Platinum 1,10-phenanthroline: Photosensitizer for photocatalytic degradation of 4-chlorophenol

It is more economic to apply photodegradation of organic pollutants in presence of the visible light irradiation (sunlight) than applying more costfull ultraviolet lamps. Hence, platinum 1,10-phenanthroline complex has been prepared and tested as a photosensitizer for photodegrading 4-chlorophenol in water, which has been found almost completely achieved (98.5 %) after three hours of visible irradiation. Nevertheless, irradiation at 364 and 254 nm exhibits lower efficiencies. At visible irradiation, the platinum complex gives the highest activation of singlet state oxygen formation (1O2) compared to 364 and 254 nm irradiation as supported by electron para-magnetic resonance data. On the other hand, the behavior of formation and disappearance of photodegradation intermediates: hydroquinone, benzoquinone, hydroxybenzoquinone, using the platinum complex applying the three current irradiations are found to supports these findings. However, organic acids have accumulated as a function of irradiation time and hence considered to be rate-controlling

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

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

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Potential of wind energy and economic assessment in Egypt considering optimal hub height by equilibrium optimizer

In Egypt, the wind market increases quickly to make it one of the top countries in the Middle East. This study discusses the viability of wind resources and the economic assessment for four locations in Egypt: Ras El-Hekma, Farafra, Nuweiba, and Aswan through two stages. In the first stage, the optimal hub height for some wind turbines has been calculated by using Equilibrium Optimizer (EO) algorithm to achieve maximum wind energy with overall minimum cost. The second stage, the economic assessment has been evaluated by using such turbines to calculate the cost of energy (COE) compared to the global and Egyptian production costs of wind energy. Developed MATLAB programs are applied for statistical analysis of wind data. The results have shown that Ras El-Hekma’s average wind speed is higher than other sites and its wind energy potential is the best. Moreover, the economic assessment for selected locations turns out that Ras El-Hekma by using EWT-DW61/22 turbine has the lowest COE

Effect of first week-intermittent fasting during Ramadan on the severity of neuropsychiatric symptoms in patients with fibromyalgia: A prospective study

Background: Fasting has been well-reported as an adjunctive therapeutic approach in some chronic pain syndromes.Aim of the workTo study the effect of Ramadan intermittent fasting (RIF) on the severity of neuropsychiatric symptoms in patients with fibromyalgia.Patients and methodsThis prospective observational study was conducted on 130 females with primary fibromyalgia eligible to fast the first week of Ramadan. The included patients were requested to answer the Revised Fibromyalgia Impact Questionnaire twice; the first targets the last week of Shaaban, while the second targets the first week of Ramadan.ResultsThe mean age of the patients was 42.3 ± 11.03 years. The percentage of patients who improved in pain scores was 47.7%, depression (58.5%) and anxiety (55.4%) after the first week of RIF. The median value for the percent of improvement in pain, depression, and anxiety scores were 20%, 25%, and 25%, respectively. On the other hand, most patients showed worsening in the scores of energy level (56.9%) and sleep quality (60%) after the first week of RIF. The median value for the percent of worsening in the energy level and sleep quality scores were 33.3% and 36.7%, respectively. The percentage of patients who showed no change in stiffness scores was 40%, memory problems (67.7%), tenderness to touch (60.8%), balance problems (88.5%), or sensitivity to loud noises, bright lights, odors, and cold (66.9%) after the first week of RIF.ConclusionRIF may improve pain, anxiety, and depression, while it has deleterious effects on sleep and fatigue among patients with fibromyalgia

Advanced non-small cell lung cancer in elderly patients: The standard every 3-weeks versus weekly paclitaxel with carboplatin

