Rutin Promotes Wound Healing by Inhibiting Oxidative Stress and Inflammation in Metformin-Controlled Diabetes in Rats

Diabetes mellitus (DM) is a metabolic disorder with a notable increase in global incidence in recent years. Individuals diagnosed with diabetes are at an elevated risk of morbidity and mortality compared with the general population. For several years, the potential of phytochemicals as anti-inflammatory agents to improve the healing of diabetic wounds has been under investigation. Rutin, a flavonoid, is a particularly promising candidate for use in wound healing. Our study aims to investigate the potential impact of a topical application of rutin nanoformulation on wound healing in streptozotocin (STZ)-induced hyperglycemic rats controlled with metformin, with a focus on its anti-inflammatory and antioxidant properties. Rats are randomized into 3 groups. GI: diabetic control group; wound untreated. GII: diabetes and rutin-NP-treated wound. GIII: diabetic + β-sitosterol-treated wound. The findings suggest that topical application of rutin-NPs has the potential to enhance the wound-healing process by attenuating oxidative stress, as evidenced by restoring GSH, CAT, and SOD antioxidants, and decreasing MDA production mediated by Nrf2 activation. Also, inflammation is suppressed, as indicated by the decreased CRP, IL-1β, IL-6, and TNF-α levels. Molecular docking data confirm the biological data of rutin, where rutin is docked into the catalytic site of the X-ray crystallographic structures of CRP, Keap-1, IL-1β, IL-6, and TNF-α via grid-based ligand docking. The binding affinity and binding energy of ligand-protein interactions demonstrate the affinity and binding to the specifically selected proteins.

The impact of physical therapy intervention of dysphagia on preventing pneumonia in acute stroke patients: A randomized controlled trial

BACKGROUND AND OBJECTIVES

Dysphagia is a common complication following stroke. It corresponds to the development of pneumonia, which is always associated with bad prognosis, longer hospital stays and increased mortality. The aim of the study was to assess the impact of physical therapy intervention of dysphagia on preventing pneumonia in acute stroke patients.

METHODS

A single-blind randomized controlled trial was carried out on 70 ischemic stroke patients with oropharyngeal dysphagia, age ranged from 49 to 65 years. They were randomly assigned to two groups (control and study) of equal number. Patients in the control group received oral care and nasogastric tube feeding, while patients in the study group received the same program in addition to the designed physical therapy program (exercises and neuromuscular electrical stimulation). The intervention program was applied for 40 min/session, 1 session/day, and 5 days/week for 4 weeks. Gugging swallowing screen (GUSS), and stroke associated pneumonia (SAP) control and prevention criteria were used to assess dysphagia and incidence of pneumonia at baseline, after two and 4 weeks of intervention for both groups.

RESULTS

Before treatment, all patients were susceptible to pneumonia after two and 4 weeks of intervention; there were a significant increase in GUSS score in both groups with more improvement in favor of the study group (p < 0.05) and a statistically significant increase in incidence of SAP after 2 weeks of intervention only in the control group (p < 0.05). The results also showed a significant negative correlation between GUSS score and SAP (r = - 0.3662, p = 0.0018) IMPLICATIONS FOR PHYSIOTHERAPY PRACTICE: adding physical therapy (exercise therapy and neuromuscular electrical stimulation) to oral care and nasogastric tube feeding is effective in improving oropharyngeal dysphagia and decreasing the incidence of aspiration pneumonia in acute ischemic stroke patients.

Immediate Neurophysiological effect of electrical stimulation via dry needling on H-reflex in post stroke spasticity

BACKGROUND

Many non-pharmacological interventions have been proposed for spasticity modulation in spastic stroke subjects.

OBJECTIVE

To investigate the immediate effect of dry needling (DN), electrical stimulation (ES), and dry needling with intramuscular electrical stimulation (DN+IMES) on H-reflex in post-stroke spasticity.

METHODS

Spastic subjects with stroke (N = 90) (55-85 years) were evaluated after 1 month of stroke onset using Modified Ashworth Scale (MAS) score ≥1. Subjects were randomly allocated to receive one session of DN - Soleus (N = 30), ES - posterior lateral side of the leg with 100 Hz and 250 μs pulse width (N = 30), or DN+IMES - Soleus (N = 30). MAS, H-reflex, maximum latency, H-amplitude, M-amplitude and H/M ratio, were recorded before and after one session of intervention. Relationships for each variable within group or the difference among groups were calculated by effect size.

