Rapid Green Synthesis of Metal Nanoparticles using Pomegranate Polyphenols

Plant extract could be an alternative to traditional chemical methods for the production of metallic nanomaterials in a clean, nontoxic and ecologically sound manner. In the present study, we aimed to develop a rapid ecofriendly method for the synthesis of both silver and gold nanoparticles using pomegranate peel extract (PPE). The bioactive constitutes and the potential antioxidant capacity of pomegranate (Punica granatum L.) extract seems to play a role in the production of metal nanoparticles. Biosynthesis of metal nanoparticles using PPE gives high yield of nanoparticles. The resulted nanoparticles provided high monodisperse character with an average particle size 50 nm for gold nanoparticles and 20 nm for silver nanoparticles

Directly printable compact chipless RFID tag for humidity sensing

In this letter, 8-bit paper based printable chipless tag is presented. The tag not only justifies the green electronic concept but also it is examined for sensing functionality. The compact tag structure comprises of seven L-shaped and one I-shaped dipole structure. These conducting tracks/dipole structures are of silver nano-particle based ink having a conductivity of 1.1 × 107 S/m. Each conducting track yields one bit corresponding to one peak. The tag design is optimized and analyzed for three different flexible substrates i.e. paper, Kapton® HN, and PET. The tag has ability to identify 28 = 256 objects, by using different binary combinations. The variation in length of particular conducting strip results in a shift of peak for that specific conducting track. This shift corresponds to logic state-1. The response of the tag for paper, Kapton® HN, and PET substrates is observed in the frequency band of 2.2–6.1 GHz, 2.4–6.3 GHz, and 2.5–6.5 GHz, respectively. The tag has an attractive nature because of its easy printability and usage of low-cost, flexible substrates. The tag can be deployed in various low-cost sensing applications

Role of Melatonin in Management of COVID-19: A Systematic Review

Background: the COVID-19 pandemic has significantly impacted global healthcare and economic systems. The clinical manifestation of the disease varies from flu-like symptoms to severe pneumonia and, in some cases, death. Melatonin and its metabolites play a crucial role in immunomodulation and possess anti-oxidative properties, capable of directly and indirectly scavenging reactive oxygen species. Objective: the aim of the present systematic review was to assess the effectiveness of melatonin in the management of COVID-19 patients and its role in expediting the return of patients to their baseline health. Methodology: the literature review was conducted up to August 2022, resulting in the identification of 533 articles after sorting them by authors and year of publication. Following the removal of 223 duplicate articles, 310 abstracts were screened, leading to the exclusion of 281. Subsequently, 29 full-text studies were evaluated for eligibility, with 22 being excluded. Finally, seven studies met the inclusion criteria and were included for further qualitative and quantitative analyses. Results: the findings revealed a noteworthy reduction in hospital stay among patients who received melatonin compared to those who received a placebo (standardized mean difference: -0.50, Standard error: 0.15, 95% CI: -0.80, -0.20, P value: 0.001). Melatonin was associated with a significant decrease in mortality in COVID-19 patients when compared to the placebo (Pooled RR: 0.21, 95% CI: 0.08, 0.56, P value: 0.002). However, there were no significant differences between melatonin and placebo regarding the need for hospitalization, ICU admission, artificial ventilation, and the requirement for oxygen therapy. Conclusion: melatonin may decrease the mortality rate among patients with COVID-19. Melatonin may reduce the duration of hospital stay in patients with COVID-19. Melatonin had no effect on the following outcomes in COVID-19 patients: the need for hospitalization, ICU admission, artificial ventilation and the need for oxygen therapy

Comparative Study between Intrapolyp Corticosteroid Injection and Oral Corticosteroid in Treatment of Allergic Nasal Polyposis

Background: Sino-nasal polyps can be treated medically (with systemic and local steroids) or surgically; but a lot of patients refuse surgical intervention or are contraindicated to use systemic steroids. Intra-polyp steroid injections have recently been utilized to deliver high concentrations of steroid directly into the nasal polyp while simultaneously shielding the patient from the systemic steroid side effects. Objectives: To assess the role and efficacy of intra-polyp injection of steroids in the management of allergic nasal polypi, as well as to compare these findings to those of oral steroid. Patients and methods: Our study involved sixty patients that attended the outpatient clinic of the ENT department at Qena University Hospital who diagnosed with allergic nasal polypi. Their ages ranged from 17 to 63 years. They were randomly divided into 2 groups (oral steroid and intra-polyp steroid injection) according to type of treatment, each consisting of 30 patients. Results: After treatment, both groups showed a statistically significant decrease in the Symptom Score, Polyp Score, and Lund-Mackay score (P <0.001), with a significant difference between them (P < 0.001). Conclusion: Intra-polyp injection of steroid appears to be a safe and effective treatment method for Sino- nasal polyposis, with results comparable to systemic corticosteroids

