Alcohol use, alcohol use disorder and heavy episodic drinking in the Eastern Mediterranean region: A systematic review

BACKGROUND AND AMS

Despite the evident public health impact, the extent and patterns of alcohol use in the Eastern Mediterranean countries remain understudied. The latest estimation for the last 12-month use of alcohol in the region was 2.9% in 2016 by the World Health Organization. We reviewed the main indicators for alcohol consumption in the region since 2010.

METHODS

We systematically searched on-line databases until September 2023, together with other global and regional sources for studies on the adult general population (aged ≥ 15 years) and young general populations (aged < 18 years) and studies on the treatment-seeking individuals with substance use in Eastern Mediterranean countries. Studies were included from 22 countries: Afghanistan, Bahrain, Djibouti, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Pakistan, Palestine, Qatar, Saudi Arabia, Somalia, Sudan, Syria, Tunisia, United Arab Emirates and Yemen.

RESULTS

A total of 148 were included (n = 95 on the prevalence of alcohol use, n = 46 on the prevalence of alcohol use disorder, regular use and heavy episodic drinking, n = 35 on alcohol use pattern among people who use substances and one report on alcohol per capita consumption, n = 29 had data for more than one category). The pooled prevalence of the last 12-month alcohol use in the adult general population was 9.5% [95% confidence interval (CI) = 6.4-13.7] among males, 2.8% (95% CI = 1.3-5.5\) among females and 6.2% (95% CI = 3.9-9.6) in both sexes in the region, with notable subregional variations. Data on the prevalence of alcohol use disorder and heavy drinking were limited to several countries, with heterogeneous indicators. The pooled estimate of alcohol as the primary substance of use among treatment-seeking people who used substances was 16.9% (95% CI = 8.8-26.9).

CONCLUSIONS

More than 30 million adults in the Eastern Mediterranean region used alcohol in the last 12 months, with a prevalence of 6.2%. This is far fewer than the global estimate of 43% of the population aged 15 years and above, but is approximately two times more than the previous estimate (2.9%), reported by the World Health Organization in 2016, which might show an increasing trend.

Lap Shear Strength and Fatigue Analysis of Continuous Carbon-Fibre-Reinforced 3D-Printed Thermoplastic Composites by Varying the Load and Fibre Content

This study focuses on evaluating the fatigue life performance of 3D-printed polymer composites produced through the fused deposition modelling (FDM) technique. Fatigue life assessment is essential in designing components for industries like aerospace, medical, and automotive, as it provides an estimate of the component's safe service life during operation. While there is a lack of detailed research on the fatigue behaviour of 3D-printed polymer composites, this paper aims to fill that gap. Fatigue tests were conducted on the 3D-printed polymer composites under various loading conditions, and static (tensile) tests were performed to determine their ultimate tensile strength. The fatigue testing load ranged from 80% to 98% of the total static load. The results showed that the fatigue life of the pressed samples using a platen press was significantly better than that of the non-pressed samples. Samples subjected to fatigue testing at 80% of the ultimate tensile strength (UTS) did not experience failure even after 1 million cycles, while samples tested at 90% of UTS failed after 50,000 cycles, with the failure being characterized as splitting and clamp area failure. This study also included a lap shear analysis of the 3D-printed samples, comparing those that were bonded using a two-part Araldite glue to those that were fabricated as a single piece using the Markforged Mark Two 3D printer. In summary, this study sheds light on the fatigue life performance of 3D-printed polymer composites fabricated using the FDM technique. The results suggest that the use of post-printing platen press improved the fatigue life of 3D-printed samples, and that single printed samples have better strength of about 265 MPa than adhesively bonded samples in which the strength was 56 MPa.

Tracing back primed resistance in cancer via sister cells

Exploring non-genetic evolution of cell states during cancer treatments has become attainable by recent advances in lineage-tracing methods. However, transcriptional changes that drive cells into resistant fates may be subtle, necessitating high resolution analysis. Here, we present ReSisTrace that uses shared transcriptomic features of sister cells to predict the states priming treatment resistance. Applying ReSisTrace in ovarian cancer cells perturbed with olaparib, carboplatin or natural killer (NK) cells reveals pre-resistant phenotypes defined by proteostatic and mRNA surveillance features, reflecting traits enriched in the upcoming subclonal selection. Furthermore, we show that DNA repair deficiency renders cells susceptible to both DNA damaging agents and NK killing in a context-dependent manner. Finally, we leverage the obtained pre-resistance profiles to predict and validate small molecules driving cells to sensitive states prior to treatment. In summary, ReSisTrace resolves pre-existing transcriptional features of treatment vulnerability, facilitating both molecular patient stratification and discovery of synergistic pre-sensitizing therapies.

Robust iron-doped manganese oxide nanoparticles from facile fabrication to photo-catalytic degradation application of binary dyes mixture

The manganese oxide (MnO2 and iron-doped manganese oxide (Fe-MnO2) nanoparticles (NPs) with reduced band gap (Eg) were fabricated through the co-precipitation process. They used to degrade Indigo Carmine (IC) and Rhodamine B (RB) binary mixture in an aqueous medium under solar light irradiation. From FT-IR, the twisting modes of the Mn-O bond and the stretching vibrations of the Fe-Mn-O2 bond were confirmed from the peaks observed at 480 cm-1,584 cm-1,675 cm-1, and 900 cm-1, 1150 cm-1, and 1200 cm-1 respectively. The MnO2 has an optical band gap of 3.2 eV, which was decreased to 3 eV in Fe-MnO2. The zero charge (PZC) point was 8 for Fe-MnO2 and 7 for MnO2. The BET surface area for Fe-MnO2 was 398 m2/g, relatively higher than MnO2 particles, having a surface area of 384 m2/g. The average crystallite sizes calculated from Scherer formulae were 37 nm for MnO2 and 31 nm for Fe-MnO2 NPs. SEM confirmed the irregular morphology of the prepared particles. It was analyzed that agglomeration occurs in MnO2 than the Fe-MnO2. The maximum degradation of IC dye was 99%, and that of RB was 98% at the optimum conditions. The data were best fitted to second-order kinetics.

