A 61-Year-Old Male With Chronic Appendicitis: A Case Report

The objective of this report is to present a rare case of chronic appendicitis with an atypical presentation. The patient presented with intermittent periumbilical pain without any other symptom, relieved by an anti-inflammatory, and later incidentally diagnosed on computed tomography (CT) scan. The patient was managed with an appendectomy during laparoscopic exploration. A 61-year-old male, with a history of renal calculi, managed type 2 diabetes mellitus, managed hypertension, and ischemic heart disease who underwent percutaneous coronary intervention 10 years ago, presented to the clinic for a CT scan to follow up a non-obstructing renal calculus diagnosed previously. The imaging showed incidental appendiceal findings, and the patient informed the medical team that he had been experiencing intermittent periumbilical pain once every 4-12 weeks for the past year, which was not associated with fever, nausea, or vomiting. At that time, oral non-steroidal anti-inflammatory drugs (NSAIDs) were prescribed, following which his symptoms subsided. A few days later, he presented to the clinic with the same complaint. The patient underwent laparoscopic exploration after numerous clinic visits and was diagnosed with chronic appendicitis. Chronic appendicitis should be explored in afebrile patients with periumbilical pain lasting for several days without other symptoms or predisposing factors. It should also be suspected in patients with recurrent or intermittent vague abdominal pain that subsides with NSAIDs. A CT scan of the abdomen should be conducted, and if the results confirm or imply chronic appendicitis, appendectomy is the preferred therapy.

A secure healthcare 5.0 system based on blockchain technology entangled with federated learning technique

In recent years, the global Internet of Medical Things (IoMT) industry has evolved at a tremendous speed. Security and privacy are key concerns on the IoMT, owing to the huge scale and deployment of IoMT networks. Machine learning (ML) and blockchain (BC) technologies have significantly enhanced the capabilities and facilities of healthcare 5.0, spawning a new area known as "Smart Healthcare." By identifying concerns early, a smart healthcare system can help avoid long-term damage. This will enhance the quality of life for patients while reducing their stress and healthcare costs. The IoMT enables a range of functionalities in the field of information technology, one of which is smart and interactive health care. However, combining medical data into a single storage location to train a powerful machine learning model raises concerns about privacy, ownership, and compliance with greater concentration. Federated learning (FL) overcomes the preceding difficulties by utilizing a centralized aggregate server to disseminate a global learning model. Simultaneously, the local participant keeps control of patient information, assuring data confidentiality and security. This article conducts a comprehensive analysis of the findings on blockchain technology entangled with federated learning in healthcare. 5.0. The purpose of this study is to construct a secure health monitoring system in healthcare 5.0 by utilizing a blockchain technology and Intrusion Detection System (IDS) to detect any malicious activity in a healthcare network and enables physicians to monitor patients through medical sensors and take necessary measures periodically by predicting diseases. The proposed system demonstrates that the approach is optimized effectively for healthcare monitoring. In contrast, the proposed healthcare 5.0 system entangled with FL Approach achieves 93.22% accuracy for disease prediction, and the proposed RTS-DELM-based secure healthcare 5.0 system achieves 96.18% accuracy for the estimation of intrusion detection.

The Prevalence of Mycobacterium tuberculosis Infection Among Cancer Patients Receiving Chemotherapy in a Tertiary Care Center

OBJECTIVE

To estimate the prevalence of tuberculosis (TB) infection among patients receiving cancer chemotherapy and to identify risk factors for latent TB reactivation.

METHODS

A cross-sectional study was conducted at a tertiary care center in Jeddah, Saudi Arabia. Patients were surveyed for TB risk factors, their records were reviewed for previous TB infection or disease, and blood samples were collected for interferon-gamma release assays (IGRAs).

RESULTS

A total of 203 patients were included. One hundred and twenty-five were females (62%). Median age was 52 years, and mean age was significantly higher in positive IGRA patients compared to negative IGRA (57.32 vs. 47.27; p = 0.009). Twenty-five patients (12.3%) had evidence of TB infection, 16 (68%) among them had a latent TB infection, while the rest received treatment for an active TB disease. The rate of active disease among cancer patients was 8 (3.9%). Additionally, 92% (23) of those with positive IGRA had solid cancers (p = 0.007), and all active TB cases occurred in this group of solid cancers.

