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A combined experimental and theoretical study investigated the corrosion inhibition potential of 2-dimethylaminopropionamidoanti-pyrine (DMAPAAP) on mild steel in 1 M hydrochloric acid (HCl) solution. The weight loss method was used to determine the corrosion rate of mild steel in HCl solution both in the absence and presence of different concentrations of DMAPAAP. The effect of exposure time and temperature on the corrosion inhibition efficiency of DMAPAAP was also investigated. The results showed that DMAPAAP exhibited good inhibitory properties against the corrosion of mild steel in an HCl solution. The corrosion rate of mild steel increased with increasing inhibitor concentration, exposure time, and temperature. The highest inhibition efficiency of 91.9 % was achieved at 5 mM concentration of DMAPAAP after 5 hours of exposure time at 333 K. Density functional theory (DFT) calculations were carried out to support the experimental results and understand the inhibition process's mechanism. The adsorption of DMAPAAP on the mild steel surface was found to be both chemisorption and physisorption and followed the Langmuir adsorption isotherm. The inhibition efficiency increased with increasing electrondonating groups in the molecule, which was attributed to forming a protective film on the metal surface. Overall, the combined experimental and theoretical study provides a deeper understanding of the corrosion inhibition mechanism of DMAPAAP on mild steel in HCl solution and demonstrates its potential as an effective corrosion inhibitor for mild steel in industrial applications. [ABSTRACT FROM AUTHOR]

Background and Objectives: Clostridium difficile is a gram-positive obligate anaerobic bacillus. Accurate and rapid diagnosis of this bacterium as well as assessment of its drug resistance pattern are one of the important issues in controlling infections caused by C. difficile. The purpose of the present study was to detect toxicogenic C. difficile and to evaluate drug resistance pattern of these strains to routine therapeutic drugs. Methods: A total of 68 samples were collected from patients hospitalized in hospitals of Qom province. All samples were rapidly cultured in the specialized CCFA Agar medium.After these procedures, the bacteria were used for DNA extraction and then PCR was performed on the cdd3 gene for definitive detection of the bacteria. Finally, the presence of A and B toxins’ genes was determined by PCR and resistance to metronidazole, vancomycin, and clindamycin, was determined by agar dilution method. Chi-square test was used to analyze the results. Results: In this study, 6 isolates had A and B toxins, the highest antibiotic resistance was against clindamycin (45.45%) and metronidazole (36.36%), and all the isolates, were sensitive to vancomycin. Conclusion: Drug resistance pattern in the obtained strains still introduces vancomycin as the treatment of choice.

This paper presents the retrofit of the two-flow heat-exchange system with utility paths in order to optimize the heat recuperation capacity under the technical limitation conditions. Analytical dependences of heat load of the existing heat exchangers and utilities on the surface area of the new heat exchanger are obtained. The work shows that the determination of technological parameters for existing heat exchangers during the retrofit of the heat exchange system is an important task because they affect the cost of retrofit. For case study, two streams problem for heat transfer in heat network at the crude and gas separation units is considered in this paper. The existing system has three heat exchangers. The temperature measurements were fulfilled for all heat exchangers and the heat loads for heat exchangers and utility were calculated. The installation of one heat exchanger at the cool side of the system is proposed in retrofit. The dependences of the temperature changes for the hot and cold process stream from the value of the additional surface were obtained for each heat exchanger. Utility capacity and capacity recovery of thermal energy in the system is also analyzed.

Different extracts from seven plant species were assayed against the cowpea beetle (Callosobruchus maculatus) in the laboratory. The plants were extracted sequentially with petroleum ether, chloroform and ethyl alcohol. The petroleum ether extract of each was fractionated into sap and unsap, then identified by GC chromatography. Also compounds isolated from chloroform and alcohol extracts of Citrullus colocynthis and petroleum ether extract of Nicandra physaloides were tested for their toxicity against the adult beetle. The sensitivity of the adults to various crude extracts revealed great variation in effectiveness. Petroleum ether and chloroform extracts of Nicandra physaloides proved to be the most toxic in comparison to other extracts tested, while petroleum ether extracts of Curcuma longa proved to be the least effective. All the fatty acid fractions of the seven plant species were toxic to the adult beetles at the tested concentrations. N. physaloides, Schinus terebinthifolius and Dodonaea viscosa resulted in 100% mortality of adults at the highest concentration tested (1.0%). Using 1.0% unsap fraction of Dodonaea viscosa resulted in 100% mortality between the adults. The least percentage mortality between the adult beetles recorded (22%) was for unsap fraction of T. orientalis at concentration of 0.0625% but increased to 80.0% mortality at concentration of 1.0%. The compounds isolated from chloroform and alcohol extracts of C. colocynthis and petroleum ether extract of N. physaloides proved to be highly efficient against C. maculatus adults.

This paper presents a social work study on relationship between thinking style and self-esteem as well as socio-economic conditions among university students. The study selects 512 students from Islamic Azad University of Najafabad in province of Esfahan, Iran and distributes a questionnaire, which measures creativity and self-esteem. We also collect students’ socio-economic conditions and analyze the information. The results of our survey disclose that thinking style and self-esteem have overlap with each other. In addition, students with better socio-economic conditions are more creative and use complex style of thinking. The study also provides some guidelines for practically implementing the results of our survey among other students.

Background: Migraine is one of the most common etiologies for headache. This very common neurological disorder has a significant impact on patients' quality of life. The aim of the current study is to evaluate the prevalence of migraine among medical students in the Hormozgan University of Medical Sciences (HUMS). Methods: A total of 350 medical students were enrolled in our descriptive study. Data were collected using the standard questionnaire of the International Headache Association. The data were analyzed by SPSS 20.0 software using descriptive statistics, Chi-Square, and Independent Samples T-Test. A P-value of ≥0.05 was considered statistically significant, since most public health professionals use this value as a standard. Results: Among the medical students in our study, 24.6% had experienced frequent, severe headaches. The underlying causes of the headaches were diagnosed in 19.8% of the students. The prevalence of migraine in our study was 16.3% (mean age=21.28±2.71years). The prevalence varied by gender, and it was greater among male students. Conclusion: Our findings indicated that there was a high prevalence of migraine among the medical students in our study, and these findings were consistent with those of previous studies in Iran and other countries.

