Exceptional performance of Fe@carbon-rich nanoparticles prepared via hydrothermal carbonization of oil mill wastes for H2S removal

Carbon-encapsulated iron oxide nanoparticles (CE-nFe) have been obtained from an industrial waste (oil mill wastewater-OMW, as a carbonaceous source), and using iron sulfate as metallic precursor. In an initial step, the hydrochar obtained has been thermally activated under an inert atmosphere at three different temperatures (600 °C, 800 °C and 1000 °C). The thermal treatment promotes the development of core-shell nanoparticles, with an inner core of α-Fe/Fe3O4, surrounded by a well-defined graphite shell. Temperatures above 800 °C are needed to promote the graphitization of the carbonaceous species, a process promoted by iron nanoparticles through the dissolution, diffusion and growth of the carbon nanostructures on the outer shell. Breakthrough column tests show that CE-nFe exhibit an exceptional performance for H2S removal with a breakthrough capacity larger than 0.5-0.6 g H2S/gcatalyst after 3 days experiment. Experimental results anticipate the crucial role of humidity and oxygen in the adsorption/catalytic performance. Compared to some commercial samples, these results constitute a three-fold increase in the catalytic performance under similar experimental conditions.

Demographic and clinical correlates of suicidal ideation in individuals with at-risk mental state (ARMS): A study from Pakistan

BACKGROUND

Suicide is a major public health concern and one of the leading causes of mortality worldwide. People with an at-risk-mental-state (ARMS) for psychosis are more vulnerable to psychiatric co-morbidity and suicide, however, there are limited data from low-middle-income countries. The present study aimed to identify the prevalence of depressive symptoms and suicidal ideation along with sociodemographic and clinical correlates of suicidal ideation in individuals with ARMS from Pakistan.

METHOD

Participants between the age of 16 and 35 years who met the criteria for ARMS based on the Comprehensive Assessment of At-Risk Mental State (CAARMS), were recruited from the community, general practitioner clinics and psychiatric units across Pakistan (n = 326). Montgomery and Asberg Depression Rating Scale (MADRS) and Social-Occupational-Functional-Assessment-Scale (SOFAS) were administered to participants.

RESULTS

The prevalence of depressive symptoms and suicidal thoughts in the sample at baseline were 91.1% (n = 297) and 61.0% (n = 199), respectively. There were significant mean differences between groups (mean difference [95% CI]; p-value) without suicidal ideation and with suicidal ideation on measures of MADRS (-5.47 [-7.14, -3.81]; p < .001), CAARMS non-bizarre ideas (-0.29 [-0.47, -0.11]; p = .002) and perceptual abnormalities (-0.23 [-0.41, -0.04]; p = .015).

CONCLUSION

These findings indicate that suicidal ideation and depressive symptoms are highly prevalent in individuals with ARMS in Pakistan. Given the pivotal developmental stages that ARMS presents, and the poor outcomes associated with co-morbid depression, there is an urgent need to prioritize the development of low-cost and scalable evidence-based interventions to address psychiatric comorbidity and suicidality in the ARMS population in Pakistan.

Infectious causes of fever of unknown origin in developing countries: An international ID-IRI study

Background

Fever of unknown origin (FUO) in developing countries is an important dilemma and further research is needed to elucidate the infectious causes of FUO.

Methods

A multi-center study for infectious causes of FUO in lower middle-income countries (LMIC) and low-income countries (LIC) was conducted between January 1, 2018 and January 1, 2023. In total, 15 participating centers from seven different countries provided the data, which were collected through the Infectious Diseases-International Research Initiative platform. Only adult patients with confirmed infection as the cause of FUO were included in the study. The severity parameters were quick Sequential Organ Failure Assessment (qSOFA) ≥2, intensive care unit (ICU) admission, vasopressor use, and invasive mechanical ventilation (IMV).