RESULTS

Significant decrease in H/M ratio in Gastrocnemius and Soleus at post-treatment within DN group (P = .024 and P = .029, respectively), large effect size (d = 0.07 and 0.62, respectively); and DN+IMES group (P = .042 and P = .001, respectively), large effect size (d = 0.69 and 0.71, respectively). No significant differences in all variables at pre-treatment and post-treatment was recorded among ES, DN, and DN+IMES groups. Significant decrease in MAS was recorded at post-treatment compared to pre-treatment within ES group (P = .002), DN group (P = .0001), and DN+IMES group (P = .0001), but not significant (P > .05) among three groups at pre-treatment (P = .194) and post-treatment (P = .485).

CONCLUSIONS

Single session of DN, ES, and the DN+IMES can significantly modulate post-stroke spasticity by possible bottom-up regulation mechanisms.

Factors that Influence the Need to Start Adaptive Radiotherapy

Introduction

Adaptive radiotherapy (ART) is an essential approach to account for anatomical and biological uncertainties. Adaptive radiotherapy is, however, time-consuming, and it is unclear which patients are eligible or when is the best time to start ART.

Methods

This prospective study was conducted at Kasr El-Aini Center of Clinical Oncology and Nuclear Medicine, Cairo, Egypt from January 2019 to December 2020. Thirty patients with pathologically proven, limited-stage small cell or stage I-II non-small cell lung cancer who were either not fit for or refused surgery or had stage III disease were recruited and underwent treatment planning to receive 60 Gy on a conventional 3D conformal radiation schedule with platinum-based chemotherapy. All patients underwent computed tomography (CT) planning within 2 and 4 weeks of starting radiation therapy to assess the need for adaptation. Pulmonary function test and echocardiography findings were assessed at the end of treatment and at 3 and 6 months after treatment, and were compared to the baseline.

Results

We found a significant reduction in mean value of the planning target volume (PTV) in the CT scans at the second (331 cm3) and fourth (257 cm3) weeks of treatment as compared to baseline (342 cm3) (p-value < 0.0001). Adaptation decreased the dose to the organ at risk with statistical significance and with improvement of the target coverage. At week 2 of radiotherapy, the need for adaptation was correlated to the conformity index (p = 0.0473), esophageal V35 (p = 0.0488), esophageal V50 (p = 0.0295), and its mean dose (p = 0.0087). At week 4 it was correlated to forced expiratory volume in 1 second (FEV1) (p = 0.0303), ratio between the forced expiratory volume in 1 second and the forced vital capacity (FEV1/FVC) (p = 0.0024), and echocardiography (p = 0.0183).

Conclusions

Conformity index and esophageal dose constraints can predict the need for adaptation at week 2, whereas baseline pulmonary function parameters and echocardiography can predict the need for adaptation at week 4 of radiotherapy.

Altered Pharmacokinetics Parameters of Vancomycin in Patients with Hematological Malignancy with Febrile Neutropenia, a Bayesian Software Estimation

The pharmacokinetics of vancomycin vary significantly between specific groups of patients, such as critically ill patients and patients with hematological malignancy (HM) with febrile neutropenia (FN). Recent evidence suggests that the use of the usual standard dose of antibiotics in patients with FN may not offer adequate exposure due to pharmacokinetic variability (PK). Therefore, the purpose of this study is to assess the effect of FN on AUC_0-24 as a key parameter for vancomycin monitoring, as well as to determine which vancomycin PK parameters are affected by the presence of FN using Bayesian software PrecisePK in HM with FN. This study was carried out in King Abdulaziz Medical City. All adult patients who were admitted to the Princess Norah Oncology Center PNOC between 1 January and 2017 and 31 December 2020, hospitalized and received vancomycin with a steady-state trough concentration measured before the fourth dose, were included. During the trial period, 297 patients received vancomycin during their stay at the oncology center, 217 of them meeting the inclusion criteria. Pharmacokinetic parameters were estimated for the neutropenic and non-FN patients using the precise PK Bayesian platform. The result showed that there was a significant difference (p < 0.05) in vancomycin clearance Cl_van, the volume of distribution at a steady-state V_dss, the volume of distribution for peripheral compartment V_dp, half-life for the elimination phase t½_β, and the first-order rate constant for the elimination process β in FN compared to non-FN patients. Furthermore, AUC_0-24 was lower for FN patients compared to non-FN patients, p < 0.05. FN has a significant effect on the PK parameters of vancomycin and AUC_0-24, which may require specific consideration during the treatment initiation.

