Dermatological Lesions of Cholesterol Embolization Syndrome and Kaposi Sarcoma Mimic Primary Systemic Vasculitis: Case Report Study

Primary systemic vasculitis can present with a wide spectrum of manifestations ranging from systemic non-specific features such as fever, malaise, arthralgia, and myalgia to specific organ damage. We describe two cases of cholesterol embolization syndrome and Kaposi sarcoma mimicking primary systemic vasculitis, both of which were characterized by features such as livedo reticularis, blue toe syndrome, a brown, purpuric skin rash, and positive p-ANCA associated with Kaposi sarcoma. Establishing the right diagnosis was challenging, and thus we aim in this study to highlight the possible ways to distinguish them from primary systemic vasculitis. Keywords: Dermatological lesions, Cholesterol embolization syndrome, Kaposi sarcoma, vasculitis mimic

Biophysical, Biochemical, and Molecular Docking Investigations of Anti-Glycating, Antioxidant, and Protein Structural Stability Potential of Garlic.

Garlic has been reported to inhibit protein glycation, a process that underlies several disease processes, including chronic complications of diabetes mellitus. Biophysical, biochemical, and molecular docking investigations were conducted to assess anti-glycating, antioxidant, and protein structural protection activities of garlic. Results from spectral (UV and fluorescence) and circular dichroism (CD) analysis helped ascertain protein conformation and secondary structure protection against glycation to a significant extent. Further, garlic showed heat-induced protein denaturation inhibition activity (52.17%). It also inhibited glycation, advanced glycation end products (AGEs) formation as well as lent human serum albumin (HSA) protein structural stability, as revealed by reduction in browning intensity (65.23%), decrease in protein aggregation index (67.77%), and overall reduction in cross amyloid structure formation (33.26%) compared with positive controls (100%). The significant antioxidant nature of garlic was revealed by FRAP assay (58.23%) and DPPH assay (66.18%). Using molecular docking analysis, some of the important garlic metabolites were investigated for their interactions with the HSA molecule. Molecular docking analysis showed quercetin, a phenolic compound present in garlic, appears to be the most promising inhibitor of glucose interaction with the HSA molecule. Our findings show that garlic can prevent oxidative stress and glycation-induced biomolecular damage and that it can potentially be used in the treatment of several health conditions, including diabetes and other inflammatory diseases

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

The Saudi Critical Care Society practice guidelines on the management of COVID-19 in the ICU: Therapy section

BACKGROUND: The rapid increase in coronavirus disease 2019 (COVID-19) cases during the subsequent waves in Saudi Arabia and other countries prompted the Saudi Critical Care Society (SCCS) to put together a panel of experts to issue evidence-based recommendations for the management of COVID-19 in the intensive care unit (ICU). METHODS: The SCCS COVID-19 panel included 51 experts with expertise in critical care, respirology, infectious disease, epidemiology, emergency medicine, clinical pharmacy, nursing, respiratory therapy, methodology, and health policy. All members completed an electronic conflict of interest disclosure form. The panel addressed 9 questions that are related to the therapy of COVID-19 in the ICU. We identified relevant systematic reviews and clinical trials, then used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach as well as the evidence-to-decision framework (EtD) to assess the quality of evidence and generate recommendations. RESULTS: The SCCS COVID-19 panel issued 12 recommendations on pharmacotherapeutic interventions (immunomodulators, antiviral agents, and anticoagulants) for severe and critical COVID-19, of which 3 were strong recommendations and 9 were weak recommendations. CONCLUSION: The SCCS COVID-19 panel used the GRADE approach to formulate recommendations on therapy for COVID-19 in the ICU. The EtD framework allows adaptation of these recommendations in different contexts. The SCCS guideline committee will update recommendations as new evidence becomes available

Power Management in Islanded Microgrids Using Multi-Agent Systems

This paper presents a power management strategy for islanded microgrids. The proposed strategy utilizes the MultiAgent System (MAS) to perform the required tasks. The strategy is divided into two stages. The first stage is an operational planning stage which aims to optimize the operation of the microgrid in the islanded mode. This is achieved by performing Optimal Power Flow (OPF) periodically in the grid connected mode using a central agent. Once the islanded mode is detected, the results of the OPF are used to balance the operation of the microgrid. Several distributed agents along with the central agent aim to further fine tune the set points obtained from the OPF based on the actual operating conditions of the microgrid. To demonstrate the effectiveness of the proposed strategy, four scenarios are simulated and presented

Industrial demand adaptation to renewable resources

The usage of renewable energy sources as an alternative energy source is faced with a major challenge introduced by the intermittency nature of the source. We have two options i) adapt the demand to the source, or ii) adapt the source to the demand. If the process demand is flexible and can be adapted to the energy source, it will enjoy cheap energy. Alternatively, non-flexible processes will require extra costs to be paid to adapt the source to the process energy requirements. This paper presents a demand response model to adapt the demand of industrial processes to the available energy source. The model is solved analytically using mixed integer linear programming. Then, three metaheuristic search algorithms were used. The results of the solving algorithms are compared with each other using the Wilcoxons' rank-sum test. Then the model is tested for two examples of flexible and rigid processes showing the differences

Serum biochemistry indices, leukogram, carcass variables and intestinal measurements of Eimeria tenella-infected or non-infected broilers treated with dietary Cinnamomum verum bark

