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Background: Rheumatoid arthritis (RA) is a common condition treated with biological disease-modifying anti-rheumatic medicines (bDMARDs). However, many patients exhibit resistance, necessitating the use of machine learning models to predict remissions in patients treated with bDMARDs, thereby reducing healthcare costs and minimizing negative effects., Objective: The study aims to develop machine learning models using data from the Kuwait Registry for Rheumatic Diseases (KRRD) to identify clinical characteristics predictive of remission in RA patients treated with biologics., Methods: The study collected follow-up data from 1,968 patients treated with bDMARDs from four public hospitals in Kuwait from 2013 to 2022. Machine learning techniques like lasso, ridge, support vector machine, random forest, XGBoost, and Shapley additive explanation were used to predict remission at a 1-year follow-up., Results: The study used the Shapley plot in explainable Artificial Intelligence (XAI) to analyze the effects of predictors on remission prognosis across different types of bDMARDs. Top clinical features were identified for patients treated with bDMARDs, each associated with specific mean SHAP values. The findings highlight the importance of clinical assessments and specific treatments in shaping treatment outcomes., Conclusion: The proposed machine learning model system effectively identifies clinical features predicting remission in bDMARDs, potentially improving treatment efficacy in rheumatoid arthritis patients., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Alsaber, Al-Herz, Alawadhi, Doush, Setiya, AL-Sultan, Saleh, Al-Awadhi, Hasan, Al-Kandari, Mokaddem, Ghanem, Attia, Hussain, AlHadhood, Ali, Tarakmeh, Aldabie, AlKadi and Alhajeri.)

Antibody-based treatment was first used in 1891 for the treatment of diphtheria. Since then, monoclonal antibodies (mAbs) have been developed to treat many diseases such as cancer and act as vaccines. However, murine-derived therapeutic mAbs were found to be highly immunogenic, and caused anti-drug antibodies (ADAs) reaction, reducing their efficacy and causing severe infusion reactions. Fully human, humanised, and chimeric antibodies were then introduced for better therapeutic efficacy. With the introduction of immune response associated with mAbs immunogenicity. This review explores the immunogenicity of mAbs, its mechanism, contributing factors, and its impact on therapeutic efficacy. It also discusses immunogenicity assessment for preclinical studies and strategies for minimising immunogenicity for effective therapeutic treatment in various diseases. Finally, predicting immunogenicity in drug development is essential for selecting top drug candidates. A lot of methods can be implemented by the researchers and developers to reduce the development of ADAs while simultaneously minimising the immunogenicity reaction of mAbs., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest., (Copyright © 2024 Elsevier GmbH. All rights reserved.)

Cancer is the main contributor for mortality in the world. Conventional therapy that available as the treatment options are chemotherapy, radiotherapy and surgery. However, these treatments are hardly cell-specific most of the time. Nowadays, extensive research and investigations are made to develop cell-specific approaches prior to cancer treatment. Some of them are photodynamic therapy, hyperthermia, immunotherapy, stem cell transplantation and targeted therapy. This review article will be focusing on the development of gene therapy in cancer. The objective of gene therapy is to correct specific mutant genes causing the excessive proliferation of the cell that leads to cancer. There are lots of explorations in the approach to modify the gene. The delivery of this therapy plays a big role in its success. If the inserted gene does not find its way to the target, the therapy is considered a failure. Hence, vectors are needed and the common vectors used are viral, non viral or synthetic, polymer based and lipid based vectors. The advancement of gene therapy in cancer treatment will be focussing on the top three cancer cases in the world which are breast, lung and colon cancer. In breast cancer, the discussed therapy are CRISPR/Cas9, siRNA and gene silencing whereas in colon cancer miRNA and suicide gene therapy and in lung cancer, replacement of tumor suppressor gene, CRISPR/Cas9 and miRNA., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest., (Copyright © 2024 Elsevier GmbH. All rights reserved.)

Hypopigmented mycosis fungoides (MF) is a rare variant of cutaneous T-cell lymphoma, a type of extranodal non-Hodgkin lymphoma. This report presents the case of a 9-year-old boy with a 2-year history of asymptomatic, hypopigmented skin lesions that were resistant to topical treatment. He was initially treated for a fungal skin infection and had received multiple courses of topical antifungals and steroids but showed no improvement, which led to further evaluation and a referral to a dermatologist. A skin biopsy was performed, and the diagnosis of hypopigmented MF was confirmed through skin histopathology and immunohistochemistry study. His lesions responded well to cycles of narrowband ultraviolet B phototherapy, showing almost complete clearance after 4 months without any side effects., Competing Interests: None., (© Academy of Family Physicians of Malaysia.)

Background: The majority of persons with dementia (PWD) are mainly cared for by their family members in the home. Evidence is however scarce on family caregivers' psychosocial burden and quality of life in Asian countries including Malaysia. This study describes the baseline data of a telephone-delivered psychoeducational intervention study and examines the determinants of outcome measures (caregiver burden, depressive and anxiety symptoms, quality of life and caregiving self-efficacy) among Malaysian family caregivers to PWD., Methods: This was a cross-sectional study originated from the baseline survey of a randomized control trial of 121 family caregivers recruited from lists of PWD who were registered at memory and psychiatry clinics in three tertiary care hospitals in Malaysia. The participants were assessed for caregiver burden by the Zarit Burden Interview, depressive and anxiety symptoms by the Hospital Anxiety and Depression Scale, quality of life by the Control, Autonomy, Self-Realization, and Pleasure Scale, and caregiving self-efficacy by the Revised Scale for Caregiving Self-Efficacy., Results: Prevalence of caregiver burden was 69.4%, depressive symptoms 32.2% and anxiety symptoms 32.2%. Family caregivers to PWD having perceived peer support e.g., social/family/friend/significant other supports were less likely to report caregiver burden, depressive and anxiety symptoms, and more likely to report higher levels of quality of life and caregiving self-efficacy. Being married and PWD's ability to self-care were associated with lesser likelihood of experiencing caregiver burden, depressive and anxiety symptoms. The other determinants of greater probability of reporting better quality of life were caregivers' employment and having Islamic faith. Marital status (married), PWD's ability to self-care, spousal relationship with PWD and shared caregiving process were associated with higher likelihood of reporting caregiving self-efficacy., Conclusion: Caregiver burden, depressive and anxiety symptoms are prevalent in family caregivers to PWD in Malaysia. Social support and caregiving related factors influence family caregivers' quality of life and caregiving self-efficacy. Implementing psychoeducational intervention and support in the psychiatry and memory clinics may help improve the psychosocial burden, quality of life and caregiving self-efficacy in family caregivers of PWD., Trial Registration: ISRCTN14565552 (retrospectively registered)., (© 2024. The Author(s).)

Aim: Chromones are promising for anticancer drug development. Methods & results: 12 chromone-based compounds were synthesized and tested against cancer cell lines. Compound 8 showed the highest cytotoxicity (LC 50 3.2 μM) against colorectal cancer cells, surpassing 5-fluorouracil (LC 50 4.2 μM). It suppressed colony formation, induced cell cycle arrest and triggered apoptotic cell death, confirmed by staining and apoptosis markers. Cell death was accompanied by enhanced reactive oxygen species formation and modulation of the autophagic machinery (autophagy marker light chain 3B (LC3B); adenosine monophosphate-activated protein kinase (AMPK); protein kinase B (PKB); UNC-51-like kinase (ULK)-1; and ULK2). Molecular docking and dynamic simulations revealed that compound 8 directly binds to ULK1. Conclusion: Compound 8 is a promising lead for autophagy-modulating anti-colon cancer drugs.

