Neonatal Subcutaneous Emphysema Secondary to Chest Tube Placement Using the Trocar Technique: A Case Report.

Subcutaneous emphysema is a type of air leak in which air accumulates within the subcutaneous layer of the skin underneath the dermal layers. The accumulation of air can be seen on imaging in relevant body areas such as the abdomen, chest, face, or neck. During physical examination, crepitus, the sensation or sound of crackling upon palpation, is the most common associated finding. Various causes for subcutaneous emphysema exist, with one such cause being thoracostomy or chest tube placement. The trocar technique, in particular, has been associated with greater complications when compared to other techniques. Here, we present a case of subcutaneous emphysema in a neonate occurring after placement of a chest tube using the trocar technique. At this time, much of the knowledge regarding subcutaneous emphysema related to chest tube placement is in the adult population. Clinicians should be aware of this complication in neonates as the body of knowledge regarding this topic continues to grow.

Radiological characteristics of invasive micropapillary carcinoma of the breast.

AIM: To analyse the various imaging features of invasive micropapillary carcinoma (IMPC), a distinct variant of breast cancer, by mammography, ultrasound, and contrast-enhanced mammography. MATERIALS AND METHODS: This study included 68 female patients with histopathologically proven invasive micropapillary carcinoma who underwent mammography, ultrasound, and contrast-enhanced mammography examinations. The findings encountered by each imaging tool were analysed using the Breast Imaging Reporting and Data System (BI-RADS) lexicon. RESULTS: In this retrospective study, 64.7% of cases were of the pure form of IMPC. Most of the cases showed an aggressive clinical course, with lymphovascular invasion noted in 76.5% of cases, while 60.3% of cases showed associated pathological lymphadenopathy. The N3 stage was reported in 25% of cases. On analysing the mammographic and ultrasound imaging findings, a significant association between irregular shape and a non-circumscribed margin with IMPC was found. Associated calcification was noted in 47% of cases. Pathological enhancement of moderate or marked conspicuity was noted in cases that underwent contrast-enhanced mammography, with the most commonly encountered finding being enhancing irregular and non-circumscribed masses. CONCLUSION: The mammographic and ultrasound imaging features of IMPC are indistinguishable from other aggressive types of breast cancer. At contrast-enhanced mammography examination, pathological enhancement of moderate to marked conspicuity was shown in all cases. The observed strong association of IMPC with lymphovascular invasion and lymph node metastasis with higher nodal stage in this study mandate meticulous sonographic examination of the axilla, as well as the infra, and supraclavicular regions if pathological axillary lymphadenopathy was noted.

Harnessing Machine Learning in Early COVID-19 Detection and Prognosis: A Comprehensive Systematic Review.

During the early phase of the COVID-19 pandemic, reverse transcriptase-polymerase chain reaction (RT-PCR) testing faced limitations, prompting the exploration of machine learning (ML) alternatives for diagnosis and prognosis. Providing a comprehensive appraisal of such decision support systems and their use in COVID-19 management can aid the medical community in making informed decisions during the risk assessment of their patients, especially in low-resource settings. Therefore, the objective of this study was to systematically review the studies that predicted the diagnosis of COVID-19 or the severity of the disease using ML. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), we conducted a literature search of MEDLINE (OVID), Scopus, EMBASE, and IEEE Xplore from January 1 to June 31, 2020. The outcomes were COVID-19 diagnosis or prognostic measures such as death, need for mechanical ventilation, admission, and acute respiratory distress syndrome. We included peer-reviewed observational studies, clinical trials, research letters, case series, and reports. We extracted data about the study's country, setting, sample size, data source, dataset, diagnostic or prognostic outcomes, prediction measures, type of ML model, and measures of diagnostic accuracy. Bias was assessed using the Prediction model Risk Of Bias ASsessment Tool (PROBAST). This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO), with the number CRD42020197109. The final records included for data extraction were 66. Forty-three (64%) studies used secondary data. The majority of studies were from Chinese authors (30%). Most of the literature (79%) relied on chest imaging for prediction, while the remainder used various laboratory indicators, including hematological, biochemical, and immunological markers. Thirteen studies explored predicting COVID-19 severity, while the rest predicted diagnosis. Seventy percent of the articles used deep learning models, while 30% used traditional ML algorithms. Most studies reported high sensitivity, specificity, and accuracy for the ML models (exceeding 90%). The overall concern about the risk of bias was "unclear" in 56% of the studies. This was mainly due to concerns about selection bias. ML may help identify COVID-19 patients in the early phase of the pandemic, particularly in the context of chest imaging. Although these studies reflect that these ML models exhibit high accuracy, the novelty of these models and the biases in dataset selection make using them as a replacement for the clinicians' cognitive decision-making questionable. Continued research is needed to enhance the robustness and reliability of ML systems in COVID-19 diagnosis and prognosis.