CONCLUSION

TB prevalence was higher in chemotherapy patients compared to the general Saudi population. Patients with solid tumors and older age had a greater risk of developing the infection, signifying the importance of preventing TB and malignancy coexistence by initiating screening policies in cancer patients.

295 SPEP IT UP! DEVELOPING AN ALGORITHM FOR ABNORMAL SERUM PLASMA ELECTROPHORESIS RESULTS IN HIP FRACTURE PATIENTS

Background

Hip fracture is a common manifestation of osteoporosis. All patients who sustain a hip fracture should receive a specialist bone health assessment, including Serum Protein Electrophoresis (SPEP) because plasma cell disorders such as multiple myeloma are an important differential diagnosis. SPEP results can be challenging to interpret without training and expertise. We aimed to review the proportion of abnormal SPEP results in hip fracture patients and used a newly developed algorithm to assess urgency of referral to haematology.

Methods

The Orthogeriatrics and Haematology teams collaborated to develop an algorithm to help facilitate decision making in hip fracture patients with abnormal SPEP results. A retrospective study was then conducted using data from the local Hip Fracture Database from Quarters 1 and 3 in 2020, and the hospital electronic laboratory system. The algorithm was used to retrospectively determine which patients warranted haematology review. The electronic appointment system was then accessed to review whether those who warranted haematology referral had appointments on the system.

Results

Of 270 hip fracture presentations, 19 duplicate records were excluded. Five patients had no data and three patients had passed away. Of the remaining 243 patients, 193 (79.42%) had SPEP’s sent. Abnormalities were detected in 116 patients (47.74%). According to the SPEP referral pathway, two patients warranted routine referral and one patient required an urgent referral, none of whom appeared to have been referred to haematology. Two patients who did not warrant haematology referral were already under haematology for different conditions.

Conclusion

Not all patients who sustain acute osteoporotic fractures with an abnormal SPEP result require haematology referral. The need for an urgent or routine haematology can be guided by the SPEP result along with other clinical features. With the introduction of this pathway, it is proposed that all hip fracture patients will be triaged in a timely, appropriate, and consistent manner.

Community- vs. hospital-based management of multidrug-resistant TB in Pakistan

BACKGROUND Multidrug-resistant TB (MDR-TB) treatment takes 18-24 months and is complex, costly and isolating. We provide trial evidence on the WHO Pakistan recommendation for community-based care rather than hospital-based care.METHODS Two-arm, parallel-group, superiority trial was conducted in three programmatic management of drug-resistant TB hospitals in Punjab and Sindh Provinces, Pakistan. We enrolled 425 patients with MDR-TB aged >15 years through block randomisation in community-based care (1-week hospitalisation) or hospital-based care (2 months hospitalisation). Primary outcome was treatment success.RESULTS Among 425 patients with MDR-TB, 217 were allocated to community-based care and 208 to hospital-based care. Baseline characteristics were similar between the community and hospitalised arms, as well as in selected sites. Treatment success was 74.2% (161/217) under community-based care and 67.8% (141/208) under hospital-based care, giving a covariate-adjusted risk difference (community vs. hospital model) of 0.06 (95% CI -0.02 to 0.15; P = 0.144).CONCLUSIONS We found no clear evidence that community-based care was more or less effective than hospital-based care model. Given the other substantial advantages of community-based care over hospital based (e.g., more patient-friendly and accessible, with lower treatment costs), this supports the adoption of the community-based care model, as recommended by the WHO.

The Pattern of Unintentional Injuries and Poisoning Among Children Admitted to King Abdulaziz Medical City, Jeddah, From 2014 to 2018 in Saudi Arabia: A Cross-Sectional Study