Introduction: Electrocution related death remains an ambiguous judgement and requires numerous valid evidence for proper medico-legal diagnosis. While the presence of electrical burn marks is a significant macroscopic indicator, it can be absent, especially on moist skin. The electrical mark still represents a fundamental indicator above all in the medico-legal field, but the identification of pathognomonic elements and signs not limited to the skin alone could be a valid help in the future, especially in unclear cases., Case Report: The deceased was brought-in-dead to the hospital from their workplace, with no signs of fatal natural diseases. External examination revealed a Y-shaped burn mark on the right side of the neck and collapsed blisters with greying rings on both heels. Internal examination showed no alarming findings. Further, histopathological analysis of the foot blisters and neck burn revealed intraepidermal detachment, elongated nuclei, and coagulative necrosis. Notably, the presence of muscle fibre casts in kidney tubules and microthrombi in lung sections which indicate rhabdomyolysis and vascular thrombosis supported electrocution-related death., Conclusion: These positive findings of the electrical burn marks externally and significant histopathological changes, collectively support the death was due to electrocution, after excluding any major, fatal injuries. Albeit, a detailed inspection of the crime scene plays an important role, in order to classify the electrocution related death.

Background: Plant-derived products or extracts are widely used in folk/traditional medicine to treat several infections, ailments, or disorders. A well-known medicinal herb, Myrtus communis is an evergreen fragrant plant native to the Mediterranean region that has been used for ages in traditional medicine around the world., Materials and Methods: The microplate alamarBlue assay and the well diffusion method were used to evaluate the zone of inhibition and MIC, respectively. The double-disc diffusion method was used to investigate the synergy between antibiotics and the extract. The crystal violet method was used to investigate biofilm development. The SulphoRhodamine-B assay and DNA flow cytometry were used to investigate the proliferation and subsequent distribution of cells among different phases of the cell cycle. The apoptotic and necrotic phases of the cancer cells were examined using flow cytometry in conjunction with Annexin V-FITC/PI labeling. Using the IBM SPSS statistical program, a one-way ANOVA with Tukey's post hoc test was employed for statistical analysis., Results: The ethanolic leaf extract of M. communis showed a strong growth inhibition effect (zone of inhibition: 20.3 ± 1.1-26.3 ± 2.5 mm, MIC: 4.88-312.5 µg/mL, and MBC: 39.07-1250 μg/mL) against several rapidly growing and slow-growing mycobacterial strains in a dose-dependent manner. Damage to the cell wall of bacterial cells was determined to be the cause of the antimycobacterial action. The extract inhibited biofilm formation (MBIC of 9.7 µg/mL) and eradicated already-formed mature and ultra-mature biofilms of M. smegmatis , with MBEC values of 78 µg/mL and 156 µg/mL, respectively. Additionally, the extract exhibited potent anticancer effects against diverse cancer cell lines of the breast (MCF-7), liver (HepG2), cervix (HeLa), and colon (HCT116) (IC 50 for HCT116: 83 ± 2.5, HepG2: 53.3 ± 0.6, MCF-7: 41.5 ± 0.6, and HeLa: 33.3 ± 3.6) by apoptosis after arresting the cells in the G 1 phase of the cell cycle., Conclusions: These results suggest that M. communis leaf extract is a potential source of secondary metabolites that could be further developed as potential anticancer and antimycobacterial agents to treat diverse types of cancers and mycobacterial infections.

Scurvy, a condition caused by vitamin C deficiency, is characterized by a syndrome of multisystem disorder due to defective collagen production and antioxidative function. This condition is infrequent in this modern era; thus, it is often not within the list of differential diagnoses. The broad clinical picture is generally overlooked as other systemic illnesses, resulting in an extensive investigation that delays the diagnosis. Herein, we report a case of an 8-year-old boy with underlying autism spectrum disorder who presented with lower limb pain and other constitutional symptoms. Examination revealed multiple hyperpigmented scars over the upper and lower limbs and gingival hyperpigmentation. With history of picky eating habits and clinical symptoms supported by radiographic findings, scurvy was suspected and subsequently confirmed based on a low level of ascorbic acid. With vitamin C supplementation and proper nutritional support, the patient recovered well., Competing Interests: We have no conflicts of interest to disclose., (© Academy of Family Physicians of Malaysia.)

The paramount importance of lithium (Li) nowadays and the mounting volume of untreated spent LIB have imposed pressure on innovators to tackle the near-term issue of Li resource depletion through recycling. The trajectory of research dedicated to recycling has skyrocketed in this decade, reflecting the global commitment to addressing the issues surrounding Li resources. Although metallurgical methods, such as pyro- and hydrometallurgy, are presently prevalent in Li recycling, they exhibit unsustainable operational characteristics including elevated temperatures, the utilization of substantial quantities of expensive chemicals, and the generation of emissions containing toxic gases such as Cl 2 , SO 2 , and NO x . Therefore, the alternative electrochemical method has gained growing attention, as it involves a more straightforward operation leveraging ion-selective features and employing water as the main reagent, which is seen as more environmentally benign. Despite this, intensive efforts are still required to advance the electrochemical method toward commercialisation. This review highlights the key points in the electrochemical method that demand attention, including the feasibility of a large-scale setup, consideration of the substantial volume of electrolyte consumption, the design of membranes with the desired features, a suitable layout of the membrane, and the absence of techno-economic assessments for the electrochemical method. The perspectives presented herein provide a crucial understanding of the challenges of advancing the technological readiness level of the electrochemical method., Competing Interests: The authors declare that they possess no conflict of interest., (This journal is © The Royal Society of Chemistry.)

Atorvastatin calcium (ATV) and proanthocyanidins (PAC) have a strong antioxidant activity, that can benefit to reduce the atherosclerotic plaque progression. Unfortunately, the bioavailability of ATV is greatly reduced due to its limited drug solubility while the PAC drug is unstable upon exposure to the atmospheric oxygen. Herein, the lyotropic liquid crystalline nanoparticles (LLCNPs) constructed by a binary mixture of soy phosphatidylcholine (SPC) and citric acid ester of monoglyceride (citrem) at different weight ratios were used to encapsulate the hydrophobic ATV and hydrophilic PAC. The LLCNPs were further characterized by small-angle X-ray scattering and dynamic light scattering. Depending on the lipid composition, the systems have a size range of 140-190 nm and were able to encapsulate both drugs in the range of 90-100%. Upon increasing the citrem content of drug-loaded LLCNPs, the hexosomes (H 2 ) was completely transformed to an emulsified inverse micellar (L 2 ). The optimum encapsulation efficiency (EE) of ATV and PAC were obtained in citrem/SPC weight ratio 4:1 (L 2 ) and 1:1 (H 2 ), respectively. There was a substantial change in the mean size and PDI of the nanoparticles upon 30 days of storage with the ATV-loaded LLCNPs exhibiting greater colloidal instability than PAC-loaded LLCNPs. The biphasic released pattern (burst released at the initial stage followed by the sustained released at the later stage) was perceived in ATV formulation, while the burst drug released pattern was observed in PAC formulations that could be attributed by its internal H 2 structure. Interestingly, the cytokine studies showed that the PAC-LLCNPs promisingly up regulate the expressions of tumor necrosis factor-alpha (TNF-α) better than the drug-free and ATV-loaded LLCNPs samples. The structural tunability of citrem/SPC nanoparticles and their effect on physicochemical characteristic, biological activities and potential as an alternative drug delivery platform in the treatment of atherosclerosis are discussed., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: INTAN DIANA MAT AZMI reports financial support was provided by Putra Malaysia University., (Copyright © 2024 Elsevier B.V. All rights reserved.)