Medication Adherence Among Geriatric Patients with Chronic Diseases in Riyadh, Saudi Arabia.

Background: Medication non-adherence is a common and significant public health problem, especially among the geriatric population. This study's objective was to measure medication adherence and associated factors among geriatric patients with chronic diseases. Methods: A cross-sectional study targeted outpatient geriatrics who suffer from chronic diseases at King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia. Telephone interviews were utilized to collect data from participants using a structured questionnaire and the GMAS validated instrument scale (General Medication Adherence Scale) intended to measure important determinants impacting adherence: patient behaviour, cost, comorbidity, and pill burden. Results: A total of 422 patients were assessed for medication adherence. The Mean overall score for GMAS was 29.9±3.1 out of 33. (64.9%) of the patients had a high level of medication adherence. The patients had a high adherence on the domain of patient behavior related non-adherence (PBNA) (13.5±1.9) out of 15, a high adherence on the domain of additional disease and pill burden (ADPB) (11.2±1.4) out of 12, and good to high adherence on the cost-related non-adherence (CRNA) (5.25±1.1) out of 6. Conclusion: The geriatric population with chronic diseases in our study had a good level of adherence to medication if compared with other international figures. To promote better medication adherence, patients must have a good understanding of their disease and strong beliefs about the medications prescribed.

Impact of Dry Sugar Beet Pulp on Milk Production, Digestibility Traits, and Blood Constituents of Dairy Holstein Cows.

Thirty multiparous lactating Holstein cows with an average live body weight of 642 ± 21 kg and an average daily milk yield of 30.46 ± 0.59 kg were used in this study. Cows with parities of 2 and 4 were used following their peak period, and were divided into three groups, with ten cows in each group. The control group was fed yellow corn grain rations (YCG), while for the 2nd and 3rd groups, 25 and 50% of YCG was replaced with dry sugar beet pulp (DSBP), denoted as DSBP25 and DSBP50, respectively. The contents of dry matter, organic matter, ether extract, nitrogen-free extract, and fiber carbohydrate in the experimental rations tended to decrease; however, crude protein, crude fiber, ash, and fiber fractions tended to increase in the DSBP25 and DSBP50 groups. Only crude fiber digestibility increased (p < 0.05) in the DSBP rations. Rumen pH value and concentration of ammonia nitrogen (NH3-N) decreased, while the concentration of total volatile fatty acids (TVFAs) increased in the DSBP25 and DSBP50 groups. The concentrations of total protein and globulin in blood plasma were higher (p < 0.05) in DSBP25 and DSBP50 than in YCG. However, plasma albumin concentration, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) activities were lower (p < 0.05) in DSBP50 than in YCG. Milk yield and yield of 4% fat-corrected milk (4% FCM) were higher (p < 0.05) in DSBP25 and DSBP50 than in YCG. Fat, protein, solids not fat (SNF), and total solids (TS) contents in milk increased significantly (p < 0.05) for feeding rations containing DSBP. Feed cost was reduced, but the output of milk yield increased with DSBP. In conclusion, introducing DSBP into the rations of Holstein dairy cows led to significant improvements in their productive performance.

Acute epiglottitis: Analysis of U.S. mortality trends from 1979 to 2017.