This paper deals with the optimization of tools geometry in sheet metal forming U-bending in order to reduce the equivalent strain, equivalent stress, and thickness change after forming. Free form surface method (Bezier curve, B-spline curve, and NURBS curve) is used to generate the die and punch profile; this technique is accurate to describing the die and punch profile. A 3D numerical simulation using the Ansys 12.1 FEM code was conducted to understand the effect of die profile in final product. The results show that the more uniform distributions in strain, stress, and thickness when using same profile radius for die and punch (Bezier curve).

To compare the efficacy of acupressure wrist bands, ondansetron, metoclopramide and placebo in the prevention of vomiting and nausea after strabismus surgery. Two hundred patients, ASA physical status I or II, aged between 10 and 60 years, undergoing strabismus surgery in Farabi Hospital in 2007-2008 years, were included in this randomized, prospective, double-blind and placebo-controlled study. Group I was the Control, group II received metoclopramide 0.2 mg/kg, group III received ondansetron 0.15 mg/kg iv just before induction, in Group IV acupressure wristbands were applied at the P6 points. Acupressure wrist bands were placed inappropriately in Groups I, II and III. The acupressure wrist bands were applied 30 min prior to the induction of anesthesia and removed six hours after surgery. Postoperative nausea and vomiting (PONV) was evaluated within 0-2 hours and 2-24 hours after surgery by a blinded observer. Results were analyzed by X2 test. A P value of < 0.05 was taken as significant. The incidence of PONV was not significantly different in acupressure, metoclopramide and ondansetron during the 24 hours. Acupressure at P6 causes a significant reduction in the incidence of PONV 24 hours after strabismus surgery as well as metoclopramide 0.2 mg/kg and ondansetron 0.15 mg/kg iv for patients aged 10 or more.

The aim of this study was to test the therapeutic efficacy of sodium alginate in a rat model of trinitrobenzene sulfonic acid (TNBS)-induced inflammatory bowel disease. This experiment was carried out using 77 Sprague-Dawley rats which were divided into six groups; normal, control, prophylactic, therapeutic and two experimental groups. Rats were sacrificed 1, 2, 3 and 6 weeks after colitis induction. Severity of colitis was graded macroscopically and assessed using serum and colonic mucosal cytokines and eicosanoids. Intrarectal TNBS (30 mg) produced a significant chronic ulcerative colitis. The lesions were most severe on day seven after TNBS instillation, and then declined, but lesions were still observed after six weeks. TNBS administration also significantly enhanced the serum and colonic mucosal cytokines (TNF-alpha and IL-6) and eicosanoids (LTB4 and PGE2) levels, which paralleled with the severity of colitis. Low viscosity sodium alginate (LVA) solution as therapeutic agent was administered orally as drinking water at concentration of 0.5% (W/V) for six weeks. Results showed that pre-treatment (in prophylactic group) and treatment with LVA were significantly able to reduce colonic damage score, serum level and colonic mucosal production of TNF-alpha, IL-6, LTB4 and PGE2 in pre-treated and treated animals compared with non-treated controls. LVA therapy is able to suppress chronic ulcerative colitis in experimental model.

Surgical face masks (SFM) are pivotal in preventing surgical site infections (SSI) in the operating room (OR). However, there are currently no specific recommendations for their most effective use. SFM effectiveness is influenced by factors such as material, fit, and duration of use, sparking ongoing debates about their benefits and risks in surgery. SFMs act as a protective barrier, but their ability to filter out harmful compounds is questioned. They can also impact communication and create a false sense of security. Nevertheless, SFMs aid in infection prevention and provide psychological comfort. Clear guidelines are needed to ensure their appropriate use in the OR. This paper offers a historical overview of surgical masks, emphasizing their role in infection prevention. It explores SFM effectiveness for both the surgical team and patients during surgery and considers their future in surgical settings. As we navigate the evolving landscape of SFMs, clear and concise guidelines are imperative to ensure their judicious and effective use in the OR. This paper serves as an essential resource for understanding the historical significance, contemporary efficacy, and prospective trajectory of SFMs in surgical practice., Competing Interests: The authors declare no potential conflicts of interest for this work, or with respect to the research, authorship, and/or publication of this article., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Purpose: Fistulotomy is considered the most effective treatment for anal fistula; however, it carries a risk of incontinence. Sphincteroplasty in the setting of fistulotomy is not standard practice due to concerns regarding healing and potential infectious complications. We aimed to compare the outcomes of patients who underwent fistulotomy with primary sphincteroplasty to those who did not undergo repair., Methods: This was a retrospective review of consecutive patients who underwent fistulotomy for cryptoglandular anal fistula. All operations were performed by one colorectal surgeon. Sphincteroplasty was performed for patients perceived to be at higher risk for continence disturbance. The main outcome measures were the healing rate and postoperative septic complications., Results: In total, 152 patients were analyzed. Group A (fistulotomy with sphincteroplasty) consisted of 45 patients and group B (fistulotomy alone) included 107 patients. Both groups were similar in age (P=0.16) and sex (P=0.20). Group A had higher proportions of multiple fistulas (26.7% vs. 6.5%, P<0.01) and complex fistulas (mid to high transsphincteric, 37.8% vs. 10.3%; P<0.01) than group B. The median follow-up time was 8 weeks. The overall healing rate was similar in both groups (93.3% vs. 90.6%, P=0.76). No significant difference between the 2 groups was noted in septic complications (6.7% vs. 3.7%, P=0.42)., Conclusion: Fistulotomy with primary sphincter repair demonstrated a comparable healing rate to fistulotomy alone, without an increased risk of postoperative septic complications. Further prospective randomized studies are needed to confirm these findings and to explore the functional outcomes of patients who undergo sphincteroplasty.