Current clinical practice in the management of phyllodes tumors of the breast: an international cross-sectional study among surgeons and oncologists

PURPOSE

Phyllodes tumors of the breast are rare fibroepithelial lesions that are classified as benign, borderline or malignant. There is little consensus on best practice for the work-up, management, and follow-up of patients with phyllodes tumors of the breast, and evidence-based guidelines are lacking.

METHODS

We conducted a cross-sectional survey of surgeons and oncologists with the aim to describe current clinical practice in the management of phyllodes tumors. The survey was constructed in REDCap and distributed between July 2021 and February 2022 through international collaborators in sixteen countries across four continents.

RESULTS

A total of 419 responses were collected and analyzed. The majority of respondents were experienced and worked in a university hospital. Most agreed to recommend a tumor-free excision margin for benign tumors, increasing margins for borderline and malignant tumors. The multidisciplinary team meeting plays a major role in the treatment plan and follow-up. The vast majority did not consider axillary surgery. There were mixed opinions on adjuvant treatment, with a trend towards more liberal regiments in patients with locally advanced tumors. Most respondents preferred a five-year follow-up period for all phyllodes tumor types.

CONCLUSIONS

This study shows considerable variation in clinical practice managing phyllodes tumors. This suggests the potential for overtreatment of many patients and the need for education and further research targeting appropriate surgical margins, follow-up time and a multidisciplinary approach. There is a need to develop guidelines that recognize the heterogeneity of phyllodes tumors.

Posterior tibial nerve stimulation as a neuromodulation therapy in treatment of neurogenic overactive bladder in multiple sclerosis: A prospective randomized controlled study

BACKGROUND

one of the major annoying disorders occurring in people with multiple sclerosis is lower urinary tract disorders (LUT). Urgency is considered the main one seriously influencing the quality of life. Neurogenic detrusor over activity (DOAB) is characterized by a hyperreflexic, overactive detrusor that responds quickly to low-intensity sensory input from general visceral afferent fibers. Overactivity has been claimed to induce random, uncontrolled contractions of the detrusor muscle, leading to intravesicular pressure rise, producing urgency, frequency, and consequently incontinence AIM: To demonstrate the therapeutic efficacy for posterior tibial nerve stimulation (PTNS) in neurogenic over active bladder (NOAB) in people with multiple sclerosis METHODS: The current trial is a prospective, randomized controlled study. Forty remitting relapsing males with MS with moderate NOAB symptoms were randomly assigned into two equal groups; control group (C) treated by selected therapeutic exercises program for strengthening pelvic floor muscles and an intervention group (ES) receiving an additional posterior tibial nerve electrical stimulation. Each session ranged from 45- 50 minutes, three days weekly for a month. Outcome measures were recorded before starting the treatment and after termination of the study intervention and included over active bladder symptoms score (OVBS) score, urodynamic parameters (uroflow, filling and voiding cystometry), and post voiding residual volume by abdominal ultrasound RESULTS: There was a significant improvement of all voiding parameters compared to baseline and the group C except frequency of urgency incontinence. A significant decrease was detected in post-treatment mean episodes number of nighttime frequency, urgency, urgency incontinence (1.65 ± 0.93, 1.2 ± 0.52 and 1.5 ± 0.76) respectively of the ES group compared to that of group C (3.05 ± 1.09, 2.25 ± 0.71 and 2.25 ± 1.06) (P < 0.01). There was a significant decrease in median post-treatment OVBS score 3 (3-3) compared to group C median score 5 (6-4). A statistically significant improvement was observed of all urodynamic parameters (bladder capacity and compliance, Detrusor overactivity (DO), maximum flow rate and post voidal residual volume in the ES group compared to the group C CONCLUSION: PTNS is a promising and potentially beneficial treatment option for NOAB symptoms in males with MS and superior to pelvic floor muscle training alone.

