The da Vinci robotic surgery system for the management of endometrial cancer: a single-center experience.

The aim of this study was to report our single-center experience of the da Vinci robotic surgery system in the management of endometrial cancer (EC) patients during 2019-2023. We descriptively summarized the preoperative, intraoperative, and postoperative outcomes. Moreover, we conducted subgroup analyses based on obesity (BMI ≥ 30 kg/m2) and the intraoperative use of indocyanine green dye (ICG). Overall, 100 patients were analyzed. Eighty-five patients (85%) were obese. The mean operative time and estimated blood loss (EBL) were 240.84 ± 70.08 min (range: 110-720) and 104.2 ± 80.3 ml (range: 20-500), respectively. The mean number of retrieved pelvic LNs was 3.01 ± 3.06 (range: 0-15). The use of ICG was employed in 58 (58%). Only a single patient (1%) underwent conversion to laparotomy. Besides, only three (3%) patients experienced vaginal laceration intraoperatively, respectively. The mean hospital stay was 1.34 ± 0.69 days (range: 1-5). No patient experienced postoperative complications. Most tumors had endometrioid histology (82%), grade-1 tumor (49%), and stage-1A disease (67%). At 3-year follow-up, only two patients (2%) developed recurrence. Patients who received the ICG had significantly lower operative time (225.86 vs. 261.52 min, p = 0.011), estimated blood loss (90 vs. 123.81 ml, p = 0.037), and hospital stay (1.12 vs. 1.64 days, p < 0.001) compared with patients who did not receive it. However, there was no significant difference between both groups regarding the number of retrieved pelvic LNs. Obesity had no significant impact on the rates of intraoperative complications, postoperative complications, and 3-year recurrence incidence. In conclusion, robotic surgery was technically feasible and safe. The use of ICG was statistically linked to favorable outcomes, in terms of decreased operative time, EBL, and hospital stay. Obesity did not impact the perioperative surgical outcomes.

Effect of Vaginal Washing before Intravaginal Prostaglandin Insertion on Induction of Labor: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

OBJECTIVE: Saline vaginal douching prior to intravaginal prostaglandin application might increase the vaginal pH, leading to improvement of prostaglandin bioavailability, by which the outcomes of labor induction can be greatly improved. Thus, we aimed to evaluate the effect of vaginal washing with normal saline before insertion of vaginal prostaglandin for labor induction. STUDY DESIGN: A systematic search was done in PubMed, Cochrane Library, Scopus, and ISI Web of Science from inception to March 2022. We selected randomized controlled trials (RCTs) that compared vaginal washing using normal saline versus no vaginal washing in the control group before intravaginal prostaglandin insertion during labor induction. We used RevMan software for our meta-analysis. Our main outcomes were the duration of intravaginal prostaglandin application, duration from intravaginal prostaglandin insertion to active phase of labor, duration from intravaginal prostaglandin insertion till total cervical dilatation, labor induction failure rate, incidence of cesarean section (CS), and rates of neonatal intensive care unit (NICU) admission and fetal infection postdelivery. RESULTS: Five RCTs were retrieved with a total number of 842 patients. Duration of prostaglandin application, duration from prostaglandin insertion to active phase of labor, and time interval from prostaglandin insertion to total cervical dilatation were significantly shorter among vaginal washing group (p < 0.05). Vaginal douching prior to prostaglandin insertion significantly decreased the incidence of failed labor induction (p < 0.001). After the removal of reported heterogeneity, vaginal washing was linked to a significant decline in CS incidence (p = 0.04). In addition, the rates of NICU admission and fetal infection were significantly lower in the vaginal washing group (p < 0.001). CONCLUSION: Vaginal washing with normal saline before intravaginal prostaglandin insertion is a useful and easily applicable method for labor induction with good outcomes. KEY POINTS: · Induction of labor is frequently used in the obstetrics field.. · We assessed vaginal washing impact before prostaglandin insertion for labor induction.. · Vaginal washing is an easily applicable method for labor induction with good outcomes..

Association Between Time Spent on Electronic Devices and Body Mass Index in Young Adults.