The infection produced by the SARS-CoV-2 virus remains a significant health crisis worldwide. The lack of specific medications for COVID-19 necessitates a concerted effort to find the much-desired therapies for this condition. The main protease (M pro ) of SARS-CoV-2 is a promising target, vital for virus replication and transcription. In this study, fifty pyrazole derivatives were tested for their pharmacokinetics and drugability, resulting in eight hit compounds. Subsequent molecular docking simulations on SARS-CoV-2 main protease afforded two lead compounds with strong affinity at the active site. Additionally, the molecular dynamics (MD) simulations of lead compounds (17 and 39), along with binding free energy calculations, were accomplished to validate the stability of the docked complexes and the binding poses achieved in docking experiments. Based on these findings, compound 17 and 39, with their favorable projected pharmacokinetics and pharmacological characteristics, are the proposed potential antiviral candidates which require further investigation to be used as anti-SARS-CoV-2 medication., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Interleukin-6 (IL-6) is a cytokine that involved in the different phases of wound healing. It is responsible for promoting inflammation, regulating tissue repair scar formation, stimulating the production of extracellular matrix components and recruiting immune cells to the wound site. Therefore, suppressing IL-6 is beneficial for wound healing. However, no small molecules are currently available in the market against the IL-6. As a result, this research gap motivates us to find a potential inhibitor. This study aimed to investigate the wound healing potential of novel β-cycloidal-derived mono-carbonyl curcumin analogs reported in the literature through screening a series of computational studies. The calculated pIC50 value of 18 compounds (below 10) showed that all compounds may have potential therapeutic efficacy. Molecular docking studies revealed that compound C12 (-45.6044 kcal/mol) bound most strongly in the active site of IL-6 compared to the FDA-approved drug clindamycin (-42.3223). The Molecular Dynamic (MD) simulation displayed that lead compound C12 had the highest stability in the active site of IL-6 compared to the reference drug clindamycin. Furthermore, MMGBSA results indicated that C12 (-20.28 kcal/mol) had the highest binding energy compared to clindamycin (-8.36 kcal/mol). The ADMET analysis predicted that C12 are favourable for drug candidates. This study recommended compound C12 as a lead IL-6 inhibitor for future testing and development as therapeutics for wound healing.Communicated by Ramaswamy H. Sarma.

Ceftazidime/avibactam (CAZ-AVI) is FDA-approved for managing infections caused by resistant gram-negative bacilli, particularly infections via carbapenem-resistant Enterobacterales pathogens. The clinical data are still limited, particularly those in Saudi Arabia. The present study is a retrospective cohort study that was carried out at the Armed Forces Hospital in the southern region of Saudi Arabia to compare the clinical and microbiological outcomes for CAZ-AVI-treated patients as monotherapy and as an add-on to standard therapy for carbapenem-resistant Klebsiella pneumonia (CRKP) OXA-48 infections to those treated with standard drugs. The study included CRKP OXA-48-like infected patients who were administered antibiotics for more than seven days from 1 August 2018 to May 2023. Patients' baseline characteristics and demography were extracted from the clinical records, and their clinical/microbiology efficiencies were assessed as per the corresponding definitions. Univariate and multivariate logistic regressions were conducted to identify the potential independent variable for CAZ-AVI efficiency. A total of 114 patient files were included for the evaluation. Among these patients, 64 used CAZ-AVI combined with standard therapy and were included in the intervention group, and 50 of them used standard therapy and were included in the comparative group. Following analysis, CAZ-AVI's clinical success was 42.2% ( p = 0.028), while the intervention versus comparative groups showed decreased 30-day all-cause mortality (50.0% versus 70.0%; p = 0.036) and infection recurrence (7.8% versus 24.0%; p = 0.019), as well as substantially increased rates of microbial eradication (68.8% versus 42.0%; p = 0.007). CAZ-AVI add-on therapy rather than monotherapy showed statistically significant favored clinical and microbial outcomes over the standard therapy. Furthermore, sex (female %), ICU admission, and fever were negatively associated with patients' 30-day all-cause mortality, serving as independent negative factors. Only fever, CRP bio levels, inotropes, and ICU admissions were significant predictors influencing the CAZ-AVI's clinical efficiency. The duration of CAZ-AVI therapy positively influenced CAZ-AVI's microbial eradication, while both WBC counts and fever experiences were negative predictors. This study shows the effective usage of CAZ-AVI against CRKP OXA-48-like infections. The influencing independent variables depicted here should recommend that clinicians individualize the CAZ-AVI dose based on co-existing risk factors to achieve optimal survival and efficacy. Prospective multicenter and randomized control studies are recommended, with individualized CAZ-AVI precision administration implemented based on patients' characteristics.

Objective: The aim of this study is to determine the prevalence rates of hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) infections among hemodialysis (HD) patients as well as to identify associated risk factors., Methodology: A multicenter cross-sectional study involved patients who had been on HD for at least three months. The study was conducted at five HD centers in Damascus, Syria from August 2019 to September 2021. HBsAg, HCV-Ab and HIV (antibody/antigen) seropositivity were identified using the third generation ELISA technique. Patients' information was extracted from their records and by face-to-face interview. Multiple logistic regression models were applied to identify risk factors associated with HBV or HCV seropositivity. The significance level was set at 5%., Results: A total of 637 patients were included in the study with a mean age (SD) of 50.5 (15.6) years and 56.7% of them were men. The dialytic age ranged from one to thirty years with a mean (SD) of 6.10 (5.6) years. The prevalence of positive hepatitis B surface antigen, anti-HCV, co-infection of HBV and HCV, and anti-HIV (antibody/antigen) were 3.2%, 22.1%, 0.7%, and 0%, respectively. After controlling for co-variables, hepatitis B vaccine was the only predictor of seropositivity of HBV (OR: 0.15, 95% CI: 0.057-0.393, P < 0.001), as it significantly protected against contracting HBV. On the other hand, the dialytic age (OR: 1.42, 95% CI: 1.12-1.94, P = 0.032) and the dialysis center were significant factors affecting the prevalence of HCV., Conclusions: The prevalence of HCV and HBV infections among HD patients in Damascus, Syria has decreased remarkably compared with the results from 2001. Nevertheless, it is still considered relatively high. Thus, there is an urgent need to strengthen the prevention and control measures for viral infection transmission in HD centers in Damascus., (© 2024. The Author(s).)