Single-cell functional genomics reveals determinants of sensitivity and resistance to natural killer cells in blood cancers

Cancer cells can evade natural killer (NK) cell activity, thereby limiting anti-tumor immunity. To reveal genetic determinants of susceptibility to NK cell activity, we examined interacting NK cells and blood cancer cells using single-cell and genome-scale functional genomics screens. Interaction of NK and cancer cells induced distinct activation and type I interferon (IFN) states in both cell types depending on the cancer cell lineage and molecular phenotype, ranging from more sensitive myeloid to less sensitive B-lymphoid cancers. CRISPR screens in cancer cells uncovered genes regulating sensitivity and resistance to NK cell-mediated killing, including adhesion-related glycoproteins, protein fucosylation genes, and transcriptional regulators, in addition to confirming the importance of antigen presentation and death receptor signaling pathways. CRISPR screens with a single-cell transcriptomic readout provided insight into underlying mechanisms, including regulation of IFN-γ signaling in cancer cells and NK cell activation states. Our findings highlight the diversity of mechanisms influencing NK cell susceptibility across different cancers and provide a resource for NK cell-based therapies.

Identifying patients at increased risk of non-ventilator-associated pneumonia on admission to hospital: a pragmatic prognostic screening tool to trigger preventative action

BACKGROUND

Non-ventilator healthcare-associated pneumonia (NV-HAP) is an important healthcare-associated infection. This study tested the feasibility of using routine admission data to identify those patients at high risk of NV-HAP who could benefit from targeted, preventive interventions.

METHODS

Patients aged ≥64 years who developed NV-HAP five days or more after admission to elderly-care wards, were identified by retrospective case note review together with matched controls. Data on potential predictors of NV-HAP were captured from admission records. Multi-variate analysis was used to build a prognostic screening tool (PRHAPs); acceptability and feasibility of the tool was evaluated.

RESULTS

A total of 382 cases/381 control patients were included in the analysis. Ten predictors were included in the final model; nine increased the risk of NV-HAP (OR between 1.68 and 2.42) and one (independent mobility) was protective (OR 0.48; 95% CI 0.30-0.75). The model correctly predicted 68% of the patients with and without NV-HAP; sensitivity 77%; specificity 61%. The PRHAPs tool risk score was 60% or more if two predictors were present and over 70% if three were present. An expert consensus group supported incorporating the PRHAPs tool into electronic logic systems as an efficient mechanism to identify patients at risk of NV-HAP and target preventative strategies.

CONCLUSIONS

This prognostic screening (PRHAPs) tool, applied to data routinely collected when a patient is admitted to hospital, could enable staff to identify patients at greatest risk of NV-HAP, target scarce resources in implementing a prevention care bundle, and reduce the use of antimicrobial agents.

Situation Analysis of Suicide and Self-Harm in the WHO Eastern Mediterranean Region

OBJECTIVE

An estimated 41,000 lives are lost to suicide each year in World Health Organization Eastern Mediterranean Region Office (WHO EMRO) countries. The objective of this study was to conduct a situation analysis for suicide and self-harm in the WHO EMRO region.

METHODS

Data on suicide were obtained from the WHO Global Health Estimates for the years 2000-2019. Information on risk groups efforts to prevent self-harm and suicide in the EMRO region were retrieved through scientific studies, grey literature, and public websites.

RESULTS

During 2000-2019, the age-standardized suicide rate was 6.7 per 100,000 inhabitants, albeit there are concerns regarding data quality. Self-harm and suicide remain criminal acts in more than half of the countries. Few countries have a national plan for prevention of suicide. Toxic agents, such as pesticides and black henna, are easily available and frequently used for suicide in some areas, as are firearms and self-immolation. Successful prevention measures include means restriction and psychosocial interventions after self-harm.

CONCLUSION

Many WHO EMRO countries remain underserved in terms of mental health care. Decriminalization of suicide and means restriction might be further promoted. Online-based tools for mental health literacy and psychosocial therapy are other options to explore.

Evaluating the cost implications of integrating SARS-CoV-2 genome sequencing for infection prevention and control investigation of nosocomial transmission within hospitals

BACKGROUND

The COG-UK hospital-onset COVID-19 infection (HOCI) trial evaluated the impact of SARS-CoV-2 whole-genome sequencing (WGS) on acute infection, prevention, and control (IPC) investigation of nosocomial transmission within hospitals.

AIM

To estimate the cost implications of using the information from the sequencing reporting tool (SRT), used to determine likelihood of nosocomial infection in IPC practice.

METHODS

A micro-costing approach for SARS-CoV-2 WGS was conducted. Data on IPC management resource use and costs were collected from interviews with IPC teams from 14 participating sites and used to assign cost estimates for IPC activities as collected in the trial. Activities included IPC-specific actions following a suspicion of healthcare-associated infection (HAI) or outbreak, as well as changes to practice following the return of data via SRT.

FINDINGS

The mean per-sample costs of SARS-CoV-2 sequencing were estimated at £77.10 for rapid and £66.94 for longer turnaround phases. Over the three-month interventional phases, the total management costs of IPC-defined HAIs and outbreak events across the sites were estimated at £225,070 and £416,447, respectively. The main cost drivers were bed-days lost due to ward closures because of outbreaks, followed by outbreak meetings and bed-days lost due to cohorting contacts. Actioning SRTs, the cost of HAIs increased by £5,178 due to unidentified cases and the cost of outbreaks decreased by £11,246 as SRTs excluded hospital outbreaks.

CONCLUSION

Although SARS-CoV-2 WGS adds to the total IPC management cost, additional information provided could balance out the additional cost, depending on identified design improvements and effective deployment.

Prevalence of injecting drug use and HIV, hepatitis B, and hepatitis C in people who inject drugs in the Eastern Mediterranean region: a systematic review and meta-analysis

BACKGROUND

Considerable disease burden is attributed to injecting drug use (IDU). This regional systematic review and meta-analysis aimed to assess the prevalence of IDU and the characteristics of people who inject drugs in the 22 countries of the WHO Eastern Mediterranean region.

METHODS

We conducted a systematic review and meta-analysis on the prevalence of IDU, estimation of the population size of people who inject drugs, the characteristics of people who inject drugs, commonly injected drugs, the prevalence of HIV, hepatitis C virus, and hepatitis B virus in people who inject drugs, and opioid agonist treatment and needle and syringe programme services. We searched PubMed, Web of Science, Scopus, Embase, and the Index Medicus for the Eastern Mediterranean Region for documents published between Jan 1, 2010, and April 17, 2022, with no language restrictions. We also searched government reports, civil society information, and UN websites and databases for grey literature published between Jan 1, 2010, and April 17, 2022. Documents were eligible if they reported or estimated an indicator of interest, or reported enough data to permit calculation of the indicator. We extracted data from the eligible documents and calculated national and regional estimates.

