Production of Silver Nanoparticles with Strong and Stable Antimicrobial Activity against Highly Pathogenic and Multidrug Resistant Bacteria

Aims. To synthesize, characterize, and analyze antimicrobial activity of AgNPs of Escherichia hermannii (SHE), Citrobacter sedlakii (S11P), and Pseudomonas putida (S5). Methods. The synthesized AgNPs were examined using ultraviolet-visible spectroscopy (UV-vis) and, zeta potential, and the size and the morphology obtained from the three different isolates were also confirmed by TEM. Results. Among the three isolates tested, SHE showed the best antimicrobial activity due to the presence of small (4–12 nm) and stable (−22 mV) AgNPs. Stability of AgNPs was also investigated and found to be dependent on the nature of isolates. Conclusion. Produced AgNPs showed particle stability and antimicrobial efficacy up to 90 days of production. Our AgNPs exhibited greater antimicrobial activity compared with gentamicin against P. aeruginosa isolates and vancomycin against S. aureus and MRSA isolates at very low concentration (0.0002 mg per Microliters)

Pediatric Dermatology In Family Medicine: Common Conditions And Management Strategies

Among the most prevalent disorders are those related to the skin.  However, in medical education and training, this class of illnesses is frequently disregarded. The first line of defence for the treatment of common dermatological diseases is a family physician. The purpose of our study was to evaluate the particular identification, management, encountering, and referral practices related to dermatological illnesses in family care. We also looked into the challenges and opportunities that family doctors experience in family medicine and saw a few of the paediatric dermatological diseases that family doctors may encounter.  Finding areas of weakness in the clinical therapy of certain dermatological disorders, however, will be aided by assessing how family doctors treat particular ailments. Thus, this needs assessment might serve as a foundation for future research on the efficacy of family medicine in treating common paediatric dermatological problems as well as aid in the development of evidence-based training for family physicians in the area

Structural, Optical, and Renewable Energy-Assisted Photocatalytic Dye Degradation Studies of ZnO, CuZnO, and CoZnO Nanostructures for Wastewater Treatment

Renewable energy can be harnessed from wastewater, whether from municipalities or industries, but this potential is often ignored. The world generates over 900 km3 of wastewater annually, which is typically treated through energy-consuming processes, despite its potential for energy production. Environmental pollution is a most important and serious issue for all and their adulterations to the aquatic system are very toxic in very low concentrations. Photocatalysis is a prominent approach to eliminating risky elements from the environment. The present study developed Zinc oxide (ZnO), Copper-doped Zinc oxide (CuZnO), and Cobalt-doped Zinc oxide (CoZnO) nanostructures (NSs) by facile hydrothermal route. The crystalline and structural stability of the synthesized nanostructures were evident from XRD and FESEM analysis. Metal, and oxygen bond and their interaction on the surfaces and their valency were explored from XPS spectra. Optical orientations and electron movements were revealed from UV-Visible analysis. After 100 min exposure time with 1 g of catalyst concentration 60%, 70%, and 89% of dye degraded, for dye concentration (5 mg/L to 50 mg/L), the huge variation observed (70% to 22%), (80% to 16%), (94% to 10%). The highest photodegradation rate (55%, 75%, 90%) was observed on pH~12 using ZnO, CoZnO, and CuZnO respectively. Photodegradation of methylene blue confirmed the largest surface area, rate of recombination, photo-excited charge carriers, photo-sensitivity range, and radical generations of ZnO, CuZnO, and CoZnO. The present study, therefore, suggested that CuZnO would be preferred to produce nanomaterials for industrial wastewater treatment like methylene

Intraventricular Hemorrhage in Preterm Infants, Review Article

Intraventricular hemorrhage (IVH) or germinal matrix (GM) in other words, is a condition that can occur in premature births and can lead to long-term medical and developmental effects. While GM/IVH can happen in full-term infants, the hemorrhage in this group of infants is different from periventricular hemorrhage (PVH)/IVH in premature infants. Family members and caregivers of preterm infants and those at risk of preterm birth are confronted with two significant uncertainties concerning these newborns: Is the survival of this child likely? Will the child experience long-term sequelae, particularly developmental sequelae, if they survive? The significance of these questions lies in their potential to impact future medical decisions, including the level of intensity in the care provided. Infants born prematurely can suffer from various acquired lesions in the central nervous system (CNS), leading to long-term disability. These lesions include GM/IVH, periventricular white matter injury, hemorrhage, and diffuse injury to the developing brain. GM/IVH continues to be a major contributor to both illness and death in premature newborns.  GM/IVH is primarily diagnosed by brain imaging techniques, typically cranial ultrasonography, as depicted below. Screening and serial examinations are essential for diagnosing GM/IVH, as it can occur without any noticeable clinical indications

Evaluation of inhaled nitric oxide (iNO) treatment for moderate-to-severe ARDS in critically ill patients with COVID-19: A multicenter cohort study