Is there a Link between Human Herpes Virus Infection and Toll-like Receptors in the Pathogenesis of Pityriasis Rosea? A Case-control Study

Human herpesvirus (HHV) 6 and 7 are involved in the pathogenesis of pityriasis rosea (PR). Our aim was to evaluate the role of the innate immune response in PR through the detection of Toll-like receptors (TLR) 2, 3, 4, 7, 8, and 9 expression in the skin of affected patients and to detect the possibility of being induced by HHV-6 and/or HHV-7 viral coexistence in these patients. Twenty-four patients with PR and 24 healthy controls were included in this case-control study. Biopsy was obtained from the PR lesion and from the healthy skin of controls for detection of HHV-6 and 7 as well as TLRs 2, 3, 4, 7, 8, and 9 gene expression using real-time polymerase chain reaction (PCR). Significantly elevated expression of all studied TLRs and significantly higher viral load of HHV-6 and 7 in PR cases were detected. A significant higher expression of TLR2 and 4 in HHV-7 positive cases and a significant positive correlation between TLR9 and HHV-7 viral load were documented. HHV6 and 7 may also be involved in the pathogenesis of PR via TLR pathways  </p

Role of Melatonin in Management of COVID-19: A Systematic Review

Background: the COVID-19 pandemic has significantly impacted global healthcare and economic systems. The clinical manifestation of the disease varies from flu-like symptoms to severe pneumonia and, in some cases, death. Melatonin and its metabolites play a crucial role in immunomodulation and possess anti-oxidative properties, capable of directly and indirectly scavenging reactive oxygen species. Objective: the aim of the present systematic review was to assess the effectiveness of melatonin in the management of COVID-19 patients and its role in expediting the return of patients to their baseline health. Methodology: the literature review was conducted up to August 2022, resulting in the identification of 533 articles after sorting them by authors and year of publication. Following the removal of 223 duplicate articles, 310 abstracts were screened, leading to the exclusion of 281. Subsequently, 29 full-text studies were evaluated for eligibility, with 22 being excluded. Finally, seven studies met the inclusion criteria and were included for further qualitative and quantitative analyses. Results: the findings revealed a noteworthy reduction in hospital stay among patients who received melatonin compared to those who received a placebo (standardized mean difference: -0.50, Standard error: 0.15, 95% CI: -0.80, -0.20, P value: 0.001). Melatonin was associated with a significant decrease in mortality in COVID-19 patients when compared to the placebo (Pooled RR: 0.21, 95% CI: 0.08, 0.56, P value: 0.002). However, there were no significant differences between melatonin and placebo regarding the need for hospitalization, ICU admission, artificial ventilation, and the requirement for oxygen therapy. Conclusion: melatonin may decrease the mortality rate among patients with COVID-19. Melatonin may reduce the duration of hospital stay in patients with COVID-19. Melatonin had no effect on the following outcomes in COVID-19 patients: the need for hospitalization, ICU admission, artificial ventilation and the need for oxygen therapy

Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background Regularly updated data on stroke and its pathological types, including data on their incidence, prevalence, mortality, disability, risk factors, and epidemiological trends, are important for evidence-based stroke care planning and resource allocation. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) aims to provide a standardised and comprehensive measurement of these metrics at global, regional, and national levels. Methods We applied GBD 2019 analytical tools to calculate stroke incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and the population attributable fraction (PAF) of DALYs (with corresponding 95% uncertainty intervals [UIs]) associated with 19 risk factors, for 204 countries and territories from 1990 to 2019. These estimates were provided for ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage, and all strokes combined, and stratified by sex, age group, and World Bank country income level. Findings In 2019, there were 12·2 million (95% UI 11·0–13·6) incident cases of stroke, 101 million (93·2–111) prevalent cases of stroke, 143 million (133–153) DALYs due to stroke, and 6·55 million (6·00–7·02) deaths from stroke. Globally, stroke remained the second-leading cause of death (11·6% [10·8–12·2] of total deaths) and the third-leading cause of death and disability combined (5·7% [5·1–6·2] of total DALYs) in 2019. From 1990 to 2019, the absolute number of incident strokes increased by 70·0% (67·0–73·0), prevalent strokes increased by 85·0% (83·0–88·0), deaths from stroke increased by 43·0% (31·0–55·0), and DALYs due to stroke increased by 32·0% (22·0–42·0). During the same period, age-standardised rates of stroke incidence decreased by 17·0% (15·0–18·0), mortality decreased by 36·0% (31·0–42·0), prevalence decreased by 6·0% (5·0–7·0), and DALYs decreased by 36·0% (31·0–42·0). However, among people younger than 70 years, prevalence rates increased by 22·0% (21·0–24·0) and incidence rates increased by 15·0% (12·0–18·0). In 2019, the age-standardised stroke-related mortality rate was 3·6 (3·5–3·8) times higher in the World Bank low-income group than in the World Bank high-income group, and the age-standardised stroke-related DALY rate was 3·7 (3·5–3·9) times higher in the low-income group than the high-income group. Ischaemic stroke constituted 62·4% of all incident strokes in 2019 (7·63 million [6·57–8·96]), while intracerebral haemorrhage constituted 27·9% (3·41 million [2·97–3·91]) and subarachnoid haemorrhage constituted 9·7% (1·18 million [1·01–1·39]). In 2019, the five leading risk factors for stroke were high systolic blood pressure (contributing to 79·6 million [67·7–90·8] DALYs or 55·5% [48·2–62·0] of total stroke DALYs), high body-mass index (34·9 million [22·3–48·6] DALYs or 24·3% [15·7–33·2]), high fasting plasma glucose (28·9 million [19·8–41·5] DALYs or 20·2% [13·8–29·1]), ambient particulate matter pollution (28·7 million [23·4–33·4] DALYs or 20·1% [16·6–23·0]), and smoking (25·3 million [22·6–28·2] DALYs or 17·6% [16·4–19·0]). Interpretation The annual number of strokes and deaths due to stroke increased substantially from 1990 to 2019, despite substantial reductions in age-standardised rates, particularly among people older than 70 years. The highest age-standardised stroke-related mortality and DALY rates were in the World Bank low-income group. The fastest-growing risk factor for stroke between 1990 and 2019 was high body-mass index. Without urgent implementation of effective primary prevention strategies, the stroke burden will probably continue to grow across the world, particularly in low-income countries.publishedVersio