FINDINGS

We identified 38 283 documents and included 201 documents in the systematic review. A total of 115 documents were included for the four outcomes for which meta-analyses were performed. The number of people who inject drugs was estimated as 864 597 (95% CI 641 909-1 205 255), amounting to a prevalence of 20·0 per 10 000 adults (95% CI 14·9-27·9) in the region. Among people who inject drugs, the prevalence of HIV was estimated as 19·22% (95% CI 12·86-26·36), hepatitis C virus as 44·82% (29·32-61·16), and hepatitis B virus as 2·66% (0·84-7·26). Countries varied greatly regarding the variables of interest and the availability of relevant data. Nine countries provided needle and syringe programme services and seven countries provided opioid agonist treatment services, mostly with very low, low, or unclear coverage.

INTERPRETATION

The prevalence of IDU in the Eastern Mediterranean region is lower than the global mean, particularly among women. The HIV infection rate is higher than the global mean, and the hepatitis C virus infection rate is lower than the global mean. Harm-reduction services are underdeveloped. Data collection on IDU and provision of services need improvement in the region.

FUNDING

World Health Organization.

TRANSLATIONS

For the Arabic, Farsi and French translations of the abstract see Supplementary Materials section.

Efficient photodegradation of methyl red dye by kaolin clay supported zinc oxide nanoparticles with their antibacterial and antioxidant activities

Kaolin clay-supported Zinc oxide (ZnO/KC) and ZnO NPs nanoparticles (NPs) were prepared by a chemical reduction process and used for the photodegradation of methyl red (MR) dye as a photocatalyst. Due to the interlayered porous structure of the KC, we achieved an extremely good association between ZnO NPs and KC. The product confirmation was conducted by Scanning electron microscopy (SEM), X-Ray diffraction (XRD), energy dispersive X-Ray (EDX), and Fourier transforms infrared (FTIR). SEM showed the irregular morphology of ZnO NPs, while ZnO/KC NCs were predominately round-shaped. Moreover, in both cases, NPs were present in both dispersed as well as agglomerated forms with an average particle size below 100 nm. The results acquired from photodegradation analyses show that ZnO NPs and ZnO/KC NCs degraded about 90 and 99% of MR dye respectively, under UV light in a short irradiation time of 10 min. The recovered and re-recovered ZnO NPs and ZnO/KC NCs also considerably photodegraded MR dye in an aqueous medium. The same NPs also exhibit promising bioactivities against two pathogenic bacteria, i.e., Citrobacter and Providencia. The antioxidant activity of ZnO/KC NCs reached to reasonable 70% compared to the 88% activity of the standard ascorbic acid.

Roll of partial slip on Ellis nanofluid in the proximity of double diffusion convection and tilted magnetic field: Application of Chyme movement

The current study aims to investigate the effect of partial slip conditions over double diffusion convection. The phenomenon is applied with the inclined magnetic flux of peristaltic flow on Ellis nanofluid model in an asymmetric channel. The fundamental differential equations are constructed and solved through lubrication approximation that gives the coupled system of ordinary differential equations. This resultant system is further solved numerically, and graphic representation are used to physically comprehend the flow quantity data. The whole procedure is carried out under the trapping mechanism by drawing contour streamlines. The knowledge gained from this work will be useful in the creation of intelligent magneto-peristaltic pumps for specific heat and medication delivery phenomena.

Drug use, drug use disorders, and treatment services in the Eastern Mediterranean region: a systematic review

Drug use is an increasing global public health concern. We reviewed the prevalence and patterns of drug use, drug use disorders, and the extent of treatment services in 21 countries and one territory in the Eastern Mediterranean region from 2010 to 2022. Online databases were systematically searched on April 17, 2022, along with other sources for grey literature. The extracted data were analysed and used for synthesis at the country, subregional, and regional levels. The prevalence of drug use is higher in the Eastern Mediterranean region than global estimates, with cannabis, opium, khat, and tramadol among the main drugs used in the region. Data on the prevalence of drug use disorders were scarce and heterogeneous. Treatment facilities for drug use disorders are available in most countries, but opioid agonist treatment exists in only seven countries. There is a need to expand evidence-based and cost-effective care. Limited data exist, especially regarding drug use disorders, treatment coverage, and drug use among women and young people.

Analyzing the Impact of Active Attack on the Performance of the AMCTD Protocol in Underwater Wireless Sensor Networks

The exponentially growing concern of cyber-attacks on extremely dense underwater sensor networks (UWSNs) and the evolution of UWSNs digital threat landscape has brought novel research challenges and issues. Primarily, varied protocol evaluation under advanced persistent threats is now becoming indispensable yet very challenging. This research implements an active attack in the Adaptive Mobility of Courier Nodes in Threshold-optimized Depth-based Routing (AMCTD) protocol. A variety of attacker nodes were employed in diverse scenarios to thoroughly assess the performance of AMCTD protocol. The protocol was exhaustively evaluated both with and without active attacks with benchmark evaluation metrics such as end-to-end delay, throughput, transmission loss, number of active nodes and energy tax. The preliminary research findings show that active attack drastically lowers the AMCTD protocol's performance (i.e., active attack reduces the number of active nodes by up to 10%, reduces throughput by up to 6%, increases transmission loss by 7%, raises energy tax by 25%, and increases end-to-end delay by 20%).

Mechanism of Double-Diffusive Convection on Peristaltic Transport of Thermally Radiative Williamson Nanomaterials with Slip Boundaries and Induced Magnetic Field: A Bio-Nanoengineering Model

The present work has mathematically modeled the peristaltic flow in nanofluid by using thermal radiation, induced a magnetic field, double-diffusive convection, and slip boundary conditions in an asymmetric channel. Peristalsis propagates the flow in an asymmetric channel. Using the linear mathematical link, the rheological equations are translated from fixed to wave frames. Next, the rheological equations are converted to nondimensional forms with the help of dimensionless variables. Further, the flow evaluation is determined under two scientific assumptions: a finite Reynolds number and a long wavelength. Mathematica software is used to solve the numerical value of rheological equations. Lastly, the impact of prominent hydromechanical parameters on trapping, velocity, concentration, magnetic force function, nanoparticle volume fraction, temperature, pressure gradient, and pressure rise are evaluated graphically.

