IPN based hydrogels for in-vivo wound dressings; catalytic wound healing dynamics and isothermal adsorption models.

Interpenetrating network (IPN) methacrylated chitosan or methacrylated flaxseed gum based hydrogels have been utilized to make outstanding in-vivo wound dressings. The photopolymerization process was accomplished in presence of Eosin-Y photoinitiator with average exposure time of 13-14 s for gelation. Spectroscopic structural investigations of 1H NMR. ATR-FTIR, TGA, and AFM techniques were used. In-vitro hemolysis test provided evidence of no cytotoxicity in both hydrogels observed. The in-vivo wound dressings were monitored for five mice coated with each hydrogel and another uncoated five mice for control (self-healing). All measurements were performed in quintuplicate (n = 5) and expressed as mean ± SD values. In wound healing dynamics, our data confirmed that wound healing pass through two stages; hemostasis and inflammation for stage 1, and proliferation and remodeling for stage 2. It also provided evidence of 1st order kinetics with descending rate of healing. Consequently, catalytic role of hydrogels in wound healing was checked via half-life (δ) and negative change of activation energy values (ΔEa). Various isothermal adsorption models demonstrated spontaneous and high binding affinities of hydrogels. It also confirmed the two-stage healing process in presence of hydrogels. Conclusively, the outstanding properties of the two hydrogels suggest their potential applications in treating venous ulcers and diabetic wound healing dressings.

Managing misdiagnosed gingival squamous cell carcinoma (GSCC) with occult symptoms: A report of two cases.

INTRODUCTION: importance: Gingival squamous cell carcinoma (GSCC) is a rare neoplasm. GSCC has nonspecific features which commonly misdiagnosed with a simple toothache. CASE PRESENTATION: These are two cases; the first one describes a 62-year-old female who presented with pain in her right posterior mandibular teeth, and she was misdiagnosed with periodontal disease, but later histopathological tests confirmed gingival squamous cell carcinoma (GSCC). Consequently, the patient underwent surgery, and the gingival tumor was totally resected. Afterward, the patient was receiving chemotherapy, and the radiotherapy was postponed until the chemotherapy completion.The second case is of a 58-year-old female who presented with pain in her mandibular incisors, and she developed a dermal fistula on her chin and therefore underwent several gingival curettages. The following histopathologic tests confirmed GSCC so she underwent surgery, after the surgery it was planned to give her chemotherapy. CLINICAL DISCUSSION: GSCC is a rare neoplasm with a 6% incidence of all oral malignancies. GSCC is a very challenging cancer for a physician or a pathologist to diagnose because GSCC usually mimics the characteristics of a large variety of diseases and abnormalities. Unlike oral neoplasms, GSCC has the least association with smoking. This may lead to make mistakes in the treatment or misdiagnose it until the late-stage of GSCC. CONCLUSION: Despite the rare incidence of Gingival squamous cell carcinoma (GSCC), clinicians should consider GSCC while investigating any localized lesion with nonspecific oral symptoms.

"Is there a doctor on board?": willingness and confidence of physicians in the Kingdom of Saudi Arabia in assisting with in-flight medical emergencies.

BACKGROUND: In-flight medical emergencies (IMEs) are common, and for a traveling physician, it is very likely to encounter such a condition. Data discussing this issue are limited. Thus, this study aimed to evaluate the willingness and confidence of physicians in the Kingdom of Saudi Arabia (KSA) in responding to IMEs. As well as, to assess the associated sociodemographic, occupational, and travel-related factors, and their previous experience with such events. METHODS: This cross-sectional, online-based, study was conducted among all physicians in KSA during January 2021. The self-administered questionnaire included questions on sociodemographic, occupational, travel profiles, willingness and confidence towards IMEs. Chi-Squared or Fisher's Exact test were used for bivariate analysis followed by the multivariable binary logistic regression analysis. RESULTS: A total of 4558 physicians participated in the study. About one-third of participants reported one or more IME incidents, and the vast majority of them provided assistance. Cardiovascular diseases were the most common IMEs. About half of the participating physicians are concerned about the medico-legal consequences of providing assistance with such a condition. Among all specialties, emergency physicians reported the highest willingness and confidence toward IMEs. Predictors for a physician's willingness to assist in IMEs were being male, having been involved in a previous IME situation, attended life support and IME courses, frequent traveling, and practicing medicine in the Central region of Saudi Arabia. CONCLUSION: Findings from the current study stressed the need for establishing standardized guidelines about the roles of healthcare workers and the legal consequences of providing medical assessment in IMEs. Moreover, training programs on IMEs to all physicians, especially those who deal with a variety of cases during their practice such as internal medicine and family medicine are also suggested.