PURPOSE: Evaluate trends in mortality due to acute epiglottitis before and after adoption of Haemophilus influenza Type b vaccination (Hib) in pediatric and adult populations. MATERIALS AND METHODS: Patients who died from acute epiglottis from 1979 to 2017 identified using National Vital Statistics System. Mortality rates calculated using age-adjusted US census data expressed in rate per 100,000 individuals. Trends analyzed using the National Cancer Institute Joinpoint Regression Program (version 4.7.0; Bethesda, Maryland). RESULTS: 1187 epiglottitis-related deaths were identified over thirty-nine years. Total deaths decreased from 65 in 1979 to 15 in 2017. Adult deaths accounted for 63.5% and decreased from 0.015 per 100,000 individuals (24 deaths) in 1979 to 0.006 per 100,000 individuals (14 deaths) in 2017. Best fitting log-liner regression model showed APC of -3.5% (95% CI, -4.2 to -2.7%) from 1979 to 2017. Pediatric and adolescent deaths accounted for 443 (37.3%) deaths, decreasing from 0.064 per 100,000 individuals (41 deaths) in 1979 to 0.001 per 100,000 individuals (1 death) in 2017. APC was -11.1% (95% CI, -13.8% to -8.3%) in 1979 to 1990; 46.5% (95% CI, -16.6% to 157.3%) in 1990 to 1993; -61.6% (95% CI, -88% to 23%) in 1993 to 1996; and 1.1% (95% CI, -2.4% to 4.7%) in 1996 to 2017. CONCLUSIONS: Mortality from acute epiglottitis decreased after widespread adoption of Hib vaccination in the US. Adults are now more likely than children to die of acute epiglottitis. Further research including multi-institutional cohort studies must be done to elucidate causative factors contributing to remaining cases of mortality.

Individuals with a Rh-positive but not Rh-negative blood group are more vulnerable to SARS-CoV-2 infection: demographics and trend study on COVID-19 cases in Sudan.

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In Sudan, several haematological studies were conducted to study the ABO blood group distribution among the population, in which the O blood group was dominant followed by the A blood group. However, there is no systematic study into any correlation between COVID-19 and the population's blood group types, therefore we have intended to study the possible effect of blood group on the acquisition of SARS-CoV-2 infection. A questionnaire-based case-control study was carried out on 557 individuals with COVID-19 in Sudan; factors such as age, blood group, previous malaria infection, history of ailments such as diabetes, hypertension and symptoms suffered were also considered and analysed. More women were infected than men, and individuals between 25 and 35 years were the most affected age group. O Rhesus-positive (O+) blood group was the least affected by the disease while A Rhesus-positive (A+) individuals were the most vulnerable. Fatigue, fever and loss of smell were the major symptoms among the patients, but 13% of SARS-COV-2-positive individuals remained asymptomatic. As the Sudan population is largely constituted of O Rhesus-positive inhabitants (approximately 50%) these results might explain the relatively lower COVID-19 incidence in the country.

Acute Pain Management Following Facial Plastic Surgery.

Facial plastic surgery, including septorhinoplasty, aging face procedures, otoplasty, and oculoplastic procedures, has varying levels of evidence for the management of acute pain after surgery. This article discusses the available evidence in these procedures and discusses the authors' recommendations for the treatment of postoperative pain, with a focus on decreasing the reliance on opioid pain medication.

Batwing mammoplasty: a safe oncoplastic technique for breast conservation in breast cancer patients with gigantomastia.

BACKGROUND: Surgical management of breast cancer with gigantomastia can be challenging when planning breast conservation, as major breast reduction is required. Complex oncoplastic procedures can carry an additional surgical risk in this situation. We suggest batwing mammoplasty as a simple and safe oncoplastic procedure for those patients. MATERIALS AND METHODS: Fourteen patients with gigantomastia diagnosed with breast cancer were included in this prospective cohort study. All underwent batwing mammoplasty and contralateral symmetrisation procedure between May 2016 and June 2018. Patient satisfaction assessed by the Breast-Q questionnaire. RESULTS: All patients had a body mass index above 30kg/m2 with a mean of 36.7kg/m2 (range 31.6-44.9kg/m2). The mean distance from midclavicular point to nipple was 42cm (range 38-50cm). The mean operative time was 83 minutes for procedures done by a single surgeon. Mean specimen weight was 1.2kg (ranging from 1.035-1.63kg). Postoperative complications occurred in 14.2% of patients. Nipple-areola complex viability was not compromised nor sensation impaired. The mean Breast-Q score for patient satisfaction with breasts was 68.6 (range 61-74). The mean score for physiological wellbeing was 77.3 (range 64-84) and the mean score for physical wellbeing was 35 (range 31-40). CONCLUSION: Batwing mammoplasty is a safe and simple oncoplastic procedure in patients who have breast cancer with gigantomastia. It has short operative time and low complications rate. In our cohort of patients, there was no delay in the delivery of adjuvant treatment. The cosmetic outcome was favourable with a high patient satisfaction.

On the impact of ethanol on the rejection and transfer mechanism during ultrafiltration of a charged macromolecule in water/ethanol.

