Bridging the gap: How investing in advanced practice nurses could transform emergency care in Africa

AIM

This paper aims to highlight the vital importance of investing in advanced practice nursing (APN) for enhancing emergency care throughout Africa.

BACKGROUND

APN's role is increasingly recognized as pivotal in optimizing healthcare, particularly in emergency settings in Africa. It offers improved patient care quality and strengthens the healthcare workforce.

SOURCES OF EVIDENCE

Evidence is drawn from successful implementations of APN in various healthcare environments. This includes the development of APN-specific curricula and training, mentorship initiatives, clinical supervision, and defining advanced nursing roles within healthcare organizations. Investing in APNs in emergency care in Africa can lead to improved quality and access to care, cost-effectiveness, enhanced patient outcomes and satisfaction, and opportunities for professional development and career advancement in the healthcare workforce.

DISCUSSION

Despite facing barriers in implementation, APN in emergency care presents innovative solutions. Investing in APN can help healthcare entities and policymakers surmount these challenges, providing specialized patient care and improving health outcomes. The discussion emphasizes the benefits such as enhanced access to care, reduced healthcare costs, and improved patient outcomes, alongside bolstering the healthcare workforce.

CONCLUSION

The necessity and benefits of investing in APN for emergency care in Africa are clear. It is crucial for improving healthcare delivery and outcomes.

IMPLICATIONS FOR NURSING PRACTICE

APN investment leads to a more competent and efficient nursing workforce, capable of addressing complex emergencies and improving patient care.

IMPLICATIONS FOR NURSING POLICY AND HEALTH/SOCIAL POLICY

The paper advocates for policies that support APN development and integration into the healthcare system, emphasizing the need for research to assess APN's long-term impact and establish best practices for its implementation in emergency care across Africa.

Impact of metformin treatment on cobalamin status in persons with type 2 diabetes

Over the last decades, low vitamin B12 status has been reported in individuals with type 2 diabetes mellitus (T2DM). Metformin, the first-line therapy for lowering blood glucose, is the main driving factor behind this association. Although the relationship between vitamin B12 deficiency and metformin is well established, results of studies on the exact effect of the dose and duration of the therapy remain inconsistent. Additionally, a lack of consensus on the definition of vitamin B12 deficiency adds to the conflicting literature. The objectives of this review were to analyze and synthesize the findings on the effects of metformin dose and duration on vitamin B12 status in patients with T2DM and to outline the potential mechanisms underlying metformin's effect on vitamin B12. Metformin therapy has adversely affected serum vitamin B12 concentrations, a marker of vitamin B12 status. The metformin usage index (a composite score of metformin dose and duration) might serve as a potential risk assessment tool for vitamin B12 screening in patients with T2DM. Considering the health implications of suboptimal vitamin B12 status, vitamin B12 concentrations should be monitored periodically in high-risk patients, such as vegans who are receiving metformin therapy for T2DM. Additionally, it is prudent to implement lifestyle strategies concurrent with metformin therapy in individuals with T2DM, promoting an overall synergistic effect on their glycemic control.

Prognostic effects of cardiopulmonary resuscitation (CPR) start time and the interval between CPR to extracorporeal cardiopulmonary resuscitation (ECPR) on patient outcomes under extracorporeal membrane oxygenation (ECMO): a single-center, retrospective observational study

BACKGROUND

The impact of the chronological sequence of events, including cardiac arrest (CA), initial cardiopulmonary resuscitation (CPR), return of spontaneous circulation (ROSC), and extracorporeal cardiopulmonary resuscitation (ECPR) implementation, on clinical outcomes in patients with both out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA), is still not clear. The aim of this study was to investigate the prognostic effects of the time interval from collapse to start of CPR (no-flow time, NFT) and the time interval from start of CPR to implementation of ECPR (low-flow time, LFT) on patient outcomes under Extracorporeal Membrane Oxygenation (ECMO).

METHODS

This single-center, retrospective observational study was conducted on 48 patients with OHCA or IHCA who underwent ECMO at Hamad General Hospital (HGH), the tertiary governmental hospital of Qatar, between February 2016 and March 2020. We investigated the impact of prognostic factors such as NFT and LFT on various clinical outcomes following cardiac arrest, including 24-hour survival, 28-day survival, CPR duration, ECMO length of stay (LOS), ICU LOS, hospital LOS, disability (assessed using the modified Rankin Scale, mRS), and neurological status (evaluated based on the Cerebral Performance Category, CPC) at 28 days after the CA.

RESULTS

The results of the adjusted logistic regression analysis showed that a longer NFT was associated with unfavorable clinical outcomes. These outcomes included longer CPR duration (OR: 1.779, 95%CI: 1.218-2.605, P = 0.034) and decreased survival rates for ECMO at 24 h (OR: 0.561, 95%CI: 0.183-0.903, P = 0.009) and 28 days (OR: 0.498, 95%CI: 0.106-0.802, P = 0.011). Additionally, a longer LFT was found to be associated only with a higher probability of prolonged CPR (OR: 1.818, 95%CI: 1.332-3.312, P = 0.006). However, there was no statistically significant connection between either the NFT or the LFT and the improvement of disability or neurologically favorable survival after 28 days of cardiac arrest.

CONCLUSIONS

Based on our findings, it has been determined that the NFT is a more effective predictor than the LFT in assessing clinical outcomes for patients with OHCA or IHCA who underwent ECMO. This understanding of their distinct predictive abilities enables medical professionals to identify high-risk patients more accurately and customize their interventions accordingly.

Human antigen R: Exploring its inflammatory response impact and significance in cardiometabolic disorders

RNA-binding proteins (RBPs) play a crucial role in the regulation of posttranscriptional RNA networks, which can undergo dysregulation in many pathological conditions. Human antigen R (HuR) is a highly researched RBP that plays a crucial role as a posttranscriptional regulator. HuR plays a crucial role in the amplification of inflammatory signals by stabilizing the messenger RNA of diverse inflammatory mediators and key molecular players. The noteworthy correlations between HuR and its target molecules, coupled with the remarkable impacts reported on the pathogenesis and advancement of multiple diseases, position HuR as a promising candidate for therapeutic intervention in diverse inflammatory conditions. This review article examines the significance of HuR as a member of the RBP family, its regulatory mechanisms, and its implications in the pathophysiology of inflammation and cardiometabolic illnesses. Our objective is to illuminate potential directions for future research and drug development by conducting a comprehensive analysis of the existing body of research on HuR.

Nursing privilege: A concept analysis

AIM

The study aimed to provide a comprehensive concept analysis of nursing privileges by elucidating its meaning and implications within the healthcare context.

DESIGN

A concept analysis paper.

METHODS

A comprehensive literature review was conducted from nursing and healthcare databases, professional nursing organizations, and regulatory bodies. Documents reviewed include research studies, policy documents and professional guidelines. The study employed Walker and Avant's eight-step method of concept analysis. This involved identifying the uses of the concept, its underlying attributes and referents, and constructing model, borderline, related and contrary cases. The antecedents, consequences and empirical referents of nursing privileges were also determined.

RESULTS

The analysis uncovered vital attributes defining nursing privileges, encompassing professional authority, autonomy, access to resources, information, influence, decision-making power, respect and recognition. Additionally, antecedents and consequences of nursing privilege were identified, spanning development and resource access, as well as professional satisfaction and enhanced patient care.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

The genetic basis and the diagnostic yield of genetic testing related to nonsyndromic hearing loss in Qatar

Hearing loss is the most predominant sensory defect occurring in pediatrics, of which, 66% cases are attributed to genetic factors. The prevalence of hereditary hearing loss increases in consanguineous populations, and the prevalence of hearing loss in Qatar is 5.2%. We aimed to investigate the genetic basis of nonsyndromic hearing loss (NSHL) in Qatar and to evaluate the diagnostic yield of different genetic tests available. A retrospective chart review was conducted for 59 pediatric patients with NSHL referred to the Department of Adult and Pediatric Medical Genetics at Hamad Medical Corporation in Qatar, and who underwent at least one genetic test. Out of the 59 patients, 39 were solved cases due to 19 variants in 11 genes and two copy number variants that explained the NSHL phenotype. Of them 2 cases were initially uncertain and were reclassified using familial segregation. Around 36.8% of the single variants were in GJB2 gene and c.35delG was the most common recurrent variant seen in solved cases. We detected the c.283C > T variant in FGF3 that was seen in a Qatari patient and found to be associated with NSHL for the first time. The overall diagnostic yield was 30.7%, and the diagnostic yield was significantly associated with genetic testing using GJB2 sequencing and using the hearing loss (HL) gene panel. The diagnostic yield for targeted familial testing was 60% (n = 3 patients) and for gene panel was 50% (n = 5). Thus, we recommend using GJB2 gene sequencing as a first-tier genetic test and HL gene panel as a second-tier genetic test for NSHL. Our work provided new insights into the genetic pool of NSHL among Arabs and highlights its unique diversity, this is believed to help further in the diagnostic and management options for NSHL Arab patients.

