Competency level and determinants among infection prevention and control staff in the Middle East and North Africa region.

BACKGROUND: Competency of the staff working in infection prevention and control (IPC) is the cornerstone of successful IPC programs. The objective was to assess competency level and associated factors among IPC staff working in the Middle East and North Africa (MENA) region. METHODS: A cross-sectional study was carried out in 2019 among active IPC staff who were members of the Arab Countries Infection Control Network. The questionnaire covered demographic and professional characteristics of IPC staff and characteristics of work facilities and IPC programs. A competency score was created from self-perceived responses to 8 competency domains. The competency score was then transformed into 100-scale and categorized into two groups (≥ median and < median). RESULTS: A total of 176 participants completed the survey. Participants were mostly female (65.7%), and the mean age was 40.2 ± 8.3 years. The mean competency score was 61.4%. It was slightly variable between domains, being highest with preventing transmission of infection (65%) and lowest with sterilization and disinfection (59%). Higher (≥ median) competency score was associated with having CBIC certification (p < 0.001). It was also associated with facilities having IPC plan (p = 0.005), IPC committee (p = 0.049), regular meetings of IPC committee (p < 0.001), and IPC plan included communications with healthcare workers (p < 0.001). Domain-specific competency scores were significantly associated with receiving same domain-specific training (p < 0.05 for all). CONCLUSIONS: The competency levels of IPC staff in the MENA region is still suboptimal. The current finding calls for more regional and national investment in IPC staff by providing up-to-date customized educational and training opportunities.

Seroprevalences and their associated predictors of chikungunya, dengue, Japanese encephalitis and zika among forest fringe dwellers of Peninsular Malaysia.

Serological evidence has shown the presence of several mosquito-borne arbovirus infections among the inhabitants of the forest fringe areas of the tropics. Among these infections, Japanese encephalitis, dengue fever, chikungunya fever and Zika fever could be targeted for vaccination to overcome severe infection and limit the disease transmission. Seroprevalence data among this high-risk population are needed to provide an estimate of the potential cost-effectiveness of any vaccine programme targeting these infections. The present study was conducted at six indigenous people (Orang Asli) villages and FELDA (Federal Land Development Authority) settlements located at the forest fringes of Malaysia. All participants consented and provided blood samples and demographic data for the study. The blood samples were tested for the presence of antibodies against CHIKV, DENV, JEV and ZIKV individually using ELISA. Results obtained were also analysed to determine the predictors for CHIKV, DENV, JEV and ZIKV seropositivity. Among the 585 samples tested, 33.0% (N=193), 41.7% (N=244), 10.3% (N=60) and 21.0% (N=123) were positive for CHIKV IgG, DENV IgG, JEV IgG and ZIKV IgG, respectively. Approximately one-third (N=220, 37.6%) of the participants were tested negative for IgG antibodies against all four arboviruses. Age of participants and type of settlement were found to be a significant predictor for CHIKV, DENV, JEV and ZIKV seropositivity. Level of education was a significant predictor for CHIKV, DENV and ZIKV seropositivity. Gender, however, was not found to be a significant predictor for infection with any of these viruses. These findings reaffirmed the significant presence of infection involving these major arboviruses among the group of people living within the forest fringe areas of Peninsular Malaysia. Hence, any future consideration of vaccination for these infections must take into consideration the marginalized and underserved communities living at the forest fringe areas of the tropics where these infections are present.

Clinical characteristics and outcomes of COVID-19 cases admitted to adult intensive care units during the pandemic: A single center experience.