Ultrafiltration (UF) is a sustainable membrane separation technique. It could be useful for the concentration/purification of bio-sourced molecules that are extracted either by pure ethanol or by water/ethanol mixtures. Nevertheless, the process optimization requires an in-depth understanding of the transfer mechanisms of solute through membranes, especially for charged solutes, that are nowadays not sufficiently documented. Previous studies achieved in aqueous media have shown that the rejection of charged solutes by an UF membrane involves at least three mechanisms: convection, diffusion and electrostatic interactions. The present study aims at a systematic analysis of the transfer mechanisms of a model protein (lysozyme) in water/ethanol mixtures (100/0-70/30 v/v) during UF by a zirconia inorganic membrane. The influence of the pH varying in the 4-9 range and of the ionic strength (I) is also discussed. The ionic strength I can be adjusted by addition of an indifferent electrolyte (NaCl) only aiming at the screening of the electrostatic interactions or by addition of a selectively adsorbed electrolyte(KH2PO4) that is able to change the isoelectric pH of the protein and thus to modulate the electrostatic interactions in a different way when compared to NaCl. Of course, both salts have an impact on the protein rejection in UF. The results are analysed using the CDE model previously developed in our group to explain the behaviour of a single protein during UF in water and accounting for convection, diffusion and electrophoretic migration. The applicability of the CDE model in water/ethanol mixtures up to 70/30 v/v is finally shown.

Associations between ApoE gene and psychological consequences post stroke in a Bahraini cohort.

BACKGROUND: The contribution of genetic factors such as the presence of ApoE allele e4 and its association with psychological consequences post stroke remains unknown within Middle-Eastern regions. This study examined the association of ApoE genotype with cognitive impairment and mood in stroke patients and compare with healthy older adults in Bahrain. METHOD: A prospective sample of n = 62 stroke patients (case group) and n = 53 healthy ageing individuals (control group) were eligible to participate in the study. A neuropsychological battery of cognitive assessments were conducted on all participants, and then stratified by cognitive function: no cognitive impairment, mild cognitive impairment and moderate to severe cognitive impairment. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS). RESULTS: Most frequent ApoE genotype was e2/e3 in case (44%) and control groups (63%). ApoE allele e3 had the highest frequency for both groups with all stroke patients presenting with this allele and 86% for the control group (χ2 = 12.14, p < .0001). Stroke patients' non-carriers for ApoE allele e4 performed better on all cognitive measures but differences were not statistically significant (ns). Carriers of ApoE allele e2 in both groups had less mood symptoms compared to non-carriers. DISCUSSION: ApoE genotype e3/e4 and e4/e4 was low in this Bahraini cohort explaining why there may been no significant associations found for this genotype variant with cognitive impairment. Further investigation of cognitive impairment and mood dysregulation with the different variants of the ApoE gene in general ageing and stroke populations is required from different ethno-cultural groups and geographical regions globally.

Multilocus sequence typing of Carnobacterium maltaromaticum strains associated with fish disease and dairy products.

AIMS: Carnobacterium maltaromaticum is a lactic acid bacterium of technological interest in the field of dairy ripening and food bioprotection and is generally recognized as safe in the United States. As it is associated with fish infections, the European Food Safety Agency did not include this species in the qualified presumption safety list of micro-organisms. This implies that the risk assessment for the species has to be performed at the strain level. METHODS AND RESULTS: Multilocus sequence typing (MLST) is a tool that (i) potentially allows to discriminate strains isolated from diseased fish from apathogenic strains and (ii) to assess the genetic relatedness between both groups of strains. In this study, we characterized by MLST 21 C. maltaromaticum strains including 16 strains isolated from diseased fish and 5 apathogenic dairy strains isolated from cheese. The resulting population structure was investigated by integrating these new data to the previously published population structure (available at http://pubmlst.org), which represents an overall of 71 strains. CONCLUSIONS: This analysis revealed that none of the strains isolated from diseased fish is assigned to a clonal complex containing cheese isolates, and that 11 strains exhibit singleton genotypes suggesting that the population of diseased fish isolates is not clonal. SIGNIFICANCE AND IMPACT OF THE STUDY: This study thus provides a population structure of C. maltaromaticum that could serve in the future as a reference that could contribute to the risk assessment of C. maltaromaticum strains intended to be used in the food chain.

Drug-Induced Sleep Endoscopy and Surgical Outcomes: A Multicenter Cohort Study.