Scavenging of Organic Pollutant and Fuel Generation through Cost-Effective and Abundantly Accessible Rust: A Theoretical Support with DFT Simulations

Waste management and energy generation are the foremost concerns due to their direct relationship with biological species and the environment. Herein, we report the utilization of iron rust (inorganic pollutant) as a photocatalyst for the photodegradation of methylene blue (MB) dye (organic pollutant) under visible light (economic) and water oxidation (energy generation). Iron rust was collected from metallic pipes and calcined in the furnace at 700 °C for 3 h to remove the moisture/volatile content. The uncalcined and calcined rust NPs are characterized through scanning electron microscopy (SEM), energy dispersive spectroscopy (EDS), Fourier-transform infrared (FTIR) analysis, X-ray Diffraction (XRD), and thermogravimetric analysis (TGA). The morphological study illustrated that the shape of uncalcined and calcined iron rust is spongy, porous, and agglomerated. The XRD and DLS particle sizes are in a few hundred nanometers range. The photodegradation (PD) investigation shows that calcined rust NPs are potent for the PD of modeled MB, and the degradation efficiency was about 94% in a very short time of 11 min. The photoelectrochemical (PEC) measurements revealed that calcined rust NPs are more active than uncalcined rust under simulated 1 SUN illumination with the respective photocurrent densities of ~0.40 and ~0.32 mA/cm². The density functional theory simulations show the chemisorption of dye molecules over the catalyst surface, which evinces the high catalytic activity of the catalyst. These results demonstrate that cheaper and abundantly available rust can be useful for environmental and energy applications.

Integrating mental health into emergency preparedness and response: lessons learned from Covid-19

Introduction

The COVID-19 crisis has disrupted health systems all over the world. In a survey by the WHO, 93% of the countries reported disruption in their mental health services. This research assessed the extent to which mental health was included in the national response to the COVID-19 pandemic in African countries. It also explored barriers and enablers to mental health integration into the COVID-19 response. Lessons learned from COVID-19 can help improve the response to future public health emergencies.

Methods

A web-based survey was sent to mental health focal points in 55 African countries. The survey assessed the perceived degree of implementation of the Inter-Agency Standing Committee (IASC) “14 Globally Recommended Activities” for mental health response to COVID-19. This was followed by in-depth interviews to explore barriers and enablers to mental health integration into the COVID-19 response.

Results

Responses were received from 28 countries. Lack of political will, poor funding, limited human resources, and weak pre-existing mental health systems were the key challenges in addressing mental health needs during COVID-19. Participants highlighted the need to capitalize on the increased attention to mental health during COVID-19 to support its integration into the emergency preparedness and response plans and strengthen health systems in the longer term. They have also stressed the importance of sustaining and strengthening the new partnerships and service delivery models that emerged during the COVID-19 pandemic.

Conclusions

The number of recommended mental health activities implemented during the COVID-19 pandemic varied considerably across African countries. Several factors limit mental health integration into emergency response. However, there are signs of optimism, as mental health gained some attention during COVID-19, which can be built on to integrate mental health into emergency response and strengthen health systems in the long term.

Key messages

• Capitalize on the increased attention to mental health during COVID-19 to support its integration into the emergency preparedness and response plans and strengthen health systems in the long term.

• Sustain and strengthen the new partnerships and service delivery models that emerged during the COVID-19 pandemic.

A study on green synthesis, characterization of chromium oxide nanoparticles and their enzyme inhibitory potential

The conventional chemical methods of nanoparticles synthesis have been effectively replaced by nanoparticle synthesis mediated by plants. The current study describes the environmental friendly synthesis of chromium oxide nanoparticles (Cr₂O₃ NPs) using Erythrophleum guineense plant extract. The synthesis of Cr₂O₃ NPs was validated by UV/VIS spectroscopy, Energy Dispersive X-Ray (EDX), Scanning Electron Microscopy (SEM), and X-ray diffraction (XRD) studies. The appearance of the Sharpe peak at 460 nm in the UV/Vis spectrum and the colour change caused by surface plasma resonance confirmed the formation of Cr₂O₃ NPs. The EDX spectrum of Cr₂O₃ nanoparticles revealed the presence of carbon, oxygen, and chromium, while SEM analysis revealed an irregular round morphology (with a size below 400 nm). In addition, XRD studies suggested their crystalline nature by the characteristic peaks at 34° and 36° and 42° (2Ɵ), respectively. The green synthesized Cr₂O₃ NPs showed promise as in-vitro cholinesterase inhibitor at tested concentrations (62.5–1,000 μg/ml), with IC₅₀ values of 120 and 100 μg/ml against Acetylcholinesterase (AChE) and Butyrylcholinesterase (BChE), respectively. The results suggested that the green synthesized Cr₂O₃ NPs could be used in the future to stop enzyme from working and for other biological activities.

Impact of Partial Slip on Double Diffusion Convection of Sisko Nanofluids in Asymmetric Channel with Peristaltic Propulsion and Inclined Magnetic Field

The current article discusses the outcomes of the double diffusion convection of peristaltic transport in Sisko nanofluids along an asymmetric channel having an inclined magnetic field. Consideration is given to the Sisko fluid model, which can forecast both Newtonian and non-Newtonian fluid properties. Lubricating greases are the best examples of Sisko fluids. Experimental research shows that most realistic fluids, including human blood, paint, dirt, and other substances, correspond to Sisko's proposed definition of viscosity. Mathematical modelling is considered to explain the flow behavior. The simpler non-linear PEDs are deduced by using an elongated wavelength and a minimal Reynolds number. The expression is also numerically calculated. The impacts of the physical variables on the quantities of flow are plotted graphically as well as numerically. The results reveal that there is a remarkable increase in the concentration, temperature, and nanoparticle fraction with the rise in the Dufour and thermophoresis variables.

Phase 2 studies of lenalidomide, subcutaneous bortezomib, and dexamethasone as induction therapy in patients with newly diagnosed multiple myeloma

There are limited prospective data on lenalidomide, subcutaneous bortezomib, and dexamethasone (RsqVd) in transplant-eligible/transplant-ineligible patients with newly diagnosed multiple myeloma. Reliable biomarkers for efficacy and toxicity are required to better tailor therapy. Two parallel studies were conducted by Cancer Trials Ireland (CTI; NCT02219178) and the Dana-Farber Cancer Institute (DFCI; NCT02441686). Patients received four 21-day cycles of RsqVd and could then receive either another 4 cycles of RsqVd or undergo autologous stem cell transplant. Postinduction/posttransplant, patients received lenalidomide maintenance, with bortezomib included for high-risk patients. The primary endpoint was overall response rate (ORR) after 4 cycles of RsqVd. Eighty-eight patients were enrolled and 84 treated across the two studies; median age was 64.7 (CTI study) and 60.0 years (DFCI study), and 59% and 57% had stage II-III disease. Pooled ORR after 4 cycles in evaluable patients was 93.5%, including 48.1% complete or very good partial responses (CTI study: 91.9%, 59.5%; DFCI study: 95.0%, 37.5%), and in the all-treated population was 85.7% (44.0%). Patients received a median of 4 (CTI study) and 8 (DFCI study) RsqVd cycles; 60% and 31% of patients (CTI study) and 33% and 51% of patients (DFCI study) underwent transplant or received further RsqVd induction, respectively. The most common toxicity was peripheral neuropathy (pooled: 68%, 7% grade 3-4; CTI study: 57%, 7%; DFCI study: 79%, 7%). Proteomics analyses indicated elevated kallikrein-6 in good versus poor responders, decreased midkine in good responders, and elevated macrophage inflammatory protein 1-alpha in patients who stopped treatment from neurotoxicity, suggesting predictive biomarkers warranting further investigation.