Background: The current work reviews the psychosocial factors associated with different urinary methamphetamine concentration levels., Methods: From April to November 2023, 243 participants from Baghdad's Al-Ataa Hospital were the subjects of a cross-sectional descriptive analysis study. We included 73 patients in this study., Result: The urinary methamphetamine concentration levels were from 3 to 92,274 ng/ml, with a mean ± SD of 10,873.6 ± 18,641. Patients diagnosed with major depression disorder exhibited higher scores on GHQ-30, UCLA, MOAS, and BDI-II with a significant P -value of 0.0001, 0.001, 0.0001, and 0.0001, consequently with an effect size of 0.015, 0.001, 1.05, and 3.24, respectively., Conclusions: The multi-screening test can produce a false positive. It frequently interferes with other drugs, especially antidepressants. This will result in patients being stigmatized and accused. On the other hand, those who accidentally come into contact with crystal smoke will experience the same withdrawal symptoms as the addicted patients. Their urinary methamphetamine level (titer) could have negative results. Urinary methamphetamine levels should be zero in healthy patients. In this situation, screening tests, expert opinion, and urine methamphetamine testing are strongly recommended., 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 Abbass, Al-Hemiary and Sahib.)

Background: Surgical site infections (SSIs) pose a global challenge, impacting patients and healthcare expenditures. This second-order meta-analysis endeavors to assess the efficacy of antibiotic sutures in averting SSIs by amalgamating data from various meta-studies., Materials and Methods: This research adhered to the PRISMA 2020 guidelines. The quality and comprehensiveness of the encompassed meta-analyses were assessed through the QUOROM checklist and AMSTAR techniques. The primary study overlap was evaluated via measures such as pairwise intersection heat maps, corrected covered area, and the citation matrix of evidence. The statistical power at the study-level was determined utilizing the meta-meta package. Data synthesis employed random and fixed effects models at a 95% CI. A meta-regression analysis was conducted to explore potential correlations between the CDC classification of SSIs, trial types, and the observed effect sizes in the studies., Results: This investigation revealed a significant reduction in SSI rates due to antimicrobial-coated sutures, evidenced by a relative risk (RR) of 0.68 (95% CI: 0.59-0.76), with a prediction interval of 0.38-1.19. The analysis encompassed 18 studies with 22 meta-analyses, demonstrating a median QUOROM score of 13.6 out of 18 and an AMSTAR score of 9.1 out of 11. The presence of moderate heterogeneity was noted ( Q =106.611, I2 =54.038%), with nonrandomized controlled trials exhibiting an RR of 0.56 (95% CI: 0.39-0.80), and RCTs displaying an RR of 0.71 (95% CI: 0.63-0.81). Subgroup analysis unveiled variable RR reductions for specific surgical procedures., Conclusion: Antimicrobial-coated sutures offer a promising approach to mitigating SSIs risk. However, their efficacy is optimally realized when employed in conjunction with other robust practices., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Polycyclic aromatic hydrocarbons (PAHs), in particular benzo [a]pyrene (BaP), have been identified as carcinogenic components of tobacco smoke. In mammals, the toxicological response to BaP-diol-epoxide is driven by cytochrome P450 (CYP1A1), a pathway which is absent in Caenorhabditis elegans. In contrast, in worms prominently the CYP-35 enzyme family seems to be induced after BaP exposure. In C. elegans, BaP exposure reduces the accumulation of lysosomal neutral lipids in a dose dependent manner and the deletion of cyp-35A2 results in a significant elevation of neutral lipid metabolism. A cyp-35A2:mCherry;unc-47:GFP dual-labelled reporter strain facilitated the identification of three potential upstream regulators that drive BaP metabolism in worms, namely elt-2, nhr-49 and fos-1. This newly described reporter line is a powerful resource for future large-scale RNAi regarding toxicology and lipid metabolism screens., Competing Interests: Declaration of competing interest 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., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Video 1Endoscopic submuscular dissection as a rescue for severe fibrosis after incomplete polypectomy., Competing Interests: Dr Booth is a consultant and researcher for Ibex Medical Analytics, a speaker for Astellas Pharma, and a consultant for Philips, PathAI, and Diagnexia US. The other authors did not disclose any financial relationships., (© 2024 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc.)

Tools available for reproducible, quantitative assessment of brain correspondence have been limited. We previously validated the anatomical fiducial (AFID) placement protocol for point-based assessment of image registration with millimetric (mm) accuracy. In this data descriptor, we release curated AFID placements for some of the most commonly used structural magnetic resonance imaging datasets and templates. The release of our accurate placements allows for rapid quality control of image registration, teaching neuroanatomy, and clinical applications such as disease diagnosis and surgical targeting. We release placements on individual subjects from four datasets (N = 132 subjects for a total of 15,232 fiducials) and 14 brain templates (4,288 fiducials), totalling more than 300 human rater hours of annotation. We also validate human rater accuracy of released placements to be within 1 - 2 mm (using more than 45,000 Euclidean distances), consistent with prior studies. Our data is compliant with the Brain Imaging Data Structure allowing for facile incorporation into neuroimaging analysis pipelines., (© 2023. The Author(s).)