Background Unintentional injuries and poisoning among children are prevalent and severe causes of hospitalization and impairment. The number of accidental injuries among children increases every year, leading to a huge burden on communities and health institutions. Methods This study is a retrospective analytical cross-sectional study. Charts from January 2014 to December 2018 were reviewed to estimate the epidemiological distribution and types of unintentional injuries among children aged 14 years or younger, including newborns, who were admitted to King Abdulaziz Medical City (KAMC), Jeddah, Saudi Arabia. Results In this study, 353 children were included. Patients were those admitted to King Abdulaziz Medical City (KAMC), Jeddah, due to unintentional injuries and whose age varies from birth to 14 years. Most of the injured children were males (60.1%), but interestingly more female patients suffered from fracture injuries than males. The most common injury was found to be falling (38.5%), followed by road traffic accidents (RTA) (26.1%). The frequency of different types of injuries varied among different age groups. Infants' injuries were mainly falling (50%), while RTA was the most common injury among adolescents (94.7%). Moreover, the head and neck area was the most affected site contributing 39.1% of all sites. Outcomes of the accidental injuries were assessed as full recovery, disability, or death. Conclusion This study showed the proportion of unintentional injuries among children from birth to 14 years old in KAMC, Jeddah, Saudi Arabia. Overall, the most prevalent type of injury found in our study was falling. Moreover, injuries were more common among male patients. We concluded that most injuries could be avoided if parents or children's guardians practiced protective strategies mainly by ensuring a safe and clear environment for the children.

Minimally invasive, indirect corneal neurotization using an ipsilateral sural nerve graft for early neurotrophic keratopathy

Purpose

Neurotrophic keratopathy is a degenerative disease characterized by damage to the corneal nerves leading to corneal hypoesthesia and anaesthesia. The resultant progressive visual deterioration is refractory to existing conventional treatment options. Corneal neurotization is a novel and effective surgical procedure that directly targets the underlying pathology of nerve loss by stimulating new corneal nerve growth. This study reports the outcomes and the pre- and postoperative in vivo confocal microscopy findings of the first published Australian case of indirect, minimally invasive, corneal neurotization using an ipsilateral sural nerve autograft.

Observations

An 11-year-old boy developed corneal hypoesthesia in the left eye following surgical debulking of a cerebellopontine angle arachnoid cyst. He was diagnosed with Mackie Stage 1 neurotrophic keratopathy. Due to his hypoesthesia, he had developed recurrent microbial keratitis and corneal ulceration secondary to foreign bodies sustained during contact sports. At presentation, he reported photophobia and dry eye symptoms, corrected-distance visual acuity was 6/18, Cochet-Bonnet aesthesiometer demonstrated reduced corneal sensation (5–15mm), Schirmer's I test was 15mm, and in vivo confocal microscopy showed a complete absence of a subepithelial corneal plexus. He underwent indirect, minimally invasive, corneal neurotization using the ipsilateral supratrochlear nerve and a sural nerve autograft. Subjective improvement in corneal sensation was noticed by the patient at 2 months. Objective improvement, measured on Cochet-Bonnet aesthesiometer, was first observed at 6 months with steady stepwise improvement to 20–35mm at 21 months. Importantly, due to the increase in corneal sensation, the patient did not develop any further corneal complications. At 12 months, dry eye symptoms resolved and Schirmer's I test improved to 30mm. At 15 months, corrected-distance visual acuity improved to 6/5 and in vivo confocal microscopy demonstrated evidence of corneal reinnervation with nerves running through the subepithelial space surrounded by healthy and active keratocytes.

Conclusions and importance

Corneal neurotization represents an exciting development in the armamentarium for the treatment of neurotrophic keratopathy and can be considered for younger patients with early-stage disease.

Normative Values for Corneal Tomography and Comparison of Both Eyes in Young Saudi Males with 20/20 Vision Using Pentacam-HR Scheimpflug Imaging

Purpose

Anterior segment evaluation using Scheimpflug imaging with the Pentacam scanner allows the acquisition of a plethora of information. It aids in screening and diagnosing corneal pathologies and determining suitability for keratorefractive procedures. This research has significant benefits in terms of establishing normative tomographic values, which is crucial in countries where Keratoconus (KC) is more prevalent, especially among young age group, along with aiding future research in the field of refractive surgery by providing relevant normative data.

Methods

A retrospective review of digital corneal tomography images for a group of medically and ophthalmologically free males aged between 18 and 21 years with 20/20 unaided distant visual acuity was performed.