BACKGROUND: COVID-19 is the largest recorded pandemic in history. It causes several complications such as shock, pneumonia, acute respiratory distress syndrome, and organ failure. The objective was to determine COVID-19 outcomes and risk factors in the intensive care (ICU) setting. METHODS: A retrospective review of prospectively collected data was conducted. Adult patients with a positive RT-PCR test for COVID-19 admitted to ICUs of a tertiary care hospital between 2020 and 2022 were included. Patients who had severe complex trauma were excluded. The outcomes examined included ventilation use and duration, length of stay (LOS), and mortality. RESULTS: A total of 964 patients were included. The mean ( ± standard deviation, SD) age was 63.7 ± 16.9 years. The majority of the patients were males (59.0 %) and Saudi (75.7 %). Ventilation use was documented in 443 (57.1 %) patients, with a mean ( ± SD) ventilation duration of 9.7 ± 8.4 days. Death occurred in 361 (37.4 %) patients after a mean ( ± SD) of 33.3 ± 44.5 days from infection. The mean ( ± SD) LOS was 30.6 ± 54.1 days in hospital and 5.2 ± 5.4 days in ICU. Ventilation use was associated with older age, males, longer ICU LOS, mortality, and admission to medical-surgical ICU. Crude mortality use was associated with older age, longer ICU LOS, use of ventilator, shorter ventilation duration, and admission to medical-surgical or respiratory ICUs. CONCLUSIONS: COVID-19 patients admitted to adult ICUs are at high risk of death and mechanical ventilation. The crude risks of both outcomes are higher in older age and longer ICU LOS and are very variable by ICU type.

Risk of central line-associated bloodstream infections during COVID-19 pandemic in intensive care patients in a tertiary care centre in Saudi Arabia.

This retrospective study compared central line-associated bloodstream infection (CLABSI) rates per 1 000 central line days, and overall mortality before and during the COVID-19 pandemic in adult, paediatric, and neonatal ICU patients at King Abdul-Aziz Medical City-Riyadh who had a central line and were diagnosed with CLABSI according to the National Healthcare Safety Network standard definition. The study spanned between January 2018 and December 2019 (pre-pandemic), and January 2020 and December 2021 (pandemic). SARS-CoV-2 was confirmed by positive RT-PCR testing. The study included 156 CLABSI events and 46 406 central line days; 52 and 22 447 (respectively) in pre-pandemic, and 104 and 23 959 (respectively) during the pandemic. CLABSI rates increased by 2.02 per 1 000 central line days during the pandemic period (from 2.32 to 4.34, p < 0.001). Likewise, overall mortality rates increased by 0.86 per 1 000 patient days (from 0.93 to 1.79, p = 0.003). Both CLABSI rates (6.18 vs. 3.7, p = 0.006) and overall mortality (2.72 vs. 1.47, p = 0.014) were higher among COVID-19 patients compared to non-COVID-19 patients. The pandemic was associated with a substantial increase in CLABSI-associated morbidity and mortality.

Novel preventive bundle for multidrug-resistant organisms in intensive care setting; tertiary care experience.

Background: A widely-accepted standardized preventive bundle targeting multidrug-resistant organisms (MDROs) is lacking. The objective was to describe the components, implementation, compliance, and impact of a novel MDROs bundle in intensive care units (ICUs). Methods: Cohort study of surveillance activities on the components of MDROs bundle (July 2019 to June 2022) and the incidence of MDROs (April 2016 to June 2022). The implementation of MDROs bundle were preceded by ICPs-led education of the staff working in target ICUs about the importance and components of the MDROs bundle. These included the overall use of antimicrobials, appropriate environmental cleaning, appropriate contact precautions, and hand hygiene compliance. Results: During implementation, the overall use of antimicrobials was 57.8 days of therapy per 100 patient-days (44,492/76,933). It was higher in adult compared with pediatric/neonatal ICUs (p < 0.001). Appropriate environmental cleaning was 74.8% (12,409/16,582), appropriate contact precautions was 83.8% (10,467/12,497), and hand hygiene compliance was 86.9% (27,023/31,096). The three components were significantly higher in pediatric/neonatal compared with adult ICUs (p = 0.027, p < 0.001, p = 0.006, respectively). The MDROs rates per 10,000 patient-days were 71.8 before (April 2016 to June 2019) and 62.0 during (July 2019 to June 2022) the bundle implementation (858/119,565 versus 891/143,649 p = 0.002). The reduction in MDROs rates were replicated in adult (p = 0.001) but not pediatric/neonatal ICUs (p = 0.530). Conclusions: The finding of this study indicate that the implementation of the current bundle was associated with a modest decrease in MDROs rates in adult ICUs. The provided detailed definitions and methodology will facilitate its use by other healthcare facilities.

