Removal of Cd2+ from aqueous solution by zeolite synthesized from Egyptian kaolin

Zeolite Na-Y was prepared from kaolin located in Wadi-Hagul, Suez, Egypt. The synthetic zeolite prepared by the hydrothermal reaction of kaolin was characterized by X-ray fluorescence (XRF), X-ray diffraction (XRD), scanning electron microscopy (SEM) and cation exchange capacity (CEC). Cadmium ion removal was investigated using the synthetic solution of Cd2+ ions with different concentrations at room temperature (25 °C ± 0.2), initial pH of the solution and contact times. The optimum contact time for removal of Cd2+ ion was 10 min, with 0.1g of synthetic zeolite and pH 7.57. The experimental data were correlated using Langmuir, Freundlich and Harkins-Jura adsorption isotherms. The maximum adsorption capacity Qm obtained from the Langmuir isotherm was 14.006 mg/g for Cd2+ ion. Kinetic studies reveal that synthetic zeolite is more effective as adsorbent for removing cadmium ion

Target Therapy in Neuroblastoma

Neuroblastoma is an embryonal malignancy that originates in the sympathetic nervous system. It is the most common solid tumor in infants and the most frequent extracranial solid tumor in children. Neuroblastoma accounts for 10% of childhood malignancies with 75% occurring in children <4 years. Stage, age, clinical and tumor genomic features are the principal criteria for determining treatment policy. Treatment modalities traditionally employed in the management of neuroblastoma are surgery, chemotherapy, and radiotherapy. Intensive multimodal treatment in patients with neuroblastoma has resulted in improved survival rates. However, there is a considerable percentage of patients with refractory and relapsed disease. Targeted therapy for neuroblastoma involves treatment aimed at molecular targets that have a unique expression in this childhood cancer. A large number of molecular targets have been identified for the treatment of high-risk and relapsed neuroblastoma. Treatment in this way aims at providing a more selective way to treat the disease and decreasing toxicities associated with the conventional treatment regimen

Detection of Helicobacter pylori oipA and dupA genes among dyspeptic patients with chronic gastritis

Helicobacter pylori (H. pylori): is a microbe with wide genetic diversity that infects the stomach of most people in developing countries, leading to several clinical outcomes among different individuals such as gastritis, ulcers, or gastric cancer. Outer inflammatory protein A (oipA) and duodenal ulcer promoting (dupA) genes are among the possible virulence factors which determine the patient outcome. Aim: To detect oipA and dupA genes of H. pylori among dyspeptic Egyptian patients, and to investigate their correlation with the varying degrees of the associated chronic gastritis. Methods: The study enrolled 50 patients with dyspepsia, attending the Gastrointestinal Endoscopy unit of the Gastroenterology and Tropical Departments at Ain Shams University Hospital for upper gastrointestinal endoscopy, in the period between, June and, December 2019. Four antral gastric biopsies were taken from each patient for polymerase chain reaction assay to detect the virulence genes oipA, dupA, and cagA and for histopathological assessment. Results: Forty patients were H. pylori positive by histopathology and PCR. cagA, oipA, and dupA were identified in 6 (15%), 13 (32.5%), 9 (22.5%) of biopsies, respectively. Both cagA and oipA genes were highly significantly associated with increasing the severity of gastritis. Only oipA virulence gene showed a highly significant association with gastroduodenitis. There was a highly significant moderate association between cagA and oipA genes. Conclusion: oipA could be a virulence biomarker that serves a great value in predicting the progress of gastric mucosal damage in patients with chronic gastritis, and targeting antimicrobial therapy in those patients to prevent severe gastroduodenal diseases

Localization of the position of vital anatomical structures in the lateral wall of maxillary sinus during different surgical intervention using cone beam computed tomography

Background: Proper information about the anatomy of the maxillary sinus is required to avoid any unexpected complications that may arise due to the close relation between the maxillary sinus and posterior superior alveolar artery. Objective: To the current study used cone beam computed tomography CBCT imaging to assess the position of the posterior superior alveolar artery (PSAA) in relationship to the alveolar ridge and the flour of maxillary sinus. Patients and Methods: A number of 95 Iraqi patients participated in this prospective study (53 females, 42 males; age range 20-49 years). From January 2021 to February 2022, attended a 2nd specialised dentistry institution in Baquba city for CBCT scanning for numerous diagnostic and management purposes. Results: According to our study, we detected the presences of artery in (83.68%) of the sample. females showed higher PSAA prevalence than men on both sides, and the difference was significant overall, Also, the existence of artery for each side and total in the intramembranous locating in females is greater than that in males, which may demonstrate that the probability of Bleeding and other side effects is higher in males, since the existence of artery in the intramembranous area in females will reduce the likelihood of traumatic injury throughout any surgical treatment. Conclusion: This research used CBCT to determine the precise location of PSAA in the Iraqi population. This data could assist in decreasing the likelihood of hemorrhage as well as other complications which may happen throughout any surgical treatment, such as dental implant placement, ridge expansion.As well as other surgical interventions in this region