Results

A total of 160 patients with infectious FUO were included in the study. Overall, 148 (92.5%) patients had community-acquired infections and 12 (7.5%) had hospital-acquired infections. The most common infectious syndromes were tuberculosis (TB) (n=27, 16.9%), infective endocarditis (n=25, 15.6%), malaria (n=21, 13.1%), brucellosis (n=15, 9.4%), and typhoid fever (n=9, 5.6%). Plasmodium falciparum, Mycobacterium tuberculosis, Brucellae, Staphylococcus aureus, Salmonella typhi, and Rickettsiae were the leading infectious agents in this study. A total of 56 (35.0%) cases had invasive procedures for diagnosis. The mean qSOFA score was 0.76±0.94 {median (interquartile range [IQR]): 0 (0-1)}. ICU admission (n=26, 16.2%), vasopressor use (n=14, 8.8%), and IMV (n=10, 6.3%) were not rare. Overall, 38 (23.8%) patients had at least one of the severity parameters. The mortality rate was 15 (9.4%), and the mortality was attributable to the infection causing FUO in 12 (7.5%) patients.

Conclusions

In LMIC and LIC, tuberculosis and cardiac infections were the most severe and the leading infections causing FUO.

Beyond survival: unraveling the adaptive mechanisms of cucurbit weeds to salt and heavy metal stress through biochemical and physiological analyses

Salt stress and heavy metal are instigating hazard to crops, menace to agricultural practices. Single and combined stresses affecting adversely to the growth and metabolism of plants. To explore salt and heavy metal resistant plant lines as phytoremediants is a need of time. Physiological responses are main adaptive responses of the plants towards stresses. This response varies with species and ecotype as well as type and level of stress. Two cucurbit weeds from two ecotypes were selected to evaluate their physiological adaptations against independent and combined stresses of various levels of salt (NaCl) and heavy metal (NiCl2). Various physiological parameters like water potential, osmotic potential, pressure potential, CO2 assimilation rate, stomatal conductance, chlorophyll a and b, carotenoids, and production of adaptive chemicals like SOD, CAT, proteins, sugars and proline were studied. Citrullus colocynthis showed more adaptive response than Cucumis melo agrestis and desert ecotype was more successful than agricultural ecotype against stresses.

Evaluation of the occurrence of venous thromboembolic events in COVID-19 outpatients

Introduction

Thrombotic events are present at higher rates among COVID-19 patients. Prophylactic use of parenteral anticoagulants during hospitalisation is recommended to reduce the risk of complications. In this context, the Tunisian Anticoagulation Survey in COVID-19 patient General Practice experience (TASC-GP) was conducted.

Objective

The evaluation of the incidence of venous thromboembolic events (VTE) and bleedings in COVID-19 patients treated in ambulatory.

Method

The TASC-GP is an observational, multicenter study included 3,383 patients from July to October 2021. The following up of patients was done 35 days after inclusion date with investigation of VTE and bleeding events. The four main enrolment criteria were: 1) age ≥ 18 years; 2) confirmed COVID-19 infection; 3) treated as an outpatient; 4) initiation of Rivaroxaban 10 mg/d. Patients were excluded if any of the following criteria applied: 1) the use of anticoagulant or thrombolytic drugs other than Rivaroxaban on admission or within days of admission; 2) the use of any dosage other than that specified in the study protocol.

Results

The mean age of the population was 51.6 ± 15.5 years with a sex ratio of 0.67, 30.7% of the population had hypertension, 23.4% were diabetic and 34.9% were obese. At least one cardiovascular comorbidity was observed in 40% of cases and 9.5% had chronic respiratory disease. The mean IMPROVE and IMPROVE DDimer scores were 0.65 ± 0.9 and 1.4 ± 1.4, respectively. The mean Improve bleeding score was 1.4 ± 1.5. A VTE was reported during follow-up in 39 patients (1.15%). Diabetes and chronic respiratory disease were independent factors for the occurrence of VTE with an odd ratio of 2.2 [95% CI 1.1–4.2] (P = 0.017) and 3.2 [95% CI 1.5–6.4] (P = 0.002) respectively. IMPROVE and IMPROVE DDimer scores were comparable in patients with and without VTE. There was no statistically significant increase in the rate of major bleeding (0.001%). The IMPROVE Bleeding score was comparable in the bleeding and non-bleeding groups at follow-up. There were no predictive factors for bleeding.

Conclusion

Our study is in agreement with the literature concerning a decrease in the rate of thrombembolic complications when using prophylactic anticoagulation versus placebo. Other VTE estimation scores including chronic respiratory disease and diabetes can be proposed. The use of Rivaroxaban in this population was not associated with increased bleeding.

Antibiotic stewardship team in a Tunisian university hospital: A four-year experience

BACKGROUND

Association between antibiotic use and antimicrobial resistance has been demonstrated in several studies; hence the importance of antibiotic stewardship programs (ASPs) to reduce the burden of this resistance.