Silver nanoparticle is widely used in various field including medical, cosmetic, food and industrial purposes due to their unique properties in electrical conductivity, thermal, and biological activities. In the medical field, silver nanoparticles (AgNPs) have been reported to have strong antimicrobial and cytotoxic activities. This study aimed to synthesize and characterize silver nanoparticles (AgNPs) using Maclurodendron porteri (MP) extract and to evaluate the antimicrobial and cytotoxic activities of the synthesised MP-AgNPs. Green method of Ultrasound Assisted Extraction (UAE) was used to extract the leaves of M. porter . Liquid Chromatography -Mass Spectrometry/Quadrupole time-of-flight (LC-MS/QTOF) was used to identify the compounds in the leaf extract of M. porteri . Characterisation of the synthesised nanoparticles involved ultraviolet-visible (UV-Vis), Fourier Transform Infrared (FTIR), scanning electromagnetic microscopy (SEM), Zeta potential Analyzer and Particle Size Analyzer. The cytotoxic assay was conducted on MCF-7 and Caco-2 cell lines by MTT assay. Antimicrobial activity was tested on Gram-negative and Gram-positive bacteria using the disc diffusion method. Based on LC-MS/QTOF analysis, 430 compounds were found. The identified major compounds consist of amino acids, polyphenols, steroids, terpenoids and heterocyclic compounds which possibly act as reducing agents. 1 mM, 5 mM and 10 mM of silver nitrate solution were mixed with the leaf extract to form silver nanoparticles. 1.2 mg/ml of MP-AgNPs were found to have antibacterial activity against B. subtilis, S. aureus, E. coli, and P. aeruginosa with inhibitory zones of 8.0 ± 0.36 mm, 8.5 ± 0.45 mm, 7.5 ± 0.36 mm, and 9.0 ± 0.40 mm respectively. MP-AgNPs showed no cytotoxic activity against Caco-2 and MCF-7 cells. In conclusion, the presence of major amine compounds such as 10,11-dihydro-10,11-dihydroxyprotriptyline and harderoporphyrin in the extract facilitated the synthesis of AgNPs and the nanoparticle showed weak bioactivities in the assay conducted., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: The authors declare no conflict of interest. Muhammad Taher reports administrative support was provided by 10.13039/501100007297International Islamic University Malaysia. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background: Infection prevention measures are the gold standard for preventing the spread of hospital-acquired infections (HAIs). COVID-19 pandemic caused major disruptions in infection prevention measures, and this has implications on the rate of HAIs. This study assessed the impact of COVID-19 pandemic on the rate and the types of HAIs at Sultan Ahmed Shah Hospital., Method: This is a retrospective cohort study that compared the rate of HAIs from April to October 2019 (pre COVID period) and April to October 2020 (during COVID period). Data was collected through the review of patients' electronic medical records., Results: There were a total of 578 patients included in the selected wards during the pre- and during the pandemic. Thirty-nine episodes (12.1%) of HAIs were report in the pre COVID period and 29 (11.3%) during COVID-19. In both periods, hospital-acquired pneumonia (HAP) was the most frequent HAI among the patients. There was a rise in catheter-associated bloodstream infections (CLABSI) (0.8%) and ventilator associated pneumonia (VAP) (1.1%) during the COVID-19 period. The most common bacteria were methicillin-resistant Staphylococcus aureus (MRSA) (28.2%) and Enterococcus faecalis (17.9%) in the Pre COVID-19 period, and Pseudomonas aeruginosa (27.6%) and Stenotrophomonas maltophilia (6.9%) during COVID-19., Conclusion: Our research concluded that the rates of HAIs during the COVID-19 pandemic were not significantly impacted by the improved in-hospital infection prevention efforts to control the pandemic. There is need for further efforts to promote adherence to preventive practices., (© 2023. The Author(s).)

The increasing levels of carbon dioxide (CO 2 ) in the atmosphere may dissolve into the ocean and affect the marine ecosystem. It is crucial to determine the level of dissolved CO 2 in the ocean to enable suitable mitigation actions to be carried out. The conventional electrode materials are expensive and susceptible to chloride ion attack. Therefore, there is a need to find suitable alternative materials. This novel study investigates the electrochemical behaviour of dissolved CO 2 on roughened molybdenum (Mo) microdisk electrodes, which were mechanically polished using silicon carbide paper. Pits and dents can be seen on the electrode surface as observed using scanning electron microscopy. X-ray diffraction spectra confirm the absence of abrasive materials and the presence of defects on the electrode surface. The electrochemical surface for the roughened electrodes is higher than that for the smoothened electrodes. Our findings show that the roughened electrodes exhibit a significantly higher electrocatalytic activity than the smoothened electrodes for the reduction of dissolved CO 2 . Our results reveal a linear relationship between the current and square root of scan rate. Furthermore, we demonstrate that saturating the electrolyte solution with CO 2 using a bubbling time of just 20 minutes at a flow rate of 5 L min -1 for a 50 mL solution is sufficient. This study provides new insights into the electrochemical behaviour of dissolved CO 2 on roughened Mo microdisk electrodes and highlights their potential as a promising material for CO 2 reduction and other electrochemical applications. Ultimately, our work contributes to the ongoing efforts to mitigate the effects of climate change and move towards a sustainable future., Competing Interests: There are no conflicts of interest to declare., (This journal is © The Royal Society of Chemistry.)

Excessive nitrate intake via ingestion pathway and dermal absorption exposures has adverse health impacts on human health. This study evaluated groundwater (GW) nitrate concentrations and health risks which focused on ingestion and dermal exposures to residents in Bachok District, Kelantan, Malaysia. Three hundred (300) samples of private wells were collected and it is found that the nitrate concentrations ranging between 0.11 and 64.01 mg/L NO 3 -N with a mean value of 10.45 ± 12.67 mg/L NO 3 -N. The possible health hazards of nitrate by ingestion and dermal contact were assessed using USEPA human health risk assessment model for adult males and females. It is observed that the mean Hazard Quotient (HQ) values of adult males and females were 0.305 ± 0.364 and 0.261 ± 0.330, respectively. About 7.3% (n = 10) and 4.9% (n = 8) of adult males and females had HQ values more than 1, respectively. It was also observed that the mean of HQ derm was lesser than HQ oral for males and females. The spatial distribution of HQ by interpolation method showed high nitrate concentrations (> 10 mg/L NO 3 -N) were distributed from the centre to the southern part of the study location, which identified as an agricultural area, indicating the used of nitrogenous fertilizers as the main source of GW nitrate contamination in this area. The findings of this study are valuable for establishing private well water protection measures to stop further deterioration of GW quality caused by nitrate., (© 2023. The Author(s), under exclusive licence to Springer Nature B.V.)

Diabetic retinopathy (DR), one of the leading causes of visual impairment and blindness worldwide, is one of the major microvascular complications in diabetes mellitus (DM). Globally, DR prevalence among DM patients is 25%, and 6% have vision-threatening problems among them. With the higher incidence of DM globally, more DR cases are expected to be seen in the future. In order to comprehend the pathophysiological mechanism of DR in humans and discover potential novel substances for the treatment of DR, investigations are typically conducted using various experimental models. Among the experimental models, in vivo models have contributed significantly to understanding DR pathogenesis. There are several types of in vivo models for DR research, which include chemical-induced, surgical-induced, diet-induced, and genetic models. Similarly, for the in vitro models, there are several cell types that are utilised in DR research, such as retinal endothelial cells, Müller cells, and glial cells. With the advancement of DR research, it is essential to have a comprehensive update on the various experimental models utilised to mimic DR environment. This review provides the update on the in vitro, in vivo, and ex vivo models used in DR research, focusing on their features, advantages, and limitations., (© 2023. BioMed Central Ltd., part of Springer Nature.)

In this study, ceria nanoparticles (NPs) and deep eutectic solvent (DES) were synthesized, and the ceria-NP's surfaces were modified by DES to form DES-ceria NP filler to develop mixed matrix membranes (MMMs). For the sake of interface engineering, MMMs of 2%, 4%, 6% and 8% filler loadings were fabricated using solution casting technique. The characterizations of SEM, FTIR and TGA of synthesized membranes were performed. SEM represented the surface and cross-sectional morphology of membranes, which indicated that the filler is uniformly dispersed in the polysulfone. FTIR was used to analyze the interaction between the filler and support, which showed there was no reaction between the polymer and DES-ceria NPs as all the peaks were consistent, and TGA provided the variation in the membrane materials with respect to temperature, which categorized all of the membranes as very stable and showed that the trend of stability increases with respect to DES-ceria NPs filler loading. For the evaluation of efficiency of the MMMs, the gas permeation was tested. The permeability of CO 2 was improved in comparison with the pristine Polysulfone (PSF) membrane and enhanced selectivities of 35.43 (α CO2/CH4 ) and 39.3 (α CO2/N2 ) were found. Hence, the DES-ceria NP-based MMMs proved useful in mitigating CO 2 from a gaseous mixture.