Basrah Preliminary Experience With COVID-19: A Report on 6404 Patients.

BACKGROUND: The first case of coronavirus disease 2019 (COVID-19) reported in Basrah was in early March 2020. This study aimed at assessing some of the characteristics of patients with COVID-19 in Basrah during the period from March 4th to September 8th, 2020. METHODS: Retrospective analysis of the University of Basrah database on COVID-19. All patients with positive COVID-19 reverse transcription polymerase chain reaction (RT-PCR) test during the study period were enrolled. RESULTS: Of 6404 patients included (males 54.8% and females 45.2%), healthcare workers constituted 11.4%. Physicians represented 16.1% of health care workers. The mean age was 39±16.7 years, those aged 61 years or more constituted 9.8%. The case fatality rate was 3% (males 55.2% and females 44.8%). No deaths were reported in adolescents or children. The highest death rate was among those aged 61 years or more. CONCLUSION: The situation of COVID-19 infection in Basrah, Iraq is evolving similar to other countries. Studies are needed to assess the influence of associated comorbidities, results of treatment regimens used and variables associated with high mortality.

Ultimate Eradication of the Ciprofloxacin Antibiotic from the Ecosystem by Nanohybrid GO/O-CNTs.

Eradication of pharmaceutical drugs from the global ecosystem has received remarkable attention due to the extensive horrible consequences on the human immunological system and the high rate of human deaths. The urgent need for drug eradication became the dominant priority for many research institutions worldwide due to the sharp increase of antimicrobial resistance (AMR) in the human body, which inhibits drug effectiveness and leads ultimately to death. Nanohybrid GO/O-CNTs was fabricated from graphene oxide (GO) cross-linked via calcium ions (Ca2+) with oxidized carbon nanotubes (O-CNTs) to eradicate the well-known ciprofloxacin antibiotic drug from aqueous solutions. The ciprofloxacin drug is medically prescribed in millions of medical prescriptions every year and typically exists in domestic and wastewaters. Characterization of the nanohybrid GO/O-CNTs was carried out through spectroscopic (Fourier Transform Infrared (FTIR) and X-ray diffraction (XRD)), thermal (Thermogravimetric analysis (TGA) and derivative thermogravimetry (DTG)), and microscopic (scanning electron microscopy (SEM)) techniques. Optimum parameters for the drug eradication process from aqueous solutions were verified and selected as follows: contact time = 4 h, pH = 6.0, temperature = 290 K, %CaCl2 = 0.5%, GO/O-CNT ratio = 4:1, and adsorbent mass = 1.0 mg. The equilibrium data were fitted to different adsorption isotherms, and the Langmuir isotherm provided the best fit to our data. Dynamic studies demonstrated a pseudo-second-order removal process for the ciprofloxacin drug, and thermodynamic parameters confirmed exothermic drug adsorption (-27.07 kJ/mol) as well as a physisorption process. For the sake of fighting against the generated AMR, our working strategy demonstrated a removal efficiency of 99.2% of the ciprofloxacin drug and drug uptake as high as 512 mg/g.

Use of nanohybrid nanomaterials in water treatment: highly efficient removal of ranitidine.

Entire elimination of pharmaceutical drugs from waste- and domestic-waters has attracted great attention due to their potent adverse effects on human health, particularly the human immune system. Many risks have been related to the presence of different types of drugs at different concentrations in wastewater. These risks include antimicrobial resistance (AMR), endocrine action, hormonal activation of cancers, and photodegradation of drugs. In this study, new nanohybrid materials consisting of graphene oxide (GO) and oxidized carbon nanotubes (OCNTs) were developed to remove a well-known drug, namely, ranitidine that treats stomach ulcers and gastrointestinal (GI) reflux disease from aqueous solutions. The characterization of synthesized nanohybrid GO-OCNTs was performed using spectroscopic (FTIR, and XRD), thermogravimetric (TGA) and microscopic (SEM) techniques. Batch adsorption experiments were used to investigate the technical feasibility of using synthesized GO-OCNTs for the removal of ranitidine from aqueous solutions. The effects of different operating conditions such as contact time, nanohybrid mass, solution temperature, solution pH, % crosslinking agent, and GO-to-OCNT ratio on the entire elimination of ranitidine were investigated. The experimental results indicated that the removal of ranitidine was very efficient, where 98.3% removal of the drug from aqueous solutions was achieved with a drug uptake of 97.8 mg g-1. Moreover, the results indicated the optimum conditions for the removal of ranitidine, which are as follows: contact time = 140 minutes, nanohybrid GO-OCNT mass = 10 mg, solution temperature = 290 K, solution pH = 6.4, % crosslinking agent = 0.5%, and GO to O-CNT ratio = 1 : 4. The equilibrium data were fitted to different adsorption isotherms and Langmuir was found to best describe our data. Dynamic studies demonstrated that ranitidine adsorption followed pseudo-second order, and the thermodynamic parameters confirmed exothermic drug adsorption as well as the physisorption process.