Case Report: Hypergranular Platelets in Vaccine-Induced Thrombotic Thrombocytopenia After ChAdOx1 nCov-19 Vaccination

Background

Vaccine-induced thrombotic thrombocytopenia (VITT) post SARS-CoV-2 vaccination is characterized by thrombocytopenia and severe thrombosis. Platelet function during patient recovery in the medium-/long-term has not been investigated fully. Here, we undertook a 3-month study, assessing the recovery of a VITT patient and assessing platelet morphology, granule content and dense-granule release at two distinct time points during recovery.

Case Presentation

A 61 year-old female was admitted to hospital 15 days post ChAdOx1 nCov-19 vaccination. Hematological parameters and peripheral blood smears were monitored over 3 months. Platelet morphology and granule populations were assessed using transmission electron microscopy (TEM) at two distinct time points during recovery, as was agonist-induced platelet dense-granule release. Upon admission, the patient had reduced platelet counts, increased D-dimer and high anti-PF4 antibodies with multiple sites of cerebral venous sinus thrombosis (CVST). Peripheral blood smears revealed the presence of large, hypergranular platelets. Following treatment, hematological parameters returned to normal ranges over the study period. Anti-PF4 antibodies remained persistently high up to 90 days post-admission. Two days after admission, VITT platelets contained more granules per-platelet when compared to day 72 and healthy platelets. Additionally, maximal ATP release (marker of dense-granule release) was increased on day 2 compared to day 72 and healthy control platelets.

Conclusion

This study highlights a previously unreported observation of platelet hypergranularity in VITT which may contribute to the thrombotic risk associated with VITT. Optimal approaches to monitoring recovery from VITT over time remains to be determined but our findings may help inform therapeutic decisions relating to anticoagulation treatment in this novel pathology.

Impact of COVID-19 on mental health and psychosocial support services in the Eastern Mediterranean Region – results of a rapid assessment

Background: Mental health has been identified by the World Health Organization as an integral component of the COVID-19 response. Aims: This study aimed to estimate the impact of COVID-19 pandemic on mental, neurological and substance use disorders (MNS) services in the Eastern Mediterranean Region. Methods: The assessment was conducted through a web-based survey that was completed by national mental health focal points and was analysed between June and August 2020. Results: School and workplace mental health services were wholly or partially disrupted in more than 70% of reporting countries. Fewer than 20% of the countries in the Region reported mental health services for children and adolescents or for older adults being fully operational. The main reasons were travel restrictions, decreases in inpatient volumes due to the cancellation of elective care, decreases in outpatient volumes due to patients not presenting and health authority directives for the closure of outpatient services. The majority (85%) of countries responded by establishing MNS helplines using telemedicine/teletherapy and digital psychological interventions. The fragile and conflict-affected states relied mostly on implementing infection prevention and control measures at MNS service facilities. Gaps were identified in the areas of addictive behaviours, substance use and neurology research related to the pandemic. Conclusion: The assessment highlights the need to strengthen capacities for monitoring changes in service delivery and utilization, and documents evidence on what works in different settings during the different phases of the pandemic to facilitate informed decisions related to the nature and timing of adaptations to service delivery.

Photocatalytic degradation of Eosin B dye in aqueous solution by cadmium oxide nanoparticles

Cadmium oxide (CdO) and potassium (K) doped CdO nanoparticles (NPs) were synthesized by the chemical co-precipitation method and were used as photocatalysts for the degradation of Eosin B dye. The X-ray diffraction results presented that the crystallite size of undoped CdO and K doped CdO NPs were 43.74 and 42.31 nm, respectively. The morphological study and percent composition of synthesized undoped CdO and K doped CdO NPs was done by scanning electron microscope and energy dispersive X-ray analysis. The formation of NPs was confirmed by Fourier transform infrared spectroscopy. The precursor decomposition to CdO after annealing at ∼500 °C was studied by thermogravimetric analysis. The undoped CdO and K doped CdO nanoparticles degraded about 80% and 90% of the dye, respectively, in 140 min. The maximum degradation efficiency of the dye was achieved at a pH of 4, dye initial concentration of 15 ppm, catalyst dose of 20 mg, and a temperature of 45 °C. The degradation efficiency observed for recovered undoped CdO and recovered doped CdO nanoparticles was found to be 63% and 77%, respectively.

Prevalence of Mental Disorders in the WHO Eastern Mediterranean Region: A Systematic Review and Meta-Analysis

Objectives: To synthesize the prevalence of mental and substance use disorders in countries of the Eastern Mediterranean Region (EMR) of the World Health Organization. Methods: The literature search was conducted across several databases in two phases. First, we searched for systematic reviews and/or meta-analyses published before 2014, reporting prevalence estimates for mental disorders in the EMR. Then, we identified new primary cross-sectional or longitudinal studies published between 2014 and 2020. Studies were included if they had a sample size of ≥ 450 and were conducted among the general adult population. Current, period and lifetime prevalence estimates for each disorder were pooled using random-effects meta-analyses, and subgroup analyses and meta-regressions were conducted. Findings: Prevalence estimates were extracted from 54 cross-sectional studies across 15 countries within the EMR. Pooled analyses of current, period and lifetime prevalence showed the highest prevalence for depression (14.8%, 95% confidence interval, CI: 10.7-20.1%), followed by generalized anxiety disorder (GAD) (10.4%, 95% CI: 7.1-14.7%), post-traumatic stress disorder (7.2%, 95% CI: 2.9-16.6%), substance use (4.0%, 95% CI: 3.1-5.2%), obsessive compulsive disorder (2.8%, 95% CI: 1.6-4.9%), phobic disorders (1.8%, 95% CI: 1.1-2.8%), panic disorders (1.1%, 95% CI: 0.6-2.2%), bipolar disorders (0.7%, 95% CI: 0.3-1.6%), and psychosis (0.5%, 95% CI: 0.3-0.9%). Populations exposed to adverse events had higher prevalence of mental disorders than the general population. Period and lifetime prevalence showed little difference across mental disorders. More pronounced differences in prevalence were seen for depression and GAD, specifically between current and lifetime prevalence (depression: current prevalence 20.5% (95% CI: 14.9-27.4%), vs. lifetime prevalence: 4.2% (95%CI: 1.8-9.6%); GAD: current prevalence 10.3% (95% CI: 6.1-17.0), vs. lifetime prevalence: 4.5% (95% CI: 2.4-8.3%). Differences between current and lifetime prevalence of mental disorders may be due to the use of different screening instruments and thresholds being applied. Conclusion: The prevalence of mental and substance use disorders in the EMR is high. Despite substantial inter-survey heterogeneity, our estimates align with previous global and regional data on mental disorders. Our meta-review provides new evidence on the burden of mental health problems in the EMR. Systematic Review Registration: PROSPERO, https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020187388.