Purpose: Portal vein (PV) reconstruction is a key factor for successful living-donor liver transplantation (LDLT). Anatomical variations of right PV (RPV) are encountered among potential donors., Methods: To evaluate a single center experience of reconstruction techniques for the right hemi-liver grafts with PV variations during the period between May 2004 and 2022., Results: A total of 915 recipients underwent LDLT, among them 52 (5.8%) had RPV anatomical variations. Type II PV was found in 7 cases (13.5%), which were reconstructed by direct venoplasty. Type III PV was found in 27 cases (51.9%). They were reconstructed by direct venoplasty in 2 cases (3.8%), Y graft interposition in 2 cases (3.8%), and in situ double PV anastomoses in 23 cases (44.2%). Type IV PV was found in 18 cases (34.6%) and was reconstructed by Y graft interposition in 9 cases (17.3%), and in situ double PV anastomoses in 9 cases (17.3%). Early right posterior PV stenosis occurred in 2 recipients (3.8%). Early PV thrombosis occurred in 3 recipients (5.8%). The median follow-up duration was 54.5 months (4 - 185). The 1-, 3-, and 5-years survival rates were 91.9%, 86%, and 81.2%, respectively. Late PV stenosis occurred in 2 recipients (3.8%) and was managed conservatively., Conclusion: Utilization of potential living donors with RPV anatomic variations may help to expand the donor pool. We found that direct venoplasty and in situ dual PV anastomoses techniques were safe, feasible, and associated with successful outcomes., (© 2023. The Author(s).)

Introduction: Femoral shaft fractures significantly impact children and families, posing a significant challenge for pediatric patients. The prevalence of limb shortening in femur shaft fractures treated with hip spica casting in our group, however, has not been the subject of many recent investigations., Aims: By comparing the prevalence of limb shortening to various age groups and common pediatric injury patterns, this research seeks to close this information gap., Methods: This research, which lasted six months and was done at the Orthopedics Unit of Khyber Teaching Hospital Peshawar, Pakistan, included 129 children with closed femur shaft fractures who were between the ages of one and six. Clinical assessments, radiological examinations, and hip spica casting, all supervised by experienced orthopedic surgeons, were carried out. Senior postgraduate trainees oversaw the study's findings., Results: The results unveiled key insights into the study population. Among the findings, 33% (n=43) of the children were aged one to three years, while 67% (n=86) fell within the three to six years age range. Gender distribution revealed that 72% (n= 93) were male. In terms of mechanism, 22% (n=28) of fractures were attributed to road traffic accidents, 69% (n=89) were the result of falls, and 5% (n=12) were due to other causes. Notably, 19% (n=29) of the children exhibited limb shortening., Conclusion: This study contributes significantly to the understanding of femur shaft fractures in children, shedding light on their complex dynamics. The study enhances our understanding of pediatric femur shaft fractures. We found that 19% of children exhibited limb shortening, underscoring the need for targeted treatment strategies. These insights can significantly improve patient care and treatment protocols for this challenging condition, benefiting both children and their families., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Kakakhel et al.)

About 10% of newborns require some degree of assistance to begin their breathing, and 1% necessitates extensive resuscitation. Sick neonates are exposed to a number of invasive life-saving procedures as part of their management, either for investigation or for treatment. In order to support the neonates with the maximum possible benefits and reduce iatrogenic morbidity, health-care providers performing these procedures must be familiar with their indications, measurements, and potential complications. Hence, the aim of this review is to summarise ten of the main neonatal intensive care procedures with highlighting of their indications, measurements, and complications. They include the umbilical venous and arterial catheterizations and the intraosseous line which represent the principal postnatal emergency vascular accesses; the peripherally inserted central catheter for long-term venous access; the endotracheal tube and laryngeal mask airway for airway control and ventilation; chest tube for drainage of air and fluid from the thorax; and the nasogastric/orogastric tube for enteral feeding. Furthermore, lumber puncture and heel stick were included in this review as very important and frequently performed diagnostic procedures in the neonatal intensive care unit., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2023 Zainab Bubakr Hamad Zubi et al.)

Background: This study evaluated the cytotoxicity of four bioceramic root canal sealers (RCSs) in vivo. The embryonic zebrafish characteristics, such as mortality, survival, hatching, and general morphology, served as the parameters for assessing cytotoxicity., Methods: The RCSs, namely GuttaFlow Bioseal, MTA Fillapex, CeraSeal Bioceramic, and iRoot SP, were mixed according to the manufacturer's guidelines. The extract solution was prepared by immersing the set RCS into 1X dilution of E3 solution. Then, the extract solution was delivered into a Petri dish where zebrafish embryos were allowed to develop. Cytotoxicity was evaluated 24, 48, 72, and 96 hours after fertilization., Results: The Kruskal-Wallis test showed that except for GuttaFlow Bioseal, the mortality, survival, and hatching of zebrafish embryos for the remaining three bioceramic RCSs were significantly different from the negative controls ( P <0.05). Significant differences were also evident in the mortality, survival, and hatching of zebrafish embryos between GuttaFlow Bioseal and three other RCSs ( P <0.05)., Conclusion: GuttaFlow Bioseal was less cytotoxic than other bioceramics RCSs; MTA Fillapex, CeraSeal Bioceramic root canal sealer, and iRoot SP root canal sealer exhibited comparable cytotoxicity., Competing Interests: The authors declare no competing interests., (©2023 The Author(s).)

Introduction: Invasive surgical procedures in the oral cavity inevitably cause trauma to the soft and hard tissues. The healing process in the oral cavity tissue occurs in a complex manner involving different types of cells, maturation process, and the time of healing. Salvadora persica (miswak) has been found to exert various positive effects on the oral cavity, including antimicrobial, anti-gingivitis, anti-cariogenic, gingival healing, and teeth whitening properties. This study aims to investigate the potential of miswak as an adjunctive therapy in promoting wound healing., Materials and Methods: 30 live Sprague-Dawley rats were used in this study. The rats' mandibular first molar tooth was extracted, and an incision wound was made on the tongue. The extraction socket and incision wound were irrigated using normal saline and different concentrations of locally processed miswak plant extracts (0.05%, 10%, and 20%) for 7 days. The rats were sacrificed for gross examination of the tooth socket and tongue healing. Both soft tissue and alveolar bone were examined microscopically., Results: Complete closure of the incision wound was observed on all rats' tongues; miswak groups showed better wound healing than control and placebo groups in the oral mucosa overlying the alveolar bones. 0.05% and 20% miswak extracts showed prominent wound healing effects in the sagittal sections of the tongue, with moderate formation of connective tissue under the wound site and notable wound contraction. The 20% miswak extract group showed the highest percentage of healed oral mucosa on the alveolar bone and higher bone deposition at the alveolar base., Conclusion: A concentration of 20% miswak extract enhances the initial phase of wound healing both in oral soft and hard tissues. Miswak extract at this concentration was not toxic to the tissues and had potential therapeutic effects in oral tissue healing., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 King Saud University.)

Introduction: Necrotizing fasciitis (NF) is a rapidly progressive necrosis of the fascial layer with a high mortality rate. It is a life-threatening medical emergency that requires urgent treatment. Lack of skin finding in NF made diagnosis difficult and required a high clinical index of suspicion. The use of ultrasound may guide clinicians in improving diagnostic speed and accuracy, thus leading to improved management decisions and patient outcomes. This literature search aims to review the use of point-of-care ultrasonography in diagnosing necrotizing fasciitis., Method: We searched relevant electronic databases, including PUBMED, MEDLINE, and SCOPUS, and performed a systematic review. Keywords used were "necrotizing fasciitis" or "necrotising fasciitis" or "necrotizing soft tissue infections" and "point-of-care ultrasonography" "ultrasonography" or "ultrasound". No temporal limitation was set. An additional search was performed via google scholar, and the top 100 entry was screened., Results: Among 540 papers screened, only 21 were related to diagnosing necrotizing fasciitis using ultrasonography. The outcome includes three observational studies, 16 case reports, and two case series, covering the period from 1976 to 2022., Conclusion: Although the use of ultrasonography in diagnosing NF was published in several papers with promising results, more studies are required to investigate its diagnostic accuracy and potential to reduce time delay before surgical intervention, morbidity, and mortality., (© 2023. The Author(s).)