Cholera is a highly contagious illness that can cause severe, acute, watery diarrhea. The WHO and the Lebanese Ministry of Health announced on the 10 October 2022 the re-emergence of Cholera in Lebanon. Data was collected from the Ministry of Public Health in Lebanon, the WHO, news announcements, as well as from online databases such as PubMed, Science Direct, news, conferences, and press releases on the current cholera outbreak. More than 669 confirmed cholera cases and 23 deaths have been reported in Lebanon up until 29 December 2022. The Ministry of Public Health is providing cooperation and support in containing the disease and covering the hospital and treatment expenses for cholera patients. This paper aims to study the epidemiology of cholera, focusing on the most recent cholera outbreak in Lebanon, and to suggest some recommendations that can be followed to fight off this outbreak., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

The recently detected virus in eastern China in 2018 led to some health concerns, especially with the global trend of spreading viruses. As a new RNA-detected genus of the henipavirus family was found in Eastern China, the number of patients affected has reached 35 through zoonotic spread, with symptoms ranging from simple fever to fatal affection of vital organs such as the brain, liver, and kidneys. Researchers have found that shrew animals might be a potential reservoir for the Langya virus; however, data is still limited regarding human-to-human transmission. Current efforts by the Chinese Health Ministry and the Taiwan Centers for Disease Control and Prevention to deduct the spread of the virus and track its origin by trying to sequence the disease genome are evident. With all this in mind, the recommendation to face this new novel virus revolves around protecting the most vulnerable population at risk of being infected, such as farmers, and preventing the spread of the virus. Efforts must be directed toward screening animals for henipavirus and diving more deeply into the etiology of how this virus has spread to humans to help understand the spread of zoonotic viruses in the future., Competing Interests: The authors declare no conflicts of interest.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

The Ministry of Health of the Republic of Uganda declared the Ebola virus disease (EVD) outbreak on 20th September 2022 after a patient infected with the rare Sudan strain of Ebola virus (EBV) died in the Mubende district. Since the year 2000, several outbreaks of the EVD from the Sudan strain have been reported in Uganda and it has been more than a decade since the last case of EVD (Sudan strain) was reported in the country. EVD is a severe, often fatal illness that affects humans and other primates and presents with varied neurological and gastrointestinal symptoms. This article has explored various efforts by the World Health Organization and the Ministry of Health of the Republic of Uganda to coordinate outbreak preparedness and response. Certain recommendations have been made to individuals and the government for early management and prevention of the EVD. Further emphasis has been also laid on effective isolation, triage, and screening of symptomatic patients., Competing Interests: No conflicts of interest declared., (© 2022 The Authors.)

Lebanon has been grappling with hepatitis A virus (HAV) outbreaks for 3 decades, to an extent that it has been now termed an endemic zone for HAV. However, the rise in cases above the annual average concerns a potential outbreak in the North, and the Bekaa governorates of Lebanon must be highlighted. Although the Lebanese health authorities have ordered a probe into the possible causes of the outbreak, it has been speculated that the immigration of Syrian refugees has overburdened public health services. Reduced seroprevalence of HAV immunoglobulin G has also led to an epidemiological shift from child to adult populations. The current economic crisis affecting Lebanese society is another significant problem that could have contributed to the rise in incidents. This article examines Lebanon's current HAV outbreak and epidemiological status, offering suggestions for the future. In the event of an outbreak, the infrastructure for water sanitation and sewage is known to allow HAV to spread via the faecal-oral pathway. Maintaining personal hygiene, early detection, and vaccination have all been recommended as significant regional and individual control measures., Competing Interests: No conflicts of interest declared., (© 2022 The Authors.)

On July 21, 2022, the USA witnessed the first case of poliomyelitis after 3 decades of its eradication. Poliomyelitis is a crippling disease that results from infection with any one of the three related poliovirus types (referred to as types P1, P2, and P3), members of the enterovirus (picornavirus) family. The New York State Department of Health confirmed that a case of paralytic poliomyelitis was reported from a 20-year-old Hungarian traveller residing in Rockland County. The detected viral sequence has been found to have vaccine-derived poliovirus type 2 (VDPV2) suggesting an origin from the live attenuated oral polio vaccine (OPV). Since immunisation remains the only preventable measure, this article explores suggestions from the Centers for Disease Control and Prevention on reliable Inactivated (killed) polio vaccination in high-risk patients along with early case detection and treatment. In light of the above-mentioned findings, this research further details future recommendations like cessation of the OPV, encouragement of inactivated polio vaccine (IPV) in vaccination schedules, sensitive epidemiological surveillance system and appropriate training for healthcare providers. The affected countries have been further advised to have effective outbreak response strategy plans in place so that they can respond and stay prepared for such outbreaks in the future., (© 2022 The Authors.)

On July 5, 2022, the Tanzanian Ministry of Health (MoH) announced the re-emergence of leptospirosis after reporting 20 confirmed symptomatic cases and 3 mortalities. Leptospirosis is caused by a spirochete bacterium that lives in an animal's renal tubule and spreads to individuals through contact with contaminated animal urine. Unsupervised agricultural practices, urban development, wildlife infiltration, and a lack of sanitation have all been proposed as potential environmental causes of the present outbreak. The MoH is taking the necessary steps to halt the spread of said outbreak with assistance from the World Health Organization (WHO). This article examines the risk factors, etiology, number of confirmed cases, and subsequent case index to analyse the epidemiology of the current leptospirosis outbreak in Tanzania's southern Linda region. In light of these findings, this research further details recent recommendations made by the WHO, Centers for Disease Control and Prevention, and MoH to mitigate such an alarming situation. These recommendations include early detection and isolation, contact tracing, and chemoprophylaxis using doxycycline. The article concludes by outlining suggestions for individuals and governments, including the launch of public awareness campaigns, immunisation, increased surveillance, rapid detection testing, and the installation of suitable purification systems, to help contain future leptospirosis outbreaks., (© 2022 The Authors.)