Results

A total of 1272 subjects (2544 eyes) were included. Findings revealed a mean maximal corneal curvature (Kmax) of 42.91 ± 1.40D (range 36.90–47.80D). The mean flat keratometry (K1) was 41.87 ± 1.31D (range 36.00–46.40D). The mean steep keratometry (K2) was 42.66 ± 1.35D (range 36.70–47.60D). The mean corneal astigmatism (CA) was 0.79 ± 0.37D (range 0.00D-2.30D). The mean central corneal thickness (CCT) was 558.53 ± 33.84 μm (range 421–677 μm). The mean thinnest corneal location thickness (TCLT) was 551.64 ± 34.08 μm (range 417–669μm). The mean corneal diameter (CD) and anterior chamber depth (ACD) were 12.13 ± 0.39 mm (range 10.50–13.60 mm) and 3.12 ± 0.29 mm (range 2.08–4.08 mm), respectively. The median differences between both eyes of the same subject were as follows: kmax difference of 0.20D (IQR 0.1–0.4); K1, K2 and CA difference of 0.20D (IQR 0.1–0.3) for all 3 parameters; CCT and TCLT difference of 5.00 μm (IQR 3.0–9.0) and 6.00 μm (IQR 3.0–10.0), respectively; CD difference of 0.10 mm (IQR 0.0–0.1); and ACD difference of 0.04 (IQR 0.02–0.06).

Conclusion

We believe our data can aid in establishing normative tomographic values and acceptable differences between both eyes. Our data may also help detect subtle corneal pathology and be useful for researchers and innovators in the field of ophthalmology.

Influence of Printing Parameters on Self-Cleaning Properties of 3D Printed Polymeric Fabrics

The processes for making self-cleaning textile fabrics have been extensively discussed in the literature. However, the exploration of the potential for self-cleaning by controlling the fabrication parameters of the fabric at the microscopic level has not been addressed. The current evolution in 3D printing technology provides an opportunity to control parameters during fabric manufacturing and generate self-cleaning features at the woven structural level. Fabrication of 3D printed textile fabrics using the low-cost fused filament fabrication (FFF) technique has been achieved. Printing parameters such as orientation angle, layer height, and extruder width were used to control self-cleaning microscopic features in the printed fabrics. Self-cleaning features such as surface roughness, wettability contact angle, and porosity were analyzed for different values of printing parameters. The combination of three printing parameters was adjusted to provide the best self-cleaning textile fabric surface: layer height (LH) (0.15, 0.13, 0.10 mm) and extruder width (EW) (0.5, 0.4, 0.3 mm) along with two different angular printing orientations (O) (45° and 90°). Three different thermoplastic flexible filaments printing materials were used: thermoplastic polyurethane (TPU 98A), thermoplastic elastomers (TPE felaflex), and thermoplastic co-polyester (TPC flex45). Self-cleaning properties were quantified using a pre-set defined criterion. The optimization of printing parameters was modeled to achieve the best self-cleaning features for the printed specimens.

Strain Release Behaviour during Crack Growth of a Polymeric Beam under Elastic Loads for Self-Healing

The response of polymeric beams made of Acrylonitrile butadiene styrene (ABS) and thermoplastic polyurethane (TPU) in the form of 3D printed beams is investigated to test their elastic and plastic responses under different bending loads. Two types of 3D printed beams were designed to test their elastic and plastic responses under different bending loads. These responses were used to develop an origami capsule-based novel self-healing mechanism that can be triggered by crack propagation due to strain release in a structure. Origami capsules of TPU in the form of a cross with four small beams, either folded or elastically deformed, were embedded in a simple ABS beam. Crack propagation in the ABS beam released the strain, and the TPU capsule unfolded with the arms of the cross in the direction of the crack path, and this increased the crack resistance of the ABS beam. This increase in the crack resistance was validated in a delamination test of a double cantilever specimen under quasi-static load conditions. Repeated test results demonstrated the effect of self-healing on structural crack growth. The results show the potential of the proposed self-healing mechanism as a novel contribution to existing practices which are primarily based on external healing agents.