Green Synthesis, Characterization and Cholinesterase Inhibitory Potential of Gold Nanoparticles

Abstract. The green synthesis of gold nanoparticles (Au NPs) from their precursor was carried out using Delphinium uncinatum and Erythrophyleum guineense plants extracts. The Au NPs obtained were characterized by various instrumental techniques such as scanning electron microscopy (SEM), energy dispersive X-ray (EDX), X-ray diffraction (XRD) and UV/Visible (UV/VIS) spectrophotometer. The SEM study presented that E. guineense (GE) and D. uncinatum (GN) synthesized gold nanoparticles was below 100 and 300 nm, respectively.  The micrographs also presented that E. guineense (GE) synthesized gold particles had irregular round shaped while the D. uncinatum (GN) synthesized nanoparticles had cylindrical shaped. The XRD spectra presented peaks at about 38.1°, 44.43°, 64.6° and 77.64° can be indexed to (111), (200), (220) and (311) orientation, respectively, which confirmed the presence of gold nanoparticles. It means that both E. guineense (GE) and D. uncinatum (GN) synthesized gold nanoparticles are highly crystalline.  The UV/VIS analysis presented that both plant extracts significantly reduced the gold slat and as a result high quantity of gold nanoparticles were formed. The E. guanense gold NP and D. uncinatum gold NPs were investigated for their in-vitro cholinesterases inhibitory potentials in 62.5-1000 µg/mL concentrations range. The bioactivity results presented that the loading of the test samples in gold NPs enhanced their AChE and BChE inhibitory potentials.   Resumen. La síntesis verde de nanopartículas de oro (NP de Au) se llevó a cabo mediante extractos de plantas de Delphinium uncinatum y Erythrophyleum guineense. Las NP de Au obtenidas se caracterizaron mediante diversas técnicas instrumentales como microscopía electrónica de barrido (SEM), dispersión de energía de rayos X (EDX), difracción de rayos X (XRD) y espectrofotómetro UV / Visible (UV / Vis). El estudio SEM reveló tamaños de las nanopartículas de oro sintetizadas por E. guineense (GE) y D. uncinatum (GN) por debajo de 100 y 300 nm, respectivamente. Las micrografías también mostraron que las partículas de oro sintetizadas por E. guineense (GE) tenían una forma redonda irregular, mientras que las nanopartículas sintetizadas por D. uncinatum (GN) tenían una forma cilíndrica. Los patrones XRD presentaron picos a aproximadamente 38.1 °, 44.43 °, 64.6 ° y 77.64 ° pueden indexarse ​​a la orientación (111), (200), (220) y (311), respectivamente, lo que confirmó la presencia de nanopartículas de oro cristalinas. El análisis UV / Vis mostró que ambos extractos de plantas formaron nanopartículas de oro. Se investigaron las NP de oro como inhibidores de colinesterasas in vitro en un intervalo de concentraciones de 62.5 a 1000 µg / ml. Los resultados de la bioactividad mostraron que la carga de las muestras de prueba en NP de oro mejoró sus potenciales inhibidores de AChE y BChE.

Crossbreed impact of double-diffusivity convection on peristaltic pumping of magneto Sisko nanofluids in non-uniform inclined channel: A bio-nanoengineering model

The consequences of double-diffusivity convection on the peristaltic transport of Sisko nanofluids in the non-uniform inclined channel and induced magnetic field are discussed in this article. The mathematical modeling of Sisko nanofluids with induced magnetic field and double-diffusivity convection is given. To simplify PDEs that are highly nonlinear in nature, the low but finite Reynolds number, and long wavelength estimation are used. The Numerical solution is calculated for the non-linear PDEs. The exact solution of concentration, temperature and nanoparticle are obtained. The effect of various physical parameters of flow quantities is shown in numerical and graphical data. The outcomes show that as the thermophoresis and Dufour parameters are raised, the profiles of temperature, concentration, and nanoparticle fraction all significantly increase.

Biodiversity of orb-web spiders (family: araneidae) of buner valley, Pakistan

The present research was carried out to explore the spider fauna of Buner valley with taxonomic study from February 2018 to January 2019. For this purpose samples were collected, four times at each month from 4 tehsils: Daggar, Gagra, Mandan and Totalai. Two methods were used, hand picking and sweep net for collection of samples. During day and night, three habitats, arid area, agriculture land and building area were search for collection. A total of 534 samples of spider were collected from four sampling sites, in which 379 were belonging to family Araniedae. After confirmation, the identified species were belonging to 8 genera (Neoscona, Argiope, Cyclosa, Araneus, Cyrtophora, Larinia, Erivoxia and Poltys) and 19 species. 18 of them were identified to specie level while a single specie to its generic level. The genus Neoscona was the dominant genus 26.31% having 5 species while the genus Argiope 21.05% is the second dominant having 4 species followed by Cyclosa 15.78% having 3 species followed by Cyrtophora and Araneus 10.52% having two species both. The Poltys and Larinia 5.26% are the rarest genera represent single-single specie both. Statistical analysis show that specie richness (D) = 5.77, Simpson index (1-D) = 0.87, Shannon index (H) = 2.33. Diversity of spiders was evenly distributed and calculated Evenness value was H/InS = 0.5408. There is also few atypical species and Fisher alpha estimate high value (Fisher α) = 4.42. Chao-1 estimated we have reported 22 species.

Addressing the Consequences of the COVID-19 Lockdown for Children's Mental Health: Investing in School Mental Health Programs

Children are likely to struggle with mental health consequences relating to the COVID-19 pandemic. School closures and home confinement increase the risk for emotional distress, domestic violence and abuse, and social isolation, as well as for disruption of sleep-wake and meal cycles, physical exercise routines, and health care access. As schools reopen, school mental health programs (SMHPs) incorporating universal approaches will be important for all children, and targeted approaches will be necessary for those more severely affected. Using their experience in Pakistan, the authors provide a roadmap for extending the World Health Organization's eastern Mediterranean region's SMHP to address the mental health consequences of COVID-19 among children globally.