Sulfonic acid-functionalized chitosan-metal-organic framework composite for efficient and rapid conversion of fructose to 5-hydroxymethylfurfural.

In pursuit of designing a bio-based catalyst for the dehydration of biomass (i.e., fructose) to 5-hydroxymethylfurfural, a novel catalytic composite was prepared by in-situ formation of an Al-based metal-organic framework in the presence of chitosan. To enhance the acidity of the as-prepared catalyst, it was sulfonated with chlorosulfonic acid. Various characterization techniques, including XRD, XPS, FTIR, SEM/EDX, TGA, and elemental mapping analysis were applied to validate the formation of the acidic composite. Fructose dehydration conditions were also optimized using Response Surface Method (RSM) and it was found that reaction in the presence of catalyst (23 wt%) in DMSO, at 110 °C for 40 min led to the formation of HMF in 97.1%. Noteworthy, the catalyst was recyclable and stable up to five runs with a minor reduction in its activity.

Facile Cu-MOF-derived Co3O4 mesoporous-structure as a cooperative catalyst for the reduction nitroarenes and dyes.

The present study describes the environmentally friendly and cost-effective synthesis of magnetic, mesoporous structure-Co3O4 nanoparticles (m-Co3O4) utilizing almond peel as a biotemplate. This straightforward method yields a material with high surface area, as confirmed by various characterization techniques. Subsequently, the utilization of m-Co3O4, graphene oxide (GO), Cu(II)acetate (Cu), and asparagine enabled the successful synthesis of a novel magnetic MOF, namely GO-Cu-ASP-m-Co3O4 MOF. This catalyst revealed remarkable stability that could be easily recovered using a magnet for consecutive use without any significant decline in activity for eight cycles in nitro compound reduction and organic dye degradation reactions. Consequently, GO-Cu-ASP-m-Co3O4 MOF holds immense potential as a catalyst for reduction reactions, particularly in the production of valuable amines with high industrial value, as well as for the elimination of toxic-water pollutants such as organic dyes.

Sulfonic acid-functionalized k-carrageenan/Cr-based metal-organic framework: An efficient and recyclable catalyst for fructose conversion to 5-hydroxymethylfurfural.

A novel bio-based catalyst was developed by in-situ forming Chromium(III) (Cr)-based metal-organic framework, MIL-101(Cr), in the presence of k-carrageenan (k-Car) and followed by a post-synthetic modification to introduce additional -SO3H functional groups into the composite structure of k-Car/MIL-101(Cr). Different analyses were conducted to confirm the successful catalyst formation. The catalyst performance was evaluated in the solid acid catalyzed dehydration of fructose to 5-hydroxymethylfurfural. The Response Surface Method (RSM) optimization determined that employing 33 wt% of the catalyst at 105 °C for 40 min resulted in a remarkable 97.8 % yield. The catalyst demonstrated suitable recyclability, maintaining its catalytic efficiency over four cycles. Comparative studies with k-Car and the non-sulfonated composite highlighted the superior activity of the catalyst, emphasizing the synergy between the k-Car, MIL-101(Cr) and the influence of -SO3H post-functionalizing on the catalytic performance.

Clay-supported bio-based Lewis acid ionic liquid as a potent catalyst for the dehydration of fructose to 5-hydroxymthylfurfural.

