Neglected Tropical Diseases of the Middle East and North Africa: Review of Their Prevalence, Distribution, and Opportunities for Control

The neglected tropical diseases (NTDs) are highly endemic but patchily distributed among the 20 countries and almost 400 million people of the Middle East and North Africa (MENA) region, and disproportionately affect an estimated 65 million people living on less than US$2 per day. Egypt has the largest number of people living in poverty of any MENA nation, while Yemen has the highest prevalence of people living in poverty. These two nations stand out for having suffered the highest rates of many NTDs, including the soil-transmitted nematode infections, filarial infections, schistosomiasis, fascioliasis, leprosy, and trachoma, although they should be recognized for recent measures aimed at NTD control. Leishmaniasis, especially cutaneous leishmaniasis, is endemic in Syria, Iran, Iraq, Libya, Morocco, and elsewhere in the region. Both zoonotic (Leishmania major) and anthroponotic (Leishmania tropica) forms are endemic in MENA in rural arid regions and urban regions, respectively. Other endemic zoonotic NTDs include cystic echinococcosis, fascioliasis, and brucellosis. Dengue is endemic in Saudi Arabia, where Rift Valley fever and Alkhurma hemorrhagic fever have also emerged. Great strides have been made towards elimination of several endemic NTDs, including lymphatic filariasis in Egypt and Yemen; schistosomiasis in Iran, Morocco, and Oman; and trachoma in Morocco, Algeria, Iran, Libya, Oman, Saudi Arabia, Tunisia, and the United Arab Emirates. A particularly noteworthy achievement is the long battle waged against schistosomiasis in Egypt, where prevalence has been brought down by regular praziquantel treatment. Conflict and human and animal migrations are key social determinants in preventing the control or elimination of NTDs in the MENA, while local political will, strengthened international and intersectoral cooperative efforts for surveillance, mass drug administration, and vaccination are essential for elimination

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 < 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

Sex difference and intra-operative tidal volume: Insights from the LAS VEGAS study

BACKGROUND: One key element of lung-protective ventilation is the use of a low tidal volume (VT). A sex difference in use of low tidal volume ventilation (LTVV) has been described in critically ill ICU patients.OBJECTIVES: The aim of this study was to determine whether a sex difference in use of LTVV also exists in operating room patients, and if present what factors drive this difference.DESIGN, PATIENTS AND SETTING: This is a posthoc analysis of LAS VEGAS, a 1-week worldwide observational study in adults requiring intra-operative ventilation during general anaesthesia for surgery in 146 hospitals in 29 countries.MAIN OUTCOME MEASURES: Women and men were compared with respect to use of LTVV, defined as VT of 8 ml kg-1 or less predicted bodyweight (PBW). A VT was deemed 'default' if the set VT was a round number. A mediation analysis assessed which factors may explain the sex difference in use of LTVV during intra-operative ventilation.RESULTS: This analysis includes 9864 patients, of whom 5425 (55%) were women. A default VT was often set, both in women and men; mode VT was 500 ml. Median [IQR] VT was higher in women than in men (8.6 [7.7 to 9.6] vs. 7.6 [6.8 to 8.4] ml kg-1 PBW, P < 0.001). Compared with men, women were twice as likely not to receive LTVV [68.8 vs. 36.0%; relative risk ratio 2.1 (95% CI 1.9 to 2.1), P < 0.001]. In the mediation analysis, patients' height and actual body weight (ABW) explained 81 and 18% of the sex difference in use of LTVV, respectively; it was not explained by the use of a default VT.CONCLUSION: In this worldwide cohort of patients receiving intra-operative ventilation during general anaesthesia for surgery, women received a higher VT than men during intra-operative ventilation. The risk for a female not to receive LTVV during surgery was double that of males. Height and ABW were the two mediators of the sex difference in use of LTVV.TRIAL REGISTRATION: The study was registered at Clinicaltrials.gov, NCT01601223

A Tröger’s Base-Derived Covalent Organic Polymer Containing Carbazole Units as a High-Performance Supercapacitor

Porous organic polymers have been received considerable attention due to their heteroatom-containing structures and high surface areas, which can offer high electrochemical performance in energy applications. The majority of reported Tröger’s base-functionalized porous organic polymers have been applied as effective candidates for sensing and gas separation/adsorption, while their use as electrode materials in supercapacitors is rare. Here, a novel covalent microporous organic polymer containing carbazole and Tröger’s base CzT-CMOP has been successfully synthesized through the one-pot polycondensation of 9-(4-aminophenyl)-carbazole-3,6-diamine (Cz-3NH2) with dimethoxymethane. The polycondensation reaction’s regioselectivity was studied using spectroscopic analyses and electronic structure calculations that confirmed the polycondensation occurred through the second and seventh positions of the carbazole unit rather than the fourth and fifth positions confirmed by first-principles calculations. Our CzT-CMOP exhibited high thermal stability of approximately 463.5 °C and a relatively high Brunauer–Emmett–Teller surface area of 615 m2 g−1 with a nonlocal density functional theory’s pore size and volume of 0.48 cm3 g−1 and 1.66 nm, respectively. In addition, the synthesized CzT-CMOP displayed redox activity due to the existence of a redox-active carbazole in the polymer skeleton. CzT-CMOP revealed high electrochemical performance when used as active-electrode material in a three-electrode supercapacitor with an aqueous electrolyte of 6 M KOH, and it showed specific capacitance of 240 F g−1 at a current density of 0.5 A g−1 with excellent stability after 2000 cycles of 97% capacitance retention. Accordingly, such porous organic polymer appears to have a variety of uses in energy-related applications