Comparative brain analysis of wild and hatchery reared Mahseer (Tor putitora) relative to their body weight and length

The present study was aimed at comparing the brain size of mahseer (Tor putitora) in relation to their body weight and standard length, to investigate the potential impact of rearing environment on brain development in fish. The weight of the brain and three of its subdivisions cerebellum (CB), optic tectum (OT), and telencephalon (TC) were measured for both wild and hatchery-reared fish. The data was analysed using multiple analysis of covariance (MANCOVA), analysis of covariance (ANCOVA), and discriminate function analysis (DFA). We found the fish reared under hatchery conditions exhibit smaller brain size related to body weight, when compared to the wild ones. A significant (p<0.5) difference was observed in the length of CB and OT concerning the standard body length while no significant difference was found in TC of the fish from both the origins. The results of the current study highlight a logical assumption that neural deficiency affects the behaviour of fish, that's why the captive-reared fish show maladaptive response and face fitness decline when released to the natural environment for wild stock enhancement. The current study concluded that hatchery-reared fish exhibit variations in gross brain morphology as compared to their wild counterpart.

Systematic analysis of leisler's bat Nyctalus leisleri (Kuhl, 1817) captured from FATA region, Pakistan

Extensive field surveys were carried out to explore the distribution of Leisler's Bat Nyctalus leisleri (Kuhl, 1819) in selected area of FATA regions, Pakistan. Specimens of Leisler's Bat Nyctalus leisleri (Kuhl, 1819) (n5) were collected from Kurram Agency (Shublan) (N33.8229788 E70.1634414) at elevation 1427m and Khyber Agency (Landi Kotel) (N34.0909899 E71.1457517) at elevation 1091m for two years survey extending from May 2013 through August 2015. The mean head and body length, hind foot length, ear length and tail length the Nyctalus leisleri specimens captured from the study area was 65.08 ± 1.58 mm, 44.06 ± 0.52 mm, 8.38 ± 0.60 mm, 13.20 ± 0.99 mm and 39.46 ± 1.46 mm, respectively. For molecular analysis the sequences of COI gene were obtained and analyzed. The mean intraspecific divergences of Nyctalus leisleri was 0.04%. The mean interspecific divergences of Nyctalus noctula and Nyctalus leisleri was 0.2%. The mean concentration of each nucleotides was A = (26.3%), T = (32.8%), G = (15.9%) and C = (25.0%). The mean A+T contents were 59.2%and C+G were 40.9%. In the phylogenetic tree Nyctalus leisleri and Nyctalus noctula clustered with significant bootstrap support value.

Addressing the double burden of the COVID-19 and noncommunicable disease pandemics: a new global governance challenge

Purpose

As the coronavirus disease 2019 (COVID-19) continues to spread across countries, it is becoming increasingly clear that the presence of pre-existing noncommunicable diseases (NCDs) dramatically increases the risk of aggravation in persons who contract the virus. The neglect in managing NCDs during emergencies may result in fatal consequences for individuals living with comorbidities. This paper aims to highlight the need for a paradigm shift in the governance of public health emergencies to simultaneously address NCD and noncommunicable disease (CD) pandemics while taking into account the needs of high-risk populations, underlying etiological factors, and the social, economic, and environmental determinants that are relevant for both CDs and NCDs.

Design/methodology/approach

The paper reviews the available global frameworks for pandemic preparedness to highlight the governance challenges of addressing the dual agenda of NCDs and CDs during a public health emergency. It proposes key strategies to strengthen multilevel governance in support of countries to better prepare for public health emergencies through the engagement of a wide range of stakeholders across sectors.

Findings

Addressing both CD and NCD pandemics during public health emergencies requires (1) a new framework that unites the narratives and overcomes service and system fragmentations; (2) a multisectoral and multistakeholder governance mechanism empowered and resourced to include stakeholders across sectors and (3) a prioritized research agenda to understand the political economy of pandemics, the role played by different political systems and actors and implementation challenges, and to identify combined strategies to address the converging agendas of CDs and NCDs.

Research limitations/implications

The article is based on the review of available published evidence.

Practical implications

The uptake of the strategies proposed will better prepare countries to respond to NCD and CD pandemics during public health emergencies.

Originality/value

The article is the first of its kind addressing the governance challenges of the dual pandemic of NCDs and CDs in emergencies.

Segmentation of Microscope Erythrocyte Images by CNN-Enhanced Algorithms

This paper presents an algorithm for segmentation and shape analysis of erythrocyte images collected using an optical microscope. The main objective of the proposed approach is to compute statistical object values such as the number of erythrocytes in the image, their size, and width to height ratio. A median filter, a mean filter and a bilateral filter were used for initial noise reduction. Background subtraction using a rolling ball filter removes background irregularities. Combining the distance transform with the Otsu and watershed segmentation methods allows for initial image segmentation. Further processing steps, including morphological transforms and the previously mentioned segmentation methods, were applied to each segmented cell, resulting in an accurate segmentation. Finally, the noise standard deviation, sensitivity, specificity, precision, negative predictive value, accuracy and the number of detected objects are calculated. The presented approach shows that the second stage of the two-stage segmentation algorithm applied to individual cells segmented in the first stage allows increasing the precision from 0.857 to 0.968 for the artificial image example tested in this paper. The next step of the algorithm is to categorize segmented erythrocytes to identify poorly segmented and abnormal ones, thus automating this process, previously often done manually by specialists. The presented segmentation technique is also applicable as a probability map processor in the deep learning pipeline. The presented two-stage processing introduces a promising fusion model presented by the authors for the first time.

Enhancement of photocatalytic potential and recoverability of Fe3O4 nanoparticles by decorating over monoclinic zirconia

BACKGROUND

Photodegradation of organic pollutants is considered to be the most suitable and cheaper technique to counter the decontamination issues. Metal nanoparticles are considered to be the most effective heterogeneous photocatalysts for photodegradation of organic pollutants. Besides, iron oxide nanoparticles are well-known photocatalysts for degrading organic pollutants.

METHODS

We reported the synthesis of neat iron oxide nanoparticles (Fe3O4 NPs) and zirconia supported iron oxide nanoparticles (Fe3O4/ZrO2 NPs) by facile chemical reduction technique for photodegradation ofa toxic azo dye namely methyl red.