AIM

To describe the antibiotic stewardship team (AST) interventions in a Tunisian university hospital.

METHODS

a cross-sectional study was conducted in the infectious diseases department in Sousse-Tunisia between 2016 and 2020. Hospital and private practice doctors have been informed of the existence of an antibiotic stewardship team. Interventions consisted of some helps to antibiotic therapy (i.e.; prescription, change or discontinuation) and/or diagnosis (i.e.; further investigations).

RESULTS

Two thousand five hundred and fourteen interventions were made including 2288 (91%) in hospitalized patients, 2152 (86%) in university hospitals and 1684 (67%) in medical wards. The most common intervention consisted of help to antibiotic therapy (80%). The main sites of infections were skin and soft tissues (28%) and urinary tract (14%). Infections were microbiologically documented in 36% of cases. The most frequently isolated microorganisms were Enterobactriaceae (41%). Antibiotic use restriction was made in 44% of cases including further investigations (16%), antibiotic de-escalation (11%), no antibiotic prescription (9%) and antibiotic discontinuation (8%). In cases where antibiotics have been changed (N=475), the intervention was associated with an overall decrease in the prescription of broad-spectrum antibiotics from 61% to 50% with a decrease in the prescription of third generation cephalosporins from 22% to 15%.

CONCLUSIONS

The majority of antibiotic stewardship team's interventions were made in hospitalized patients, university hospitals and medical wards. These interventions resulted in an overall and broad-spectrum antibiotic use reduction.

Occurrence of Hypopituitarism in Tunisian Turner Syndrome patients: familial versus sporadic cases

OBJECTIVE

To explore unusual association between Turner Syndrome (TS) and Hypopituitarism in a Tunisian cohort.

METHODS

We reported 6 patients with TS associated to Hypopituitarism, including three familial cases except the fourth sister who showed only a TS phenotype. Biochemical analysis, resonance magnetic imaging and cytogenetic analyses were performed.

RESULTS

The average age of our patients was 17.2 years (11-31 years). They were all referred for short stature and pubertal delay, except for the fourth sister who presented spontaneous puberty with the integrity of the pituitary axis and the presence of an X ring chromosome. Karyotype analysis showed monosomy in 3 cases and a mosaic TS in the 3 remaining cases, including one patient with abnormal X chromosome structure. Somatotropic and corticotropic deficiencies were confirmed in 2 sporadic cases while the gonadotropic and thyrotropic axes were spared. In contrast; familial cases were consistently affected by the integrity of the corticotropic axis. MRI showed pituitary hypoplasia in all familial cases and pituitary stalk interruption syndrome in only one sporadic case. No correlation was found between the chromosome formula and the anterior pituitary involvement.

CONCLUSION

Co-segregation of congenital Hypopituitarism with pituitary hypoplasia and X chromosome aberrations could imply a molecular anomaly of transcription factors responsible for the differentiation and development of pituitary cells such as PROP1, POUF1, Hesx1, Lhx3, Lhx4. The etiopathogenic link between X chromosome abnormalities and the occurrence of Hypopituitarism remains unclear; however, the progress of molecular biology may clarify the interrelation between transcription factors and sex chromosome segregation abnormalities.

Heat induction in two-dimensional graphene-Fe3O4 nanohybrids for magnetic hyperthermia applications with artificial neural network modeling

We report the synthesis and characterization of graphene functionalized with iron (Fe³⁺) oxide (G-Fe₃O₄) nanohybrids for radio-frequency magnetic hyperthermia application. We adopted the wet chemical procedure, using various contents of Fe₃O₄ (magnetite) from 0-100% for making two-dimensional graphene-Fe₃O₄ nanohybrids. The homogeneous dispersal of Fe₃O₄ nanoparticles decorated on the graphene surface combined with their biocompatibility and high thermal conductivity make them an excellent material for magnetic hyperthermia. The morphological and magnetic properties of the nanohybrids were studied using scanning electron microscopy (SEM) and a vibrating sample magnetometer (VSM), respectively. The smart magnetic platforms were exposed to an alternating current (AC) magnetic field of 633 kHz and of strength 9.1 mT for studying their hyperthermic performance. The localized antitumor effects were investigated with artificial neural network modeling. A neural net time-series model was developed for the assessment of the best nanohybrid composition to serve the purpose with an accuracy close to 100%. Six Nonlinear Autoregressive with External Input (NARX) models were obtained, one for each of the components. The assessment of the accuracy of the predicted results has been done on the basis of Mean Squared Error (MSE). The highest Mean Squared Error value was obtained for the nanohybrid containing 45% magnetite and 55% graphene (F₄₅G₅₅) in the training phase i.e., 0.44703, which is where the model achieved optimal results after 71 epochs. The F₄₅G₅₅ nanohybrid was found to be the best for hyperthermia applications in low dosage with the highest specific absorption rate (SAR) and mean squared error values.