Caffeine and halloysite nanoclay mineral that are bio-based compounds were utilized to synthesize a novel Lewis acid heterogeneous catalyst. To this aim, halloysite was functionalized with 2,4,6-trichloro-1,3,5-triazine and reacted with caffeine, which was then converted to ionic liquid via a reaction with ZnCl2. The catalyst was applied for promoting the dehydration of fructose to 5-hydroxymethylfurfural. To investigate the effects of the reaction variables, response surface methodology was used. The product was achieved in 98.5% in 100 min using a catalyst loading of 30 wt% at 100 °C. Moreover, the catalyst was recyclable up to six runs with slight zinc leaching. Comparison of the catalytic activity of the catalyst with that of halloysite and a control catalyst with one caffeine-based Lewis acid ionic liquid confirmed the superior activity of the former and the important role of 2,4,6-trichloro-1,3,5-triazine for increasing the number of the grafted caffeine and thus the acidic sites of the catalyst. A plausible reaction mechanism was proposed, and the activity of the catalyst for other carbohydrates was also studied. According to the results, this catalyst catalyzed the reaction of other substrates to furnish 5-hydroxymethylfurfural in low to moderate yields. According to the kinetic studies, the activation energy was estimated to be 22.85 kJ/mol.

Symptomatic MERS-CoV infection reduces the risk of future COVID-19 disease; a retrospective cohort study.

BACKGROUND: The general human immune responses similarity against different coronaviruses may reflect some degree of cross-immunity, whereby exposure to one coronavirus may confer partial immunity to another. The aim was to determine whether previous MERS-CoV infection was associated with a lower risk of subsequent COVID-19 disease and its related outcomes. METHODS: We conducted a retrospective cohort study among all patients screened for MERS-CoV at a tertiary care hospital in Saudi Arabia between 2012 and early 2020. Both MERS-CoV positive and negative patients were followed up from early 2020 to September 2021 for developing COVID-19 infection confirmed by RT-PCR testing. RESULTS: A total of 397 participants followed for an average 15 months during COVID-19 pandemic (4.9 years from MERS-CoV infection). Of the 397 participants, 93 (23.4%) were positive for MERS-CoV at baseline; 61 (65.6%) of the positive cases were symptomatic. Out of 397, 48 (12.1%) participants developed COVID-19 by the end of the follow-up period. Cox regression analysis adjusted for age, gender, and major comorbidity showed a marginally significant lower risk of COVID-19 disease (hazard ratio = 0.533, p = 0.085) and hospital admission (hazard ratio = 0.411, p = 0.061) in patients with positive MERS-CoV. Additionally, the risk of COVID-19 disease was further reduced and became significant in patients with symptomatic MERS-CoV infection (hazard ratio = 0.324, p = 0.034) and hospital admission (hazard ratio = 0.317, p = 0.042). CONCLUSIONS: The current findings may indicate a partial cross-immunity, where patients with symptomatic MERS-CoV have a lower risk of future COVID-19 infection and related hospitalization. The present results may need further examination nationally using immunity markers.

Awareness of health care workers with appropriate infection control practices related to multi-patient use of Close Loop Medication Administration device.

Background: Portable computerized devices represent a potential source of healthcare infections. The objective was to assess the knowledge, attitudes, and practices (KAP) of healthcare workers (HCWs) toward infection control practices used with Close Loop Medication Administration (CLMA) devices. Additionally, to quantify the impact of education and training on the bacterial burden on CLMA devices. Methods: The study design consisted of two steps: a cross-sectional study was conducted among HCWs working in a tertiary care center in Riyadh, Saudi Arabia. A 32-item questionnaire was used to assess KAP information. The second step was environmental samples collected from the surfaces of CLMA devices before and after implementing a multifaceted intervention. Result: A total of 325 HCWs were included in the study. The mean age was 32.6±7.4 years. The majority were females (92%) and nurses (91.3%). The overall KAP score was 74.8%, 74.2% adequate knowledge, 79.3% positive attitude, and 71.3% appropriate practices. KAP score was better (≥ median KAP score) among HCWs working in laboratory and organ transplant units (P<0.001). It was also better among those with a longer duration of work experience (P<0.001) and those who received related training (P<0.001). Approximately 75% of HCWs expressed their need for more information about CLMA. Post-interventional samples had much lower bacterial burden, with the positive rate reduced from 51.4% before intervention to 16.8% after intervention (P<0.001). Conclusions: Awareness and behavior of HCWs about appropriate infection control practices related to portable devices is still inadequate. A multifaceted intervention including education and training significantly reduces the bioburden on portable devices.