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

Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019

Background Regularly updated data on stroke and its pathological types, including data on their incidence, prevalence, mortality, disability, risk factors, and epidemiological trends, are important for evidence-based stroke care planning and resource allocation. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) aims to provide a standardised and comprehensive measurement of these metrics at global, regional, and national levels. Methods We applied GBD 2019 analytical tools to calculate stroke incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and the population attributable fraction (PAF) of DALYs (with corresponding 95% uncertainty intervals UIs]) associated with 19 risk factors, for 204 countries and territories from 1990 to 2019. These estimates were provided for ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage, and all strokes combined, and stratified by sex, age group, and World Bank country income level. Findings In 2019, there were 12.2 million (95% UI 11.0-13.6) incident cases of stroke, 101 million (93.2-111) prevalent cases of stroke, 143 million (133-153) DALYs due to stroke, and 6.55 million (6.00-7.02) deaths from stroke. Globally, stroke remained the second-leading cause of death (11.6% 10.8-12.2] of total deaths) and the third-leading cause of death and disability combined (5.7% 5.1-6.2] of total DALYs) in 2019. From 1990 to 2019, the absolute number of incident strokes increased by 70.0% (67.0-73.0), prevalent strokes increased by 85.0% (83.0-88.0), deaths from stroke increased by 43.0% (31.0-55.0), and DALYs due to stroke increased by 32.0% (22.0-42.0). During the same period, age-standardised rates of stroke incidence decreased by 17.0% (15.0-18.0), mortality decreased by 36.0% (31.0-42.0), prevalence decreased by 6.0% (5.0-7.0), and DALYs decreased by 36.0% (31.0-42.0). However, among people younger than 70 years, prevalence rates increased by 22.0% (21.0-24.0) and incidence rates increased by 15.0% (12.0-18.0). In 2019, the age-standardised stroke-related mortality rate was 3.6 (3.5-3.8) times higher in the World Bank low-income group than in the World Bank high-income group, and the age-standardised stroke-related DALY rate was 3.7 (3.5-3.9) times higher in the low-income group than the high-income group. Ischaemic stroke constituted 62.4% of all incident strokes in 2019 (7.63 million 6.57-8.96]), while intracerebral haemorrhage constituted 27.9% (3.41 million 2.97-3.91]) and subarachnoid haemorrhage constituted 9.7% (1.18 million 1.01-1.39]). In 2019, the five leading risk factors for stroke were high systolic blood pressure (contributing to 79.6 million 67.7-90.8] DALYs or 55.5% 48.2-62.0] of total stroke DALYs), high body-mass index (34.9 million 22.3-48.6] DALYs or 24.3% 15.7-33.2]), high fasting plasma glucose (28.9 million 19.8-41.5] DALYs or 20.2% 13.8-29.1]), ambient particulate matter pollution (28.7 million 23.4-33.4] DALYs or 20.1% 16.6-23.0]), and smoking (25.3 million 22.6-28.2] DALYs or 17.6% 16.4-19.0]). Interpretation The annual number of strokes and deaths due to stroke increased substantially from 1990 to 2019, despite substantial reductions in age-standardised rates, particularly among people older than 70 years. The highest age-standardised stroke-related mortality and DALY rates were in the World Bank low-income group. The fastest-growing risk factor for stroke between 1990 and 2019 was high body-mass index. Without urgent implementation of effective primary prevention strategies, the stroke burden will probably continue to grow across the world, particularly in low-income countries