209 Breast Lymphoma Treatment Outcomes in a Pakistani Population: 20 Years of Experience at a Single Centre

Background

Breast lymphomas constitute a rare disease entity. To date, limited relevant data have been reported. We therefore here present a review of breast lymphoma patients treated at a single centre over 20-year period, focusing on histological types, treatment modalities and outcomes.

Method

We identified patients who were diagnosed and treated for breast lymphoma at a single centre from January 1995 to January 2014 and extracted data regarding patient demographics and clinical data.

Results

Twenty-seven patients with breast lymphoma were identified, of which 3 were males. Median age at diagnosis was 37 years (range:22-76 years). Chemotherapy was main stay of treatment and 55.6% patients also received radiation to affected breast. At our institute, only 3 patients, all with progressive disease, had surgery performed to achieve local palliation. Complete response after chemotherapy was seen in 63% patients and partial response in 7.4%, while 26% patients demonstrated disease progression. The mean follow up was 46.8 months. Seven patients (33.3%) who were alive at last follow up, as well as 1 patient who died, survived more than 5 years after diagnosis.

Conclusions

Patients with breast lymphoma should receive aggressive treatment, with combination of chemotherapy and radiation therapy. Surgery should be limited for diagnosis and palliation of local symptoms in cases of progressive disease.

210 Prognosis of Breast Cancer in Very Young Age (Less Than 30 Years)

Background

Breast cancer diagnosed at younger age has aggressive biology being triple negative and high grade and associated with poor prognosis.

Method

Retrospectively data of 121 patients age 30 years or younger registered during the year 2008 was reviewed. Demographics studied were age at diagnosis, gender, pregnancy, or lactation associated, family history, histopathological diagnosis, stage of the disease, receptors, type of treatment, response, local recurrence, distant relapse, survival.

Results

One patient was male. Age range 20 -30 years, single patient had bilateral involvement. half 50.4%(n = 61) patients had locally advanced disease at presentation. Pregnancy/ lactation associated breast cancer was seen in 29.8%(n = 36). Most common stage was stage III (52.1%) & stage II (33.9%). IDC was the most common histology 94.2% (n = 114) Triple negative was most common molecular subtype present in 46.3%(56). After 5 years follow up, local recurrence was observed in 12.4%(n = 15), cancer related deaths were 42.1%(n = 51).

Conclusions

Breast cancer in very young has very aggressive tumor biology, needs aggressive treatment with surgery, chemotherapy, radiation therapy and hormonal therapy, furthermore there is need to identify possible environmental factors which may contribute in the rising incidence in this age group.

Neurological manifestations following cured malaria: don't forget post-malaria neurological syndrome

Introduction

Cerebral malaria which occurs during the active infection is the most common neurological complication of malaria. Other complications including post-malaria neurological syndrome (PMNS) can rarely occur following complete recovery from the disease. We report a case of post-malaria neurological syndrome in a Tunisian patient.

Case presentation

A 26-year-old Tunisian man with no past medical history was admitted in 2016 for a muscle weakness of the 4 limbs, seizures, tetraparesis and myoclonus which appeared after he returned from Côte d'Ivoire where he had been treated three weeks ago for Plasmodium falciparum malaria with favorable outcome. Blood smears for malaria were negative. Brain MRI showed multiple hypersignal cerebral lesions. Investigations didn't show any infectious, metabolic, toxic, vascular or tumoral etiology. Thus, the diagnosis of PMNS was considered. The patient was treated with methylprednisolone with favorable outcome. Two years later, he was completely asymptomatic.

Conclusion

PMNS should be considered in patients with neurological symptoms occurring within two months of cured acute disease in which blood smears for malaria are negative and other etiologies have been ruled out. In most cases, the disease is self-limited while in severe cases corticosteroid therapy should be prescribed with favorable outcome.