Efficacy and Safety of Hydroxyurea as Adjuvant Therapy in Pediatric Patients of Transfusion-Dependent Beta-Thalassemia Major at Zhob, Balochistan

Background

Hydroxyurea is being used effectively in sickle cell anemia and thalassemia intermedia. Its role in transfusion-dependent beta-thalassemia major yet needs to be clearly established. This study has been carried out to assess the efficacy and safety of hydroxyurea as adjuvant therapy in pediatric cases of transfusion-dependent beta-thalassemia major disease.

Materials and methods

This quasi-experimental study was carried out at District Headquarter Hospital (DHQ), Zhob, from February 2021 to January 2022. One hundred ten cases fulfilling the inclusion-exclusion criteria were selected and divided into groups of 55 each. Group A cases received hydroxyurea (10-20 mg/kg/day) in addition to blood transfusion and chelation therapy. Group B received a blood transfusion and chelation therapy only. Both groups were compared in terms of blood transfusion requirement, mean hemoglobin, and mean serum ferritin levels. All the data were analyzed with SPSS 21 (IBM Corp., Armonk, NY).

Results

Of Group A cases, three were dropped because of side effects of hydroxyurea, and two were lost to follow-up. Similarly, three cases of Group B lost to follow-up, one patient withdrew consent, and one child died at home; thus both groups were left with 50 cases each. The mean age of participants was 11.98 + 3.74 years. There were 51 males and 49 females. Both the groups were comparable in terms of age and gender. Similarly, mean hemoglobin levels and serum ferritin levels were comparable at the start of the study. After one year, there was a significant improvement in mean hemoglobin level (p<0.001) and a significant reduction in serum ferritin levels (p=0.014) in the group taking adjuvant hydroxyurea. The requirement of packed red blood cells (RBCs) significantly decreased in cases taking hydroxyurea (p<0.001).

Conclusion

Hydroxyurea is a safe and effective treatment that significantly decreases the packed RBC transfusion requirement in transfusion-dependent thalassemia children, improves hemoglobin levels, and reduces serum ferritin levels compared to the children on blood transfusions alone.

Polypropylene pyrolysis kinetics under isothermal and non-isothermal conditions: a comparative analysis

The kinetics of polypropylene pyrolysis has been studied under isothermal and non-isothermal conditions using Arrhenius and Kissinger–Akahira–Sunose (KAS) equations. Under isothermal conditions, applying first order kinetic model, activation energy (Ea) and pre-exponential factor (A) were investigated and observed as 119.7 kJ mol−1 and 1.2 × 1010 min−1, while in case of non-isothermal kinetics using Kissinger–Akahira–Sunose method, the average Ea and A were found to be 91.23 kJ mol−1 and 2.3 × 107 min−1, respectively. A comparison among the isothermal and non-isothermal reactions was made on the basis of kinetics parameters. The results from both the methods showed trivial variation in kinetic parameters of the pyrolysis reaction which may be due to two major reasons. Firstly, the selection of the kinetic model applied and secondly the inconsistency due to various experimental conditions used which can be reduced at optimized conditions. As the disposal of plastic materials need reliable kinetics information to model their decomposition reactions, therefore, the kinetics data thus obtained from pyrolysis reaction of model polypropylene will help in the utilization of polypropylene waste as energy source on industrial scale.

Corona Virus Disease 2019 (COVID-19) Diagnostic Tests: A Glimpse

Mass testing for COVID-19 infection is one of the core measures in tackling the global spread of the disease. Testing is vital to diagnose and estimate cases, attack rates and case fatality rates- critical data for policy-making. As COVID-19 continues to spread globally, the demand for more extensive laboratory testing and innovative technology increases. However, countries around the world have been struggling to keep up pace with the worldwide demand to expand testing strategy. The pandemic evolves, so does our knowledge and understanding of diagnostic tests of COVID-19. Here we aim to review major challenges related to COVID-19 diagnostic tests and future development. So, the ongoing urgency and demand for tests would certainly steer the rapid uptake of novel techniques, which in turn would boost our understanding of diagnostic tests for COVID-19.