MicroRNA-208a: a Good Diagnostic Marker and a Predictor of no-Reflow in STEMI Patients Undergoing Primary Percutaneuos Coronary Intervention

MicroRNA-208a is a cardiac specific oligo-nucleotide. We aimed at investigating the ability of microRNA-208a to diagnose myocardial infarction and predict the outcome of primary percutaneuos coronary angiography (PCI). Patients (n = 75) presented by chest pain were recruited into two groups. Group 1 (n = 40) had ST elevation myocardial infarction (STEMI) and underwent primary PCI: 21 patients had sufficient reperfusion and 19 had no-reflow. Group 2 (n = 35) had negative cardiac troponins (cTns). Plasma microRNA-208a expression was assessed using quantitative polymerase chain reaction and patients were followed for occurrence of in-hospital major adverse cardiac events (MACE). MicroRNA-208a could diagnose of MI (AUC of 0.926). After primary PCI, it was superior to cTnT in prediction of no-reflow (AUC difference of 0.231, P = 0.0233) and MACE (AUC difference of 0.367, P = 0.0053). Accordingly, circulating levels of miR-208a can be used as a diagnostic marker of MI and a predictor of no-reflow and in-hospital MACE

Disparities in prevalence and barriers to hypertension control: a systematic review

Controlling hypertension (HTN) remains a challenge, as it is affected by various factors in different settings. This study aimed to describe the disparities in the prevalence and barriers to hypertension control across countries of various income categories. Three scholarly databases—ScienceDirect, PubMed, and Google Scholar—were systematically examined using predefined search terms to identify potentially relevant studies. Original research articles published in English between 2011 and 2022 that reported the prevalence and barriers to HTN control were included. A total of 33 studies were included in this systematic review. Twenty-three studies were conducted in low and middle-income countries (LMIC), and ten studies were from high-income countries (HIC). The prevalence of hypertension control in the LMIC and HIC studies ranged from (3.8% to 50.4%) to (36.3% to 69.6%), respectively. Concerning barriers to hypertension control, patient-related barriers were the most frequently reported (n = 20), followed by medication adherence barriers (n = 10), lifestyle-related barriers (n = 8), barriers related to the affordability and accessibility of care (n = 8), awareness-related barriers (n = 7), and, finally, barriers related to prescribed pharmacotherapy (n = 6). A combination of more than one category of barriers was frequently encountered, with 59 barriers reported overall across the 33 studies. This work reported disparities in hypertension control and barriers across studies conducted in LMIC and HIC. Recognizing the multifactorial nature of the barriers to hypertension control, particularly in LMIC, is crucial in designing and implementing customized interventions

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

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

Detection of pulmonary involvement in lupus patients with and without clinical pulmonary symptoms

Background: Systemic lupus erythematosus (SLE) involves different body organs including lungs, however, there is limited information on silent pulmonary involvement in systemic lupus, so, the purpose of this study is to identify both occult and manifest pulmonary complication in patients with SLE and its correlation with disease activity parameters, and high resolution computed tomography (HRCT) findings. Method: Fifty female patients fulfilling the ACR criteria for SLE were enrolled and evaluated using chest X-ray, echocardiography (Echo), pulmonary function tests (PFT) and HRCT of the chest to find out the pulmonary involvement. Results: This study was carried out on 50 SLE female patients, 24 (48%) of them were with pulmonary manifestations and 26 (52%) of them were without pulmonary manifestations. HRCT showed abnormalities in 32 patients in contrast to chest X-ray which showed abnormalities only in 22 patients (P-value < 0.05). Mild pulmonary hypertension was found in 4 (8%) patients. Pulmonary function tests indicated that the majority of the patients (80%) presented with restrictive pattern with equal percentage of both symptomatic and asymptomatic patients. Diffusion defect was in 56% of all studied patients. Few patients showed obstructive pattern (4%). Residual volume was high in most of the patients. Conclusion: Pulmonary involvement is present in a significant number of SLE patients as detected by PFTs and HRCT, however, the majority of patients were asymptomatic. Decreased diffusing capacity of females with systemic lupus is prevalent