Exploring new horizons in neuroscience disease detection through innovative visual signal analysis

Brain disorders pose a substantial global health challenge, persisting as a leading cause of mortality worldwide. Electroencephalogram (EEG) analysis is crucial for diagnosing brain disorders, but it can be challenging for medical practitioners to interpret complex EEG signals and make accurate diagnoses. To address this, our study focuses on visualizing complex EEG signals in a format easily understandable by medical professionals and deep learning algorithms. We propose a novel time-frequency (TF) transform called the Forward-Backward Fourier transform (FBFT) and utilize convolutional neural networks (CNNs) to extract meaningful features from TF images and classify brain disorders. We introduce the concept of eye-naked classification, which integrates domain-specific knowledge and clinical expertise into the classification process. Our study demonstrates the effectiveness of the FBFT method, achieving impressive accuracies across multiple brain disorders using CNN-based classification. Specifically, we achieve accuracies of 99.82% for epilepsy, 95.91% for Alzheimer's disease (AD), 85.1% for murmur, and 100% for mental stress using CNN-based classification. Furthermore, in the context of naked-eye classification, we achieve accuracies of 78.6%, 71.9%, 82.7%, and 91.0% for epilepsy, AD, murmur, and mental stress, respectively. Additionally, we incorporate a mean correlation coefficient (mCC) based channel selection method to enhance the accuracy of our classification further. By combining these innovative approaches, our study enhances the visualization of EEG signals, providing medical professionals with a deeper understanding of TF medical images. This research has the potential to bridge the gap between image classification and visual medical interpretation, leading to better disease detection and improved patient care in the field of neuroscience.

COVID-19 lockdowns weigh heavily on youth: an analysis of the impact on BMI for Age Z scores in children and adolescents

BACKGROUND

The COVID-19 pandemic has significantly impacted the lifestyle and health of children and adolescents. This study aimed to assess the lifestyle changes brought about by COVID-19-related school closures and their impact on the Body Mass Index for Age Z (BAZ) scores of governmental school students in Qatar.

METHODS

An analytical cross-sectional study was conducted between June and August 2022 targeting students aged 8-15 years. Data on lifestyle behaviors were gathered through telephone interviews with parents of selected students. The BAZ scores before and after school closures that were automatically calculated by the electronic health records system were extracted.

RESULTS

We completed 1546 interviews. We found a significant increase in unhealthy food categories, a reduction in physical activity and an increase in the screen time over the period of schools' closure. The BAZ increased significantly by 0.30 (95% CI 0.26-0.35). The increase in BAZ scores was significantly higher among male students and the younger age group compared to females and older counterparts, respectively. The student's age group, sex, nationality and change in physical activity were significant predictors of the change in BAZ scores.

CONCLUSIONS

School closures during the COVID-19 pandemic negatively impacted the lifestyle of students in Qatar and resulted in a significant increase in the BAZ scores.

A hybridization of evolution strategies with iterated greedy algorithm for no-wait flow shop scheduling problems

This study investigates the no-wait flow shop scheduling problem and proposes a hybrid (HES-IG) algorithm that utilizes makespan as the objective function. To address the complexity of this NP-hard problem, the HES-IG algorithm combines evolution strategies (ES) and iterated greedy (IG) algorithm, as hybridizing algorithms helps different algorithms mitigate their weaknesses and leverage their respective strengths. The ES algorithm begins with a random initial solution and uses an insertion mutation to optimize the solution. Reproduction is carried out using (1 + 5)-ES, generating five offspring from one parent randomly. The selection process employs (µ + λ)-ES, allowing excellent parent solutions to survive multiple generations until a better offspring surpasses them. The IG algorithm's straightforward search mechanism aids in further improving the solution and avoiding local minima. The destruction operator randomly removes d-jobs, which are then inserted one by one using a construction operator. The local search operator employs a single insertion approach, while the acceptance-rejection criteria are based on a constant temperature. Parameters of both ES and IG algorithms are calibrated using the Multifactor analysis of variance technique. The performance of the HES-IG algorithm is calibrated with other algorithms using the Wilcoxon signed test. The HES-IG algorithm is tested on 21 Nos. Reeves and 30 Nos. Taillard benchmark problems. The HES-IG algorithm has found 15 lower bound values for Reeves benchmark problems. Similarly, the HES-IG algorithm has found 30 lower bound values for the Taillard benchmark problems. Computational results indicate that the HES-IG algorithm outperforms other available techniques in the literature for all problem sizes.

The role of point-of-care ultrasound (POCUS) imaging in clinical outcomes during cardiac arrest: a systematic review

BACKGROUND

Cardiac arrest in hospital and out-of-hospital settings is associated with high mortality rates. Therefore, a bedside test that can predict resuscitation outcomes of cardiac arrest patients is of great value. Point-of-care ultrasound (POCUS) has the potential to be used as an effective diagnostic and prognostic tool during cardiac arrest, particularly in observing the presence or absence of cardiac activity. However, it is highly susceptible to "self-fulfilling prophecy" and is associated with prolonged cardiopulmonary resuscitation (CPR), which negatively impacts the survival rates of cardiac arrest patients. As a result, the current systematic review was created to assess the role of POCUS in predicting the clinical outcomes associated with out-of-hospital and in-hospital cardiac arrests.

METHODS

The search for scientific articles related to our study was done either through an electronic database search (i.e., PubMed, Medline, ScienceDirect, Embase, and Google Scholar) or manually going through the reference list of the relevant articles. A quality appraisal was also carried out with the Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS-2), and the prognostic test performance (sensitivity and sensitivity) was tabulated.

RESULTS

The search criteria yielded 3984 articles related to our topic, of which only 22 were eligible for inclusion. After reviewing the literature, we noticed a wide variation in the definition of cardiac activity, and the statistical heterogeneity was high; therefore, we could not carry out meta-analyses. The tabulated clinical outcomes based on initial cardiac rhythm and definitions of cardiac activity showed highly inconsistent results.

CONCLUSION

POCUS has the potential to provide valuable information on the management of cardiac arrest patients; however, it should not be used as the sole predictor for the termination of resuscitation efforts.

A novel on design and implementation of hybrid MPPT controllers for solar PV systems under various partial shading conditions

At present, fossil fuel-based power generation systems are reducing drastically because of their less availability in nature. In addition, it produces hazardous gasses and high environmental pollution. So, in this work, the solar natural source is selected for generating the electricity. Due to the nonlinear behavior of PV, achieving maximum voltage from the Photovoltaic (PV) system is a more tough job. In this work, various hybrid optimization controllers are studied for tracing the working power point of the PV under different Partial Shading Conditions. The studied hybrid optimization MPPT methods are equated in terms of oscillations across MPP, output power extraction, settling time of the MPP, dependency on the PV modeling, operating duty value of the converter, error finding accuracy of MPPT, algorithm complexity, tracking speed, periodic tuning required, and the number of sensing parameters utilized. Based on the simulative comparison results, it has been observed that the modified Grey Wolf Optimization based ANFIS hybrid MPPT method provides good results when equated with the other power point tracking techniques. Here, the conventional converter helps increase the PV source voltage from one level to another level. The proposed system is investigated by using the MATLAB/Simulink tool.