Ionothermal synthesis of magnetic N-doped porous carbon to immobilize Pd nanoparticles as an efficient nanocatalyst for the reduction of nitroaromatic compounds.

Carbon materials play important roles as catalysts or catalyst supports for reduction reactions owing to their high porosity, large specific surface area, great electron conductivity, and excellent chemical stability. In this paper, a mesoporous N-doped carbon substrate (exhibited as N-C) has been synthesized by ionothermal carbonization of glucose in the presence of histidine. The N-C substrate was modified by Fe3O4 nanoparticles (N-C/Fe3O4), and then Pd nanoparticles were stabilized on the magnetic substrate to synthesize an eco-friendly Pd catalyst with high efficiency, magnetic, reusability, recoverability, and great stability. To characterize the Pd/Fe3O4-N-C nanocatalyst, different microscopic and spectroscopic methods such as FT-IR, XRD, SEM/EDX, and TEM were applied. Moreover, Pd/Fe3O4-N-C showed high catalytic activity in reducing nitroaromatic compounds in water at ambient temperatures when NaBH4 was used as a reducing agent. The provided nanocatalyst's great catalytic durability and power can be attributed to the synergetic interaction among well-dispersed Pd nanoparticles and N-doped carbonaceous support.

Preparation of magnetic biochar functionalized by polyvinyl imidazole and palladium nanoparticles for the catalysis of nitroarenes hydrogenation and Sonogashira reaction.

Catalysts are essential materials in biotechnology, medicine, industry, and chemistry. On the other hand, recycling and using waste materials is important in economic efficiency and green chemistry. Thus, biochar was prepared from the stem and roots of the Spear Thistle to recover waste. After magnetizing the biochar, its surface was modified with polyvinyl imidazole. Finally, this modified biochar was decorated with Pd nanoparticles and used as a selective and recyclable nanocatalyst in the hydrogenation of nitroarenes and the Sonogashira reaction. The structure of this organic-inorganic nanocatalyst has been characterized by FESEM-EDS, XRD, FT-IR, TEM, and VSM techniques. In the hydrogenation reaction with the amount of 30 mg of nanocatalyst, the temperature of 50 °C in the water solvent, the reaction efficiency reached 99% for 30 min. In addition, under optimal conditions for the Sonogashira reaction: 1.0 mmol iodobenzene, 1.2 mmol phenylacetylene, 20 mg MBC-PVIm/Pd, 2 mmol K2CO3 in H2O at 50 C for 15 min, the reaction efficiency reached 95%. The recyclability of magnetic nanocatalysts was investigated and recognized this nanocatalyst can be used several times without notable loss of its activity.

Efficient oxidation of sulfides to sulfoxides catalyzed by heterogeneous Zr-containing polyoxometalate grafted on graphene oxide.

In this study, a tri-component composite named Zr/SiW12/GO was meticulously prepared through an ultrasonic-assisted method. This composite incorporates zirconium nanoparticles (Lewis acid), a negatively charged Keggin type polyoxometalate, and graphene oxide, and serves as a remarkable heterogeneous catalyst. The Keggin component plays multiple roles as reducing, encapsulating, and bridging agents, resulting in a cooperative effect among the three components that significantly enhances the catalytic activity. The catalytic performance of Zr/SiW12/GO was thoroughly investigated in the oxidation of sulfides to sulfoxides under mild conditions, employing H2O2 as the oxidant. Remarkably, this composite exhibited exceptional stability and could be effortlessly recovered and reused up to four times without any noticeable loss in its catalytic activity.

Occurrence and dietary exposure assessment of heavy metals in baby foods in the Kingdom of Saudi Arabia.

