported mild adverse events, such as loss of energy, fever, abdominal pain, diarrhoea, and muscle aches. Two individuals attributed their symptoms to heavy alcohol intake following prophylaxis. CONCLUSIONS: The targeted malaria outbreak response demonstrated high acceptability, safety, and feasibility of the selected interventions. Malaria transmission was rapidly controlled using the available community resources. This experience suggests the effectiveness of the programmatic response for future outbreaks.

A novel potentiometric screen-printed electrode based on crown ethers/nano manganese oxide/Nafion composite for trace level determination of copper ion in biological fluids.

Copper levels in biological fluids are associated with Wilson's, Alzheimer's, Menke's, and Parkinson's diseases, making them good biochemical markers for these diseases. This study introduces a miniaturized screen-printed electrode (SPE) for the potentiometric determination of copper(II) in some biological fluids. Manganese(III) oxide nanoparticles (Mn2O3-NPs), dispersed in Nafion, are drop-casted onto a graphite/PET substrate, serving as the ion-to-electron transducer material. The solid-contact material is then covered by a selective polyvinyl chloride (PVC) membrane incorporated with 18-crown-6 as a neutral ion carrier for the selective determination of copper(II) ions. The proposed electrode exhibits a Nernstian response with a slope of 30.2 ± 0.3 mV/decade (R2 = 0.999) over the linear concentration range 5.2 × 10-9 - 6.2 × 10-3 mol/l and a detection limit of 1.1 × 10-9 mol/l (69.9 ng/l). Short-term potential stability is evaluated using constant current chronopotentiometry (CP) and electrochemical impedance spectroscopy (EIS). A significant improvement in the electrode capacitance (91.5 µF) is displayed due to the use of Mn2O3-NPs as a solid contact. The presence of Nafion, with its high hydrophobicity properties, eliminates the formation of the thin water layer, facilitating the ion-to-electron transduction between the sensing membrane and the conducting substrate. Additionally, it enhances the adhesion of the polymeric sensing membrane to the solid-contact material, preventing membrane delamination and increasing the electrode's lifespan. The high selectivity, sensitivity, and potential stability of the proposed miniaturized electrode suggests its use for the determination of copper(II) ions in human blood serum and milk samples. The results obtained agree fairly well with data obtained by flameless atomic absorption spectrometry.

Long-term clinical outcomes of intravascular imaging-guided percutaneous coronary intervention versus angiography-guided percutaneous coronary intervention in complex coronary lesions: a systematic review and meta-analysis.

Background: In this study, we aim to discuss the long-term clinical outcomes of intravascular ultrasound imaging-guided percutaneous intervention (IVUS-PCI) versus angiography-guided percutaneous coronary intervention (PCI) in complex coronary lesions over a mean period of 2 years. Methods: A systematic search and meta-analysis were conducted to assess the efficacy of using intravascular ultrasound or optical coherence tomography guidance in coronary artery stenting compared to angiography. Results: A total of 11 randomized controlled trials with 6740 patients were included. For the primary outcome, a pooled analysis (3.2 vs 5.6%). For secondary outcomes, the risk was significantly low in image-guided percutaneous intervention compared with angiography. Conclusion: Intravascular imaging-guided PCI is significantly more effective than angiography-guided PCI in reducing the risk of target lesion revascularization, target vessel revascularization, cardiac death, major adverse cardiovascular events and stent thrombosis.

A meta-analysis was conducted to compare intravascular ultrasound guidance/optical coherence tomography percutaneous coronary intervention with angiography percutaneous coronary intervention with target lesion revascularization as the primary outcome and target vessel revascularization, stent thrombosis, myocardial infarction, major adverse cardiovascular events, all cause death and cardiac death as the secondary outcomes.

Exploring the Antimicrobial, Antioxidant, and Antiviral Potential of Eco-Friendly Synthesized Silver Nanoparticles Using Leaf Aqueous Extract of Portulaca oleracea L.