ABSTRACTWe compared the outcomes of various concentrations of Cinnamomum verum bark powder (CNP), a natural product, to a conventional anticoccidial drug in induced Eimeria tenella infection in broilers aged 21 days. On day 21, 250 birds (Ross 308) were randomly assigned to one of 10 treatments, five of which had Eimeria tenella infection and five of which did not. Results 14 days post-infection (dpi) revealed that the treatments had a significant effect on body weight gain (BWG) and production efficiency factor (PEF). Although the 2 g CNP and Salinomycin (Sacox) treatments performed equally well, the 2 g CNP had the highest BWG and PEF under challenging conditions. Although the PEF improved satisfactorily at 14 dpi, the loss of BWG at 7 dpi did not compensate at 14 dpi. Challenged birds had longer and heavier small intestines, atrophiedceca, lower creatinine levels and higher eosinophils % than unchallenged birds. The elevation lesion score and oocyst secretion of challenged birds decreased with increasing cinnamon dosage. In conclusion, 6 g CNP as a natural product could be as effective as Sacox against occidiosis, with 2 g CNP performing best at 14 dpi. However, more research is required to fully understand its anticoccidial mechanisms.Highlights Cinnamomum verum bark may benefit broiler health by reducing Eimeria tenella oocysts.Under coccidial challenge, Cinnamomum verum bark at 2 g/kg diet may improve broiler body weight gain and production efficiency at 34 days of age (14 days post-infection).The lesion score and oocyst secretion of challenged birds decreased less as cinnamon dosage was increased

Gas Sensing Performance of Zinc Oxide Nanoparticles Fabricated via <i>Ochradenus baccatus</i> Leaf

ZnO nanoparticles (NPs) were prepared by green synthesis using plant leaf extraction of Ochradenus baccatus and characterized by XRD, FESEM, HRTEM, and Raman spectroscopy techniques. Since elevated CO levels have been associated with inflammatory conditions, cardiovascular diseases, and respiratory disorders and the methane gas primarily produced by gut microbiota and linked to gastrointestinal disorders and other abnormal methane levels in breath samples, the nanoparticles were applied for gas sensor fabrication. Thus, the gas sensors fabricated using ZnO nanoparticles were investigated for CH4, H2, CO, and NO2 gases. The gas sensing was performed for the fabricated sensors at various operating temperatures and gas concentrations. Interestingly, leaf-extracted green synthesized ZnO NPs were more sensitive to CH4, CO, and NO2 gases than to H2. The results of sensing studies revealed that the nanoparticles exhibit a selectivity toward gas depending on the gas type. The sensor response was also studied against the humidity. These findings bridge between the laboratory and industry sectors for future gas sensors development, which can be used for exhaled breath analysis and serve as potential diagnostic tools for highly sensitive contagious diseases

Knowledge, perceptions, and readiness of telepharmacy among community pharmacists

Telepharmacy is a practical part of telemedicine that refers to providing pharmaceutical services within the scope of the pharmacist's obligations while maintaining a temporal and spatial distance between patients, users of health services, and healthcare professionals. The present study was a cross-sectional study conducted among community pharmacists in Saudi Arabia between March and May 2022 to assess their knowledge, perceptions, and readiness for telepharmacy. The survey was filled out by 404 respondents. The majority of respondents were male (59.90%) and the age of more than half of them was between 30 and 39 years old (54.46%). Most participants worked in urban areas (83.66%), and 42.57% had less than five years of experience in a pharmacy. Most participants agreed that telepharmacy is available in Saudi Arabia (82.67%). Approximately 70% of pharmacists felt that telepharmacy promotes patient medication adherence, and 77.72% agreed that telepharmacy increases patient access to pharmaceuticals in rural areas. More than 72% of pharmacists said they would work on telepharmacy initiatives in rural areas for free, and 74.26% said they would work outside of usual working hours if necessary. In the future, this research could aid in adopting full-fledged telepharmacy pharmaceutical care services in Saudi Arabia. It could also help academic initiatives by allowing telepharmacy practice models to be included as a topic course in the curriculum to prepare future pharmacists to deliver telepharmacy services

Assessment of the levels of awareness toward cardiopulmonary resuscitation: A community-based study in Northern Saudi Arabia

BACKGROUND: Cardiopulmonary resuscitation (CPR) is a procedure performed in an emergency when the heart stops. Early initiation of CPR can save many lives. Thus, the aim of the present study was to assess the level of awareness toward CPR in a community-based study in Northern Saudi Arabia. MATERIALS AND METHODS: This is a cross-sectional survey conducted in the city of Hail, Northern Saudi Arabia. Data about CPR were obtained from 442 Saudi volunteers living in the city of Hail. RESULTS: A family history of ischemic heart disease was indicated in 148/442 (33.5%) of the participants. On asking the participants whether they have previous information about CPR, about 258/442 (58.4%) persons indicated “Yes,” 118/442 (26.6%) replied “May be,” and the remaining 66/442 (15%) replied “No.” CONCLUSION: The study showed a high level of awareness about CPR, which might be attributed to the majority of highly educated participants. Effective and sustainable public CPR training programs are needed to be implemented to preserve better knowledge and awareness of CPR in the general population