Early childhood exposure to heavy metals like arsenic (As), cadmium (Cd), and lead (Pb) through baby foods unfolds many concerns about their toxic effects on growth and health. In this study, occurrence and dietary intake of As, Cd, and Pb in stage 1 infant formula (0-6 months), stage 2 infant formula (7-12 months), cereal-based meals, and biscuits were estimated. First, the levels of As, Cd, and Pb were determined with ICP-MS, followed by the calculation of estimated daily intake (EDI), target hazard quotient (THQ), and hazard index (HI) for As and Cd, and margin of exposure (MoE) for Pb. Mean levels of As, Cd, and Pb were the highest in cereal-based meals and biscuits as 15.5-11.1, 5.18-8.76, and 35.2-53.8 µg/kg, respectively. Newborns to 6 months old infants were estimated to be the highest exposed population to Cd and Pb (0.08 and 0.36 µg/kg bw/day), while infants aged 7-12 months old were exposed the highest to As. Based on the THQ, HI, and MoE findings, the current exposure levels from the selected baby foods to As, Cd, and Pb pose low potential chronic risks to both infant age groups. This research provides a roadmap for future investigations in chemical contaminants often detected in baby foods consumed regularly by Saudi infants.

Isotope Labeling and Biochemical Assessment of Liver-Triacylglycerol in Patients with Different Levels of Histologically-Graded Liver Disease.

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) prevalence is rapidly growing, and fatty liver has been found in a quarter of the US population. Increased liver lipids, particularly those derived from the pathway of de novo lipogenesis (DNL), have been identified as a hallmark feature in individuals with high liver fat. This has led to much activity in basic science and drug development in this area. No studies to date have investigated the contribution of DNL across a spectrum of disease, although it is clear that inhibition of DNL has been shown to reduce liver fat. OBJECTIVES: The purpose of this study was to determine whether liver lipid synthesis increases across the continuum of liver injury. METHODS: Individuals (n = 49) consumed deuterated water for 10 d before their scheduled bariatric surgeries to label DNL; blood and liver tissue samples were obtained on the day of the surgery. Liver lipid concentrations were quantitated, and levels of protein and gene expression assessed. RESULTS: Increased liver DNL, measured isotopically, was significantly associated with liver fatty acid synthase protein content (R = 0.470, P = 0.003), total steatosis assessed by histology (R = 0.526, P = 0.0008), and the fraction of DNL fatty acids in plasma very low-density lipoprotein-triacylglycerol (R = 0.747, P < 0.001). Regression analysis revealed a parabolic relationship between fractional liver DNL (percent) and NAFLD activity score (R = 0.538, P = 0.0004). CONCLUSION: These data demonstrate that higher DNL is associated with early to mid stages of liver disease, and this pathway may be an effective target for the treatment of NAFLD and nonalcoholic steatohepatitis. This study was registered at clinicaltrials.gov as NCT03683589.

Evidence-Based Interventions to Reduce the Incidence of Common Multidrug-Resistant Gram-Negative Bacteria in an Adult Intensive Care Unit.

Background Multidrug-resistant Gram-negative bacteria (MDR-GNB) present a significant and escalating hazard to healthcare globally. Context-specific interventions have been implemented for the prevention and control of MDR-GNB in several healthcare facilities. The objective of this study was to implement and evaluate the effectiveness of evidence-based interventions in the incidence and dissemination of MDR-GNB. Methods This was a pre-and post-intervention study conducted in three phases at King Abdulaziz Medical City Jeddah, Saudi Arabia. During Phase-1, the data on each of the four MDR-GNB (Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Escherichia coli) were collected prospectively. Genomic fingerprinting was performed on isolates using enterobacterial repetitive intergenic consensus-polymerase chain reaction (ERIC-PCR) to determine clonality and establish a link between different strains within and between the hospital wards/units. In the second phase, targeted interventions were implemented in the adult intensive care unit (ICU) based on previously determined risk factors and included the education of healthcare workers on hand hygiene, disinfection of patients' surrounding, daily chlorhexidine baths, and disinfection rooms on discharge with hydrogen peroxide fogging after MDR-GNB patients were discharged. An antibiotic restriction protocol was simultaneously implemented as part of the hospital antibiotic stewardship program. In the third phase, the effectiveness of the interventions was evaluated by comparing the incidence rate and clonality (using ERIC-PCR genetic fingerprints) of MDR-GNB before and after the intervention. Results A significant reduction of MDR-GNB was observed in Phase-2 and Phase-3 compared with Phase-1. The mean incidence rate of MDR-GNB per 1000 patient days in Phase-1 (pre-intervention) was 11.08/1000, followed by 6.07 and 3.54/1000 in Phase-2 and Phase-3, respectively. A statistically significant reduction was observed in the incidence rate of MDR-GNB in the adult ICU (P=0.007), whereas no statistically significant decrease (P=0.419) was observed in areas other than the adult ICU. Two A. baumannii strains appear to be circulating within the ICU environment with reduced frequency in Phase-2 and Phase-3 compared to Phase-1. Conclusion  There was a significant reduction in the incidence of MDR-GNB in the adult ICU due to the successful implementation of both infection control and stewardship interventions, albeit challenging to ascertain the relative contribution of each.