Herein, the prospective applications of green fabricated silver nanoparticles (Ag-NPs) within the biomedical field were investigated. The leaf aqueous extract of Portulaca oleracea L., a safe, cheap, and green method, was used to fabricate Ag-NPs. The maximum plasmon resonance of synthesized NPs has appeared at 420 nm. The various biomolecules present in the plant extract to assemble spherical Ag-NPs with sizes of 5-40 nm were analyzed using Fourier transform infrared and transmission electron microscopy. The Ag was the major content of the formed Ag-NPs with an atomic percent of 54.95% and weight percent of 65.86%, as indicated by EDX. The crystallographic structure of synthesized NPs was confirmed by the diffraction of the X-ray. The dynamic light scattering exhibits the homogeneity and mono-dispersity nature with a polydispersity index of 0.37 in the colloidal fluid and a zeta potential value of -36 mV. The synthesized Ag-NPs exhibited promising antimicrobial efficacy toward various prokaryotic and eukaryotic pathogenic microorganisms with low MIC values of 12.5 µg mL-1 and 6.25 µg mL-1, respectively. Additionally, the P. oleracea-formed Ag-NPs showed optimistic antioxidant activity assessed by DPPH and H2O2 assay methods with the highest scavenging percentages of 88.5 ± 2.3% and 76.5 ± 1.7%, respectively, at a concentration of 200 µg mL-1. Finally, the biosynthesized Ag-NPs showed high antiviral properties toward the hepatitis A virus and Cox-B4 with inhibition percentages of 79.16 ± 0.5% and 73.59 ± 0.8%, respectively. Overall, additional research is essential to explore the Ag-NP-based aqueous extract of P. oleracea for human health. In the current investigation the use of synthesized Ag-NPs as antimicrobial, antioxidant, and antiviral agents to protect against pathogenic microbes, degenerative diseases caused by various oxidative stresses, and deadly viruses is recommended.

Linking abusive supervision to service sabotage through work alienation in nurses: A cross-sectional study.

BACKGROUND: Abusive supervision has detrimental effects on nurses, but the mechanisms connecting abusive supervision to negative outcomes for nurses have not been well-established in the nursing literature. AIM: This study aimed to investigate whether work alienation mediates the relationship between abusive supervision and nurses' service sabotage. METHODS: This descriptive cross-sectional study was conducted from November to December 2021 with 204 nurses working at a teaching hospital in Damanhour, Egypt. Data were collected using a demographic information form, the Abusive Supervision Scale, the Work Alienation Scale and the Service Sabotage Scale. Study hypotheses were evaluated using structural equation modelling. RESULTS: Our findings revealed a significant association between abusive supervision, work alienation, and service sabotage among nurses. Abusive supervision was found to be linked to nurses' service sabotage through work alienation. CONCLUSION: Our study suggests that nurses who are subject to abusive supervision are more likely to feel alienated, which increases the probability of them engaging in behaviours that have a negative impact on the quality of care they provide. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Synthesis and characterization of bio-nanocomposite based on chitosan and CaCO3 nanoparticles for heavy metals removal.

Water is a vital component of life; therefore, it is critical to have access to pure water for various life-sustaining activities including agriculture and human consumption. An eco-friendly nanocomposite based on chitosan (Cs) and nanomaterials (CaCO3-NPs) were combined to amalgamate the advantages of biopolymers and nanomaterials to overcome the problems of instability, poor mechanical properties, and low removal percentage of biopolymers. The as-prepared samples were characterized and were used for the removal of heavy metal from wastewater. X-ray diffractometer, Fourier transform infrared spectroscopy, and transmission electron microscope were used to distinguish the prepared absorbents. The absorption of the heavy metals by as-prepared samples was examined at different conditions. The kinetic and isotherm models of the adsorption process were also studied. The data showed that the removal percentages of Cd, Cu, Pb, Zn, Cr and Ni by the composite were 98.0, 94.8, 99.0, 97.9, 97.4 and 98.3 %, respectively. The kinetic and isothermal studies showed that the absorption of these metal ions by the samples obeyed a pseudo-second-order mechanism and Langmuir isotherm model, respectively. In addition, the maximum adsorption capacities of Cd, Cu, Pb, Zn, Cr, and Ni ions by as-prepared nanocomposite were 83.33, 47.84, 98.03, 89.28, 62.11, and 63.69 mg/g, respectively.

Characterization of Some "Hashish" Samples in the Egyptian Illicit Trafficking Market Using a Thermal Separation Probe and Gas Chromatography-Mass Spectrometry.