Objective: Simulation is increasingly recognized as an important supplement to operative training. The live rat femoral artery model is a well-established model for microsurgical skills simulation. In this study, the authors present an 11-year experience incorporating a comprehensive, longitudinal microsurgical training curriculum into a Canadian neurosurgery program. The first goal was to evaluate training effectiveness, using a well-studied rating scale with strong validity. The second goal was to assess the impact of the curriculum on objective measures of subsequent operating room performance during postgraduate year (PGY)-5 and PGY-6 training., Methods: PGY-2 neurosurgery residents completed a 1-year curriculum spanning 17 training sessions divided into 5 modules of increasing fidelity. Both perfused duck wing and live rat vessel training models were used. Three modules comprised live microvascular anastomosis. Trainee performance was video recorded and blindly graded using the Objective Structured Assessment of Technical Skills Global Rating Scale. Eleven participants who completed the training curriculum and 3 subjects who had not participated had their subsequent operative performances evaluated when they were at the PGY-5 and PGY-6 levels., Results: Eighteen participants completed 106 microvascular anastomoses during the study. There was significant improvement in 6 measurable skills during the curriculum. The mean overall score was significantly higher on the fifth attempt compared with the first attempt for all 3 live anastomotic modules (p < 0.001). Each module had a different improvement profile across the skills assessed. Those who completed the microvascular skills curriculum demonstrated a greater number of independent evaluations during superficial surgical exposure, deep exposure, and primary maneuvers at the PGY-5 and PGY-6 levels., Conclusions: High-fidelity microsurgical simulation training leads to significant improvement in microneurosurgical skills. Transfer of acquired skills to the operative environment and durability for at least 3 to 4 years show encouraging preliminary results and are subject to ongoing investigation.

On April 23, 2022, the Ministry of Health of the Democratic Republic of the Congo announced an EVD outbreak after discovering 2 confirmed cases and identifying 267 contacts. With collaboration from the WHO, the MoH are taking many interventions to prevent further expansion of this outbreak. Forty-six years ago, the Ebola virus was first discovered in 1976 near the Ebola River in the DRC. Since then, 13 outbreaks of EVD have occurred in the DRC and, in 2020, it witnessed the second largest EVD outbreak in the world, resulting in 3481 cases and 2299 mortalities. This article discusses the epidemiology of the current DRC outbreak by examining the etiology of EVD, the number of affected cases, and the subsequent case index. Considering these data, this paper discusses measures taken by the MoH, WHO, CDC, and UNICEF to mitigate the Ebola outbreak, such as supporting local teams to provide essential care, training medical staff, and raising awareness for vaccination. Finally, by comparing the gravity of the situation to current measures, this article provides recommendations for individuals and governments to protect themselves and mitigate future outbreaks., (© 2022 The Authors.)

Introduction: Brachial plexus avulsion (BPA) injuries commonly occur secondary to motor vehicle collisions, usually in the young adult population. These injuries are associated with significant morbidity, and up to 90% of patients suffer from deafferentation pain. Neuromodulation procedures can be efficacious in the treatment of refractory neuropathic pain, although the treatment of pain due to BPA can be challenging. Dorsal root entry zone (DREZ) lesioning is a classical and effective neurosurgical technique which has become underutilized in treating refractory root avulsion pain. Methods: A systematic review of the different technical nuances, procedural efficacy, and complication profiles regarding DREZ lesioning for BPA injuries in the literature is included. We also present an institutional case series of 7 patients with BPA injuries who underwent DREZ lesioning. Results: In the literature, 692 patients were identified to have undergone DREZ lesioning for pain related to BPA. In 567 patients, the surgery was successful in reducing pain intensity by over 50% in comparison to baseline (81.9%). Complications included transient motor deficits (11%) and transient sensory deficits (11%). Other complications including permanent disability, cardiovascular complications, infections, or death were rare (<1.9%). In our case series, all but one patient achieved >50% reduction in pain intensity, with the mean pre-operative pain of 7.9 ± 0.63 (visual analog scale) reduced to 2.1 ± 0.99 at last follow-up ( p < 0.01). Conclusion: Both the literature and the current case series demonstrate excellent pain severity reduction following DREZ ablation for deafferentation pain secondary to BPA., 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 © 2021 Chalil, Wang, Abbass, Santyr, MacDougall and Staudt.)

Acute kidney injury (AKI) is associated with high mortality and morbidity risk. Factors predictive of mortality can guide in early identification of high-risk patients and escalation of therapy to improve outcomes. There is a paucity of data on AKI in Pakistan, and this study was done to determine in-hospital AKI mortality and the associated predictors of mortality. This was a prospective observational study conducted in the Acute Medical Unit and High Dependency Unit of Pak Emirates Military Hospital, Rawalpindi, from June to December 2018. Based on the Kidney Disease Improving Global Outcomes (KDIGO) AKI definition, 130 critically ill patients were included, while patients with chronic kidney disease were excluded. Data were collected on demographic profile-morbid conditions, etiology, laboratory values, and outcomes. The overall mortality was 45.4% (59/130) and varied with the stage of AKI, as it was 21.6%, 36.0%, and 61.8% in KDIGO stages 1, 2, and 3, respectively (P <0.05). There was a significant association (P <0.001) between sepsis, age >65 years, and mortality. Patients with inhospital mortality had higher median serum creatinine and mean potassium levels (P <0.01), with lower mean sodium levels and bicarbonate levels <10 mmol/L. However, on multivariate analysis using variables age >65 years, AKI stage 3, oliguria, bicarbonate <10 mmol/L, and sodium levels <130 mmol/L, only age [odds ratio (OR): 3.16, confidence interval (CI) 95%: 1.40-7.15), AKI stage 3 (OR: 3.12, CI 95%: 1.32-7.38], and low sodium levels <130 mmol/L (OR: 4.52, CI 95%: 1.40-14.61) were found to be independent predictors of mortality. Diabetes mellitus need for vasopressors, oliguria, hemodialysis requirement, and mean leukocyte counts had no significant association with mortality. AKI was associated with high in-hospital mortality in critically ill patients. Sepsis, hypertension, older age, Stage 3 AKI, higher mean creatinine, and potassium were predictive of increased mortality risk.