Regional Agriculture and Food Systems Amid the COVID-19 Pandemic: The Case of the Near East and North Africa Region

The COVID-19 pandemic affected agri-food systems worldwide. However, while the impacts differed from one country/region to another, the scholarly literature seems to focus on developed countries in the Global North. Consequently, this review scrutinizes the literature on the pandemic's impacts in the Near East and North Africa (NENA) region. A search on the Web of Science in March 2023 generated 334 documents, of which 151 were eligible for inclusion in the systematic review. According to the bibliometric analysis, the most active nations are Saudi Arabia, Egypt, Jordan, the United Arab Emirates, and Lebanon. In general, the coverage of studies is better in the Gulf region than in the less developed countries of North Africa and those suffering from wars (cf. Libya, Syria, and Yemen). Studies generally focus on crop production and the downstream food chain (cf. distribution and consumption). While the pandemic influenced every pillar of food security, this research concentrates on access and utilization. Meanwhile, the lion's share of the literature deals with the pandemic's socio-economic effects, especially those linked to food (in)security and health. The pandemic, which laid bare the agri-food system vulnerabilities, should be seized to foster the transition towards more resilient agri-food systems in the NENA region.

iMRSAPred: Improved Prediction of Anti-MRSA Peptides Using Physicochemical and Pairwise Contact-Energy Properties of Amino Acids

Methicillin-resistant Staphylococcus aureus (MRSA) is a growing concern for human lives worldwide. Anti-MRSA peptides act as potential antibiotic agents and play significant role to combat MRSA infection. Traditional laboratory-based methods for annotating Anti-MRSA peptides are although precise but quite challenging, costly, and time-consuming. Therefore, computational methods capable of identifying Anti-MRSA peptides accelerate the drug designing process for treating bacterial infections. In this study, we developed a novel sequence-based predictor "iMRSAPred" for screening Anti-MRSA peptides by incorporating energy estimation and physiochemical and sequential information. We successfully resolved the skewed imbalance phenomena by using synthetic minority oversampling technique plus Tomek link (SMOTETomek) algorithm. Furthermore, the Shapley additive explanation method was leveraged to analyze the impact of top-ranked features in the prediction task. We evaluated multiple machine learning algorithms, i.e., CatBoost, Cascade Deep Forest, Kernel and Tree Boosting, support vector machine, and HistGBoost classifiers by 10-fold cross-validation and independent testing. The proposed iMRSAPred method significantly improved the overall performance in terms of accuracy and Matthew's correlation coefficient (MCC) by 5.45 and 0.083%, respectively, on the training data set. On the independent data set, iMRSAPred improved accuracy and MCC by 3.98 and 0.055%, respectively. We believe that the proposed method would be useful in large-scale Anti-MRSA peptide prediction and provide insights into other bioactive peptides.

Serum metabolic signatures for Alzheimer's Disease reveal alterations in amino acid composition: a validation study

INTRODUCTION

Alzheimer's Disease (AD) is complex and novel approaches are urgently needed to aid in diagnosis. Blood is frequently used as a source for biomarkers; however, its complexity prevents proper detection. The analytical power of metabolomics, coupled with statistical tools, can assist in reducing this complexity.

OBJECTIVES

Thus, we sought to validate a previously proposed panel of metabolic blood-based biomarkers for AD and expand our understanding of the pathological mechanisms involved in AD that are reflected in the blood.

METHODS

In the validation cohort serum and plasma were collected from 25 AD patients and 25 healthy controls. Serum was analysed for metabolites using nuclear magnetic resonance (NMR) spectroscopy, while plasma was tested for markers of neuronal damage and AD hallmark proteins using single molecule array (SIMOA).

RESULTS

The diagnostic performance of the metabolite biomarker panel was confirmed using sparse-partial least squares discriminant analysis (sPLS-DA) with an area under the curve (AUC) of 0.73 (95% confidence interval: 0.59-0.87). Pyruvic acid and valine were consistently reduced in the discovery and validation cohorts. Pathway analysis of significantly altered metabolites in the validation set revealed that they are involved in branched-chain amino acids (BCAAs) and energy metabolism (glycolysis and gluconeogenesis). Additionally, strong positive correlations were observed for valine and isoleucine between cerebrospinal fluid p-tau and t-tau.

CONCLUSIONS

Our proposed panel of metabolites was successfully validated using a combined approach of NMR and sPLS-DA. It was discovered that cognitive-impairment-related metabolites belong to BCAAs and are involved in energy metabolism.

ChatGPT is not ready yet for use in providing mental health assessment and interventions

Background

Psychiatry is a specialized field of medicine that focuses on the diagnosis, treatment, and prevention of mental health disorders. With advancements in technology and the rise of artificial intelligence (AI), there has been a growing interest in exploring the potential of AI language models systems, such as Chat Generative Pre-training Transformer (ChatGPT), to assist in the field of psychiatry.

Objective

Our study aimed to evaluates the effectiveness, reliability and safeness of ChatGPT in assisting patients with mental health problems, and to assess its potential as a collaborative tool for mental health professionals through a simulated interaction with three distinct imaginary patients.

Methods

Three imaginary patient scenarios (cases A, B, and C) were created, representing different mental health problems. All three patients present with, and seek to eliminate, the same chief complaint (i.e., difficulty falling asleep and waking up frequently during the night in the last 2°weeks). ChatGPT was engaged as a virtual psychiatric assistant to provide responses and treatment recommendations.

Results

In case A, the recommendations were relatively appropriate (albeit non-specific), and could potentially be beneficial for both users and clinicians. However, as complexity of clinical cases increased (cases B and C), the information and recommendations generated by ChatGPT became inappropriate, even dangerous; and the limitations of the program became more glaring. The main strengths of ChatGPT lie in its ability to provide quick responses to user queries and to simulate empathy. One notable limitation is ChatGPT inability to interact with users to collect further information relevant to the diagnosis and management of a patient's clinical condition. Another serious limitation is ChatGPT inability to use critical thinking and clinical judgment to drive patient's management.

Conclusion

As for July 2023, ChatGPT failed to give the simple medical advice given certain clinical scenarios. This supports that the quality of ChatGPT-generated content is still far from being a guide for users and professionals to provide accurate mental health information. It remains, therefore, premature to conclude on the usefulness and safety of ChatGPT in mental health practice.

The prevalence of probable overactive bladder and associated risk factors among medical students in Jordan: a cross-sectional study

BACKGROUND

To discuss the impact of overactive bladder (OAB) on medical students. overactive bladder. is a chronic condition that causes sudden and intense urges to urinate, which can have significant physical and psychological effects on patients' lives. The prevalence of OAB among medical students is relatively high, with some studies reporting rates as high as 35.4%. This research aims to shed light on the prevalence rates and risk factors associated with OAB among medical students in Jordan.

METHODS

A cross-sectional study was conducted using an online self-reported questionnaire as the study tool. The questionnaire collected the sociodemographic, health, and academic characteristics of medical students, as well as the new 7-item OABSS score.

RESULTS

Out of the total sample of medical students surveyed (n = 525), 44.5% reported experiencing symptoms of OAB. Furthermore, the analysis also revealed that there was a significant difference in the prevalence of OAB between the ages of medical students. In addition, the study also found that there was a significant association between OAB symptoms and basic years, positive history of diagnostic UTI, positive history of recent trauma, high stress, and taking certain medications.

CONCLUSIONS

The study highlights the need for further research in this area and emphasizes the possible implications of OAB for medical students, including the need for additional support and resources to manage the condition.

TMR for Peripheral Sensory Nerve Neuroma around the Wrist Utilizing the Distal Anterior Interosseous Nerve

Injury to the peripheral sensory nerves of the hand and wrist is common and can lead to debilitating neuromas and significantly impair patients' quality of life. Target-muscle reinnervation (TMR) is a novel method for treating neuromas that can result in significant clinical improvement. However, TMR for the peripheral sensory nerves in the hand and wrist is restricted by the limited options for motor branches. The adaptability of the anterior interosseous nerve (AIN) as a target for TMR treating peripheral sensory neuroma has not been thoroughly investigated or implemented therapeutically. This study aimed to evaluate the use of AIN as a viable recipient of TMR for treating peripheral sensory neuromas around the wrist. In this retrospective study, eight patients were included over 18 months from June 2021 to January 2023 at Hamad Medical Corporation. The average follow-up time after TMR was 13 months. The peripheral sensory nerves involved were the radial sensory nerve in five cases, the palmar cutaneous branch of the median nerve in one case, and the median nerve in one case. The preoperative average VAS pain score was 7 of 10 compared with the postoperative pain score of 2 of 10. In conclusion, the AIN can be used as a first-choice motor target for all peripheral sensory neuromas around the wrist for the following reasons: first, it can be reached by the peripheral sensory nerves around the wrist; second, the pronator quadratus muscle is expandable; and third, the AIN can be taken with a long proximal tail for flexible coaptation with the peripheral sensory nerves.

3D Oleophilic Sorbent Films Based on Recycled Low-Density Polyethylene

Recycling low-end, one-time-use plastics-such as low-density polyethylene (LDPE)-is of paramount importance to combat plastic pollution and promote sustainability in the modern green economy. This study valorizes LDPE waste by transforming it into 3D oleophilic swellable thin films through a process involving dissolution, phase separation, and extraction. These films are subsequently layered using a customized polypropylene (PP) based nonwoven fabric separator and securely sealed in a zigzag pattern. The zigzag-shaped seal enhances the adhesion of pollutants to the sorbent by providing wire curvatures that increase retention time and uptake capacity. As a result, the sorbent exhibits impressive oil uptake capacities, with immediate and equilibrium values of 120 g/g and 85 g/g, respectively. Notably, the as-prepared sorbent demonstrates low water retention and high selectivity for oil, outperforming commercially available oil sorbents. The unique design involving a 3D-film structure, superposed films, and a zigzag-shaped seal offers a sustainable and value-added solution to the issues of LDPE waste and oil spills on water surfaces.