RESULTS

The XRD and FTIR analysis has demonstrated a crystalline phase Fe3O4 NPs. The morphological features via scanning electronic microscopy (FESEM) suggested agglomerated morphology of neat Fe3O4 NPs with 803.54 ± 5.11 nm average particle size and revealed the uniform morphology and homogenous dispersion of Fe3O4 NPs over ZrO2 surface in Fe3O4/ZrO2 nanocomposite. A polydispersity index (PDI) of 0.47 showed sufficient variations in the particle size of neat Fe3O4 NPs, which is also supported by the results obtained from atomic force microscopy (AFM), FESEM and Transmission Electron Microscopy (TEM). Fe3O4/ZrO2 NPs demonstrated efficient methyl red degradation over a short period of time under simulated light and degraded about ~ 91.0 ± 1.0% and 87.0 ± 1.0% dye in 40 min, under UV and visible light, respectively.

CONCLUSION

The excellent photodegradation efficacy and sustainability of Fe3O4/ZrO2 NPs can be attributed to the homogenous distribution of Fe3O4 NPs over ZrO2, which facilitates the generation of photoexcitons (electrons and holes), enhanced charge transfer and minimize the charge recombination.

Identifying pathways for large-scale implementation of a school-based mental health programme in the Eastern Mediterranean Region: a theory-driven approach

Globally there is a substantial burden of mental health problems among children and adolescents. Task-shifting/task-sharing mental health services to non-specialists, e.g. teachers in school settings, provide a unique opportunity for the implementation of mental health interventions at scale in low- and middle-income countries (LMICs). There is scant information to guide the large-scale implementation of school-based mental health programme in LMICs. This article describes pathways for large-scale implementation of a School Mental Health Program (SMHP) in the Eastern Mediterranean Region (EMR). A collaborative learning group (CLG) comprising stakeholders involved in implementing the SMHP including policymakers, programme managers and researchers from EMR countries was established. Participants in the CLG applied the theory of change (ToC) methodology to identify sets of preconditions, assumptions and hypothesized pathways for improving the mental health outcomes of school-aged children in public schools through implementation of the SMHP. The proposed pathways were then validated through multiple regional and national ToC workshops held between January 2017 and September 2019, as the SMHP was being rolled out in three EMR countries: Egypt, Pakistan and Iran. Preconditions, strategies and programmatic/contextual adaptations that apply across these three countries were drawn from qualitative narrative summaries of programme implementation processes and facilitated discussions during biannual CLG meetings. The ToC for large-scale implementation of the SMHP in the EMR suggests that identifying national champions, formulating dedicated cross-sectoral (including the health and education sector) implementation teams, sustained policy advocacy and stakeholders engagement across multiple levels, and effective co-ordination among education and health systems especially at the local level are among the critical factors for large-scale programme implementation. The pathways described in this paper are useful for facilitating effective implementation of the SMHP at scale and provide a theory-based framework for evaluating the SMHP and similar programmes in the EMR and other LMICs.

The influence of primary care physicians' mental health knowledge, attitudes and self-efficacy on referrals to specialised services: findings from a longitudinal pilot trial

BACKGROUND

Training based on the Mental Health Gap Action Programme (mhGAP) is being increasingly adopted by countries to enhance non-specialists' mental health capacities. However, the influence of these enhanced capacities on referral rates to specialised mental health services remains unknown.

AIMS

We rely on findings from a longitudinal pilot trial to assess the influence of mental health knowledge, attitudes and self-efficacy on self-reported referrals from primary to specialised mental health services before, immediately after and 18 months after primary care physicians (PCPs) participated in an mhGAP-based training in the Greater Tunis area of Tunisia.

METHOD

Participants included PCPs who completed questionnaires before (n = 112), immediately after (n = 88) and 18 months after (n = 59) training. Multivariable analyses with linear mixed models accounting for the correlation among participants were performed with the SAS version 9.4 PROC MIXED procedure. The significance level was α < 0.05.

RESULTS

Data show a significant interaction between time and mental health attitudes on referrals to specialised mental health services per week. Higher scores on the attitude scale were associated with more referrals to specialised services before and 18 months after training, compared with immediately after training.

CONCLUSION

Findings indicate that, in parallel to mental health training, considering structural/organisational supports to bring about a sustainable change in the influence of PCPs' mental health attitudes on referrals is important. Our results will inform the scale-up of an initiative to further integrate mental health into primary care settings across Tunisia, and potentially other countries with similar profiles interested in further developing task-sharing initiatives.

Single-use lidocaine hydrochloride 5 per cent w/v and phenylephrine hydrochloride 0.5 per cent w/v topical spray; can it now be employed as a multi-use atomiser?

OBJECTIVE

This study investigated the risk of contamination of lidocaine hydrochloride 5 per cent w/v and phenylephrine hydrochloride 0.5 per cent w/v topical solution after modification of the application technique.

METHODS

This paper reports a prospective basic sciences study involving 22 study samples and 1 control sample of the lidocaine hydrochloride and phenylephrine hydrochloride topical anaesthetic spray. The samples were assessed for microbiological contamination after a single use on patients using a modified application technique. The modification involves keeping the nozzle (actuator) pressed down whilst withdrawing the spray to at least 30 cm (1 ft) from the patient, before releasing the nozzle (actuator) and subsequently reapplying the spray.

RESULTS

Three of the 23 samples confirmed bacterial growth in the bottle contents, but there was no growth in any of the samples from the pump. These bacteria are considered to be contaminants.

CONCLUSION

There is a potential to use the lidocaine hydrochloride 5 per cent w/v and phenylephrine hydrochloride 0.5 per cent w/v topical solution as a multi-use spray by changing the actuator between patients. This would have significant beneficial cost implications without the attendant infection control risk.

Hematite and Magnetite Nanostructures for Green and Sustainable Energy Harnessing and Environmental Pollution Control: A Review

The optoelectrical and magnetic characteristics of naturally existing iron-based nanostructures, especially hematite and magnetite nanoparticles (H-NPs and M-NPs), gained significant research interest in various applications, recently. The main purpose of this Review is to provide an overview of the utilization of H-NPs and M-NPs in various environmental remediation. Iron-based NPs are extensively explored to generate green energy from environmental friendly processes such as water splitting and CO₂ conversion to hydrogen and low molecular weight hydrocarbons, respectively. The latter part of the Review provided a critical overview to use H-NPs and M-NPs for the detection and decontamination of inorganic and organic contaminants to counter the environmental pollution and toxicity challenge, which could ensure environmental sustainability and hygiene. Some of the future perspectives are comprehensively presented in the final portion of the script, optimiztically, and it is supported by some relevant literature surveys to predict the possible routes of H-NPs and M-NPs modifications that could enable researchers to use these NPs in more advanced environmental applications. The literature collection and discussion on the critical assessment of reserving the environmental sustainability challenges provided in this Review will be useful not only for experienced researchers but also for novices in the field.