The integral imaging microscopy system provides a three-dimensional visualization of a microscopic object. However, it has a low-resolution problem due to the fundamental limitation of the F-number (the aperture stops) by using micro lens array (MLA) and a poor illumination environment. In this paper, a generative adversarial network (GAN)-based super-resolution algorithm is proposed to enhance the resolution where the directional view image is directly fed as input. In a GAN network, the generator regresses the high-resolution output from the low-resolution input image, whereas the discriminator distinguishes between the original and generated image. In the generator part, we use consecutive residual blocks with the content loss to retrieve the photo-realistic original image. It can restore the edges and enhance the resolution by ×2, ×4, and even ×8 times without seriously hampering the image quality. The model is tested with a variety of low-resolution microscopic sample images and successfully generates high-resolution directional view images with better illumination. The quantitative analysis shows that the proposed model performs better for microscopic images than the existing algorithms.

Illegal waste disposal represents a risk health factor for vector-borne diseases by providing shelter for rodents and their ectoparasites. The presence of the Phlebotomus papatasi vector of Leishmania major , an etiologic agent of zoonotic cutaneous leishmaniasis (ZCL), was assessed at illegal waste sites located at the vicinity of villages in endemic areas of Central Tunisia. The study was performed over a two-year period over three nights from July to September 2017, and over three nights in September 2018. Household waste is deposited illegally forming dumpsites at the vicinity of each village and contains several rodent burrows of Psammomys obesus , the main reservoir host of L. major . Sandflies were collected from rodent burrows in the natural environment and in dumpsites using sticky traps and were identified at species level. Female sandflies were tested for the presence of L. major by PCR. Our entomological survey showed that Phlebotomus papatasi is the most abundant sandfly species associated with rodent burrows in these waste sites. The densities of P. papatasi in dumpsites are significantly higher compared to the natural environment. The minimum infection rate of P. papatasi with L. major in these illegal waste sites is not significantly different compared to the natural environment. Considering the short flight range of P. papatasi , increases in its densities, associated with burrows of P. obesus in illegal waste sites located at the edge of villages, expands the overlap of infected ZCL vectors with communities. Thus, illegal waste sites pose a high risk of spreading ZCL to neighboring home ranges. Waste management is an environmentally friendly method of controlling sandfly populations and should be included in an integrated management program for controlling ZCL in endemic countries.

Background: Conventional medications for Crohn's disease (CD) include anti-inflammatory drugs, immunosuppressants and corticosteroids. If an individual does not respond, or loses response to first-line treatments, then biologic therapies such as tumour necrosis factor-alpha (TNF-α) antagonists such as adalimumab are considered for treating CD. Maintenance of remission of CD is a clinically important goal, as disease relapse can negatively affect quality of life., Objectives: To assess the efficacy and safety of adalimumab for maintenance of remission in people with quiescent CD., Search Methods: We searched the Cochrane IBD Group Specialized Register, CENTRAL, MEDLINE, Embase, and clinicaltrials.gov from inception to April 2019., Selection Criteria: We considered for inclusion randomized controlled trials (RCTs) comparing adalimumab to placebo or to an active comparator., Data Collection and Analysis: We analyzed data on an intention-to-treat basis. We calculated risk ratios (RRs) and corresponding 95% confidence intervals (95% CI) for dichotomous outcomes. The primary outcome was failure to maintain clinical remission. We define clinical remission as a Crohn's Disease Activity Index (CDAI) score of < 150. Secondary outcomes were failure to maintain clinical response, endoscopic remission, endoscopic response, histological remission and adverse events (AEs). We assessed biases using the Cochrane 'Risk of bias' tool. We used GRADE to assess the overall certainty of evidence supporting the primary outcome., Main Results: We included six RCTs (1158 participants). We rated four trials at low risk of bias and two trials at unclear risk of bias. All participants had moderate-to-severe CD that was in clinical remission. Four studies were placebo-controlled (1012 participants). Two studies (70 participants) compared adalimumab to active medication (azathioprine, mesalamine or 6-mercaptopurine) in participants who had an ileocolic resection prior to study enrolment. Adalimumab versus placebo Fifty-nine per cent (252/430) of participants treated with adalimumab failed to maintain clinical remission at 52 to 56 weeks, compared with 86% (217/253) of participants receiving placebo (RR 0.70, 95% CI 0.64 to 0.77; 3 studies, 683 participants; high-certainty evidence). Among those who received prior TNF-α antagonist therapy, 69% (129/186) of adalimumab participants failed to maintain clinical or endoscopic response at 52 to 56 weeks, compared with 93% (108/116) of participants who received placebo (RR 0.76, 95% CI 0.68 to 0.85; 2 studies, 302 participants; moderate-certainty evidence). Fifty-one per cent (192/374) of participants who received adalimumab failed to maintain clinical remission at 24 to 26 weeks, compared with 79% (149/188) of those who received placebo (RR 0.66, 95% CI 0.52 to 0.83; 2 studies, 554 participants; moderate-certainty evidence). Eighty-seven per cent (561/643) of participants who received adalimumab reported an AE compared with 85% (315/369) of participants who received placebo (RR 1.01, 95% CI 0.94 to 1.09; 4 studies, 1012 participants; high-certainty evidence). Serious adverse events were seen in 8% (52/643) of participants who received adalimumab and 14% (53/369) of participants who received placebo (RR 0.56, 95% CI 0.39 to 0.80; 4 studies, 1012 participants; moderate-certainty evidence) and withdrawal due to AEs was reported in 7% (45/643) of adalimumab participants compared to 13% (48/369) of placebo participants (RR 0.59, 95% CI 0.38 to 0.91; 4 studies, 1012 participants; moderate-certainty evidence). Commonly-reported AEs included CD aggravation, arthralgia, nasopharyngitis, urinary tract infections, headache, nausea, fatigue and abdominal pain. Adalimumab versus active comparators No studies reported failure to maintain clinical remission. One study reported on failure to maintain clinical response and endoscopic remission at 104 weeks in ileocolic resection participants who received either adalimumab, azathioprine or mesalamine as post-surgical maintenance therapy. Thirteen per cent (2/16) of adalimumab participants failed to maintain clinical response compared with 54% (19/35) of azathioprine or mesalamine participants (RR 0.23, 95% CI 0.06 to 0.87; 51 participants). Six per cent (1/16) of participants who received adalimumab failed to maintain endoscopic remission, compared with 57% (20/35) of participants who received azathioprine or mesalamine (RR 0.11, 95% CI 0.02 to 0.75; 51 participants; very low-certainty evidence). One study reported on failure to maintain endoscopic response at 24 weeks in ileocolic resection participants who received either adalimumab or 6-mercaptopurine (6-MP) as post-surgical maintenance therapy. Nine per cent (1/11) of adalimumab participants failed to maintain endoscopic remission compared with 50% (4/8) of 6-MP participants (RR 0.18, 95% CI 0.02 to 1.33; 19 participants)., Authors' Conclusions: Adalimumab is an effective therapy for maintenance of clinical remission in people with quiescent CD. Adalimumab is also effective in those who have previously been treated with TNF-α antagonists. The effect of adalimumab in the post-surgical setting is uncertain. More research is needed in people with recent bowel surgery for CD to better determine treatment plans following surgery. Future research should continue to explore factors that influence initial and subsequent biologic selection for people with moderate-to-severe CD. Studies comparing adalimumab to other active medications are needed, to help determine the optimal maintenance therapy for CD., (Copyright © 2020 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.)