Identification of SCAR markers for genetic authentication of Dendrobium nobile Lindl

Dendrobium nobile Lindl. is an orcid plant with important medicinal values. This is a colourful houseplant, and also a popular herb in traditional Chinese medicine (TCM). The variants of this plant from different geographic regions might be high, and in this study, we aimed to develop specific sequence characterized amplified region (SCAR) markers for the identification of specific variant of this plant. Different cultivars of D. nobile were collected from nine different places of China, and one cultivar from Myanmar. DNA materials were extracted from the plant samples, random amplified polymorphic DNA (RAPD) were developed, cloned and sequenced for the development of SCAR markers. We have developed four SCAR markers, which are specific to the cultivar from Luzhou China, and clearly distinguishable (genetically) from other cultivars. These SCAR markers are deposited in GenBank (accession number MZ417502, MZ484089, MZ417504 and MZ417505). Four SCAR markers for D. nobile are effective molecular technique to genetically identify the different cultivars or species, and this method is applicable for genetic characterization and identification of other plant species too.

Impact of COVID-19 pandemic on quality of partner relationship and sexual activity among COVID positive males: a cross sectional study

OBJECTIVE

Our aim was to assess sexual activity, partner relationships among males who had been infected with COVID-19, to study the impact of COVID-19 infection on partner relationship and to find out the association between partner and sexual relationship during lockdown.

MATERIALS AND METHODS

A cross sectional study was conducted in Saudi Arabia through social media platforms via online questionnaire between December 1, 2020 and January 31, 2021 among 871 participants after a pilot study among 20 participants of which 497 were included in the study. Statistical analysis was conducted using SPSS version 20.0 (IBM Inc., Armonk, NY, USA). Responses were presented as frequencies and percentages and the association was studied using Chi squared test/Fisher's exact test. The value of p ≤ .05 was considered significant.

RESULTS

Out of the total study participants, nearly 85% of them belonged to the age range of 18 to 39 years, more than half of the participants were married. In the six months prior to the study being conducted, 268 respondents (53.9%) did not have sexual relationships. Respondents with positive COVID-19 infection reported that their partner lived with them in the same house during home isolation and was also found to be significantly associated with having intact sexual relationships in the last six months of the lockdown period (p-value < .001). Moreover, respondents who reported having good relationships with their partners during the pandemic were found to be significantly associated with having intact sexual relationships during the pandemic lockdown (p-value < .001).

CONCLUSIONS

Among the COVID-19-positive respondents, sexual activity and partner relationships were largely found to be intact during the pandemic lockdown period.

Compliance with contact lens care and factors driving noncompliance in health-care students in Jeddah, Saudi Arabia

PURPOSE

This study aimed to assess compliance to contact lens care behaviors and determine common factors influencing noncompliance among a population of university students in Jeddah, Saudi Arabia.

METHODS

This is an observational, cross-sectional study in which a previously validated self-administered questionnaire consisting of 12 questions addressing compliance to contact lens wear and care was E-mailed through the university message center.

RESULTS

A total of 388 participants completed the questionnaire. Of those who completed the survey, 150 were contact lens users with an experience of 1 month or more. The average compliance rate to contact lens care was around 66%. High levels of compliance were reported in sharing contact lenses, sleeping with contact lenses, showering/swimming with contact lenses, and using water to clean contact lenses. Moderate levels of compliance were shown in overuse of contact lenses, adherence to instructions of lens cleaning, cleaning the lens case, and adherence to aftercare visits. The lowest levels of compliance were noted in washing hands before lens use and lens case replacement. Gender, smoking, contact lens experience, type and modality of contact lens usage, and contact lens purchase site were found to have a significant association with behaviors showing poor compliance. Believing there is no harm in wearing lenses for longer than the recommended replacement schedule was the primary reason given for overusing contact lenses.

CONCLUSION

Moderate levels of compliance were generally reported by respondents, necessitating the need for better strategies to reinforce the importance of compliance to contact lens care in the Saudi population.