OBJECTIVE: To evaluate the association between findings of blinded reviews of preoperative drug-induced sleep endoscopy (DISE) examinations using the VOTE Classification and obstructive sleep apnea (OSA) surgical outcomes in a large multicenter, international cohort. METHODS: Retrospective, multi-center cohort study of adults without tonsillar hypertrophy who underwent pharyngeal surgery for OSA. The study included only participants without enlarged tonsils. Four independent reviewers performed blinded review of preoperative DISE videos using the VOTE Classification system and scoring of a primary structure contributing to airway obstruction. DISE findings were examined for an association with surgical outcomes with univariate analyses and multiple regression. RESULTS: Two hundred seventy-five study participants were included from 14 centers. Mean age was 51.4 ± 11.8 years, and body mass index was 30.1 ± 5.2 kg/m2 . There was moderate interrater reliability (kappa = 0.40-0.60) for DISE findings. Oropharyngeal lateral wall-related obstruction was associated with poorer surgical outcomes (adjusted odds ratio (AOR) 0.51; 95% CI 0.27, 0.93). Complete tongue-related obstruction was associated with a lower odds of surgical response in moderate to severe OSA (AOR 0.52; 95% CI 0.28, 0.98), with findings that were similar but not statistically significant in other analyses. Surgical outcomes were not clearly associated with the degree and configuration of velum-related obstruction or the degree of epiglottis-related obstruction. Surgical response was associated with tonsil size and body mass index (inversely). CONCLUSION: DISE findings concerning the oropharyngeal lateral walls and tongue may be the most important findings of this evaluation technique. LEVEL OF EVIDENCE: 2B Laryngoscope, 129:761-770, 2019.

Surgical and neurological complications in temporal lobe epilepsy surgery in modern era.

BACKGROUND: Temporal lobe epilepsy is the most common form of focal epilepsy, and surgical treatment has been proven to be an effective and safe management. Despite its safety, it is important to know that some complications and/or even death can be seen after surgery. Neurosurgeons should be able to precisely inform epilepsy surgery candidates about the possible unwanted/unexpected conditions after surgery. METHODS: Fifty-three patients who underwent anterior temporal lobe resection due to temporal lobe epilepsy by a single surgeon were investigated retrospectively regarding postoperative surgical and neurological complications. RESULTS: Overall complication rate was found to be 19%, surgical complications comprised 13.2% whereas neurological complications were 5.8%. Three patients underwent a second surgery whereas the rest had medical treatment or recovered spontaneously. Fortunately persistent complication rate was found to be 0%, and there was no mortality. CONCLUSIONS: Anterior temporal lobe resection is a safe and very effective surgical modality for the treatment of temporal lobe epilepsy. However, unexpected complications may be possible in this modern era and a surgeon should trust in him/herself not in modern equipments.

Prognostic value of serum soluble FMS-like tyrosine kinase (sFlt-1) levels in pre-eclampsia and eclampsia; a prospective cohort study.

OBJECTIVE: To evaluate the levels of circulating sFlt-1 in pre-eclampsia (PE) and eclampsia patients and to assess its prognostic value in detection of PE complications. METHODS: The present study was a prospective cohort study conducted in tertiary hospital between January and December 2016. Included patients were divided into two groups; (Group I) severe PE group and (Group II) eclampsia group. Age-, parity-, and gestational age-matched women had approached to participate in the study as a control group (Group III). Serum sFlt-1 levels were measured at inclusion and 2 days later with all basic investigations. Patients were followed up until delivery to record any complications. Correlation analysis was performed between the serum sFlt-1 levels and clinical, laboratory investigations. Receiver operating characteristic analysis was constructed for the evaluation of the area under curve (AUC) as well as the sensitivity and specificity regarding the cutoff point of sFlt-1 level that predict occurrence of complications. RESULTS: The study included 84 women. Women with complicated severe PE showed higher sFlt-1 levels than in non-complicated cases (120.2 ± 19.6 versus 72.2 ± 19.6, p < 0.001). Similarly, the mean serum level of sFlt-1 in complicated eclampsia was higher than in non-complicated cases (298.3 ± 75.2 versus 128.1 ± 36.5, p < 0.001) (OR = 1.119, 95% CI: 10.057-1.184, p < 0.001). SFlt-1 levels were strongly correlated with systolic blood pressure (r = 0.641) and diastolic blood pressure (r = 0.540) (p < 0.001 and p < 0.001, respectively). At cutoff point 102.60 ng/ml of sFlt-1 levels, the sensitivity was 90% and specificity was 80% with AUC = 0.923, 95% CI: 0.871-0.975. CONCLUSIONS: Serum sFlt-1 can be used as a prognostic marker to predict the occurrence of complications of preeclampsia.