Emerging trends of carbon emissions and foreign direct investment: accounting for ecological footprints, renewable energy, globalization, and technological innovations in BRICS

This paper investigates the intricate interplay between carbon emissions and foreign direct investment within the context of Brazil, Russia, India, China, and South Africa (BRICS) for the period spanning 2000 to 2022. In our comprehensive analysis, we incorporate ecological footprint, renewable energy, globalization, and technological innovations as exogenous variables. Employing a system of simultaneous equations across the BRICS panel, we aim to fully elucidate the proposed relationships. Our empirical findings underscore the following key insights: foreign direct investment, technological innovations, and the adoption of renewable energy sources significantly contribute to the mitigation of carbon emissions in these selected nations. However, it is essential to note that ecological footprints exhibit a positive association with carbon emissions, raising concerns on two fronts: escalating environmental degradation and increased land pressure, both of which contribute to rising ecological footprints in BRICS countries. Additionally, our analysis reveals that foreign direct investment is influenced by its capacity to reduce carbon emissions and bolster renewable energy adoption, while globalization amplifies investment trends within the BRICS nations. To address the environmental repercussions of mining activities, it is imperative to implement stringent control and regulation measures, given their potential adverse impacts, including soil pollution, acid mine drainage, erosion, biodiversity loss, excessive water resource consumption, and wastewater disposal challenges. Nevertheless, proactive steps such as recycling mining waste, adopting environmentally friendly mining equipment, combatting illegal mining, and enhancing overall mining sustainability offer promising avenues to mitigate the environmental footprint of mining operations.

Accidental portal vein catheterization during pleural drainage catheter insertion: a case report

BACKGROUND

Iatrogenic portal vein (PV) injuries following pleural drainage catheter (PDC) insertion are rare but life-threatening. This case report emphasizes the importance of prompt recognition and effective interventional radiology (IR) management.

CASE PRESENTATION

A 38-year-old Asian male, admitted for a non-ST-segment elevation myocardial infarction, suffered a critical PV injury during PDC insertion, leading to rapid clinical deterioration. The IR team conducted a portogram, retrieved the catheter, and successfully executed an embolization procedure. The patient's recovery, confirmed through imaging and improving liver function tests, enabled discharge with follow-up instructions.

CONCLUSIONS

This case highlights the clinical significance of promptly recognizing and effectively managing iatrogenic PV injuries during PDC insertion, with the pivotal role of IR. Collaboration between IR and surgical teams is crucial for optimizing patient outcomes.

Exploring patients' experiences with telehealth in obstetrics care during the COVID-19 pandemic: A qualitative study

AIM

The aim of this study was to evaluate patients' experiences with telehealth provision of obstetrics and gynecology care during the COVID-19 pandemic qualitatively.

DESIGN AND SETTING

In this study, a qualitative research design, namely descriptive phenomenology, was employed. Participants were recruited from the OB department at UMass Memorial Medical center in Worcester, MA, between 6/2020 and 7/2020.

METHODS

Between June 2020 and July 2020, in-depth interviews were conducted with 18 women receiving care at the Obstetrics and Maternal and Fetal Medicine clinics. Data were analyzed using qualitative thematic analysis, as outlined by Braun and Clarke.

RESULTS

Telehealth is a feasible and safe health-care tool that is available during these unprecedented times. This study provided qualitative evidence based on patients' perspectives and experiences. Participants' meanings in relation to their experiences of using telehealth services emerged from the data in four themes: the overall experience of using modern telehealth platforms, telehealth and its perceived benefits, telehealth and its perceived challenges, and telehealth and its potential future use.

CONCLUSION

While this study highlights areas in telehealth implementation that require improvement, the overall positive experiences and consistent perceived benefits of most participants suggests that telehealth can be an important tool in healthcare delivery for appropriate patients and situations moving forward in a post-pandemic world.

IMPACT

During the global pandemic, telehealth has been recognized to have the potential to play a critical role in healthcare delivery. Establishing qualitative evidence-based practices in the emerging field of telehealth for OB services is pivotal to mitigate potential safety, feasibility, and cost issues that could be associated with the rapid adoption of telehealth. Yet, this qualitative study However highlighted several challenges that are necessary to be addressed in order for telehealth to meet maximum effectiveness and functionality in the future.

Studying carrier frequency of spinal muscular atrophy in the State of Qatar and comparison to other ethnic groups: Pilot study

BACKGROUND

Spinal muscular atrophy (SMA) is an autosomal recessive disease caused by mutations and deletions in SMN1 at exon 7. The carrier frequency for SMN1 mutations ranges from 2 to 4% in the general population.

METHODS

We examined allelic, genotypic relatedness and copy number (CN) variations and frequencies of SMN1 and SMN2, in 13,426 samples from Qatar biobank (QBB) to provide a precise estimation of SMA carrier frequency in Qatar in comparison to other populations.

RESULTS

The SMA carrier frequency was found to be (2.8%) and the rs143838139 was found in 491/13426 (3.66%) of individuals. The SNP rs121909192, which is a pathogenic risk factor, was found in 321/13500 (2.38%). In Addition 242/11379 (2.13%) had two copies of SMN1 and the rs143838139, which may explain the (2 + 0) silent carrier. Additionally, two participants were found to be SMA type 4 with 0 and 4 copy numbers in SMN1 and SMN2, respectively.

CONCLUSION

The SMA carrier frequency in Qatar was found to be comparable to Saudi Arabia and Caucasians. The likely pathogenic variant, rs121909192, was found to be significantly higher when compering with other in our study. The rs143838139 variant, which has a strong association with the silent carrier genotype, has been found. Consequently, testing for this SNP may enhance the precision of evaluating the likelihood of a patient having an affected child. We conclude that the frequency of SMA carriers varies within the Qatar population and other ethnic groups.

A new simple and innovative technique for surgical drains fixation

Seroma is a common complication post many plastic surgery procedures. To overcome this issue, drain insertion became a standard of care in many procedures. Existing methods for fixing the drain like the Roman sandal, purse string, and mesentery have limitations, including loosening and skin problems. A new, innovative, and efficient drain fixation technique is introduced in this paper. It involves using silk or similar non-absorbable sutures in a simple five-step process. This method ensures secure drain placement without undesirable outcomes. It avoids the need to force a knot over the skin, reducing the risk of skin damage or necrosis. In conclusion, the study introduces a straightforward, safe, and effective drain fixation method, reducing risks associated with fluid accumulation after surgery.

Congenital absence of appendix: a rare condition that could result in severe complications-a review of literature

Acute appendicitis is the most frequent cause of abdominal pain and acute emergency surgeries, with a mortality risk of 6-7% at its onset. Since atypical deviations in these structures are rare, they can lead to diagnosis confusion and increase the risk of a worsening of the patient's clinical picture. We present the case of a 35-year-old patient who had surgery after being diagnosed with acute appendicitis. Based on clinical assessment (Alvarado score 8), appendix agenesis was discovered intraoperatively and confirmed by postoperative pathology. Excess dissection while looking for the appendix caused an intraoperative complication of cecal damage, which was treated with a right hemicolectomy. Until now, just a few cases have been described in the literature. We record this case owing to its rarity and with the goal of further understanding the illness, which will lead to improved surgical results in similar patients.

Excision and reconstruction of dorsal nasal mucous cyst using dorsal nasal flap technique: a case report and literature review

Congenital nasal masses are very rare presentations. Among these masses is a mucous cyst, which might be considered either a congenital or an acquired mass. Our report presents a case of recurrent dorsal nasal swelling that was initially managed with an open rhinoplasty. However, 1 year after the surgery, the swelling started to grow rapidly, and the patient presented with a disfigured nose. We scheduled the patient for the excision of the dorsal nasal swelling and reconstruction using the dorsal nasal flap approach. Several surgical techniques have been performed and published in the literature; however, this is the first time the dorsal nasal flap technique is being reported as a surgical approach to dorsal nasal mucous cysts. While mucous cyst formation might be congenital, the majority occur after rhinoplasty surgery. However, they can be prevented by minimizing unnecessary trauma during the surgery and ensuring the thorough removal of all epithelial tissue and foreign bodies.