Unsteady MHD Mixed Convection Flow of Non-Newtonian Casson Hybrid Nanofluid in the Stagnation Zone of Sphere Spinning Impulsively

In the present analysis, an unsteady MHD mixed convection flow is scrutinized for a non-Newtonian Casson hybrid nanofluid in the stagnation zone of a rotating sphere, resulting from the impulsive motion of the angular velocity of the sphere and the velocity of the free stream. A set of linearized equations is derived from the governing ones, and these differential equations are solved numerically using the hybrid linearization–differential quadrature method. The surface shear stresses in the x- and y-directions and the surface heat transfer rate are improved due to the Casson βo, mixed convection α, rotation γ and magnetic field M parameters. In addition, as nanoparticles, the solid volume fraction (parameter ϕ) increases, and the surface shear stresses and the rate of heat transfer are raised. A comparison between earlier published data and the present numerical computations is presented for the limiting cases, which are noted to be in very good agreement

π-Electron-Extended Triazine-Based Covalent Organic Framework as Photocatalyst for Organic Pollution Degradation and H₂ Production from Water

Herein, we report the efficient preparation of π-electron-extended triazine-based covalent organic framework (TFP-TPTPh COF) for photocatalysis and adsorption of the rhodamine B (RhB) dye molecule, as well as for photocatalytic hydrogen generation from water. The resultant TFP-TPTPh COF exhibited remarkable porosity, excellent crystallinity, high surface area of 724 m2 g−1, and massive thermal stability with a char yield of 63.41%. The TFP-TPTPh COF demonstrated an excellent removal efficiency of RhB from water in 60 min when used as an adsorbent, and its maximum adsorption capacity (Qm) of 480 mg g−1 is among the highest Qm values for porous polymers ever to be recorded. In addition, the TFP-TPTPh COF showed a remarkable photocatalytic degradation of RhB dye molecules with a reaction rate constant of 4.1 × 10−2 min−1 and an efficiency of 97.02% under ultraviolet–visible light irradiation. Furthermore, without additional co-catalysts, the TFP-TPTPh COF displayed an excellent photocatalytic capacity for reducing water to generate H2 with a hydrogen evolution rate (HER) of 2712 μmol g−1 h−1. This highly active COF-based photocatalyst appears to be a useful material for dye removal from water, as well as solar energy processing and conversion

High-Molecular-Weight PLA-b-PEO-b-PLA Triblock Copolymer Templated Large Mesoporous Carbons for Supercapacitors and CO2 Capture

High-molecular-weight PLA(440)-b-PEO454-b-PLA(440) (LEL) triblock copolymer was synthesized through simple ring-opening polymerization (ROP) by using the commercial homopolymer HO-PEO454-OH as the macro-initiator. The material acted as a single template to prepare the large mesoporous carbons by using resol-type phenolic resin as a carbon source. Self-assembled structures of phenolic/LEL blends mediated by hydrogen bonding interaction were determined by FTIR and SAXS analyses. Through thermal curing and carbonization procedures, large mesoporous carbons (>50 nm) with a cylindrical structure and high surface area (>600 m(2)/g) were obtained because the OH units of phenolics prefer to interact with PEO block rather than PLA block, as determined by FTIR spectroscopy. Furthermore, higher CO2 capture and good energy storage performance were observed for this large mesoporous carbon, confirming that the proposed approach provides an easy method for the preparation of large mesoporous materials

Hollow microspherical and microtubular [3 + 3] carbazole-based covalent organic frameworks and their gas and energy storage applications

Covalent organic frameworks (COFs) are a family of crystalline porous networks having applications in various fields, including gas and energy storage. Despite respectable progress in the synthesis of such crystalline materials, examples of the use of template-free methods to construct COFs having hollow nano-and microstructures are rare. Furthermore, all reported methods for synthesizing these hollow structural COFs have involved [4 + 2] and [3 + 2] condensations. Herein, we report the synthesis of hollow microspherical and microtubular carbazole-based COFs through template-free, one-pot, [3 + 3] condensations of the novel triamine 9-(4-aminophenyl)-carbazole-3,6-diamine (Car-3NH(2)) and triformyl linkers with various degrees of planarity. Depending upon the monomer's planarity, a unique morphological variety was observed. A time-dependent study revealed that each COF formed through an individual mechanism depended on the degree of planarity of the triformyl linker; it also confirmed that the hollow structures of these COFs formed through inside-out Ostwald ripening. Our COFs exhibited high Brunauer-Emmett-Teller surface areas (up to ca. 1400 m(2) g(-1)), excellent crystallinity, and high thermal stability. Moreover, the CO2 uptake capacities of these COFs were excellent: up to 61 and 123 mg g(-1) at 298 and 273 K, respectively. The high surface areas facilitated greater numbers of strong interactions with CO2 molecules, leading to high CO2 uptake capacities. Moreover, the prepared COFs exhibited redox activity because of their redox-active triphenylamine and pyridine groups, which can be utilized in electrochemical energy storages. Accordingly, such hollow COFs having high surface areas appear to be useful materials for industrial and biological applications