Interpenetrating network gelatin methacryloyl (GelMA) and pectin-g-PCL hydrogels with tunable properties for tissue engineering.

The design of new hydrogel-based biomaterials with tunable physical and biological properties is essential for the advancement of applications related to tissue engineering and regenerative medicine. For instance, interpenetrating polymer network (IPN) and semi-IPN hydrogels have been widely explored to engineer functional tissues due to their characteristic microstructural and mechanical properties. Here, we engineered IPN and semi-IPN hydrogels comprised of a tough pectin grafted polycaprolactone (pectin-g-PCL) component to provide mechanical stability, and a highly cytocompatible gelatin methacryloyl (GelMA) component to support cellular growth and proliferation. IPN hydrogels were formed by calcium ion (Ca2+)-crosslinking of pectin-g-PCL chains, followed by photocrosslinking of the GelMA precursor. Conversely, semi-IPN networks were formed by photocrosslinking of the pectin-g-PCL and GelMA mixture, in the absence of Ca2+ crosslinking. IPN and semi-IPN hydrogels synthesized with varying ratios of pectin-g-PCL to GelMA, with and without Ca2+-crosslinking, exhibited a broad range of mechanical properties. For semi-IPN hydrogels, the aggregation of microcrystalline cores led to formation of hydrogels with compressive moduli ranging from 3.1 to 10.4 kPa. For IPN hydrogels, the mechanistic optimization of pectin-g-PCL, GelMA, and Ca2+ concentrations resulted in hydrogels with comparatively higher compressive modulus, in the range of 39 kPa-5029 kPa. Our results also showed that IPN hydrogels were cytocompatible in vitro and could support the growth of three-dimensionally (3D) encapsulated MC3T3-E1 preosteoblasts in vitro. The simplicity, technical feasibility, low cost, tunable mechanical properties, and cytocompatibility of the engineered semi-IPN and IPN hydrogels highlight their potential for different tissue engineering and biomedical applications.

Engineering a sprayable and elastic hydrogel adhesive with antimicrobial properties for wound healing.

Hydrogel-based bioadhesives have emerged as alternatives for sutureless wound closure, since they can mimic the composition and physicochemical properties of the extracellular matrix. However, they are often associated with poor mechanical properties, low adhesion to native tissues, and lack of antimicrobial properties. Herein, a new sprayable, elastic, and biocompatible composite hydrogel, with broad-spectrum antimicrobial activity, for the treatment of chronic wounds is reported. The composite hydrogels were engineered using two ECM-derived biopolymers, gelatin methacryloyl (GelMA) and methacryloyl-substituted recombinant human tropoelastin (MeTro). MeTro/GelMA composite hydrogel adhesives were formed via visible light-induced crosslinking. Additionally, the antimicrobial peptide Tet213 was conjugated to the hydrogels, instilling antimicrobial activity against Gram (+) and (-) bacteria. The physical properties (e.g. porosity, degradability, swellability, mechanical, and adhesive properties) of the engineered hydrogel could be fine-tuned by varying the ratio of MeTro/GelMA and the final polymer concentration. The hydrogels supported in vitro mammalian cellular growth in both two-dimensional and three dimensional cultures. The subcutaneous implantation of the hydrogels in rats confirmed their biocompatibility and biodegradation in vivo. The engineered MeTro/GelMA-Tet213 hydrogels can be used for sutureless wound closure strategies to prevent infection and promote healing of chronic wounds.

Dissolution enhancement of curcumin via curcumin-prebiotic inulin nanoparticles.