Turning waste avocado stones and montmorillonite into magnetite-supported nanocomposites for the depollution of methylene blue: adsorbent reusability and performance optimization

The existence of methylene blue (MB) in wastewater even as traces is raising environmental concerns. In this regard, the performances of four adsorbents, avocado stone biochar (AVS-BC), montmorillonite (MMT), and their magnetite Fe3O4-derived counterparts, were compared. Results showed the superior performance of Fe3O4@AVS-BC and Fe3O4@MMT nanocomposites with removal percentages (%R) of 95.59% and 88%. The morphological features of AVS-BC as revealed by SEM analysis showed a highly porous surface compared to a plane and smooth surface in the case of MMT. Surface analysis using FT-IR and Raman spectroscopies corroborated the existence of the Fe-O peaks upon loading with magnetite. The XRD analysis confirmed the formation of cubic magnetite nanoparticles. The adsorption process in the batch mode was optimized using central composite design (CCD). Equilibrium and kinetic isotherms showed that the adsorption of MB onto Fe3O4@AVS-BC fitted well with the Langmuir isotherm and the pseudo-second-order (PSO) model. The maximum adsorption capacity (qm) was 118.9 mg/g (Fe3O4@AVS-BC) and 72.39 mg/g (Fe3O4@MMT). The Fe3O4@AVS-BC showed a higher selectivity toward MB compared to other organic contaminants. The MB-laden adsorbent was successfully used for the remediation of Cr (III), Ni (II), and Cd (II) with removal efficiencies hitting 100% following thermal activation.

Clinical Characteristics and Outcomes of Patients With Antithyroid Drug-Related Liver Injury

Context

Antithyroid drugs (ATDs) are the cornerstone of hyperthyroidism management. Hepatotoxicity due to ATDs can range from mild transaminase elevation to liver transplantation requirement and mortality.

Objective

The primary objective of the systematic review was to assess the clinical characteristics and outcomes of patients with drug induced liver injury (DILI) due to ATDs.

Methods

We conducted a systematic review of PUBMED, SCOPUS, and EMBASE on characteristics and outcomes of adults (>18 years) with DILI due to ATDs. We defined DILI as bilirubin ≥2.5 mg/dL or international normalized ratio >1.5 with any rise in alanine aminotransferase (ALT), aminotransferase (AST), or alkaline phosphatase (ALP), or an elevation of ALT or AST >5 times or ALP >2 times the upper limit of normal without jaundice/coagulopathy.

Results

The review included 100 articles describing 271 patients; 148 (70.8%) were female (N = 209). Mean age was 42.9 ± 17.2 years. Graves' disease was the most common indication for ATDs. Carbimazole/methimazole (CBM/MMI) was the most common offending agent (55.7%). DILI pattern was hepatocellular in 41.8%, cholestatic in 41.3%, and mixed in 16.9%. Outcomes included death in 11.8%, liver transplantation in 6.4%, partial improvement in 2.2%, and complete resolution in 79.6% with a median time (IQR) to resolution of 45 (20-90) days. Patients in the propylthiouracil (PTU) group had higher initial bilirubin, initial AST, initial ALT, peak ALT, peak AST, severe and fatal DILI, liver transplantation, and mortality than CBM/MMI. Rechallenge of antithyroid medication was infrequently reported (n = 16) but was successful in 75%.

Conclusion

DILI due to ATDs can present with different patterns and should prompt immediate drug discontinuation. Referral to a hepatologist should be considered if severe as transplantation is sometimes required. PTU-induced DILI may have worse outcomes than CBM/MMI.

Use of machine learning to assess factors affecting progression, retention, and graduation in first-year health professions students in Qatar: a longitudinal study

BACKGROUND

Across higher education, student retention, progression, and graduation are considered essential elements of students' academic success. However, there is scarce literature analyzing these attributes across health professions education. The current study aims to explore rates of student retention, progression, and graduation across five colleges of the Health Cluster at Qatar University, and identify predictive factors.

METHODS

Secondary longitudinal data for students enrolled at the Health Cluster between 2015 and 2021 were subject to descriptive statistics to obtain retention, progression and graduation rates. The importance of student demographic and academic variables in predicting retention, progression, or graduation was determined by a predictive model using XGBoost, after preparation and feature engineering. A predictive model was constructed, in which weak decision tree models were combined to capture the relationships between the initial predictors and student outcomes. A feature importance score for each predictor was estimated; features that had higher scores were indicative of higher influence on student retention, progression, or graduation.

RESULTS

A total of 88% of the studied cohorts were female Qatari students. The rates of retention and progression across the studied period showed variable distribution, and the majority of students graduated from health colleges within a timeframe of 4-7 years. The first academic year performance, followed by high school GPA, were factors that respectively ranked first and second in importance in predicting retention, progression, and graduation of health majors students. The health college ranked third in importance affecting retention and graduation and fifth regarding progression. The remaining factors including nationality, gender, and whether students were enrolled in a common first year experience for all colleges, had lower predictive importance.

CONCLUSIONS

Student retention, progression, and graduation at Qatar University Health Cluster is complex and multifactorial. First year performance and secondary education before college are important in predicting progress in health majors after the first year of university study. Efforts to increase retention, progression, and graduation rates should include academic advising, student support, engagement and communication. Machine learning-based predictive algorithms remain a useful tool that can be precisely leveraged to identify key variables affecting health professions students' performance.

Carbimazole-Resistant Grave's Thyrotoxicosis is a Diagnostic and Therapeutic Dilemma, Case Report with Literature Review

Background

Carbimazole (CBZ) (or methimazole) is the most used drug inducing and maintaining remission in thyrotoxicosis, especially Grave's disease (GD). Rarely, situations arise when patients do not respond to recommended or even supratherapeutic doses of CBZ. It poses a challenge to diagnose drug resistance and ultimately manage hyperthyroidism, which can otherwise be fatal if left untreated. Propylthiouracil (PTU) has been used as an alternative in such patients amid increased side effect risks. Additionally, definitive therapy has been recommended with ablation or surgery. However, the best modality of inducing euthyroidism in drug-resistant patients is yet to be established. On literature search, twenty similar cases were found in the literature search. This study summarizes the past literature with addition of a new case of anti-thyroid drug resistant (ATDR) GD.

Case Presentation

A 34-year-old female presented with a 5-day history of progressively worsening fatigue, heat intolerance, sweating, and palpitations. She was diagnosed with GD based on her thyroid function tests (TFTs) and started on CBZ and propranolol. Despite being compliant with CBZ 20 mg once daily and then twice daily, her TFTs remained unchanged for 4 months. However, patient revisited the emergency with continued thyrotoxicosis and unchanged TFTs. Her dose was eventually increased to 20 mg thrice daily, and administration under supervision did not improve her TFTs. The patient was shifted to PTU 150 mg thrice daily with steroids, with minimal improvement. The patient eventually underwent thyroidectomy to avoid long-term PTU use.

Conclusion

ATDR GD is rare and remains a diagnostic and therapeutic challenge. Optimal management should focus on carefully excluding other possibilities and shared decision-making in its management. Most patients may require definitive therapy; hence, arrangements should be made timely with simultaneous attempts to reduce the thyrotoxic state, which otherwise poses a continued threat to patients' life with potentially serious complications.

Deferasirox in Patients with Chronic Kidney Disease: Assessing the Potential Benefits and Challenges

Chronic kidney disease (CKD) is a major global health concern, affecting millions of people worldwide. The progressive decline in kidney function often necessitates renal replacement therapy, such as hemodialysis (HD) or peritoneal dialysis (PD), to maintain a patient's health. Iron overload, which is common in CKD patients on dialysis, can lead to severe complications, including cardiovascular disease and infections where most of the existing iron chelators are deemed unsuitable due to their suboptimal clearance in patients with compromised renal function, it becomes a significant challenge to effectively manage iron overload. Deferasirox (DFX), an oral iron chelator, has emerged as a promising treatment option for managing iron overload in these patients. However, the use of DFX comes with its unique set of challenges, such as its cost, potential side effects, and the need for close monitoring of patients, as well as the noticeable scarcity of comprehensive and rigorous clinical studies confirming its efficacy and safety of DFX. In this review, we delve into both the promising prospects and the emerging challenges associated with DFX use in managing CKD patients on HD or PD, striving for a comprehensive understanding that informs better clinical practice and patient care.