Bacteriological cure rate and changes in milk composition in mastitis vaccinated ewes affected with subclinical mastitis.

AIM: The aim of this study was to investigate the effects of using a commercially-available polyvalent mastitis vaccine on the bacteriological cure rate of existing subclinical mastitis in Awassi sheep. MATERIALS AND METHODS: A total of 164 lactating ewes were divided into two main groups according to udder health and milk somatic cell count (SCC): Group 1=normal (N; n=80) and Group 2=subclinical mastitis (SC; n=84). Each group was then subdivided randomly into two treatment groups: N vaccinated (Nvax; n=38), N non-vaccinated (Nnvax; n=42), SC vaccinated (SCvax; n=42), and SC non-vaccinated (SCnvax; n=42). The vaccine was administered as per manufacturer's recommendations. Milk samples were collected aseptically from all ewes before vaccine administration (T0) and again on days 28 (T2) and 42 (T3) of the experiment. RESULTS: In the SC group, the bacteriological cure rates in vaccinated and non-vaccinated ewes were 76% and 69%, respectively. In N group, the new intramammary infection rates in vaccinated and non-vaccinated ewes were 48% and 50%, respectively. Vaccination of normal ewes resulted in a significant (p<0.05) reduction in bacterial growth rate both at day 28 and day 42 of the study. The prevalence of new intramammary infection rate in Nvax ewes on days 28 and 42 was 19% and 20%, respectively. The prevalence of new intramammary infection rate in Nnvax group on days 28 and 42 was 33% and 30%, respectively. In SCvax group, the bacterial growth rate on days 28 and 42 was 44% and 35%, respectively. In SCnvax group, the bacterial growth rate on days 28 and 42 was 27% and 32%, respectively. There was no statistically significant effect of vaccination on any of the studied milk composition parameters. CONCLUSIONS: This is a preliminary study that indicated a possible protective effect of vaccination against mastitis in sheep. Further, case-controlled studies are indicated to estimate the level of immunity this vaccine provides to vaccinated sheep.

Preparation of polyaniline/PbS core-shell nano/microcomposite and its application for photocatalytic H2 electrogeneration from H2O.

Lead sulfide (PbS) and polyaniline (PANI) nano/microparticles were prepared. Then, PANI/PbS core-shell nano/microcomposites (I, II, and III) were prepared by oxidative polymerization of different aniline concentrations (0.01, 0.03, and 0.05 M), respectively, in the presence of 0.05 M PbS. FT-IR, XRD, SEM, HR-TEM, and UV-Vis analyses were carried out to characterize the samples. From the FT-IR data, there are redshifts in PbS and PANI nano/microparticles bands in comparison with PANI/PbS nano/microcomposites. The average crystallite sizes of PANI/PbS core-shell nano/microcomposites (I, II, and III) from XRD analyses were 46.5, 55, and 42.16 nm, respectively. From the optical analyses, nano/microcomposite (II) has the optimum optical properties with two band gaps values of 1.41 and 2.79 eV. Then, the nano/microcomposite (II) membrane electrode supported on ITO glass was prepared and applied on the photoelectrochemical (PEC) H2 generation from H2O. The characteristics current-voltage and current-time behaviors were measured at different wavelengths from 390 to 636 nm. Also, the incident photon-to-current conversion efficiency (IPCE) under monochromatic illumination condition was calculated. The optimum values for IPCE were 36.5 and 35.2% at 390 and 405 nm, respectively. Finally, a simple mechanism for PEC H2 generation from H2O using the nano/microcomposite (II) membrane electrode was mentioned.

Antibacterial activity of silver nanoparticles against field and reference strains of Mycobacterium tuberculosis, Mycobacterium bovis and multiple-drug-resistant tuberculosis strains.