Experimental analysis of excited state dynamics in Anderson-type POM@porphyrin hybrids in relevance to third-order nonlinear optical properties

This work accounts for the active contribution of life time decay in the field of nonlinear optics, especially for an energetic donor acceptor couple (porphyrin and polyoxometalate (POM)). Currently, two POM free porphyrins (Di-Tris-N@Por and Di-Tris@Por) and their two hybrids with POM (Di-Tris-NPor@Di-AndPOM-1 and Di-TrisPor@Di-AndPOM-2) have been studied keenly in nanosecond time span and resulted lifetimes ([Formula: see text]1 and [Formula: see text]2) have been compared with nonlinear optical parameters. The results demonstrated that Di-Tris-NPor@Di-AndPOM-1 exhibited better third-order nonlinear optical susceptibility [Formula: see text]3, second hyperpolarizability [Formula: see text] and nonlinear absorption [Formula: see text] and Di-TrisPor@Di-AndPOM-2 than Di-TrisPor@Di-AndPOM-2. This superiority of nonlinear optical parameters was supported by lifetime decay studies and electrochemical studies. It is revealed that more relaxation time in excited states lower will be the NLO response. The lifetime decay ([Formula: see text]1) value of Di-Tris-NPor@Di-AndPOM-1 is 3.86ns which is higher than Di-TrisPor@Di-AndPOM-2 possessing lifetime decay ([Formula: see text]1) value of 2.45ns. Moreover, lower energy of charge separated state (-0.88 eV) of Di-Tris-NPor@Di-AndPOM-1 indicates the facile electron transfer in Di-Tris-NPor@Di-AndPOM-1 than Di-TrisPor@Di-AndPOM-2 which experienced more energy of charge separated state. Rapid intersystem crossing is also responsible for the electron transfer from porphyrin moiety to POM moiety.

Activity of Fosfomycin Against The Spectrum of Uropathogens Causing Cystitis

Background:

Urinary tract infections (UTIs) are the most frequent bacterial infections, commonly seen in females. High degree of antimicrobial resistance in uropathogens has challenged the use of therapeutic agents. Fosfomycin which is an old antibiotic with distinctive characteristics, seems to be a promising novel therapeutic agent with a good bactericidal activity towards multi-drug resistant (MDR) uropathogens.

Objective:

The main objective of the study is to evaluate the antibacterial activity of fosfomycin among uropathogens causing cystitis.

Methods:

The study was carried out between 2017-2018. A total of 2060 UTI suspects from outpatient department (OPDs) and inpatient department (IPDs) were screened. Out of 2060 screened patients 1658 were IPD patients and 402 were OPD patients. Patient’s midstream urine samples were collected aseptically and processed according to standard protocols. The frequency of extended-spectrum-beta lactamases (ESBLs) producer and carbapenem resistance were estimated respectively. Cultures with significant growth of uropathogens were identified and minimum inhibitory concentration (MIC) to fosfomycin was determined by agar dilution (AD) and by E-test methods.

Results:

184 out of 2060 (8.9%) urine samples showed significant growth of uropathogens. Uropathogenic Escherichia coli (UPEC) (64%,118/184) was found to be the mostly isolated uropathogen. Among these Gram-negative uropathogens, 80% were ESBLs producers, 43.2% were carbapenem-resistant and 78% isolates were found to be MDR. The fosfomycin susceptibility for UPEC was 95% by AD method.

Conclusions:

This study suggests that Fosfomycin is reasonably effective and can be used in the treatment of MDR uropathogens along with uncomplicated UTIs.

Practising refraction in ophthalmology: instructive or outdated? A prospective study and literature review

CLINICAL RELEVANCE

Many ophthalmologists preform clinical refactions, although little is known of the perceptions and practise of refraction by ophthalmologists and key barriers preventing this aspect of ophthalmic practice.

BACKGROUND

Although there are numerous studies on visual acuity in ophthalmology, there is no study to date on the practice of refraction by ophthalmologists. This study evaluates the practice patterns of ophthalmologists in current practice. It specifically addresses perceptions of ophthalmologists about (a) the importance of refraction in clinical practice, and (b) barriers to performing refraction. The methodology and frequency of performing refraction by ophthalmologists is also assessed.

METHODS

This cross-sectional study was conducted at the Annual Scientific Congress of the Royal Australian and New Zealand College of ophthalmologists in 2017, held in Perth, Australia. All attending ophthalmologists and ophthalmology trainees were invited to participate. Participants completed a 17-variable questionnaire on the perceptions of practitioners about refraction and their practice of it. Data were analysed using Microsoft Excel and IBM SPSS Version 24.