3D Printed Polymer Piezoelectric Materials: Transforming Healthcare through Biomedical Applications

Three-dimensional (3D) printing is a promising manufacturing platform in biomedical engineering. It offers significant advantages in fabricating complex and customized biomedical products with accuracy, efficiency, cost-effectiveness, and reproducibility. The rapidly growing field of three-dimensional printing (3DP), which emphasizes customization as its key advantage, is actively searching for functional materials. Among these materials, piezoelectric materials are highly desired due to their linear electromechanical and thermoelectric properties. Polymer piezoelectrics and their composites are in high demand as biomaterials due to their controllable and reproducible piezoelectric properties. Three-dimensional printable piezoelectric materials have opened new possibilities for integration into biomedical fields such as sensors for healthcare monitoring, controlled drug delivery systems, tissue engineering, microfluidic, and artificial muscle actuators. Overall, this review paper provides insights into the fundamentals of polymer piezoelectric materials, the application of polymer piezoelectric materials in biomedical fields, and highlights the challenges and opportunities in realizing their full potential for functional applications. By addressing these challenges, integrating 3DP and piezoelectric materials can lead to the development of advanced sensors and devices with enhanced performance and customization capabilities for biomedical applications.

Spontaneous coronary artery dissection: an overview

The prevalence of spontaneous coronary artery dissection (SCAD) has increased over the last decades in young adults presenting with acute coronary syndrome. Although the diagnostic tools, including intracoronary imaging, have permitted a more accurate diagnosis of SCAD, the prognosis and overall outcomes remain dismal. Furthermore, the disproportionate sex distribution affecting more women and the underdiagnosis in many parts of the world render this pathology a persistent clinical challenge, particularly since the management remains largely supportive with a limited and controversial role for percutaneous or surgical interventions. The purpose of this review is to summarize the available literature on SCAD and to provide insights into the gaps in knowledge and areas requiring further investigation.

Medical Admission Prediction Score (MAPS); a simple tool to predict medical admissions in the emergency department

INTRODUCTION

Overcrowding in the emergency departments (ED) is linked to adverse clinical outcomes, a negative impact on patient safety, patient satisfaction, and physician efficiency. We aimed to design a medical admission prediction scoring system based on readily available clinical data during ED presentation.

METHODS

In this retrospective cross-sectional study, data on ED presentations and medical admissions were extracted from the Emergency and Internal Medicine departments of a tertiary care facility in Qatar. Primary outcome was medical admission.

RESULTS

Of 320299 ED presentations, 218772 were males (68.3%). A total of 11847 (3.7%) medical admissions occurred. Most patients were Asians (53.7%), followed by Arabs (38.7%). Patients who got admitted were older than those who did not (p <0.001). Admitted patients were predominantly males (56.8%), had a higher number of comorbid conditions and a higher frequency of recent discharge (within the last 30 days) (p <0.001). Age > 60 years, female gender, discharge within the last 30 days, and worse vital signs at presentations were independently associated with higher odds of admission (p<0.001). These factors generated the scoring system with a cut-off of >17, area under the curve (AUC) 0.831 (95% CI 0.827-0.836), and a predictive accuracy of 83.3% (95% CI 83.2-83.4). The model had a sensitivity of 69.1% (95% CI 68.2-69.9), specificity was 83.9% (95% CI 83.7-84.0), positive predictive value (PPV) 14.2% (95% CI 13.8-14.4), negative predictive value (NPV) 98.6% (95% CI 98.5-98.7) and positive likelihood ratio (LR+) 4.28% (95% CI 4.27-4.28).

CONCLUSION

Medical admission prediction scoring system can be reliably applied to the regional population to predict medical admissions and may have better generalizability to other parts of the world owing to the diverse patient population in Qatar.

Association of Subclinical Hypothyroidism with Type 2 Diabetes Mellitus in Qatar: A Cross-Sectional Study

Purpose

The relationship between subclinical hypothyroidism and type 2 diabetes mellitus (T2DM) in Qatar is under-studied, despite the high prevalence of diabetes in the region. This study evaluates the potential association between subclinical hypothyroidism and T2DM in Qatar.

Patients and Methods

A cross-sectional study used participants with and without T2DM from the Qatar Biobank (QBB). Logistic regression analysis was used to assess the association between subclinical hypothyroidism and T2DM, with multivariable logistic regression used to adjust for potential confounders.

Results

The study found that subclinical hypothyroidism was significantly associated with a 2.82 increase in the odds of having T2DM (OR=2.82, 95% CI (1.13, 7.02), p=0.026) after adjusting for potential confounders. The proportion of subclinical hypothyroidism among individuals with T2DM in Qatar was 4.6%, significantly higher than in those without T2DM (2.8%, p=0.18).

Conclusion

This study demonstrates a significant association between subclinical hypothyroidism and T2DM in Qatar. Further research is required to investigate the directionality of this association and its clinical implications.

Multimodal deep learning for liver cancer applications: a scoping review

Background

Hepatocellular carcinoma is a malignant neoplasm of the liver and a leading cause of cancer-related deaths worldwide. The multimodal data combines several modalities, such as medical images, clinical parameters, and electronic health record (EHR) reports, from diverse sources to accomplish the diagnosis of liver cancer. The introduction of deep learning models with multimodal data can enhance the diagnosis and improve physicians' decision-making for cancer patients.

Objective

This scoping review explores the use of multimodal deep learning techniques (i.e., combining medical images and EHR data) in diagnosing and prognosis of hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA).

Methodology

A comprehensive literature search was conducted in six databases along with forward and backward references list checking of the included studies. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extension for scoping review guidelines were followed for the study selection process. The data was extracted and synthesized from the included studies through thematic analysis.

Results

Ten studies were included in this review. These studies utilized multimodal deep learning to predict and diagnose hepatocellular carcinoma (HCC), but no studies examined cholangiocarcinoma (CCA). Four imaging modalities (CT, MRI, WSI, and DSA) and 51 unique EHR records (clinical parameters and biomarkers) were used in these studies. The most frequently used medical imaging modalities were CT scans followed by MRI, whereas the most common EHR parameters used were age, gender, alpha-fetoprotein AFP, albumin, coagulation factors, and bilirubin. Ten unique deep-learning techniques were applied to both EHR modalities and imaging modalities for two main purposes, prediction and diagnosis.

Conclusion

The use of multimodal data and deep learning techniques can help in the diagnosis and prediction of HCC. However, there is a limited number of works and available datasets for liver cancer, thus limiting the overall advancements of AI for liver cancer applications. Hence, more research should be undertaken to explore further the potential of multimodal deep learning in liver cancer applications.

IoT platforms assessment methodology for COVID-19 vaccine logistics and transportation: a multi-methods decision making model

The supply chain management (SCM) of COVID-19 vaccine is the most daunting task for logistics and supply managers due to temperature sensitivity and complex logistics process. Therefore, several technologies have been applied but the complexity of COVID-19 vaccine makes the Internet of Things (IoT) a strong use case due to its multiple features support like excursion notification, data sharing, connectivity management, secure shipping, real-time tracking and monitoring etc. All these features can only feasible through choosing and deploying the right IoT platform. However, selection of right IoT platform is also a major concern due to lack of experience and technical knowledge of supply chain managers and diversified landscape of IoT platforms. Therefore, we introduce a decision making model for evaluation and decision making of IoT platforms that fits for logistics and transportation (L&T) process of COVID-19 vaccine. This study initially identifies the major challenges addressed during the SCM of COVID-19 vaccine and then provides reasonable solution by presenting the assessment model for selection of rational IoT platform. The proposed model applies hybrid Multi Criteria Decision Making (MCDM) approach for evaluation. It also adopts Estimation-Talk-Estimation (ETE) approach for response collection during the survey. As, this is first kind of model so the proposed model is validated and tested by conducting a survey with experts. The results of the proposed decision making model are also verified by Simple Additive Weighting (SAW) technique which indicates higher results accuracy and reliability of the proposed model. Similarly, the proposed model yields the best possible results and it can be judged by the precision, accuracy and recall values i.e. 93%, 93% and 94% respectively. The survey-based testing also suggests that this model can be adopted in practical scenarios to deal with complexities which may arise during the decision making of IoT platform for COVID-19 SCM process.