Pharmacological basis of the putative therapeutic effect of Topical Vitamin D3 on the experimental model of atopic dermatitis in mice

OBJECTIVE

The aim of the study was to explore the effect of topical vitamin D3 in atopic dermatitis (AD) induced by ovalbumin (OVA) in contrast with topical betamethasone in mice.

MATERIALS AND METHODS

35 BALB/c adult male mice, weighing between 25-30 gm were used to induce AD by topically sensitizing the dorsal surface of the skin with the OVA patch. Subsequently, treatments were performed in each group by application of vitamin D3 cream (0.0003%), betamethasone cream (0.1%), or vehicles (QV cream) on the skin.

RESULTS

Remarkably, vitamin D3 had a marked improvement in the skin of OVA-induced AD mice. Additionally, vitamin D3 revealed a considerable diminution in the levels of IgE, IL-5, filaggrin, and epidermal thickness, whereas a significant augmentation in the levels of IL-4 and IL-13 was observed when compared with the control group, and histopathological studies had further confirmed these findings.

CONCLUSIONS

This study essentially highlighted the anti-inflammatory effect of vitamin D3 by effective alteration in the immunological components responsible for AD. Moreover, this pioneer experimental work represents a new paradigm and sheds a light on the importance of vitamin D3 in the implications of AD. A comprehensive creative approach is crucial to concretely establish and further corroborate vitamin D3 for this therapeutic role.

Mortality Predictors Among COVID-19 Elderly in Taif, Saudi Arabia

Background

By December 2021, the COVID-19 pandemic had caused more than 266 million cases and 5 million deaths, especially among geriatric patients.

Objective

To identify determinants of COVID-19-related death in geriatric patients.

Methods

This is a comparative retrospective study involving 145 COVID-19 hospitalized patients who are more than 60 years old, conducted at King Faisal Medical Complex in Taif, Saudi Arabia, from June 2020 to August 2020. The main outcome studied was COVID-19-related death.

Results

Out of 145 elderly COVID-19 patients, 11% have died. There was a significant difference between those who died and the surviving group regarding hospital stay duration, with a higher duration median among those who died (22 days vs 12 day respectively, p=0.002). Transfer to ICU, mechanical ventilation, low oxygen saturation, shortness of breath, respiratory support, x-ray trend, and prolonged QT interval showed significant statistical differences between them (p<0.001, <0.001, 0.017, 0.045, <0.001, <0.001, 0.004, respectively). After doing logistic regression of predictors for progression to death, putting patients on oxygen only vs mechanical ventilation was statistically significant, with an adjusted odds ratio (AOR) of 0.038 (p=0.012). Worse x-rays vs constant also were statistically significant and had AOR of 23.459 (p=0.001). There was a significant moderate positive correlation between duration of hospital stay and duration from admission to medication start (SP=0.336 and p<0.001).

Conclusion

We recommend accurately monitoring patients using x-rays to determine which patients have worse x-rays. However, the cost-benefit of using radiation must be well assessed and needs further research to determine if its benefit outweighs its risks, especially in high-risk patients. Furthermore, mechanically ventilated patients must be carefully monitored. Finally, the duration of hospital stay was highly correlated with the duration from admission to medication start. Therefore, proper treatment must be started as early as possible.

Mohamed A, Alfadil A, Alharbi AE. Safety and efficacy of COVID-19 Vaccines in special populations

Coronavirus disease 2019 (COVID-19), is a pandemic that resulted in extreme human and economic losses.  A higher incidence of morbidity and mortality to COVID-19 was demonstrated in a special population. Factors that impact the disease severity include old age, obesity, pregnancy, diabetes mellitus, cancer, and immunosuppressive drugs. Fortunately, several COVID-19 vaccines were developed such as Pfizer-BioNTech, Moderna, Oxford-AstraZeneca, and Johnson & Johnson among others. These vaccines have shown good efficacy and safety profiles in the general population, but serious rare adverse effects were reported related to specific vaccines. Several studies are undergoing to test the efficacy in special populations. Reduced efficacy or delayed immunological response to COVID-19 vaccines were suggested for patients with autoimmune disorders or organ transplant patients, especially those receiving certain medications such as rituximab. There is a concern about organ rejection in organ transplant patients. Despite these facts, there is an agreement among health care providers to consider prioritization of the above-mentioned groups for receiving vaccinations with the same precautions followed for the general population. It is recommended to ongoing studies determine the efficacy and safety of COVID-19 vaccines in patients with comorbidities based on clinical data.