Drugs that are illegal have long been a part of Egyptian society. The most widely misused form of narcotic is marijuana, also known as "bango", and other cannabis-related products like "hashish". The chemical profile of some available "hashish" in the local Egyptian illegal market and its possible country of origin are investigated using a gas chromatography-mass spectrometry technique in conjunction with a thermal separation probe (TSP/GC/MS). The TSP/GC/MS method reveals the presence of 23 different terpenes, of which caryophylla-4(12),8(13)-dien-5α-ol, isoaromadendrene epoxide, caryophyllene, and alloaromadendrene oxide-(1) are detected in high relative proportions. Ten cannabinoid components are also detected. These are cannabiorcochromene (CBC-C1), tetrahydrocannabivarin (THCV), delta-8-tetrahydrocannabinol (delta-8-THC), exo-THC, cannabichromene, cannabidiol (CBD), cannabielsoin (CBE), dronabinol (delta-9-THC), cannabigerol (CBG), and cannabinol (CBN). Phenotypic index (THC % + CBN %)/CBD %) is measured for the test samples to identify both the nature of the samples (fiber- or drug-type cannabis) and the country of origin.

An Eco-Friendly Approach Utilizing Green Synthesized Titanium Dioxide Nanoparticles for Leather Conservation against a Fungal Strain, Penicillium expansum AL1, Involved in the Biodeterioration of a Historical Manuscript.

The main hypothesis of the present research is investigating the efficacy of titanium oxide nanoparticles (TiO2-NPs) to prevent the growth of fungal strains when applied on leather under an experimental study. Therefore, fifteen fungal strains were isolated from a deteriorated historical manuscript (papers and leathers) and identified by traditional methods and ITS sequence analysis, including Aspergillus chevalieri (one isolate), A. nidulans (two strains), A. flavus (four strains), A. cristatus (one strain), A. niger (one strain), Paecilomyces fulvus (two strains), Penicillium expansum (two strains), and P. citrinum (two strains). The enzymes cellulase, amylase, pectinase, and gelatinase, which play a crucial role in biodegradation, were highly active in these fungal strains. TiO2-NPs were formed using the cell-free filtrate of the probiotic bacterial strain, Lactobacillus plantarum, and characterized. Data showed that the TiO2-NPs were successfully formed with a spherical shape and anatase phase with sizes of 2-8 nm. Moreover, the EDX analysis revealed that the Ti and O ions occupied the main component with weight percentages of 41.66 and 31.76%, respectively. The in vitro cytotoxicity of TiO2-NPs toward two normal cell lines, WI38 and HFB4, showed a low toxicity effect against normal cells (IC50 = 114.1 ± 8.1µg mL-1 for Wi38, and 237.5 ± 3.5µg mL-1 for HFB4). Therefore, concentrations of 100 µg mL-1 were used to load on prepared leather samples before inoculation with fungal strain P. expansum AL1. The experimental study revealed that the loaded TiO2-NPs have the efficacy to inhibit fungal growth with percentages of 73.2 ± 2.5%, 84.2 ± 1.8%, and 88.8 ± 0.6% after 7, 14, and 21 days, respectively. Also, the analyses including SEM, FTIR-ART, color change, and mechanical properties for leather inoculated with fungal strain AL1 in the absence of NPs showed high damage aspects compared to those inoculated with fungal strains in the presence of TiO2-NPs.

Antifungal Activity of Cell-Free Filtrate of Probiotic Bacteria Lactobacillus rhamnosus ATCC-7469 against Fungal Strains Isolated from a Historical Manuscript.