On the Suitability of Almond Shells for the Manufacture of a Natural Low-Cost Bioadsorbent to Remove Brilliant Green: Kinetics and Equilibrium Isotherms Study

Almond production generates a large number of coproducts, but the farmer's interest mainly focuses on the nutritional and commercial aspects of the kernel for getting the best return from their harvests. Thus, almond coproducts such as almond shells that represent more than 70% of biomass remain underexplored. In this work, the suitability of almond shell powder (ASP) as a natural low-cost adsorbent was evaluated in the adsorption of brilliant green dye (BG), which is known as a chemical pollutant. Brunauer-Emmett-Teller (BET) method, for the determination of specific surface area, Fourier-transform infrared spectroscopy (FTIR), and scanning electron microscopy (SEM) techniques were performed to characterize the ASP adsorbent. The batch adsorption kinetic study for the removal of BG dye was carried out by varying pH, temperature, initial concentration of the dye, bioadsorbent dose, and contact time. It was found that 98% of BG dye is removed under the following optimal experimental conditions: ASP bioadsorbent dose of 1 g/L at T = 25°C, pH = 6.8, and C 0 = 1 g/L, which proves that ASP can be used as an excellent low-cost bioadsorbent for the removal of BG dye from wastewater. The experimental isotherm data were analyzed using Freundlich and Langmuir models. The results show the best correlation with single-layer adsorption, and the adsorption kinetics seems to follow a pseudo-second-order model.

Epidemiology of breast cancer in women based on diagnosis data from oncologists and senologists in Algeria

BACKGROUND

Breast cancer (BC) is a major health issue threatening women's life. No reliable epidemiological data on BC diagnosed by oncologists/senologists are available in Algeria.

METHODS

The BreCaReAl study, a non-interventional prospective cohort study, included adult women with confirmed BC in Algeria. Disease incidence, patients and disease characteristics, treatment patterns, and mortality rate were recorded up to 12 months of follow-up.

RESULTS

Overall, 1,437 patients were analysed: median age was 48 [41;57] years and 337 (23.5%) women had a family history of BC. BC incidence was 22.3 (95% CI: 21.5; 23.2) cases per 100,000 inhabitants over 8 months. Delayed diagnosis was reported in 400 (29.2%) patients. First line of treatments were mainly chemotherapy and surgery. Twenty-eight serious adverse events were reported including 10 (37.0%) events which led to death. Mortality rate reached 3.2% at 12 months CONCLUSION: A delayed diagnosis highlights the importance of implementing more effective screening strategies.

Diagnostic value of dipstick test in adult symptomatic urinary tract infections: results of a cross-sectional Tunisian study

Urinary tract infections (UTIs) are common. The diagnosis is confirmed by urine culture which is costly and takes at least 24 hours before results are known. The aim of this study was to determine the diagnostic accuracy of dipstick test for the diagnosis of UTI in symptomatic adult patients. We conducted a cross-sectional study in the department of Infectious Diseases, Sousse-Tunisia during a two-year period. We included all patients with clinical signs of UTI. Urine samples were tested for the presence of leukocyte esterase (LE) and nitrites. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of LE and nitrites were calculated against urine culture as gold standard. Four hundred thirty one patients, 139 men (32%) and 292 women (68%) were included. One hundred sixty six patients (39%) had UTI. The most frequently isolated microorganism was Escherichia coli (75%). LE had a high sensitivity (87%) but a low specificity (64%), while nitrites had a high specificity (95%) but a low sensitivity (48%). Combined positive LE and nitrites had a high PPV (85%) and combined negative LE and nitrites had a high NPV (92%), while positive LE combined with negative nitrites had a low PPV (47%) and a low NPV (53%). In conclusion, in adult patients with UTI symptoms, an alternate diagnosis should be considered if the LE is negative, while an early empirical antibiotic therapy against Enterobacteriaceae should be started if the nitrites are positive.

Alternaria alternata infection causing rhinosinusitis and orbital involvement in an immunocompetent patient

Invasive fungal rhinosinusitis is a rare infection that occurs primarily in immunocompromised patients. The fungal pathogen Alternaria alternata is rarely associated with rhinosinusitis. We report a case of A. alternata rhinosinusitis in an immunocompetent patient.