Satisfaction with life and psychological distress during the COVID-19 pandemic: An Egyptian online cross-sectional study

BACKGROUND

Coronavirus disease 2019 (COVID-19) is a novel sickness that emerged worldwide as an unprecedented crisis and led to major effects on the daily life of the general public as well as negative impacts on their mental well-being.

AIM

This study aimed to assess satisfaction with life and psychological distress during the COVID-19 pandemic in Egypt.

SETTING

An online study was conducted in Egypt.

METHODS

A cross-sectional online survey was fulfilled by 1056 Egyptian adults from 06 to 13 June 2020. Psychological distress and satisfaction with life were measured by Arabic validated versions of the Kessler Psychological Distress Scale (K10) and the Satisfaction with Life Scale (SWLS).

RESULTS

About half of the surveyed respondents (51%) were satisfied with their life, whilst 57.4% experienced severe psychological distress. The independent predictors of satisfaction with life are being married, satisfactory income, low distress, moderate distress and high distress (adjusted odds ratio [AOR] = 1.2, 3.0, 2.5, 6.9, 5.2 and 2.1, respectively). Being a female, having secondary education, secondary education, unsatisfactory income and presence of mental illness are the independent predictors of mental distress (AOR = 2.3, 3.9, 1.9, 1.9, 1.6 and 4.0, respectively).

CONCLUSION

The study provides evidence about the high prevalence of psychological distress during the peak period of Egypt's COVID-19 pandemic. The study results highlight the enhancement of development interventions to promote psychological well-being and feeling of satisfaction with life during the pandemic.

Shaker A. Substance Use Disorder and COVID-19; Forensic Medicine and Pharmacology Perspectives: A Concise Narrative Review

Many investigations have confirmed the link between a substance use disorder (SUD) and the COVID-19 pandemic's increased risk of infection and consequences. This narrative review aims to understand these issues from a pharmacological standpoint, as well as the pandemic's impact on forensic medicine. Research and review articles included in this review were selected through an extensive search of databases such as PubMed and the use of appropriate keywords e.g. “substance use disorder” and “COVID-19”. Due to a weakened immune system and degeneration of the respiratory system's defense systems, SUDs have been shown to increase the risk of COVID-19 infection. Furthermore, some substances raise pro-inflammatory mediators, exposing the body to a cytokine storm. SUD frequently causes secondary comorbidities, such as the liver, lung and cardiovascular disease, complicating the treatment of COVID-19 infections. Some misused substances can compromise the treatment's effectiveness or safety. This study also looked at the effects of the pandemic on forensic medicine. It underlines the importance of developing safe forensic examination procedures and methodologies during pandemics. The use of narcotic substances was documented as one of the reasons for the increase in the frequency of COVID-19 and the severity of its repercussions.

Castor oil for labor initiation in women with a previous cesarean section: a double-blind randomized study

Objective: To evaluate the efficacy of castor oil in initiation of labor in women who had one previous cesarean section. This study was conducted as a trial to increase the rate of vaginal birth after cesarean (VBAC) and decrease the rate of elective repeated cesarean section (ERCS).Methods: A double-blinded randomized controlled study was conducted in an Egyptian University Hospital from July 2019 to July 2020. The participants were 70 pregnant women who had one previous cesarean section, singleton pregnancy in cephalic presentation, with a Bishop score ≤6 attempting to perform a trial of labor. Sixty mL castor oil was administered to group A and 60 mL sunflower oil was administered to group B (as a placebo) for initiation of labor at the start of week 39. Primary outcomes were the percentage of women entering the active phase of labor within 24 h after receiving castor oil or placebo and the number of successful VBAC deliveries.Results: Labor started in 16 patients (45.7%) within 24 h in the castor oil group and in 3 patients in the placebo group (8.5%), while the rate of successful VBAC was 65.7% (23 patients) in the castor oil group and 48.5% (17 patients) in the placebo group.Conclusion: Castor oil appears to be an effective, low-cost, and non-harmful method for the initiation of labor in patients with a previous cesarean section.