Objective: To evaluate the association between time spent on electronic devices (TSED) and body mass index in young adults. Methods: This cross-sectional study was conducted from June to December 2021 on 1877 students (aged 18-22 yrs) from multiple health Colleges of Imam Abdulrahman Bin Faisal University. The main tools of the study were 1) Body mass index (BMI) and an online questionnaire. The subjects were categorized into 3 main groups based on their TSED: 1) Low TSED < 2 hours/day, 2) Medium TSED= 3 to 5 hours/day, 3) Excessive TSED ≥ 6 hours /day. Based on BMI, subjects were categorized into three main groups: Normal and underweight (BMI ≤ 24.9), overweight (BMI > 25-29.9), and obese (BMI > 30). Results: Participants' average age was 20 ± 2 years. The average BMI was 23.5 k/m2. The % of students falling into the categories of normal weight, overweight, and obesity was 69.2%, 19.05%, and 11.7% respectively. The average TSED of study participants was 8.2 ± 3.45 hrs /24 hours. 71.15% of participants indicated a TSED of ≥6 hrs/24 hours and 23.71% reported a TSED of 3-5 hrs/24 hours. Only 3.15% of participants reported TSED of ≤2 hrs/24 hours. Although a rise in the mean BMI was observed with an increase in the TSED, but this difference was not statistically significant. The pairwise wise comparison also failed to demonstrate any difference in BMI between different categories of TSED. Furthermore, no significant positive correlation was found between increased BMI and excessive TSED (P = 0.37). Conclusion: A high percentage of young adults (31.2%) were overweight or obese, but excessive TSED was not significantly associated with increased BMI in this study population. Further studies are recommended to identify the effects of other factors in causing increased BMI in young adults.

Elastic Nanofibrous Membranes for Medical and Personal Protection Applications: Manufacturing, Anti-COVID-19, and Anti-Colistin Resistant Bacteria Evaluation.

Herein, in the present work two series of thermoplastic polyurethane (TPU) nanofibers were manufactured using the electrospinning techniques with ZnO and CuO nanoparticles for a potential use as an elastic functional layer in antimicrobial applications. Percentages of 0%, 2 wt%, and 4 wt% of the nanoparticles were used. The morphological characterization of the electrospun TPU and TPU/NPs composites nanofibers were observed by using scanning electron microscopy to show the average fiber diameter and it was in the range of 90-150 nm with a significant impact of the nanoparticle type. Mechanical characterization showed that TPU nanofiber membranes exhibit excellent mechanical properties with ultra-high elastic properties. Elongation at break reached up to 92.5%. The assessment of the developed nanofiber membranes for medical and personal protection applications was done against various colistin resistant bacterial strains and the results showed an increment activity by increasing the metal oxide concentration up to 83% reduction rate by using TPU/ZnO 4% nanofibers against K. pneumoniae strain 10. The bacterial growth was completely eradicated after 8 and 16 h incubation with TPU/ZnO and TPU/CuO nanofibers, respectively. The nanofibers SEM study reveals the adsorption of the bacterial cells on the metal oxides nanofibers surface which led to cell lysis and releasing of their content. Finally, in vitro study against Spike S-protein from SARS-CoV-2 was also evaluated to investigate the potent effectiveness of the proposed nanofibers in the virus deactivation. The results showed that the metal oxide concentration is an effective factor in the antiviral activity due to the observed pattern of increasing the antibacterial and antiviral activity by increasing the metal oxide concentration; however, TPU/ZnO nanofibers showed a potent antiviral activity in relation to TPU/CuO.

Biodegradable Nanofibrous Membranes for Medical and Personal Protection Applications: Manufacturing, Anti-COVID-19 and Anti-Multidrug Resistant Bacteria Evaluation.