Tuberculosis (TB) is an endemic disease in animals and humans in Egypt. This study aims to investigate the antimycobacterial activity of silver nanoparticles(AgNPs) by determining the minimal inhibitory concentration (MIC) of AgNPs, using the microplate Alamar blue assay. The AgNPs were chemically synthesised and their form and size were characterised by ultraviolet-visible absorption spectrophotometry, transmission electron microscopy and X-ray diffraction.The reference strains of Mycobacterium bovis and Mycobacterium tuberculosisH37Rv, and one multiple-drug-resistant (MDR) strain of M. tuberculosis were tested, as well as clinical isolates of M. bovis and M. tuberculosis. The AgNPs were tetrahydral with a few spherical particles and an average particle size of 50 nm. The mycobacterial strains were varied with MICs of AgNPs. Both reference strains of M. tuberculosis and M. bovis, in addition to the MDR strain of M. tuberculosis, were successfully inhibited by AgNPs at MICs of 1 ?g/ml, 4 ?g/ml and 16 ?g/ml, respectively, whereas clinical isolates of M. bovis and M. tuberculosis were inhibited at MIC values of 4-32 ?g/ml and 1-16 ?g/ml, respectively. The AgNPs showed an in vitro chemotherapeutic effect against Mycobacterium spp.Thus, they can be used to treat TB not only in humans but also in animals, and maybe useful in TB prevention and control strategies worldwide.

En Egypte, la tuberculose est une maladie endémique chez l'homme comme chez l'animal. Les auteurs présentent les résultats d'une étude conduite pour mesurer l'activité antibactérienne des nanoparticules d'argent (NPAg) en déterminant les valeurs de concentration minimale inhibitrice (CMI) des NPAg au moyen du test au bleu Alamar sur microplaques. Les NPAg ont été synthétisées par une méthode chimique et leur forme et taille ont été caractérisées par spectrophotométrie d'absorption dans l'ultra-violet, microscopie électronique à transmission et diffraction des rayons X. L'étude a cible les souches de référence de Mycobacterium bovis et de Mycobacterium tuberculosis H37Rv, ainsi qu'une souche multirésistante de M. tuberculosis et des isolats cliniques de M. bovis et M. tuberculosis. Les NPAg étaient à structure tétraédrique avec quelques particules sphériques ; la taille moyenne des particules etait de 50 nm.La CMI des NPAg variait en fonction des souches. L'inhibition des deux souches de reference de M. tuberculosis et M. bovis et de la souche multirésistante de M. tuberculosis était obtenue avec des CMI de NPAg de 1 ?g/ml, 4 ?g/ml et16 ?g/ml, respectivement, tandis que les isolats cliniques de M. bovis et de M. tuberculosis étaient inhibés en présence de NPAg à des CMI comprises entre 4 et 32 ?g/ml et 1­16 ?g/ml, respectivement. L'efficacité chimiothérapeutique des NPAg contre Mycobacterium spp. a été démontrée in vitro. Ces nanoparticules peuvent donc servir à traiter la tuberculose non seulement chez l'homme mais également chez les animaux et contribuer ainsi aux stratégies de prévention et de lutte contre la tuberculose dans le monde.

En Egipto, la tuberculosis es una enfermedad endemica que afecta a personas y animales. Los autores describen un estudio encaminado a analizar la actividad antimicobacteriana de las nanoparticulas de plata, determinando para ello la concentracion inhibitoria minima de nanoparticulas mediante el ensayo de microtitulacion en placa con azul Alamar. Tras sintetizar quimicamente las nanoparticulas de plata y caracterizar su forma y tamano por espectrometria de absorcion ultravioleta-visible, microscopia electronica de transmision y difraccion de rayos X, se sometieron a prueba las cepas de referencia de Mycobacterium bovis y Mycobacterium tuberculosis H37Rv, asi como una cepa multirresistente de M. tuberculosis y muestras de M. bovis y M. tuberculosis aisladas a partir de casos clinicos. Salvo unas pocas de forma esferica, las nanoparticulas de plataeran tetraedricas. Su tamano era en promedio de 50 nm. Tras someter las cepas de micobacterias a distintas concentraciones de nanoparticulas, se observo que estas inhibian el crecimiento de las cepas de referencia de M. tuberculosis y M. bovis y de la cepa multirresistente de M. tuberculosis a concentraciones minimas de 1 ?g/ml, 4 ?g/ml y 16 ?g/ml, respectivamente, mientras que las muestras clinicas de M. bovis y M. tuberculosis quedaban inhibidas por la presencia de nanoparticulas a valores de concentracion minima de 4­32 ?g/ml y 1­16 ?g/ml, respectivamente. Tambien se observo que, in vitro, las nanoparticulas de plata mostraban actividad farmacologica contra Mycobacterium spp. De ahi se sigue que pueden ser empleadas para tratar la tuberculosis no solo en personas, sino tambien en animales, y que pueden resultar utiles en todo el mundo para las estrategias de prevencion y control de la tuberculosis.

Smartphones in clinical practice: doctors' experience at two Dublin paediatric teaching hospitals.