Phytochemicals against COVID -19, Pharmacological Perspectives: A Systematic Review

Background: Many publications discussed the potential role of medicinal plants in the management of COVID-19. However, clinical studies of the efficacy and safety of specified phytochemical(s) are limited. Objectives: To explore the pharmacological profile of specified compounds against COVID-19 Method: Systematic literature search of academic databases to explore specified phytochemicals for the management of COVID-19 using appropriate search terms. Rayyan software was used to organize 786 citations of which. 236 articles were included in this review. Results: Initially 70 compounds were identified to have a potential role in the management of COVID-19. In this review, 18 compounds were selected for further search Conclusion: In vitro anti-SARS-CoV-2activity has been demonstrated for a variety of natural compounds. However, preclinical research for most phytochemicals is scarce, and only a few compounds have been evaluated in clinical trials against COVID-19. A comprehensive pharmacological profile of these phytochemicals is urgently needed.

Protective Effects of Low Dose Vorinostat on Cisplatin-Induced Nephrotoxicity in Rats

BACKGROUND AND AIM

Cisplatin (cis-diamminedichloroplatinum [II]; CDDP) is the most widely used drug in cancer chemotherapy. The nephrotoxicity of CDDP is one of its major side effects. Vorinostat (VST) has been reported to have antioxidant and anti-inflammatory effects in bothin-vitro and in vivo models. The present study aimed to explore the potential protective effects of VST against CDDP-induced nephrotoxicity in rats.

MATERIALS AND METHODS

The rats were randomly divided into 4 groups; control group, CDDP group (received CDDP 7.5 mg/kg IP single dose 5 days before the end of the experiment), VST group, (received VST 15 mg/kg/day by gastric gavage for 28 days), and CDDP + VST group (received CDDP + VST as above). Blood and kidney samples were collected on the 28th day for biochemical and histopathological examinations.

RESULTS

Administration of CDDP single dose (7.5 mg/kg IP) 5 days before the end of the experiment (at day 23) produced a significant decrease in renal glutathione levels and a significant increase in serum urea nitrogen, creatinine, renal malondialdehyde, tumor necrosis factor-alpha, tumor suppressor protein (p53) and nuclear factor kappa B levels compared to the control group. Pretreatment with VST for 28 days significantly attenuated all unfavorable changes of these parameters. Histopathological analysis showed that VST significantly decreased kidney inflammatory and degenerative changes induced by CDDP. VST also significantly increased Bcl-2 and decreased Caspas- 3 immunoexpression in renal tissues.

CONCLUSION

These results suggest that VST alleviates CDDP-induced nephrotoxicity in rats showing a novel therapeutic potential for the management of nephrotoxicity induced by CDDP.

Should intravenous acetaminophen be considered for post craniotomy pain management? A Meta-analysis of randomized controlled trials

INTRODUCTION

Post craniotomy pain management with opioids is challenging due to their side effects, which might mask neurological deterioration symptoms. Recently, intravenous (IV) acetaminophen has been tested in this population. This meta-analysis aimed to synthesize evidence from published randomized controlled trials (RCTs) about the efficacy of IV acetaminophen in reducing pain scores in postoperative craniotomy patients.

EVIDENCE ACQUISITION

A computer literature search of PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) was conducted. We selected RCTs comparing IV acetaminophen versus placebo for postoperative pain management in craniotomy patients. Data on the visual analog scale (VAS), opioid requirements, hospital stay, and patients' satisfaction weexretr acted and pooled as standardized mean difference (SMD) with the corresponding 95% confidence intervals (CI) in the meta-analysis model.

EVIDENCE SYNTHESIS

Five RCTs, with a total of 493 patients, were pooled in the final analysis. Patients in the IV acetaminophen group had significantly lower VAS pain scores compared to the placebo group (SMD -0.28, 95% CI [-0.46 to -0.10]). However, in terms of opioid requirement, hospital stay, and patients' satisfaction, there were no statistically significant differences between both groups (P>0.05).