Ulnar Nerve Injury during Treatment of Fourth and Fifth Metacarpal Fractures: A Case Report and Anatomical Review

The deep branch of the ulnar nerve (DBUN) is a pure motor nerve. It passes through a hypothenar fibromuscular tunnel and courses radially on the interossei surface. The DBUN is not frequently considered during hand fracture surgery, despite the anatomical course of the nerve in close relation to the carpal and metacarpal bones, which makes it vulnerable to penetrating injury and being injured during hand surgery fixations. In this article, we describe a case of DBUN injury after percutaneous pinning of the fourth and fifth metacarpal bone fractures complicated by intrinsic muscle wasting of the hand that was treated with neuroma excision and sural nerve graft. We present the case of a 36-year-old man, who had a fracture of the base of the fourth and fifth metacarpal bones, which was treated with multiple K-wires. A few months later, the patient presented with weak abduction/adduction of the three ulnar fingers and prominent wasting in the intrinsic muscles of the hand. On hand exploration, a 2-cm neuroma was found along the course of the DBUN distal to the hypothenar fibromuscular tunnel, which was treated by neuroma excision and nerve grafting. Fractures of the fourth and fifth metacarpals and carpometacarpal dislocations are very common and are often treated surgically. To fix these fractures, awareness of the DBUN course in the hand and its proximity to the carpal and metacarpal bones is important. High caution should be taken during percutaneous pinning by inserting K-wires under radiological guidance, minimizing pining attempts and limiting pin tip protrusion to 1-2 mm.

Mg-Doped PLA Composite as a Potential Material for Tissue Engineering-Synthesis, Characterization, and Additive Manufacturing

Magnesium (Mg)/Polylactic acid (PLA) composites are promising materials for bone regeneration and tissue engineering applications. PLA is a biodegradable and biocompatible polymer that can be easily processed into various shapes and structures, such as scaffolds, films, and fibers, but has low biodegradability. Mg is a biocompatible metal that has been proven to have good biodegradability and osteoconductivity, which makes it suitable for bone tissue engineering. In this study, we prepared and characterized a Mg/PLA composite as a potential material for direct ink writing (DIW) in 3D printing. The results showed that the addition of Mg has a significant impact on PLA's thermal and structural properties and has also significantly increased the degradation of PLA. XRD was used to determine the degree of crystallinity in the PLA/Mg composite, which provides insight into its thermal stability and degradation behavior. The crystallization temperature of PLA increased from 168 to 172 °C for a 15 wt% Mg incorporation, and the melting temperature reduced from 333 °C to 285 °C. The surface morphology and composition of these films were analyzed with SEM. The films with 5 wt% of Mg particles displayed the best-ordered honeycomb structure in their film form. Such structures are considered to affect the mechanical, biological and heat/mass transfer properties of the Mg/PLA composites and products. Finally, the composite ink was used as a feed for direct ink writing in 3D printing, and the preliminary 3D printing experiments were successful in resulting in dimensionally and structurally integral scaffold samples. The shape fidelity was not very good, and some research is needed to improve the rheological properties of the ink for DIW 3D printing.

Designing super-fast trimodal sponges using recycled polypropylene for organics cleanup

Sorbent pads and films have been commonly used for environmental remediation purposes, but designing their internal structure to optimize access to the entire volume while ensuring cost-effectiveness, ease of fabrication, sufficient strength, and reusability remains challenging. Herein, we report a trimodal sorbent film from recycled polypropylene (PP) with micropores, macro-voids, and sponge-like 3D cavities, developed through selective dissolution, thermally induced phase separation, and annealing. The sorbent has hundreds of cavities per cm2 that are capable of swelling up to twenty-five times its thickness, allowing for super-fast saturation kinetics (within 30 s) and maximum oil sorption (97 g/g). The sorption mechanism follows a pseudo-second-order kinetic model. Moreover, the sorbent is easily compressible, and its structure is retained during oil sorption, desorption, and resorption, resulting in 96.5% reuse efficiency. The oil recovery process involves manually squeezing the film, making the cleanup process efficient with no chemical treatment required. The sorbent film possesses high porosity for effective sorption with sufficient tensile strength for practical applications. Our integrated technique results in a strengthened porous polymeric structure that can be tailored according to end-use applications. This study provides a sustainable solution for waste management that offers versatility in its functionality.

Optimal Reactive Power Dispatch in ADNs using DRL and the Impact of Its Various Settings and Environmental Changes

Modern active distribution networks (ADNs) witness increasing complexities that require efforts in control practices, including optimal reactive power dispatch (ORPD). Deep reinforcement learning (DRL) is proposed to manage the network's reactive power by coordinating different resources, including distributed energy resources, to enhance performance. However, there is a lack of studies examining DRL elements' performance sensitivity. To this end, in this paper we examine the impact of various DRL reward representations and hyperparameters on the agent's learning performance when solving the ORPD problem for ADNs. We assess the agent's performance regarding accuracy and training time metrics, as well as critic estimate measures. Furthermore, different environmental changes are examined to study the DRL model's scalability by including other resources. Results show that compared to other representations, the complementary reward function exhibits improved performance in terms of power loss minimization and convergence time by 10-15% and 14-18%, respectively. Also, adequate agent performance is observed to be neighboring the best-suited value of each hyperparameter for the studied problem. In addition, scalability analysis depicts that increasing the number of possible action combinations in the action space by approximately nine times results in 1.7 times increase in the training time.

Chromophobe renal cell carcinoma with sarcomatoid and heterologous osteosarcoma-like differentiation: a case report and literature review

Chromophobe renal cell carcinoma (CRCC) is a subtype of renal cell carcinoma (RCC) with a favorable prognosis. Sarcomatoid differentiation in RCC is assumed to be the outcome of the parent tumor's dedifferentiation and associated with poorer prognosis. Sarcomatoid differentiation can be detected in CRCC as well as other subtypes, but the occurrence of divergent osteosarcoma-like components in sarcomatoid CRCC is extremely unusual. Only six cases have been previously reported in the literature, we reviewed them and presented the seventh case in a 71-year-old male who had a left kidney heterogeneous mass. The resected tumor showed a sarcoma-like spindle cell area with an adjacent osteosarcoma area producing lacy bone material and bony trabeculae in a hard area mixed with a typical CRCC. In conclusion, sarcomatoid CRCC with osteosarcomatous differentiation is a very rare tumor and should be kept in mind especially when dealing with small or frozen sections biopsies.

Improved exosome isolation methods from non-small lung cancer cells (NC1975) and their characterization using morphological and surface protein biomarker methods

This study has demonstrated improved methods for isolating exosomes from non-small lung cancer cells, which address the problems characterized by exosome morphological and chemical methods. To improve the isolation methods, cells from the NCI 1975 cell line were used as the source for exosomes. The isolation processes were carried out using serial isolation techniques in addition to specific preservation tools. The isolated exosomes were characterized using transmission electron microscopy (TEM), and scanning electron microscopy (SEM) was added for further assurance of the investigation results. The statistical analysis results showed that the size distributions of apoptotic vesicles (APV) 450 nm and necrotic bodies (NCB) 280 nm (extracellular vesicles) were significantly different from exosomes (P < 0.001). In contrast, the exosome size distribution was not significantly different from the published exosome sizes, as demonstrated by statistical analysis tools. This study confirmed the improved methods for isolating exosomes that make exosomes accessible for use in the diagnosis and prognosis of non-small cell lung cancer (NSCLC).

Epidemiological Determinants of Patient Non-Conveyance to the Hospital in an Emergency Medical Service Environment

BACKGROUND

The increasing prevalence of comorbidities worldwide has spurred the need for time-effective pre-hospital emergency medical services (EMS). Some pre-hospital emergency calls requesting EMS result in patient non-conveyance. Decisions for non-conveyance are sometimes driven by the patient or the clinician, which may jeopardize the patients' healthcare outcomes. This study aimed to explore the distribution and determinants of patient non-conveyance to hospitals in a Middle Eastern national Ambulance Service that promotes the transportation of all emergency call patients and does not adopt clinician-based non-conveyance decision.

METHODS

Using R Language, descriptive, bivariate, and binary logistic regression analyses were conducted for 334,392 multi-national patient non-conveyance emergency calls from June 2018 to July 2022, from a total of 1,030,228 calls to which a response unit was dispatched.

RESULTS

After data pre-processing, 237,862 cases of patient non-conveyance to hospital were retained, with a monthly average of 41.96% (n = 8799) of the emergency service demands and a standard deviation of 5.49% (n = 2040.63). They predominantly involved South Asians (29.36%, n = 69,849); 64.50% (n = 153,427) were of the age category from 14 to 44 years; 61.22% (n = 145,610) were male; 74.59% (n = 177,424) from the urban setting; and 71.28% (n = 169,552) had received on-scene treatment. Binary logistic regression with full variables and backward methods identified the final models of the determinants of patient non-conveyance decisions with an Akaike information criterion prediction estimator, respectively, of (250,200) and (250,169), indicating no significant difference between both models (Chi-square test; p-value = 0.63).