INTRODUCTION: We conducted a study at two main centres for paediatric surgery in the Republic of Ireland, Temple Street Children's University Hospital (TSCUH) and Our Lady's Children's Hospital Crumlin (OLCHC). AIM: The aim of the study was to assess doctors' opinions, frequency and methods of smartphone use in clinical practice. METHODS: Doctors (n = 265) at the two hospitals were invited to complete a 12-item survey. Descriptive statistics were calculated accordingly. RESULTS: Almost 50% (132/256) responded; 98.4% owned a smartphone and 76% owned an iPhone. Seventy-nine percent used medical apps and 59% used the OLCHC formulary. Ninety-seven percent used smartphones for inter-team communication with 73.5% (n = 97) using WhatsApp. Smartphone camera was used by 57% for clinical photos and 41% for photos of radiological imaging. Only 42% reported obtaining consent for smartphone camera use from patients or guardians. Ninety-two percent either 'strongly agreed' or 'agreed' that smartphones positively impact their practice. CONCLUSION: Smartphone usage is universal among healthcare professionals and their influence is growing in patient care.

Extract of Bauhinia vahlii Shows Antihyperglycemic Activity, Reverses Oxidative Stress, and Protects against Liver Damage in Streptozotocin-induced Diabetic Rats.

BACKGROUND: Several studies have affirmed the effectiveness of some Bauhinia plants as antihyperglycemic agents. OBJECTIVE: We investigated the possible effect of Bauhinia vahlii leaves extract in reducing hyperglycemia and reversing signs of organ damage associated with diabetes in streptozotocin (STZ) rat model. MATERIALS AND METHODS: Both polar fraction of the B. vahlii leaves (defatted ethanolic extract [DEE]) and nonpolar fraction (n-hexane extract) were evaluated in vitro for α-glucosidase inhibition and 2,2-diphenyl-1-picrylhydrazyl radical scavenging potential. DEE was selected for further in vivo studies and was administered at two doses, i.e., 150 or 300 mg/kg to STZ-diabetic rats for 4 weeks. RESULTS: Only DEE exhibited in vitro antioxidant and antihyperglycemic activities and its oral administration at both dose levels resulted in significant reduction in fasting blood glucose and glycated hemoglobin. Furthermore, signs of oxidative stress as indicated by hepatic reduced glutathione, nitric oxide, and malondialdehyde levels were completely reversed. In addition, histopathological examination and measurement of serum aspartate transaminase and alanine transaminase levels showed that DEE protected the liver from signs of liver pathogenesis when compared to diabetic untreated animals and those treated with metformin. Phytochemical analysis of DEE showed high flavonoids content with quercitrin as the major constituent along with other quercetin glycosides. CONCLUSION: This study strongly highlights the possible beneficial effect of B. vahlii leaves extract in relieving hyperglycemia and liver damage in STZ-diabetic rats and recommends further investigation of the value of quercetin derivatives in controlling diabetes and ameliorating liver damage associated with it. SUMMARY: The polar fraction of the Bauhinia vahlii leaves (defatted ethanolic extract [DEE]) exhibited both in vitro antioxidant activity in 2,2-diphenyl-1-picrylhydrazyl scavenging assay and strong α-glucosidase inhibition while the nonpolar fraction (n-hexane extract) failed to show any activity in both assays. DEE was further investigated in streptozotocin-induced diabetic rat model where oral administration of DEE at 2 doses (150 and 300 mg/kg) for 4 weeks resulted in significant reduction in fasting blood glucose and glycated hemoglobin and reversal of oxidative stress signs as indicated by measurement of hepatic reduced glutathione, nitric oxide, and malondialdehyde levels. In addition, histopathological examination and measurement of serum aspartate transaminase and alanine transaminase levels showed that DEE protected the liver from signs of pathogenesis observed in diabetic untreated rats. Phytochemical analysis of DEE showed high flavonoid content with quercitrin as the major constituent (62.9 ± 0.18 mg/mg). Abbreviations used: ALT: Alanine transaminase, AST: Aspartate transaminase, DEE: Defatted ethanol extract, DPPH: 2,2-diphenyl-1-picrylhydrazyl, FBG: Fasting blood glucose, GAE: Gallic acid equivalent, GSH: Reduced glutathione, Hb1Ac: Glycated hemoglobin, HE: Hexane extract MDA: Malondialdehyde, QE: Quercetin equivalent, STZ: Streptozotocin, TAC: Total antioxidant capacity.