AbstractBackgroundPaclitaxel and platinum-based chemotherapy is considered to be a standard approach for locally advanced and metastatic non-small cell lung cancer (NSCLC). In recent years, paclitaxel on a weekly schedule in combination with carboplatin has been widely used because it is associated with a lower incidence of neuropathy and myelosuppression. Otherwise, only a few studies are available in elderly patients with NSCLC.PurposeThe aim of our study was to evaluate the efficacy and safety of weekly paclitaxel combined with carboplatin compared with the classic 3-weekly schedule of paclitaxel and carboplatin as initial therapy and the feasibility of subsequent maintenance therapy versus observation in elderly patients with locally advanced (stage IIIB) and metastatic (stage IV) NSCLC.Patients and methodsNinty patients ⩾65years with stage IIIB–IV NSCLC were randomly assigned to one of the following arms: arm1, paclitaxel 90mg/m2 weekly for 3 of 4weeks with carboplatin (area under the curve {AUC}=6) on day 1 of each 4week cycle; and arm 2, paclitaxel 200mg/m2 with carboplatin (AUC=6) on day 1 of each 3-week. After four cycles of chemotherapy, those with objective response or stable disease were randomized to weekly paclitaxel (70mg/m2, 3 of 4weeks) or observation as maintenance therapy. Primary end point was response while second end points included survival and toxicity.ResultsEighty-six patients were evaluable for response, overall responses were recorded in 42.9% in arm 1 versus 31.8% in arm 2; stable disease was 38.1% in arm 1 versus 27.3% in arm 2 and progressive disease was 19% in arm 1 versus 40.9% in arm 2. The median time to progression and median survival times were 7months and 10.8months in arm 1 versus 5.6months and 9months in arm 2, respectively. The 1-year survival rates were 47.6% in arm 1 versus 36.4% in arm 2. Grade 3/4 anemia was more common in arm 1 (23.8%) than arm 2 (9.1%). Grade 3/4 neutropenia and febrile neutropenia occurred in 14.3% and 4.7% in arm 1 versus 22.7% and 9.1% in arm 2. Grade 2/3 neuropathy occurred in 4.7% in arm 1 versus 13.6% in arm 2.ConclusionsEfficacy was similar between the weekly regimen and the standard regimen of carboplatin and paclitaxel for elderly patients with advanced NSCLC and may be advantageous based on its favorable tolerability profile

Bayesian Inferential Approaches and Bootstrap for the Reliability and Hazard Rate Functions under Progressive First-Failure Censoring for Coronavirus Data from Asymmetric Model

This paper deals with the estimation of the parameters for asymmetric distribution and some lifetime indices such as reliability and hazard rate functions based on progressive first-failure censoring. Maximum likelihood, bootstrap and Bayesian approaches of the distribution parameters and reliability characteristics are investigated. Furthermore, the approximate confidence intervals and highest posterior density credible intervals of the parameters are constructed based on the asymptotic distribution of the maximum likelihood estimators and Markov chain Monte Carlo technique, respectively. In addition, the delta method is implemented to obtain the variances of the reliability and hazard functions. Moreover, we apply two methods of bootstrap to construct the confidence intervals. The Bayes inference based on the squared error and LINEX loss functions is obtained. Extensive simulation studies are conducted to evaluate the behavior of the proposed methods. Finally, a real data set of the COVID-19 mortality rate is analyzed to illustrate the estimation methods developed here

Limiting the role of antibiotics in children with adenotosilitis

Background In the past, group A beta-haemolytic streptococcus infection consequences were the main goal of empirical antibiotic therapy of sore throat. Antimicrobial stewardship is crucial due to the threats posed by multi-resistant pathogens. The aim of this study : was to investigate the possibility of limiting the role of antibiotic in children with adenotosilitis &nbsp;Methods: This hospital-based, randomised, prospective research involved 120 child who visited OPD of both Pediatrics and Otorhinolaryngology departments,&nbsp; pesented with adenotonsillitis&nbsp; were enrolled . All cases met the eligibility requirements were randomly assigned to two groups: 60 cases in Group A got systemic antibiotics. Group B 60 cases received symptomatic treatment with&nbsp; immune modulator, vit D 2000-5000 IU orally once daily. The cases were selected through 2 months from February 2022 to April 2022. Age :2 years&nbsp; to 9&nbsp; years. In&nbsp; younger children less than 3 years, dysphagia was expressed by the mothers as difficult swallowing and crying&nbsp; during feeding with drolling of saliva. Results: Regarding baseline symptoms and indicators and after three days, there was no discernible difference between groups A and B. However, after six days of therapy, group B considerably outperformed group A in terms of absent sore throat, dysphagia, and tonsillar hypertrophy.&nbsp