RESULTS

At this Congress, 213 attendees completed the survey, with most being consultant general ophthalmologists (85%). Twenty-six percent of participants either 'really loved' or 'liked' refracting patients. Those who reported feeling competent with refraction were more likely to perform it themselves (p = 0.001). Individuals most commonly reported taking 3-5 minutes to refract a patient (38%). Participants under the age of 65, and participants practising paediatric ophthalmology, were more likely to perform a refraction.

CONCLUSIONS

The literature indicates that this is the first study to describe the practice patterns of refraction by ophthalmologists. Although ophthalmologists found refraction important, the majority preferred patients to be refracted by others. Key barriers to ophthalmologists performing refraction included the time required to perform the refraction, a busy clinic, and the availability of alternative providers.

Subpalpebral Antibiotic Lavage as Safe, Emergent, and Cost-Effective Management of Acute Infectious Keratitis Related to Contact Lens Overwear: Case Report and Literature Review

PURPOSE

The aim of this study is to describe the technique of subpalpebral antibiotic lavage (SAL), which is a highly therapeutic, efficient, and cost-effective method for managing severe bacterial keratitis.

METHODS

This case report describes a 26-year-old woman with severe bacterial keratitis in the right eye due to contact lens overwear, with progressive corneal thinning, a hypopyon, impending perforation, and marked visual loss to perception of light despite treatment with intensive topical antibiotics. This was managed with SAL that involves the insertion of a cannula transcutaneously into the upper conjunctival fornix to provide continuous antibiotic irrigation of the ocular surface.

RESULTS

By 11 weeks after presentation, the cornea and anterior chamber appeared clinically quiescent, and visual acuity improved to 20/40 corrected in the right eye.

CONCLUSIONS

Bacterial keratitis is a potentially blinding condition for which contact lens wear is an important risk factor. Most cases are successfully managed with topical medications; however, in cases of treatment failure, a second-line approach such as SAL can be sight-saving. SAL uses readily available equipment for the delivery of high concentrations of antibiotics to the ocular surface, thus increasing therapeutic efficacy and reducing nursing staff workload. Despite its advantages, the literature reveals apparent underutilization of this technique.

Intra-articular Versus Intravenous Tranexamic Acid in Primary Total Knee Replacement

Background

Total knee replacement (TKR) is an artificial joint surgical procedure that replaces the damaged articular surfaces of the knee joint. Despite several studies on the efficacy of intra-articular and intravenous Tranexamic acid (TX) use in reducing blood loss following TKR, the route of TXA administration is still an ongoing topic of debate. Our study aimed to compare total knee replacement efficacy (hemoglobin level, hematocrit level, hospital stay, and complications) of intra-articular and intravenous tranexamic acid administration.

Material and Methods

 A Prospective study was conducted at the Department of Orthopedics, Shifa International Hospital, Islamabad. The study duration was six months (August 2020 to February 2021). A sample size of 60 patients was calculated using the WHO calculator. Patients were selected through non-probability consecutive sampling. Patients were randomly divided into two groups; Group A was given intraarticular TXA, while group B was given intra-venous TXA following total knee replacement. Patients were followed for 48 hours. Data were analyzed using SPSS version 24. An Independent T-test was applied, and a P value≤0.05 was considered significant.

Results

A total of 60 patients were included in the study. There were 20 (33.3%) male and female 40 (66.7%). The mean age of patients was 64.4±10.8SD. Post-operative hemoglobin level in group A was 11.09±0.39SD, and in group B was 9.93±1.73SD (p=0.03). Postoperatively, the mean HCT level in group A was 30.53±4.26SD and group B 26.88±5.48SD (p=0.01).

Conclusion

Intra-articular administration of TXA is more effective than intravenous administration in controlling postoperative blood loss following total knee replacement.

[Medical rehabilitation for children with scoliosis]

The article presents a literature review on the prevalence, relevance, social significance, and principles of medical rehabilitation of children with different types of scoliosis in scoliotic disease. The current classification, diagnostics features, and clinical course of the disease are addressed. Current approaches to the choice of medical rehabilitation methods for scoliotic disease in children are described: therapeutic exercise, hydrokinesiotherapy, massage, physiotherapeutic treatment, kinesiotaping, and corseting. Special consideration is given to postoperative management and stages of medical rehabilitation of children with scoliosis, including resort treatment.