CONCLUSIONS

This meta-analysis provides class one evidence that IV Acetaminophen can significantly reduce postoperative pain in craniotomy patients with an excellent safety profile; however, there are not benefits in terms of hospital stay, opioid requirement, or patients' satisfaction.

Role of polymeric materials in preventing COVID-19 infection

The safety of personal protective equipment (PPE) is very important, and so is the choice of materials used. The ability of electrostatic charges (ESCs) generated from the friction of engineered materials to attract or repel viruses has a significant impact on their applications. This study examined the ESCs generated on the surface of PPE used by healthcare workers to enhance their potential effectiveness in protecting the wearer from viruses. This is a crucial consideration for the newly emerged severe acute respiratory syndrome corona virus 2 (SARS-CoV-2), which has a negative charge. The magnitudes and signs of generated ESCs on the surfaces of the PPE were determined experimentally using an Ultra Stable Surface DC Voltmeter. The high negative ESCs acquired by the polyethylene disposable cap and facemask are expected to repel negatively charged viruses and prevent them from adhering to the outer layer of the material. Also, the choice of polypropylene for facemasks and gowns is excellent because it is an aggressively negatively charged material in the triboelectric series. This property guarantees that facemasks and gowns can repel viruses from the wearer. However, the positive ESCs generated on latex glove surfaces are of great concern because they can attract negatively charged viruses and create a source of infection. In conclusion, it is necessary to ensure that PPE be made of materials whose surfaces develop a negative ESC to repel viruses, as well as to select polyethylene gloves.

Optimizing gentamicin dosing in different pediatric age groups using population pharmacokinetics and Monte Carlo simulation

Introduction

The use of once daily dosing of aminoglycosides in pediatrics is increasing but studies on dose optimization targeting the pediatric population are limited. This study aimed to derive a population pharmacokinetic model of gentamicin and apply it to design optimal dosing regimens in pediatrics.

Methods

Population pharmacokinetics of gentamicin in pediatrics was described from a retrospective chart review of plasma gentamicin concentration data (peak/ trough levels) of pediatric patients (1 month − 12 years), admitted to non-critically ill pediatrics. Monte Carlo simulations were performed on the resulting pharmacokinetic model to assess the probability of achieving a C_max/MIC target of 10 mg/L over a range of gentamicin MICs of 0.5–2 mg/L and once daily gentamicin dosing regimens. Results: A two-compartment model with additive residual error best described the model with weight incorporated as a significant covariate for both clearance and volume of distribution. Monte Carlo simulations demonstrated a good probability of target attainment even at a MIC of 2 mg/L, where neonates required doses of 6-7 mg/kg/day and older pediatrics required lower daily doses of 4–5 mg/kg/day while maintaining trough gentamicin concentration below the toxicity limit of 1 mg/L. Conclusion: Once daily dosing is a reasonable option in pediatrics that allows target attainment while maintaining trough gentamicin level below the limits of toxicity.

Robust Adaptive HCS MPPT Algorithm-Based Wind Generation System Using Model Reference Adaptive Control

To treat the stochastic wind nature, it is required to attain all available power from the wind energy conversion system (WECS). Therefore, several maximum power point tracking (MPPT) techniques are utilized. Among them, hill-climbing search (HCS) techniques are widely implemented owing to their various features. Regarding current HCS techniques, the rotor speed is mainly perturbed using predefined constants or objective functions, which makes the selection of step sizes a multifaceted task. These limitations are directly reflected in the overall dynamic WECS performance such as tracking speed, power fluctuations, and system efficiency. To deal with the challenges of the existing HCS techniques, this paper proposes a new adaptive HCS (AD-HCS) technique with self-adjustable step size using model reference adaptive control (MRAC) based on the PID controller. Firstly, the mechanical power fluctuations are detected, then the MRAC continuously optimizes the PID gains so as to generate an appropriate dynamic step size until harvesting the maximum power point (MPP) under the optimal tracking conditions. Looking specifically at the simulation results, the proposed AD-HCS technique exhibits low oscillations around the MPP and a small settling time. Moreover, WECS efficiency is increased by 5% and 2% compared to the conventional and recent HCS techniques, respectively. Finally, the studied system is confirmed over a 1.5 MW, gird-tied, double-fed induction generator (DFIG) WECS using MATLAB/Simulink.