Herein, twelve fungal strains were isolated from a deteriorated historical manuscript dated back to the 18th century. The obtained fungal strains were identified, using the traditional method and ITS sequence analysis, as Cladosporium herbarum (two strains), Aspergillus fumigatus (five strains), A. ustus (one strain), A. flavus (two strains), A. niger (one strain), and Penicillium chrysogenum (one strain). The ability of these fungal strains to degrade the main components of the paper was investigated by their activity to secrete extracellular enzymes including cellulase, amylase, gelatinase, and pectinase. The cell-free filtrate (CFF) ability of the probiotic bacterial strain Lactobacillus rhamnosus ATCC-7469 to inhibit fungal growth was investigated. The metabolic profile of CFF was detected by GC-MS analysis, which confirmed the low and high molecular weight of various active chemical compounds. The safe dose to be used for the biocontrol of fungal growth was selected by investigating the biocompatibility of CFF and two normal cell lines, Wi38 (normal lung tissue) and HFB4 (normal human skin melanocyte). Data showed that the CFF has a cytotoxic effect against the two normal cell lines at high concentrations, with IC50 values of 525.2 ± 9.8 and 329.1 ± 4.2 µg mL-1 for Wi38 and HFB4, respectively. The antifungal activity showed that the CFF has promising activity against all fungal strains in a concentration-dependent manner. The highest antifungal activity (100%) was recorded for a concentration of 300 µg mL-1 with a zone of inhibition (ZOI) in the ranges of 21.3 ± 0.6 to 17.7 ± 0.5 mm. At a concentration of 100 µg mL-1, the activity of CFF remained effective against all fungal strains (100%), but its effectiveness decreased to only inhibit the growth of eight strains (66%) out of the total at 50 µg mL-1. In general, probiotic bacterial strains containing CFF are safe and can be considered as a potential option for inhibiting the growth of various fungal strains. It is recommended that they be used in the preservation of degraded historical papers.

The relationship between nursing students' readiness and attitudes for E-learning: The mediating role of self leadership: An online survey (comparative study).

BACKGROUND: To meet the learning demands of new generation students, higher education institutions should apply relevant breakthroughs in science, technology, and education to update their educational policies or teaching techniques. Aim To investigate the relationship between nursing students' readiness and attitudes toward e-learning, as well as the role of self­leadership in mediating this relationship. METHODS: This is a descriptive comparative research. A total of 410 students consented to participate after being recruited from two nursing colleges at Alexandria and Damanhur Universities in Egypt and completing self-administered, online surveys. RESULTS: The majority of the participants (83.3 % and 76.9 %, respectively) were female from Alexandria and Damanhur University, and their mean self­leadership scores were 3.89.49 at Alexandria and 3.65.40 at Damanhur University. According to the SEM, self­leadership accounted for 74 % of the variance in students' attitudes and 87 % of the variance in students' readiness for e-learning. CONCLUSION: Self­leadership is an important predictor of students' attitudes and readiness for e-learning. The study's implications: Self­leadership allows students to accept responsibility for themselves, and the idea that one can be accountable for guiding oneself through life is thrilling, especially in today's environment.

Green Synthesis of Zinc Oxide Nanoparticles Using an Aqueous Extract of Punica granatum for Antimicrobial and Catalytic Activity.

The peel aqueous extract of Punica granatum was utilized to fabricate zinc oxide nanoparticles (ZnO-NPs) as a green approach. The synthesized NPs were characterized by UV-Vis spectroscopy, Fourier transform infrared (FT-IR), X-ray diffraction (XRD), transmission electron microscopy (TEM), and scanning electron microscopy, which was attached to an energy dispersive X-ray (SEM-EDX). Spherical, well arranged, and crystallographic structures of ZnO-NPs were formed with sizes of 10-45 nm. The biological activities of ZnO-NPs, including antimicrobial and catalytic activity for methylene blue dye, were assessed. Data analysis showed that the antimicrobial activity against pathogenic Gram-positive and Gram-negative bacteria, as well as unicellular fungi, was observed to occur in a dose-dependent manner, displaying varied inhibition zones and low minimum inhibitory concentration (MIC) values in the ranges of 6.25-12.5 µg mL-1. The degradation efficacy of methylene blue (MB) using ZnO-NPs is dependent on nano-catalyst concentration, contact time, and incubation condition (UV-light emission). The maximum MB degradation percentages of 93.4 ± 0.2% was attained at 20 µg mL-1 after 210 min in presence of UV-light. Data analysis showed that there is no significant difference between the degradation percentages after 210, 1440, and 1800 min. Moreover, the nano-catalyst showed high stability and efficacy to degrade MB for five cycles with decreasing values of 4%. Overall, P. granatum-based ZnO-NPs are promising tools to inhibit the growth of pathogenic microbes and degradation of MB in the presence of UV-light emission.

Predictors of severity and outcome of multiple sclerosis relapses.