Tuning the acidity of halloysite by polyionic liquid to develop an efficient catalyst for the conversion of fructose to 5-hydroxymethylfurfural.

In an attempt to prepare a low-cost and efficient acidic heterogeneous catalyst for the conversion of fructose to 5-hydroxymethylfurfural under mild reaction conditions, the acidity of halloysite was improved by covalent grafting of an acidic polyionic liquid. More precisely, halloysite was first vinyl functionalized and then polymerized with vinyl imidazole and 2-acrylamido-2-methylpropanesulfonic acid. The tangling imidazole rings were further converted to acidic ionic liquids by treating them with chlorosulfuric acid. UV-Vis spectroscopy and Hammett equation confirmed that conjugation of acid polyionic liquid resulted in the increase of the acidity of halloysite. Investigation of the efficiency of the catalyst for the synthesis of 5-hydroxymethylfurfural and optimization of reaction variables showed that 5-hydroxymethylfurfural was yielded in 97.8% after 30 min under the optimum conditions, i.e. catalyst loading of 20 wt% at 70 °C. Notably, the catalyst was highly reusable and it could be reused for at least seven reaction runs with insignificant loss of its activity. Furthermore, this catalyst could also promote the conversion of sucrose and maltose to give moderate yields of 5-hydroxymethylfurfural.

Perspectives and practices of dietitians with regards to social/mass media use during the transitions from face-to-face to telenutrition in the time of COVID-19: A cross-sectional survey in 10 Arab countries.

During the COVID-19 pandemic, most healthcare professionals switched from face-to-face clinical encounters to telehealth. This study sought to investigate the dietitians' perceptions and practices toward the use of social/mass media platforms amid the transition from face-to-face to telenutrition in the time of COVID-19. This cross-sectional study involving a convenient sample of 2,542 dietitians (mean age = 31.7 ± 9.5; females: 88.2%) was launched in 10 Arab countries between November 2020 and January 2021. Data were collected using an online self-administrated questionnaire. Study findings showed that dietitians' reliance on telenutrition increased by 11% during the pandemic, p = 0.001. Furthermore, 63.0% of them reported adopting telenutrition to cover consultation activities. Instagram was the platform that was most frequently used by 51.7% of dietitians. Dietitians shouldered new difficulties in dispelling nutrition myths during the pandemic (58.2% reported doing so vs. 51.4% pre-pandemic, p < 0.001). Compared to the pre-pandemic period, more dietitians perceived the importance of adopting tele nutrition's clinical and non-clinical services (86.9% vs. 68.0%, p = 0.001), with 76.6% being confident in this practice. In addition, 90.0% of the participants received no support from their work facilities for social media usage. Following the COVID-19 outbreak, the majority of dietitians (80.0%) observed a rise in public interest in nutrition-related topics, particularly those pertaining to healthy eating habits (p = 0.001), healthy recipes (p = 0.001), nutrition and immunity (p = 0.001), and medical nutrition therapies (p = 0.012). Time constraint was the most prevalent barrier to offering telenutrition for nutrition care (32.1%), whereas leveraging a quick and easy information exchange was the most rewarding benefit for 69.3% of the dietitians. In conclusion, to ensure a consistent provision of nutrition care delivery during the COVID-19 pandemic, dietitians working in Arab countries adopted alternative telenutrition approaches through social/mass media.