Three-dimensional (3D) printing technology has presently been explored widely in the field of pharmaceutical research to produce various conventional as well as novel dosage forms such as tablets, capsules, oral films, pellets, subcutaneous implants, scaffolds, and vaginal rings. The use of this innovative method is a good choice for its advanced technologies and the ability to make tailored medicine specifically for individual patient. There are many 3D printing systems that are used to print tablets, implants, and vaginal rings. Among the available systems, the fused deposition modeling (FDM) is widely utilized. The FDM has been regarded as the best choice of printer as it shows high potential in the production of tablets as a unit dose in 3D printing medicine manufacturing. In order to design a 3D-printed tablet or other dosage forms, the physicochemical properties of polymers play a vital role. One should have proper knowledge about the polymer's properties so that one can select appropriate polymers in order to design 3D-printed dosage form. This review highlighted the various physicochemical properties of polymers that are currently used as filaments in 3D printing. In this manuscript, the authors also discussed various systems that are currently adopted in the 3D printing., (© 2023. The Author(s), under exclusive licence to American Association of Pharmaceutical Scientists.)

Lysosome is a primary degradative organelle and is crucial in cellular homeostasis. A reduction in its function due to ageing has been associated with the development of Alzheimer's disease (AD), a common neurodegenerative disorder characterised by the deposition of neurotoxic amyloid plaque in the brain and cerebral vessel walls. The breakdown of the blood-brain barrier (BBB) plays a vital role in the pathogenesis of AD. However, the impact of lysosomal dysfunction on brain endothelial cells, the key component of the BBB, in the disease progression is yet to be fully understood. In this study, human brain endothelial cells (HBEC-5i) were exposed to a lysosomotropic compound, chloroquine (CQ) for 24 h. Cell viability was assessed with the 3-(4,5-dimethylthiazol-2-yl)- 2,5-diphenyltetrazolium bromide (MTT) assay to determine the inhibitory concentration (IC) at IC 10 (17.5 µM), IC 25 (70.5 µM), and IC 50 (125 µM). The morphological changes observed include vacuoles arrested in the cytosols and cell shrinkage that were more prominent at IC 25 and IC 50 . Lysosomal dysfunction was evaluated by measuring the lysosomal-associated membrane protein-1 (LAMP-1) and microtubule-associated protein light chain 3-II (LC3-II) using the capillary-based immunoassay. LC3-II was significantly increased at IC 25 and IC 50 (p < 0.05 and p < 0.001 , respectively). The concentration of intracellular and extracellular Aβ42 was quantitated using the enzyme-linked immunosorbent assay, which demonstrated a significant increase (p < 0.05) in intracellular Aβ42 at IC 25 . This study showed that perturbation of lysosomal function impairs autophagy that leads to intracellular increment of Aβ, indicating the important roles of lysosomes in endothelial cells homeostasis and disease progression., Competing Interests: Conflict of interest statement The authors declare that there are no conflicts of interest in this work., (Copyright © 2023 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)

Background: Necrotizing pneumonia is rare in children and is one of the most serious complications of a lung infection caused by antibiotic failure. We present a 12-year-old leukopenic child with a long-lasting lung infection, presenting as having a lung hydatid cyst, but diagnosing with necrotizing pneumonia in the right bilobed lung. Failure to medical treatment and ongoing leukopenia justified surgical intervention with positive results., Case Presentation: The patient was referred to our teaching hospital's pediatric surgery department. He had previously been diagnosed with intestinal tuberculosis (TB) and received anti-TB treatment. On referral to our hospital, the patient was suffering from restlessness, frequent coughing, fever, vomiting, and diarrhea. Following the completion of the clinical work-up, a blood test revealed leukopenia (white blood cell count of 2100/microliter), a normal platelet count, and a lesion in the right lung. Computerized tomography scanning (CT-Scan) image reported a lung hydatid cyst. In the pediatrics ward, a broad-spectrum antibiotics regimen with triple-antibiotic therapy (linezolid, vancomycin, and metronidazole) was instituted and continued for a week with no response, but worsening of the condition. In the pediatric surgery ward, our decision for surgical intervention was due to the failure of medical treatment because of a pulmonary lesion. Our team performed right lung upper lobe anterior segment wedge resection due to necrotizing pneumonia and followed the patient 45 days post-operation with a reasonable result., Conclusion: Living in remote rural areas with low resources and inaccessibility to proper and specialized diagnostic and treatment centers will all contribute to an improper diagnosis and treatment of lung infection. In total, all of these will increase the morbidity and mortality due to lung necrosis in the pediatric population, regardless of their age. In low-resource facilities, high-risk patients can benefit from surgical intervention to control the ongoing infection process., (© 2023. The Author(s).)