Biodegradable nanofibrous hybrid membranes of polyvinyl alcohol (PVA) with ZnO and CuO nanoparticles were manufactured and characterized, and their anti-COVID-19 and anti-multidrug resistant bacteria activities were also evaluated. The morphological structures of the prepared PVA composites nanofibers were observed by scanning electron microscope (SEM), which revealed a homogenous pattern of the developed nanofibers, with an average fibrous diameter of 200-250 nm. Moreover, the results of the SEM showed that the fiber size changed with the type and the concentration of the metal oxide. Moreover, the antiviral and antibacterial potential capabilities of the developed nanofibrous membranes were tested in blocking the viral fusion of SARS-COV-2, as a representative activity for COVID-19 deactivation, as well as for their activity against a variety of bacterial strains, including multi-drug resistant bacteria (MDR). The results revealed that ZnO loaded nanofibers were more potent antiviral agents than their CuO analogues. This antiviral action was attributed to the fact that inorganic metallic compounds have the ability to extract hydrogen bonds with viral proteins, causing viral rupture or morphological changes. On the other hand, the anti-multi-drug resistant activity of the prepared nanofibers was also evaluated using two techniques; the standard test method for determining the antimicrobial activity of immobilized antimicrobial agents under dynamic contact conditions and the standard test method for determining the activity of incorporated antimicrobial agents in polymeric or hydrophobic materials. Both techniques proved the superiority of the ZnO loaded nanofibers over the CuO loaded fibers. The results of the antiviral and antibacterial tests showed the effectiveness of such nanofibrous formulas, not only for medical applications, but also for the production of personal protection equipment, such as gowns and textiles.

Hybrid Nanofibrous Membranes as a Promising Functional Layer for Personal Protection Equipment: Manufacturing and Antiviral/Antibacterial Assessments.

In this research work, nanofibrous hybrids are manufactured, characterized, and assessed as active antiviral and antibacterial membranes. In more detail, both polyvinyl alcohol (PVA) and thermoplastic polyurethane (TPU) nanofibrous (NF) membranes and their composites with embedded silver nanoparticles (Ag NPs) are manufactured by an electrospinning process. Their morphological structures have been investigated by a scanning electron microscope (SEM) which revealed a homogenous distribution and almost beads-free fibers in all manufactured samples. Characterization with spectroscopic tools has been performed and proved the successful manufacturing of Ag-incorporated PVA and TPU hybrid nanofibers. The crystalline phase of the nanofibers has been determined using an X-ray diffractometer (XRD) whose patterns showed their crystalline nature at an angle value (2θ) of less than 20°. Subsequent screening of both antiviral and antibacterial potential activities of developed nanohybrid membranes has been explored against different viruses, including SARS-Cov-2 and some bacterial strains. As a novel approach, the current work highlights potential effects of several polymeric hybrids on antiviral and antibacterial activities particularly against SARS-Cov-2. Moreover, two types of polymers have been tested and compared; PVA of excellent biodegradable and hydrophilic properties, and TPU of excellent mechanical, super elasticity, hydrophobicity, and durability properties. Such extreme polymers can serve a wide range of applications such as PPE, filtration, wound healing, etc. Consequently, assessment of their antiviral/antibacterial activities, as host matrices for Ag NPs, is needed for different medical applications. Our results showed that TPU-Ag was more effective than PVA-Ag as HIV-1 antiviral nanohybrid as well as in deactivating spike proteins of SARS-Cov-2. Both TPU-Ag and PVA-Ag nanofibrous membranes were found to have superior antimicrobial performance by increasing Ag concentration from 2 to 4 wt.%. Additionally, the developed membranes showed acceptable physical and mechanical properties along with both antiviral and antibacterial activities, which can enable them to be used as a promising functional layer in Personal Protective Equipment (PPE) such as (surgical gowns, gloves, overshoes, hair caps, etc.). Therefore, the developed functional membranes can support the decrease of both coronavirus spread and bacterial contamination, particularly among healthcare professionals within their workplace settings.

Exploring patient-safety culture in the community pharmacy setting: a national cross-sectional study.