BACKGROUND: Multiple Sclerosis (MS) is a demyelinating disease of the central nervous system (CNS). The most common type of MS is the relapsing-remitting MS (RRMS) where relapses are the main component of the disease course. However, the relationship between the characteristics of the relapses on one hand and their severity and outcome on the other hand has not been fully characterized. OBJECTIVES: To explore the characteristics of relapses among a cohort of Egyptian MS patients and their relation to the severity and outcome of the disease. SUBJECTS AND METHODS: We analyzed 300 attacks from 223 patients in a retrospective study to identify demographic, clinical and paraclinical (laboratory and radiological) factors affecting: 1- Severity of relapses (the difference between the EDSS at the day of maximum worsening and the EDSS before the onset of the attack). 2- Outcome of relapses (the difference between the EDSS at the day of maximum improvement and the EDSS before the onset of the relapse). RESULTS: Severe attacks were most likely to occur in patients who are males, single, presenting with poly-symptomatic presentation, slower tempo of evolution of attack symptoms, longer duration of the attack, absence of DMTs at the time of the attack. The risk of having a severe relapse is more than 3 times when the patient is single. Regarding attack outcome, poorly recovered attacks were more common in patients with older age at disease onset and at attack onset, male sex, higher number of relapses, longer duration of illness prior to the attack, severe relapses, polysymptomatic presentation, associated cognitive symptoms, slower tempo of symptom evolution, longer duration of the attack, patients on OCPs, smoking, and presence of black holes in brain MRI. The risk of having relapses with partial or no recovery is more than five times when the patient has black holes in brain MRI and more than 4 times when the patient is a smoker. CONCLUSION: Bearing in mind the demographic characteristics as well as the clinical and paraclinical characteristics of each attack and their relation to attack severity and outcome are a key to understanding the individual disease course of every patient and hence tailoring the best therapeutic plan suitable for his individual needs. In other words, prompt, rapid intervention in male patients, polysymptomatic attacks, slower tempo of evolution of attack symptoms and longer duration of the attack should be adopted since these factors are predictive of severe relapses as well as poor relapse outcome.

All-solid-state paper-based potentiometric combined sensor modified with reduced graphene oxide (rGO) and molecularly imprinted polymer for monitoring losartan drug in pharmaceuticals and biological samples.

A cost-effective, highly selective and sensitive paper-based potentiometric combined sensor for losartan potassium drug (LOS) is fabricated, characterized and used for the drug monitoring. The sensor consists of 2 strips of filter paper (20 × 5 mm each) as platform, each imprinted with 4 mm diameter circular spot of carbon. One carbon spot is covered by a reduced graphene oxide (rGO) for use as a substrate for the recognition sensor and the other without rGO is used for the reference electrode. LOS molecularly imprinted drug polymer (MIP) is applied onto the graphene oxide containing strip to act as a drug recognition sensing material and a solid-state polyvinyl butyral (PVB) is applied onto the second carbon spot to act as a reference electrode. Performance characteristics of the combined sensor are examined with chronopotentiometry (CP) and electrochemical impedance spectroscopy (EIS). Increase effect of rGO on the interfacial double-layer capacitance of the sensing membrane and consequently on the potential stability is confirmed. The developed combined sensor (strip cell) displays a Nernstian slope of -58.2 ± 0.3 mV/decade (R2 = 0.9994) over the linear range 8.5 × 10-7 - 6.9 × 10-2 M with a detection limit of 2.7 ± 0.3 × 10-7 M. The sensor shows remarkable selectivity toward various related compounds especially those commonly used by the COVID-19 patients such as paracetamol, ascorbic acid and dextromethorphan. The assay method is validated and proved to be satisfactory for direct potentiometric determination of LOS-K in some pharmaceutical formulations and in spiked human urine samples. An average recovery of 96.3 ± 0.3-98.7 ± 0.6% of the nominal or spiked concentration and a mean relative standard deviation of ±0.6% are obtained. The use of an indicating and a reference electrodes combined into a single flexible disposable paper platform enables applications to a minimum sample volume due to the close proximity of the responsive membrane and the liquid junction. The efficiency of the proposed sensor in complex urine matrix suggests its application in hospitals for rapid diagnosis of overdose patients and for quality control/quality assurance tests in pharmaceutical industry.