In recent years, previously reported studies revealed a high efficiency of pollutant degradation by coupling photocatalysis and electrochemical processes (PECs) using titanium dioxide (TiO 2 ) photoelectrode rather than using photocatalysis or electrocatalysis alone. However, some of the TiO 2 photoelectrodes that have been reported were not cost-effective. This is due to the use of expensive chemicals and certain expensive equipment in the fabrication process, other than involving complicated preparation steps. Therefore, this study is aimed at investigating the PEC performance and stability of low-cost TiO 2 -polyvinyl chloride (TiO 2 -PVC) composite photoelectrode for Reactive Orange 16 (RO16) degradation. The materials characterisation using the ATR-FTIR, XRD and UV-Vis DRS proved that TiO 2 and TiO 2 -PVC were successfully synthesised. The micrograph obtained for the surface characterisation using the FESEM showed that the smooth surface of freshly prepared photoelectrodes turned slightly rough with tiny pits formation after five continuous PEC processes. Nevertheless, the photoelectrode retained its original shape in good condition for further PEC processes. By PEC process, the fabricated photoelectrode showed 99.4% and 51.1% of colour and total organic carbon (TOC) removal, respectively, at optimised PEC parameters (1.0 mol L -1 NaCl concentration, 10 V applied voltage, 120 min degradation time and initial pH 2). Moreover, the fabricated photoelectrode demonstrated sufficient reusability potential (~ 96.3%) after five cycles of PEC processes. In summary, a low-cost and stable composite photoelectrode with high efficiency in RO16 degradation was successfully fabricated and could be potentially applied for other emerging pollutants degradation via the PEC degradation technique., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: To report the incidence, risk factors, and outcome of severe COVID-19 disease in kidney transplant recipients attending a Saudi hospital at a single center in the Kingdom of Saudi Arabia., Methods: A retrospective chart-based cohort study involving all kidney transplant recipients tested for COVID-19 in the Armed Forces Hospital Southern Region, KSA., Results: Of 532 kidney transplant recipients who reported to the center, from March 2020 to June 2022, 180 were tested for COVID-19. Of these recipients, 31 (17%) tested positive. Among the 31 positive recipients, 11 were treated at home, 15 were admitted to the noncritical isolation ward, and 5 were admitted to the intensive care unit (ICU). Older age (P = .0001), higher body mass index (P = .0001), and history of hypertension (P = .0023) were more frequent in the COVID-19-positive recipients. Admission to the ICU was more frequent in older recipients (P = .0322) with a history of ischemic heart disease (P = .06) and higher creatinine baseline (P = .08) presenting with dyspnea (P = .0174), and acute allograft dysfunction (P = .002). In the ICU group, 4 (80%) patients required hemodialysis, and 4 (80%) died., Conclusions: Kidney transplant recipients with COVID-19 could have a higher risk for developing acute kidney injury, dialysis, and mortality than the general population. ICU admission and renal replacement therapy were more evident in older recipients with a history of ischemic heart disease, presenting with shortness of breath (P = .017) and a higher serum creatinine baseline. Acute allograft dysfunction was the independent predictor of mortality among patients admitted to the ICU., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objectives: Endoscopic retrograde cholangiopancreatography (ERCP) has shown great safety and efficacy in the management of post-living-donor liver transplantation (LDLT) biliary complications. Pancreatitis is the most commonest and the most feared complication after ERCP., Methods: We reviewed the data of liver transplant recipients who underwent ERCP for biliary complications after LDLT between 2011 and 2022., Results: In total 63 patients underwent ERCP after LDLT. They were targeted to 134 set of ERCP. Pancreatitis occurred in 52 sets (38.8%). We subclassified the patients into two groups, without pancreatitis: 31 patients (49.2%) and with pancreatitis 32 patients (50.8%). A higher incidence of pancreatitis was noticed with the first ERCP set (P = 0.04). Biliary strictures were more noted in the pancreatitis group (P = 0.025). Difficult cannulation requiring precut was more observed in the pancreatitis group (P = 0.007). Also, more frequent sphincterotomy was observed in the pancreatitis group (P = 0.003). Longer hospital stay, more fever, abdominal pain and vomiting were noted in the pancreatitis group (P = 0.001). Higher post-ERCP serum amylase (P = 0.001) and creatinine (P = 0.021), while lower serum calcium (P = 0.21) were noticed in the pancreatitis group. On multivariate analysis, preoperative diabetes, number of biliary anastomoses (single/multiple) and difficult cannulation requiring precut were significant predictors of post-ERCP pancreatitis., Conclusion: Patient-related risk factors and bedside procedure-related risk factors play an essential role in the development of pancreatitis after ERCP for LDLT recipients. Endoscopists should be mindful by those high-risk patients during ERCP to apply appropriate techniques to prevent the development of this serious complication., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Topical agents are sometimes applied to surgical wounds after closure; these may include antiseptics or antibiotics. Minimal research has been undertaken to investigate the effect of topical regimens on the tensile strength of suture materials., Aim: To investigate the effect of four commonly used wound care regimens on the tensile strength of suture materials., Methods: The failure load of 9 different suture materials was tested using the Instron Electroplus E3000 tensile testing machine (Instron Corporation, Norwood, Massachusetts). Tensile strength was represented as the failure load, measured in Newtons (N), and defined as the maximal load that could be applied across the suture prior to failure. Each suture was tested dry and after immersion in one of 4 products for 7 days and tested on day 7. The immersion agents tested were: sodium chloride 0.9%, MicroSafe® (Sonoma Pharmaceuticals, Petaluma, CA), Aqueous Povidone-iodine 10% solution (Betadine-Mundipharma), and Fucidin ointment., Results: Sodium chloride 0.9%, MicroSafe®, Aqueous Povidone-iodine 10%, and Fucidin seem to increase the failure load of most absorbable and non-absorbable sutures. However, the failure load of Polyglactin 910 suture (Surgilactin, coated, violet-Ethicon) is reduced by long-term exposure to either sodium chloride 0.9% or MicroSafe®, while the failure load of the Polydioxanone suture (PDS Plus-Ethicon) is reduced by long-term exposure to MicroSafe® only., Conclusion: In our experiment, the commonly used wound care products have been shown to alter the tensile strength of suture materials. Further human studies are required to ascertain the clinical validity and applicability of our findings., (© 2022. The Author(s) under exclusive licence to Société Internationale de Chirurgie.)

Background: Lack of public understanding, perception and awareness of the biological effects of prenatal ultrasound has led to the non-medical use of ultrasound. An educational programme is required to enlighten pregnant women and the public regarding prenatal ultrasound safety., Objective: To evaluate the effectiveness of educational modules (video and brochure) in improving knowledge, awareness and perception (KAP) among pregnant women regarding prenatal ultrasound safety., Methods: This is a quasi-experimental study with a pre-and post-test design. This study recruited 51 pregnant women as respondents from the Obstetrics and Gynaecology clinic (O&G) of Hospital Canselor Tuanku Muhriz (HCTM). The first phase of the study was conducted by distributing a set of closed-ended questionnaires with multiple choice and Likert scale answers to assess the KAP of pregnant women regarding the safe use of prenatal ultrasound, followed by educational modules where the respondents were allocated into three groups (17 watched a video, 17 received brochure and 17 received combined media). After the intervention, the respondents' KAP were assessed using the same questionnaire., Results: The Wilcoxon signed rank test showed that educational modules like video, brochure and combined media had a statistically significant increase in post-test scores over the pre-test scores (video: mean rank = 9.00, p < 0.05) (brochure: mean rank = 9.79,p < 0.05) and (combined media: mean rank = 10.17, p > 0.05). The Kruskal Wallis test indicated that educational video was more effective in improving the KAP of pregnant women than the brochure and combined media (mean rank = 34.62, p < 0.05). Among the parameters, the occupation has the strongest positive correlation with the post-test knowledge score in improving the KAP of pregnant women regarding the safe use of prenatal ultrasound., Conclusion: The educational video is the most effective approach for enhancing pregnant women's KAP. The educational module on the safety of prenatal ultrasound is thought to dispel myths by providing accurate information to audiences from various backgrounds., Competing Interests: The authors declare no conflict of interest., (© 2022 The Authors.)

Aging is a universal process that can cause diminished function of organs and various diseases. The most striking consequences of aging can be seen visibly on the skin, which acts as a barrier against various external insults. Aging of the skin consists of intrinsic and extrinsic processes that work in concert and influence each other. Intrinsic aging involves biochemical degenerative processes that gradually takes place with age. Extrinsic aging are biochemical processes driven by external influences that lead to aging. There are significant morphological changes at all levels in aged skin that have a profound effect on the characteristics of the skin. Even though skin is subjected to damage by external insults, it is equipped with a healing capability in order to restore its normal structure and function. However, aging has a significant impact on the skin's healing function by prolonging the inflammatory phase and increasing the production of reactive oxygen species (ROS). This shifts the healing process towards having more protein degradation, which can lead to chronic wound healing with an abundance of complications.

Individuals with cerebral palsy (CP) frequently present with multiple feeding problems, which may require food texture modification to ensure safe feeding. This review aims to explore the challenges individuals with CP and their caregiver's face and recommend modified food textures to ensure safety and improve the quality of life and nutritional status. A systematic search was carried out through four databases (i.e., EBSCO (Medline), PubMed, Science Direct, and Web of Science) between January 2011 and May 2022. Out of 86 articles retrieved, seven were selected based on keywords and seven other studies through manual search-five cross-sectional studies, two qualitative studies, one correlational study, one mixed method study, one case-control study, two sections of books, and two educational materials. The findings suggest that preparation and intake of food with modified texture play a necessary role in the safety of swallowing in addition to physical, social, and environmental aspects. Safety was found to be the crucial part of the food texture modification provision besides considering the stress of the caregivers and the nutritional status of individuals with CP. Currently, there are no standard guidelines available pertaining to food texture modification. This led to uncertainties in the dietary provision among caregivers, which may lead to undernourishment. Hence, standard guidelines relating to food texture modification that focuses on food preparation and menus with calorie and nutrient information are timely to be developed.