Background: Adalimumab is an IgG1 monoclonal antibody that targets and blocks tumor necrosis factor-alpha, a pro-inflammatory cytokine involved in the pathogenesis of Crohn's disease (CD). A significant proportion of people with CD fail conventional therapy or therapy with biologics or develop significant adverse events. Adalimumab may be an effective alternative for these individuals., Objectives: The objectives of this review were to assess the efficacy and safety of adalimumab for the induction of remission in CD., Search Methods: We searched MEDLINE, Embase, CENTRAL, the Cochrane IBD Group Specialized Register, ClinicalTrials.Gov and the World Health Organization trial registry (ICTRP) from inception to 16 April 2019. References and conference abstracts were searched to identify additional studies., Selection Criteria: Randomized controlled trials (RCTs) comparing any dose of adalimumab to placebo or an active comparator in participants with active CD were included., Data Collection and Analysis: Two authors independently screened studies, extracted data and assessed bias using the Cochrane 'Risk of bias' tool. The primary outcome was the failure to achieve clinical remission, as defined by the original studies. Clinical remission was defined as a Crohn's Disease Activity Index (CDAI) score of less than 150 points. Secondary outcomes included failure to achieve clinical response (defined as a decrease in CDAI of > 100 points or > 70 points from baseline), failure to achieve endoscopic remission and response, failure to achieve histological remission and response, failure to achieve steroid withdrawal, adverse events (AEs) and serious adverse events (SAEs), withdrawal from study due to AEs and quality of life measured by a validated instrument. We calculated the risk ratio (RR) and 95% confidence intervals (95% CI) for dichotomous outcomes. Data were pooled for analysis if the participants, interventions, outcomes and time frame were similar. Data were analyzed on an intention-to-treat basis. The overall certainty of the evidence was assessed using GRADE., Main Results: Three placebo-controlled RCTs (714 adult participants) were included. The participants had moderate to severely active CD (CDAI 220 to 450). Two studies were rated as at low risk of bias and one study was rated as at unclear risk of bias. Seventy-six per cent (342/451) of adalimumab participants failed to achieve clinical remission at four weeks compared to 91% (240/263) of placebo participants (RR 0.85, 95% CI 0.79 to 0.90; high-certainty evidence). Forty-four per cent (197/451) of adalimumab participants compared to 66% (173/263) of placebo participants failed to achieve a 70-point clinical response at four weeks (RR 0.68, 95% CI 0.59 to 0.79; high-certainty evidence). At four weeks, 57% (257/451) of adalimumab participants failed to achieve a 100-point clinical response compared to 76% (199/263) of placebo participants (RR 0.77, 95% CI 0.69 to 0.86; high-certainty evidence). Sixty-two per cent (165/268) of adalimumab participants experienced an AE compared to 72% (188/263) of participants in the placebo group (RR 0.90, 95% CI 0.74 to 1.09; moderate-certainty evidence). Two percent (6/268) of adalimumab participants experienced a SAE compared to 5% (13/263) of participants in the placebo group (RR 0.44, 95% CI 0.17 to 1.15; low-certainty evidence). Lastly, 1% (3/268) of adalimumab participants withdrew due to AEs compared to 3% (8/268) of participants in the placebo group (RR 0.38, 95% CI 0.11 to 1.30; low-certainty evidence). Commonly reported adverse events included injection site reactions, abdominal pain, fatigue, worsening CD and nausea. Quality of life data did not allow for meta-analysis. Three studies reported better quality of life at four weeks with adalimumab (measured with either Inflammatory Bowel Disease Questionnaire or Short-Form 36; moderate-certainty evidence). Endoscopic remission and response, histologic remission and response, and steroid withdrawal were not reported in the included studies., Authors' Conclusions: High-certainty evidence suggests that adalimumab is superior to placebo for induction of clinical remission and clinical response in people with moderate to severely active CD. Although the rates of AEs, SAEs and withdrawals due to AEs were lower in adalimumab participants compared to placebo, we are uncertain about the effect of adalimumab on AEs due to the low number of events. Therefore, no firm conclusions can be drawn regarding the safety of adalimumab in CD. Futher studies are required to look at the long-term effectiveness and safety of using adalimumab in participants with CD., (Copyright © 2019 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.)