CONCLUSIONS

Despite exercising a cautious protocol by encouraging patient transportation to hospital, patient non-conveyance seems to be a problem in the healthcare system that strains the pre-hospital medical response teams' resources. Policies and regulations should be adopted to encourage individuals to access other primary care centers when required rather than draining emergency services for non-emergency situations.

Identifying the role of vision transformer for skin cancer-A scoping review

Introduction

Detecting and accurately diagnosing early melanocytic lesions is challenging due to extensive intra- and inter-observer variabilities. Dermoscopy images are widely used to identify and study skin cancer, but the blurred boundaries between lesions and besieging tissues can lead to incorrect identification. Artificial Intelligence (AI) models, including vision transformers, have been proposed as a solution, but variations in symptoms and underlying effects hinder their performance.

Objective

This scoping review synthesizes and analyzes the literature that uses vision transformers for skin lesion detection.

Methods

The review follows the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Revise) guidelines. The review searched online repositories such as IEEE Xplore, Scopus, Google Scholar, and PubMed to retrieve relevant articles. After screening and pre-processing, 28 studies that fulfilled the inclusion criteria were included.

Results and discussions

The review found that the use of vision transformers for skin cancer detection has rapidly increased from 2020 to 2022 and has shown outstanding performance for skin cancer detection using dermoscopy images. Along with highlighting intrinsic visual ambiguities, irregular skin lesion shapes, and many other unwanted challenges, the review also discusses the key problems that obfuscate the trustworthiness of vision transformers in skin cancer diagnosis. This review provides new insights for practitioners and researchers to understand the current state of knowledge in this specialized research domain and outlines the best segmentation techniques to identify accurate lesion boundaries and perform melanoma diagnosis. These findings will ultimately assist practitioners and researchers in making more authentic decisions promptly.

Non-Wettable Microporous Sheets Using Mixed Polyolefin Waste for Oil-Water Separation

Mixed polyolefin-based waste needs urgent attention to mitigate its negative impact on the environment. The separation of these plastics requires energy-intensive processes due to their similar densities. Additionally, these materials cannot be blended without compatibilizers, as they are inherently incompatible and immiscible. Herein, non-wettable microporous sheets from recycled polyethylene (PE) and polypropylene (PP) are presented. The methodology involves the application of phase separation and spin-casting techniques to obtain a bimodal porous structure, facilitating efficient oil-water separation. The resulting sheets have an immediate and equilibrium sorption uptake of 100 and 55 g/g, respectively, due to the presence of micro- and macro-pores, as revealed by SEM. Moreover, sheets possess enhanced crystallinity, as evidenced by XRD; hence, they retain their structure during sorption and desorption and are reusable with 98% efficiency. The anti-wetting properties of the sheets are enhanced by applying a silane coating, ensuring waterless sorption and a contact angle of 140°. These results highlight the importance of implementing sustainable solutions to recycle plastics and mitigate the oil spill problem.

Unexpected presentation of ischemic colitis: a case report and review of the literature

Ischemic colitis accounts for many cases of bowel infarction. Usually, it has various manifestations, such as vomiting, abdominal pain, hematochezia and many other symptoms. Risk factors might include age, medications, hypercoagulable state and chronic illnesses. However, it can still occur in healthy young patients. This might make it difficult for physicians to establish a correct diagnosis and generate the appropriate treatment plan for patients suffering from ischemic colitis. In this case we report a previously healthy 37-year-old female who had a sudden onset of lower abdominal pain associated with hematochezia. This patient was treated for upper respiratory tract infection by amoxicillin-clavulanate 2 weeks prior to her symptoms. The computed tomography abdomen findings along with the exploratory laparotomy confirmed the diagnosis of ischemic colitis. Ischemic colitis is a serious condition with high mortality and morbidity rate. Therefore, prompt investigation, and if indicated, surgical intervention should be calculated in sick patients complaining of abdominal pain and lower gastrointestinal bleeding.

Patient exposure during videofluoroscopic swallowing studies performed by speech-language pathologists

Videofluoroscopic swallowing studies (VFSSs) are fluoroscopic examinations performed by speech and language pathologists (SLPs), for the evaluation of the oral and pharyngeal phases of swallowing, in patients who are diagnosed with symptoms like dysphagia and speech impairment. The study was focused on the evaluation of the patient doses from VFSS performed at Hamad Medical Corporation hospitals. Data on the patient exposure and examination parameters were extracted from the Radiation Dose Monitoring system, statistically analysed and compared with literature. For adult patients, the mean (median) values for fluoroscopy time and kerma-air product were 2.8 (2.7) min and 181 (144) cGycm2, respectively. For children, the respective mean (median) values were 2.6 (2.4) min and 15.3 (9.2) cGycm2. The results of the study indicate that the VFSS are performed by well-trained health professionals, and as a result, image quality sufficient for a confident diagnosis is obtained at relatively low dose levels.

Sickle cell leg ulcer successfully managed by hyperbaric oxygen: a case report

Sickle cell leg ulcers (SCLUs) are usually chronic, painful, and devastating complications of sickle cell disease. Skin vaso-occlusion with compromised blood flow, chronic inflammation, and endothelial dysfunction is thought to be the underlying mechanism. It is usually slow to heal, and it may become chronic and superinfected. The management of SCLUs is usually challenging and requires a multidisciplinary team. Multiple systemic and local therapies have been tried in SCLU treatment. However, the outcome is variable: currently, there are no official recommendations for the best effective treatment. Herein, we report a 34-year-old male patient with non-transfusion-dependent sickle cell disease who was suffering from a chronic left ankle ulcer and was successfully managed with hyperbaric oxygen therapy, resulting in a complete resolution of this devastating complication.

The Elusive SLIPPERS Syndrome (Supratentorial Lymphocytic Inflammation with Parenchymal Perivascular Enhancement Responsive to Steroids): A Case Report and Literature Review

Background

In 2015, the term "SLIPPERS" was created to refer to a rare type of encephalomyelitis called CLIPPERS syndrome that affects the pons and sometimes other nearby structures, but in this case, it primarily affects the supratentorial region. This variation of the condition is responsive to treatment with steroids.

Case Description

We report the case of a patient who presented with seizures and visual field deficit and had typical radiological and histopathological characteristics of SLIPPERS syndrome.

Conclusion

Although the literature is inundated with CLIPPERS syndrome, its supratentorial variant is extremely rare. To our knowledge, this is fourth case of SLIPPERS syndrome to be reported in literature and serves to enhance clinicopathological understanding of this elusive entity.

Below- versus above-elbow cast treatment of displaced distal forearm fractures in children: A systematic review and meta-analysis of randomized controlled trials

Objectives

Distal forearm fractures are the most common pediatric fractures. This study aimed to investigate the effectiveness of below-elbow cast treatment for displaced distal forearm fractures in children compared to above-elbow cast through meta-analysis of randomized controlled trials.

Methods

Several databases from January 1, 2000 until October 1, 2021 were searched for randomized controlled trials that assessed below versus above-elbow cast treatment of displaced distal forearm fractures in pediatric patients. The main meta-analysis comparison was based on the relative risk of loss of fracture reduction between children undergoing below versus above-elbow cast treatment. Other outcome measures including re-manipulation and cast-related complications were also investigated.

Results

Nine studies were eligible of the 156 articles identified, with a total of 1049 children. Analysis was undertaken for all included studies with a sensitivity analysis conducted for studies with high quality. In the sensitivity analysis, the relative risks of loss of fracture reduction (relative risk = 0.6, 95% confidence interval = 0.38, 0.96) and re-manipulation (relative risk = 0.3, 95% confidence interval = 0.19, 0.48) between the below and above-elbow cast groups were in favor of below-elbow cast and statistically significant. Cast-related complications were in favor of below-elbow cast but did not attain statistical significance (relative risk = 0.45, 95% confidence interval = 0.05, 3.99). Loss of fracture reduction was noted in 28.9% of patients treated with above-elbow cast and 21.5% in below-elbow cast. Re-manipulation was attempted in 48.1% versus 53.8% of children who lost fracture reduction in the below-elbow cast and above-elbow cast groups, respectively.

Conclusion

Below-elbow cast treatment was favored, with statistical significance, in terms of loss of fracture reduction and re-manipulation, and was not associated with a higher risk of cast-related complications. The accumulative evidence currently does not support above-elbow cast treatment and below-elbow cast treatment should be the mainstay for displaced distal forearm fractures in children.

Level of evidence

Level I, meta-analysis of therapeutic level I studies.