OBJECTIVE: The community pharmacy is one setting that plays a crucial role in patient safety. To develop tailored patient safety improvement programs in this setting, it is essential to know the perspectives of the pharmacies' staffs on patient safety. Thus, in this study, we assessed patient-safety culture in the community pharmacy setting in Saudi Arabia. METHODS: Between January and August of 2019, we conducted a cross-sectional study among staff working in the community pharmacies in Saudi Arabia. Data on patient safety culture were collected using the Pharmacy Survey on Patient Safety Culture (PSOPSC). Analyses were performed with descriptive statistics (frequency/percentages), Fisher's Exact test, Chi-square analysis, and multivariable ordinal logistic regression with proportional odds model analysis. RESULTS: PSOPSC data from 805 community pharmacies in Saudi Arabia were received (response rate: 78%). The overall average positive response rate for the 11 dimensions of the PSOPSC survey was 60.2%, with a range from 34.8% in the dimension of Staffing, Work Pressure, and Pace to 76.4% in the dimension of Teamwork. Most participants responded positively, as in total, 504 (62.6%) of the participants rated their pharmacy as 'excellent' or 'very good' on patient safety. Gender and work experience in a pharmacy were important predictors of the overall patient safety grade. CONCLUSIONS: The study revealed that all dimensions are scope for further improvement, and critical consideration ought to be given to the areas of weakness, for the most part in the dimension of Staffing, Work Pressure, and Pace.

Experimental and Computational Approaches of Newly Polymorphic Supramolecular H-Bonded Liquid Crystal Complexes.

New 1:2 liquid crystalline supramolecular H-bonded complexes (SMHBCs) were synthesized through double H-bond interactions between 4-(nicotinoyloxy) phenyl nicotinate as the base component and two molecules of 4-n-alkoxybenzoic acid (An). The base component was expected to be in two conformers according to the orientation of the N atom and the carboxylate group, syn conformer (I) and anti-conformer (II). DFT calculations revealed that only one of the two possible conformers of I exists, and the addition of the two molecules of the alkoxy acids (A n) did not affect its conformation. The mesomorphic properties of all of the prepared complexes (I/A n), bearing different terminal flexible alkoxy chains were investigated, and the formation of the H-bonds were confirmed by differential scanning calorimetry (DSC), and the phases were identified by polarized optical microscopy (POM), and FT-IR spectroscopy. Highly thermally stable mesophases possessing broad temperature ranges were observed for all investigated complexes compared to their individual components. Depending on the length of the terminal flexible alkoxy chain, the prepared SMHBCs were shown to exhibit di- or tri-morphic enantiotropic mesophases. The effect of replacing one of the -COO- connecting units by an azo group (-N=N-) in the basic molecule (I), on the mesomorphic properties has been investigated experimentally (via DSC) and theoretically (via DFT). The DFT calculations revealed that the polarizability, the dipole moment, and the aspect ratio of the investigated SMHBCs are lower than those of their corresponding ester/azo analogs. All these factors rationalize the enhanced smectic mesophase ranges of the complexes compared with those of the ester/azo analogs. The high aspect ratios and dipole moments of the SMHBCs of the azo derivative enforces the lateral intermolecular attraction that permits the formation of the more ordered smectic C mesophase with respect to the enhanced polymorphic mesophases of the diester derivative.

New Symmetrical U- and Wavy-Shaped Supramolecular H-Bonded Systems; Geometrical and Mesomorphic Approaches.

New mesomorphic symmetrical 2:1 supramolecular H-bonded complexes of seven phenyl rings were prepared between 4-n-alkoxyphenylazobenzoic acids and 4-(2-(pyridin-3-yl)diazenyl)phenyl nicotinate. Mesomorphic studies of the prepared complexes were investigated using differential scanning calorimetry (DSC) and polarizing optical microscopy (POM). Fermi bands of the formed H-bonded interactions were confirmed by FT-IR spectroscopy. Geometrical parameters for all complexes were performed using the density functional theory (DFT) calculations method. Theoretical results revealed that the prepared H-bonded complexes are in non-linear geometry with U-shaped and wavy-shaped geometrical structures; however, the greater linearity of the wavy-shaped compounds could be the reason for their stability with respect to the U-shaped conformer. Moreover, the stable, wavy shape of supramolecular H-bonded complexes (SMHBCs) has been used to illustrate mesomeric behavior in terms of the molecular interaction. The experimental mesomorphic investigations revealed that all complexes possess enantiotropic smectic C phase. Phases were confirmed by miscibility with a standard smectic C (SmC) compound. A comparison was constructed to investigate the effect of incorporating azophenyl moiety into the mesomeric behavior of the corresponding five-membered complexes. It was found that the addition of the extra phenylazo group to the acid moiety has a great increment of the mesophase stability (TC) values with respect to the monotropic SmC phase of the five aromatic systems to the high stable enantiotropic SmC mesophase.