Microplastic (MP) pollution is everywhere. In terrestrial environments, microfibres (MFs) generated from textile laundering are believed to form a significant component of MPs entering soils, mainly through sewage sludge and compost applications. The aim of this study was to assess the effect of MFs on a keystone soil organism. We exposed the earthworm Lumbricus terrestris to soil with polyester MFs incorporated at rates of 0, 0.1 and 1.0 %w/w MF for a period of 35 days (in the dark at 15 °C; n = 4 for each treatment). Dried plant litter was applied at the soil surface as a food source for the earthworms. We assessed earthworm vitality through mortality, weight change, depurate production and MF avoidance testing. In addition, we measured stress biomarker responses via the expression of metallothionein-2 (mt-2), heat shock protein (hsp70) and superoxide dismutase (sod-1). Our results showed that exposure and ingestion of MFs (as evidenced by subsequent retrieval of MFs within earthworm depurates) were not lethal to earthworms, nor did earthworms actively avoid MFs. However, earthworms in the MF1.0% treatment showed a 1.5-fold lower cast production, a 24.3-fold increase in expression of mt-2 (p < 0.001) and a 9.9-fold decline in hsp70 expression (p < 0.001). Further analysis of soil and MF samples indicated that metal content was not a contributor to the biomarker results. Given that burrowing and feeding behaviour, as well as molecular genetic biomarkers, were modulated in earthworms exposed to MFs, our study highlights potential implications for soil ecosystem processes due to MF contamination., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

In this study dibenzylidene ketone derivatives (2E,5E)-2-(4-methoxybenzylidene)-5-(4-nitrobenzylidene) cyclopentanone (AK-1a) and (1E,4E)-4-(4-nitrobenzylidene)-1-(4-nitrophenyl) oct-1-en-3-one (AK-2a) were newly synthesized, inspired from curcuminoids natural origin. Novel scheme was used for synthesis of AK-1a and AK-2a. The synthesized compounds were characterized by spectroscopic techniques. AK-1a and AK-2a showed high computational affinities (E-value > - 9.0 kcal/mol) against cyclooxygenase-1, cyclooxygenase-2, proteinase-activated receptor 1 and vitamin K epoxide reductase. AK-1a and AK-2a showed moderate docking affinities (E-value > - 8.0 kcal/mol) against mu receptor, kappa receptor, delta receptor, human capsaicin receptor, glycoprotein IIb/IIIa, prostacyclin receptor I 2 , antithrombin-III, factor-II and factor-X. AK-1a and AK-2a showed lower affinities (E-value > - 7.0 kcal/mol) against purinoceptor-3, glycoprotein-VI and purinergic receptor P 2 Y 12 . In analgesic activity, AK-1a and AK-2a decreased numbers of acetic acid-induced writhes (P < 0.001 vs. saline group) in mice. AK-1a and AK-2a significantly prolonged the latency time of mice (P < 0.05, P < 0.01 and P < 0.001 vs. saline group) in hotplate assay. AK-1a and AK-2a inhibited arachidonic acid and adenosine diphosphate induced platelet aggregation with IC 50 values of 65.2, 37.7, 750.4 and 422 µM respectively. At 30, 100, 300 and 1000 µM concentrations, AK-1a and AK-2a increased plasma recalcification time (P < 0.001 and P < 0.001 vs. saline group) respectively. At 100, 300 and 1000 µg/kg doses, AK-1a and AK-2a effectively prolonged bleeding time (P < 0.001 and P < 0.01 vs. saline group) respectively. Thus in-silico, in-vitro and in-vivo investigation of AK-1a and AK-2a reports their analgesic, antiplatelet and anticoagulant actions.

Objective: To evaluate the antibacterial activity of the extracts of Laurus nobilis against three Gram-positive bacteria (Staphylococcus aureus ATCC 25923, Enterococcus faecalis ATCC 29212 and Staphylococcus epidermidis CIP 444) and two Gram-negative bacteria (Escherichia coli ATCC 35218 and Pseudomonas aeruginosa ATCC 27853). Also, the antibiofilm activity has been investigated against the biofilm produced by Staphylococcus epidermidis CIP 444., Materials: The polysaccharides, essential oil, and fatty oils extracted from the plant were used in broth microdilution methods to study the minimal inhibitory concentration, and then the minimal bactericidal concentration was determined., Results: The results showed that alginate, fucoidan, fatty oils and essential oil have good antibacterial activities against the 5 bacterial strains, and a negligible biofilm eradication activity of fucoidan, laminaran, fatty oil, and essential oil was observed, but a promising biofilm eradication activity was obtained with alginate, which showed a reduced biofilm mass even at low concentration., Conclusions: The extracts obtained have promising antibacterial capacities which need further investigation for them to be incorporated in medical or nutritional applications., (Copyright © 2014 Hainan Medical College. Published by Elsevier B.V. All rights reserved.)

Background and Objectives: Robotic surgery has been advocated for the radical excision of rectal cancer. Most data supporting its use have been reported from European and Asian centers, with a paucity of data from the United States documenting clear advantages of the robotic technique. This study compares the short-term outcome of robotic versus laparoscopic surgery., Methods: Consecutive patients who underwent laparoscopic (group 1) or robotic (group 2) rectal cancer excision at a single institution over a 2-year period were retrospectively reviewed. The main outcome measures were operative time, blood loss, conversion rates, number of lymph nodes, margin positivity, length of hospital stay, complications, and readmission rates., Results: Forty-two patients were analyzed. The median operative time was shorter in group 1 than that in group 2 (240 minutes vs 260 minutes, P=.04). No difference was noted in blood loss, transfusion rates, intraoperative complications, or conversion rates. There was no difference in circumferential or distal margin positivity. The median length of stay was shorter in group 1 (5 days vs 6 days, P=.05). The 90-day complication rate was similar in both groups (33% vs 43%, P=.75), but there was a trend toward more anastomotic leaks in group 1 (14% vs 0%, P=.23). Similarly, a non-statistically significant trend toward a higher readmission rate was noted in group 1 (24% vs 5%, P=.18)., Conclusion: Robotic rectal cancer excision yielded a longer operative time and hospital length of stay, although immediate oncologic results were comparable. The need for randomized data is critical to determine whether the added resource utilization in robotic surgery is justifiable.