Complete cricotracheal separation, which is the most severe type of laryngeal trauma, is an uncommonly seen injury that clinicians have limited experience in managing. However, it is potentially fatal. Due to limited exposure to this condition, mismanagement can occur, which may further aggravate the patient's condition. The most crucial part of managing this injury is to establish a secure airway. Tracheostomy under local anesthesia is the preferred method of airway stabilization, in order to avoid further injuries to the airway caused by endotracheal intubation. Here, we discuss the management of complete cricotracheal separation based on a case experienced in the east coast region of Malaysia, where this type of injury is rarely encountered., Competing Interests: Conflicts of interest The authors have no conflicts of interest to declare., (© 2022 The Korean Society of Traumatology.)

Uncontrolled bleeding is linked to higher treatment costs, risk of post-surgical infection and increased disease and death. Hemostatic agents are used to treat excessive bleeding. A good hemostatic agent controls bleeding effectively, reduces the need for blood transfusion, removes the need for systemic drugs to control bleeding, results in shorter surgery time, and reduces the cost and length of hospital stay of the patient. Gelatin-based hemostatic agents have been widely used in medical and dental procedures, owing to their biodegradability and biocompatibility, as well as availability and low cost of raw materials. In this narrative literature review, we discuss the background and different types of gelatin-based hemostatic agents in medical and dental procedures, the comparison of gelatin-based and non-gelatin-based hemostatic agents, and the usage and development of enhanced or novel gelatin-based hemostatic agents. Gelatin-based hemostatic agents are effective and important part of bleeding control, as evidenced by its wide application in medicine and dentistry. The development of novel combination gelatin-based hemostatic agents has much potential for effective control of excessive bleeding., (© 2022 The Authors.)

Here, we present two 7.1- and 7.3-bp near-complete genome sequences of Burkholderia pseudomallei strains of HTAA077 and HRPB058, isolated from a pus culture from a confirmed melioidosis patient at Hospital Tengku Ampuan Afzan, Kuantan, Malaysia, and from blood culture from a patient at Hospital Raja Permaisuri Bainun, Ipoh, Malaysia, using a Nanopore MinION instrument.

Background: Use of pesticides has been linked to neurobehavioral deficits among exposed workers. In Malaysia, organophosphate and pyrethroid pesticides are commonly used to control mosquito-borne diseases., Objectives: This study aims to assess workers' lifetime occupational pesticide exposure and examine the relationship with neurobehavioral health., Methods: A cross-sectional study was conducted on 158 pesticide-exposed and 176 non-exposed workers. To collect historical exposure and job tasks, a questionnaire and an occupational history interview were used. Pesticide exposure was measured in a subgroup of workers via inhalation and skin contact. The total pesticide intake of each worker was assessed using inhalation and dermal exposure models. CANTAB® computerised neurobehavioral performance assessments were used., Results: The participants' mean age was 31 (8) years. Pirimiphos-methyl (median = 0.569 mg/m3, Interquartile range [IQR] = 0.151, 0.574) and permethrin (median = 0.136 mg/m3, IQR = 0.116, 0.157) had the highest measured personal inhalation concentrations during thermal spraying. The estimated total lifetime pesticide intake for exposed workers ranged from 0.006 g to 12800 g (median = 379 g and IQR = 131, 794 g). Dermal exposure was the predominant route of pesticide intake for all workers. Compared to controls, workers with high lifetime pesticide intake had lower Match to Sample Visual (adjusted B = -1.4, 95% Confidence Interval (CI) = -2.6, 0.1), Spatial Recognition Memory (adjusted B = -3.3, 95% CI = -5.8, 0.8), Spatial Span (SSP) (adjusted B = -0.6, 95% CI = -0.9, 0.3) scores. Workers with low pesticide intake performed worse than controls (adjusted B = -0.5, 95% CI = -0.8, -0.2) in the SSP test, but scored higher in the Motor Screening test (adjusted B = 0.9, 95% CI = 0.1, 1.6). Higher Paired Associates Learning test scores were observed among higher (adjusted B = 7.4, 95% CI = 2.3, 12.4) and lower (adjusted B = 8.1, 95% CI = 3, 13.2) pesticide intake groups. There was no significant difference between the Reaction Time and Pattern Recognition Memory tests with lifetime pesticide intake after adjusting for confounders., Conclusion: Pesticide exposure has been linked to poorer neurobehavioral performance. As dermal exposure accounts for a major fraction of total intake, pesticide prevention should focus on limiting dermal exposure., (© The Author(s) 2022. Published by Oxford University Press on behalf of the British Occupational Hygiene Society.)

Background: Both bromodomain and extra-terminal domain (BET) proteins and spleen tyrosine kinase (SYK) represent promising targets in diffuse large B-cell (DLBCL) and Burkitt's lymphoma (BL). We evaluated the anti-lymphoma activity of the isoform-specific bivalent BET inhibitor AZD5153 (AZD) and the pan-BET inhibitor I-BET151 (I-BET) as single agents and in combination with SYK inhibitor Entospletinib (Ento) in vitro. Methods: The effect of the single agents on cell proliferation and metabolic activity was evaluated in two DLBCL and two BL cell lines. Proliferation, metabolic activity, apoptosis, cell cycle and morphology were further investigated after a combined treatment of AZD or I-BET and Ento. RNAseq profiling of combined AZD+Ento treatment was performed in SU-DHL-4 cells. Results: Both BET inhibitors reduced cell proliferation and metabolic activity in a dose- and time-dependent manner. Combined BET and SYK inhibition enhanced the anti-proliferative effect and induced a G0/G1 cell cycle arrest. SU-DHL-4 demonstrated a pronounced modulation of gene expression by AZD, which was markedly increased by additional SYK inhibition. Functional enrichment analyses identified combination-specific GO terms related to DNA replication and cell division. Genes such as ADGRA2 , MYB , TNFRSF11A , S100A10 , PLEKHH3 , DHRS2 and FOXP1-AS1 were identified as possible key regulators. Conclusion: Simultaneous inhibition of BET and SYK enhanced the anti-proliferative effects, and induced a combination-specific gene expression signature.

Background In light of the ongoing coronavirus disease 2019 (COVID-19) pandemic, vaccination is one of the most important defensive strategies in combating the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Vaccine hesitancy or anti-vaccination attitude has become a barrier to the nationwide vaccination program, potentially sabotaging the effectiveness of vaccination. Thus far, Google Trends (GT) has been used extensively for monitoring information-seeking behavior during the pandemic. We aimed to investigate the association between Google search, the vaccination rate, and the number of vaccinated and infected cases among the Malaysian population. Material and method GT's customizable geographic and temporal filters were applied to include results for predetermined keywords from January 1, 2021, to December 31, 2021. Both Malay and English languages were used to reflect the multi-racial and multi-lingual community in Malaysia. The search volume index (SVI) derived was compared with the numbers of vaccinated and infected cases which were extracted from the open-access database (COVIDNOW in Malaysia) within the same period. Both analyses were performed independently by two authors to ensure accuracy of the data extraction process. A descriptive analysis was used to compare GT analyses and the number of daily vaccinations and positive COVID-19 cases. Results The information-seeking behavior in the public fluctuated from time to time. The interest surged during the initiation of vaccination program and upon the outbreak of COVID-19 in Malaysia. The surge in interest prior to the peak of vaccination rate also indicated that the public tended to get information online prior to getting the vaccines.  Conclusion This observational study illustrates the ability of GT to monitor the interest of vaccination among the Malaysian population during the pandemic. By monitoring the dynamic changes in Google Trends, healthcare authorities can get a glimpse of public perceptions such as attitude towards COVID-19 vaccine, hence potentially identify and stymie any dangerous online anti-vaccination rhetoric swiftly., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Kow et al.)