Dissolution enhancement of curcumin via prebiotic inulin designed to orally deliver poorly water-soluble curcumin at duodenum low acidity (pH 5.5) was investigated. Different prebiotic inulin-curcumin nanoparticles were synthesized in ethanol-water binary system at different pre-adjusted pH values. Characterization via FTIR, XRD and TGA revealed the formation of curcumin-inulin conjugates, whereas surface morphology via SEM and TEM techniques implied the formation of nanoparticle beads and nanoclusters. Prebiotic inulin-curcumin nanoparticles prepared at pH 7.0 demonstrated a maximum curcumin dissolution enhancement of ≈90% with respect to 30% for curcumin alone at pH 5.5. Power law constant values were in accordance with dissolution enhancement investigations. All samples show Fickian diffusion mechanism. XRD investigations confirm that inulin maintain its crystalline structure in curcumin-inulin conjugate structure, which confirms that it can exert successfully its prebiotic role in the gastrointestinal (GI) tract. Therefore, the use of curcumin-inulin nanoparticles can perform dual-mission in the GI tract at the duodenum environment; release of 90% of curcumin followed by prebiotic activity of inulin, which will probably play a significant role in cancer therapeutics for the coming generations.

Stimuli pH-responsive (N-vinyl imidazole-co-acryloylmorpholine) hydrogels; mesoporous and nanoporous scaffolds.

Tunable mesoporosity and nanoporosity of stimuli pH-responsive (N-vinyl imidazole-ran-acryloylmorpholine) hydrogels studied in terms of %swelling at various ionic strength, pH, temperature, and crosslinker concentration values were investigated. Hydrogel properties including diffusional exponent, number of links between two crosslinks, rms end-to-end distance and mesh size of gels were evaluated. The structural sequence of the scaffolds was tested and verified using Kelen-Tudos technique, and Alfrey-Price relationship. Hydrogels were characterized using FTIR, thermogravimetric analysis, differential scanning calorimetry, and freeze-dried Scanning electron micrographs techniques. The reversible pH responsiveness and possible mesoporous and nanoporous (i.e., 0.88-4.03 nm) structures suggest their suitable candidate in membrane technology and/or is an adequate drug delivery vehicle in drug delivery systems.

Inulin and poly(acrylic acid) grafted inulin for dissolution enhancement and preliminary controlled release of poorly water-soluble Irbesartan drug.

In this article, inulin and poly(acrylic acid) grafted inulin copolymer were used to enhance the dissolution of poorly water-soluble Irbesartan drug and to control its drug release rate, respectively. Topological structure of inulin showed sleazy separable flower-like platelets and granules accumulated above each other, which adapt it to physically bind Irbesartan drug and enhance its dissolution. Consequently, the increase of inulin content in the polymeric matrix was found to increase the drug dissolution gradually until it reaches its maximum (∼90%) within the first 60 min. The release rate had followed zero-order transport mechanism. On the other hand, the poly(acrylic acid) grafted inulin copolymer, characterized using (1)H NMR, FTIR, TGA, and SEM techniques, was found to form highly consistent amorphous systems of two-dimensional surfaces with some voids topology. Such features adapted it to control Irbesartan drug dissolution (∼33%) and show Fickian diffusion mechanism.

Hemoglobin level as a risk factor for lower respiratory tract infections in Lebanese children.

BACKGROUND: Pneumonia is the biggest single cause of childhood death under the age of 5 years, and anemia affects approximately 30% of infants and children all over the world. AIM: Determination of the relationship between anemia and lower respiratory tract infection as a risk factor in Lebanese children. PATIENTS AND METHODS: A total number of two hundred infants and children aged nine months to twelve years were included; One hundred cases were hospitalized for lower respiratory tract infection in Department of Pediatrics, Makassed General Hospital, and one hundred healthy, age and sex matched controls, were selected from outpatient department. Complete blood count, iron level, ferritin level, and total iron binding capacity were taken if hemoglobin level less than eleven gram per deci-liter. In addition peripheral blood smear, chest radiograph and C-reactive protein were done to hospitalized cases. Definition of iron deficiency anemia and normal laboratory values were predetermined. RESULTS: Anemia was found in 32% of hospitalized cases and 16% of healthy controls. Mean hemoglobin level was 9.99 ± 0.62 gram per deci-liter and 11.99 ± 0.92 gram per deci-liter in anemic and non-anemic group respectively with a significant P-value of 0.001. C-reactive protein levels and number hospitalization days were similar among the anemic and non-anemic group. History of recurrent chest infections was significantly higher in both anemic group and hospitalized cases compared to non-anemic group and healthy controls. Low hemoglobin level was a risk factor for lower respiratory tract infection with a P-value of 0.008. CONCLUSION: Anemic children were two times more susceptible to lower respiratory tract infection compared to the control group, and iron deficiency anemia was predominating. Accurate diagnosis and prevention of anemia, whatever its etiology, is essential.