Background: Inhaled nitric oxide (iNO) is used as rescue therapy in patients with refractory hypoxemia due to severe COVID-19 acute respiratory distress syndrome (ARDS) despite the recommendation against the use of this treatment. To date, the effect of iNO on the clinical outcomes of critically ill COVID-19 patients with moderate-to-severe ARDS remains arguable. Therefore, this study aimed to evaluate the use of iNO in critically ill COVID-19 patients with moderate-to-severe ARDS. Methods: This multicenter, retrospective cohort study included critically ill adult patients with confirmed COVID-19 treated from March 01, 2020, until July 31, 2021. Eligible patients with moderate-to-severe ARDS were subsequently categorized into two groups based on inhaled nitric oxide (iNO) use throughout their ICU stay. The primary endpoint was the improvement in oxygenation parameters 24 h after iNO use. Other outcomes were considered secondary. Propensity score matching (1:2) was used based on the predefined criteria. Results: A total of 1598 patients were screened, and 815 were included based on the eligibility criteria. Among them, 210 patients were matched based on predefined criteria. Oxygenation parameters (PaO2, FiO2 requirement, P/F ratio, oxygenation index) were significantly improved 24 h after iNO administration within a median of six days of ICU admission. However, the risk of 30-day and in-hospital mortality were found to be similar between the two groups (HR: 1.18; 95% CI: 0.77, 1.82; p = 0.45 and HR: 1.40; 95% CI: 0.94, 2.11; p= 0.10, respectively). On the other hand, ventilator-free days (VFDs) were significantly fewer, and ICU and hospital LOS were significantly longer in the iNO group. In addition, patients who received iNO had higher odds of acute kidney injury (AKI) (OR (95% CI): 2.35 (1.30, 4.26), p value = 0.005) and hospital/ventilator-acquired pneumonia (OR (95% CI): 3.2 (1.76, 5.83), p value = 0.001). Conclusion: In critically ill COVID-19 patients with moderate-to-severe ARDS, iNO rescue therapy is associated with improved oxygenation parameters but no mortality benefits. Moreover, iNO use is associated with higher odds of AKI, pneumonia, longer LOS, and fewer VFDs

Survival implications vs. complications: unraveling the impact of vitamin D adjunctive use in critically ill patients with COVID-19—A multicenter cohort study

BackgroundDespite insufficient evidence, vitamin D has been used as adjunctive therapy in critically ill patients with COVID-19. This study evaluates the effectiveness and safety of vitamin D as an adjunctive therapy in critically ill COVID-19 patients.MethodsA multicenter retrospective cohort study that included all adult COVID-19 patients admitted to the intensive care units (ICUs) between March 2020 and July 2021. Patients were categorized into two groups based on their vitamin D use throughout their ICU stay (control vs. vitamin D). The primary endpoint was in-hospital mortality. Secondary outcomes were the length of stay (LOS), mechanical ventilation (MV) duration, and ICU-acquired complications. Propensity score (PS) matching (1:1) was used based on the predefined criteria. Multivariable logistic, Cox proportional hazards, and negative binomial regression analyses were employed as appropriate.ResultsA total of 1,435 patients were included in the study. Vitamin D was initiated in 177 patients (12.3%), whereas 1,258 patients did not receive it. A total of 288 patients were matched (1:1) using PS. The in-hospital mortality showed no difference between patients who received vitamin D and the control group (HR 1.22, 95% CI 0.87–1.71; p = 0.26). However, MV duration and ICU LOS were longer in the vitamin D group (beta coefficient 0.24 (95% CI 0.00–0.47), p = 0.05 and beta coefficient 0.16 (95% CI −0.01 to 0.33), p = 0.07, respectively). As an exploratory outcome, patients who received vitamin D were more likely to develop major bleeding than those who did not [OR 3.48 (95% CI 1.10, 10.94), p = 0.03].ConclusionThe use of vitamin D as adjunctive therapy in COVID-19 critically ill patients was not associated with survival benefits but was linked with longer MV duration, ICU LOS, and higher odds of major bleeding

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

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

Maturity Assessment for Integrated Care during Health Transformation Using SCIROCCO Tool

Background: Integrated health care has the ability to provide adequate care system in different modalities of medical care. Saudi Arabia is going through major transformation in its health care services in order to provide sufficient resources. A 12-dimension SCIROCCO online self-assessment tool, was extracted from the B3-MM, was used for the scaling up of health intervention and for assessing the maturity level of integrated care within different regions. SCIROCCO tool assess a step wise scaling up technique to evaluate how to scale up integrated care during heath transformation. By having knowledge of the factors which make this strategy difficult to implement this study evaluates to what extent SCIROCCO technique was applied. Methods: The SCIROCCO tool was used to assess the maturity of systems of Jazan, Saudi Arabia for integrated care system and for the evaluation of factors affecting scaling up. Data was collected from Stakeholders from multiple disciplines including decision-maker, healthcare professional, IT specialist by self-assessment method. The outcomes of the self-assessment process were visually captured in the form of spider diagrams. Results: All three fundamental steps of the scaling up procedure were executed with satisfactory devotion. Integrated heath transformation in Jazan yielded 18 points out of 60 on spider diagram according to SCIROCCO tool. Majority of the dimensions have no more than 3 score. Digital Health care transformation in Jazan needs to be improved in most of the aspects. Conclusion: This study assesses maturity level of integrated care in Jazan and concludes that An ICT infrastructure to support integrated care has been agreed together with a recommended set of technical standards but there are Still local variations or some systems in place are not yet standardized. Learning about integrated care and change management was in place but not widely implemented