Optimal evaluation of energy yield and driving force in microbial metabolic pathway variants.

This work presents a methodology to evaluate the bioenergetic feasibility of alternative metabolic pathways for a given microbial conversion, optimising their energy yield and driving forces as a function of the concentration of metabolic intermediates. The tool, based on thermodynamic principles and multi-objective optimisation, accounts for pathway variants in terms of different electron carriers, as well as energy conservation (proton translocating) reactions within the pathway. The method also accommodates other constraints, some of them non-linear, such as the balance of conserved moieties. The approach involves the transformation of the maximum energy yield problem into a multi-objective mixed-integer linear optimisation problem which is then subsequently solved using the epsilon-constraint method, highlighting the trade-off between yield and rate in metabolic reactions. The methodology is applied to analyse several pathway alternatives occurring during propionate oxidation in anaerobic fermentation processes, as well as to the reverse TCA cycle pathway occurring during autotrophic microbial CO2 fixation. The results obtained using the developed methodology match previously reported literature and bring about insights into the studied pathways.

Comparative study between ventriculosubgaleal shunt and external ventricular drain for management of post infective hydrocephalus among pediatrics.

PURPOSE: Post infective hydrocephalus (PIH) is a type of hydrocephalus which occurs after an infection of the brain or cerebrospinal fluid (CSF). Treatment of PIH requires temporary measures such as external ventricular drain (EVD) and ventriculosubgaleal shunt (VSGS) until CSF becomes clear and ready to implement VP shunt. Limited research has been done to explore the tradeoff between these approaches particularly in pediatric PIH patients. Our study compares the complications, mortality rates, and the cost of used resources of both procedures. METHODS: A prospective study was conducted for 18 months in which we compared between VSGS and EVD for management of PIH involving 42 randomized cases with 21 patients in group A operated by VSGS and 21 patients in group B operated by EVD. RESULTS: Our results show a statistically significant difference between both groups in the duration of implementation of VSGS/EVD until resolution of infection occurs. Additionally, a higher rate of pediatric intensive care unit (PICU) admission and a longer length of hospital stay (LOS) were recorded among the EVD group. No statistically significant difference between the number of complications that happened in both despite variations in their forms. Moreover, both groups showed nearly similar mortality rates. CONCLUSION: There is no significant difference in the rate of complications between VSGS and EVD for PIH. Based on that, VSGS emerges as a favorable and cost-effective option for the management of PIH which leads to less economic burden on patients and the country's health resources, especially in developing countries.

An individual approach to intraoperative parathyroid hormone measurement during total thyroidectomy.

PURPOSE: Hypocalcemia is a common complication of thyroidectomy. Measurement of the intraoperative serum parathyroid hormone (PTH) levels became an established technique but it requires further improvements. We aimed to assess intraoperative PTH level testing results against the hypothesis that the PTH assay may be performed almost immediately after thyroid gland removal. METHODS: A retrospective cohort study. During total thyroidectomy surgery, the patients had PTH levels measured at the cutting time and again immediately after the thyroid gland is removed. Post-operatively, serial total blood calcium levels were obtained twice daily and recorded. RESULTS: Among 63 enrolled patients, 39 had multinodular goiter, 15 thyroid carcinoma, and nine had Graves' disease. The mean age was 59.8 ± 15.3 years, 43 females. The mean PTH level before surgery was 45.8 ± 22.0 pg/mL. Post-operatively, 11/63 patients developed hypocalcemia with serum calcium levels <8 mg/dL. Four patients with ≥50 % decrease in PTH concentration were normocalcemic a day after surgery and were discharged early. Four patients with ≥70 % PTH decrease were treated accordingly during prolonged hospitalization and did not suffer from permanent hypocalcemia. The cut-off value of 70 % decrease after the gland removal was able to predict postoperative hypocalcemia with a sensitivity of 100 %, specificity 82.9 %, PPV 60.0 % and NPV 100 %. CONCLUSION: Measurements of intraoperative PTH may not be performed at fixed time intervals but after 1-2 min after removal of the thyroid gland. Defining those not at risk would allow the majority of patients to be waived from post-operative blood calcium testing and safely discharged early after surgery.

Paromomycin and Miltefosine Combination as an Alternative to Treat Patients With Visceral Leishmaniasis in Eastern Africa: A Randomized, Controlled, Multicountry Trial.

BACKGROUND: This study aimed to determine whether paromomycin plus miltefosine (PM/MF) is noninferior to sodium stibogluconate plus paromomycin (SSG/PM) for treatment of primary visceral leishmaniasis in eastern Africa. METHODS: An open-label, phase 3, randomized, controlled trial was conducted in adult and pediatric patients at 7 sites in eastern Africa. Patients were randomly assigned to either 20 mg/kg paromomycin plus allometric dose of miltefosine (14 days), or 20 mg/kg sodium stibogluconate plus 15 mg/kg paromomycin (17 days). The primary endpoint was definitive cure after 6 months. RESULTS: Of 439 randomized patients, 424 completed the trial. Definitive cure at 6 months was 91.2% (155 of 170) and 91.8% (156 of 170) in the PM/MF and SSG/PM arms in primary efficacy modified intention-to-treat analysis (difference, 0.6%; 97.5% confidence interval [CI], -6.2 to 7.4), narrowly missing the noninferiority margin of 7%. In the per-protocol analysis, efficacy was 92% (149 of 162) and 91.7% (155 of 169) in the PM/MF and SSG/PM arms (difference, -0.3%; 97.5% CI, -7.0 to 6.5), demonstrating noninferiority. Treatments were well tolerated. Four of 18 serious adverse events were study drug-related, and 1 death was SSG-related. Allometric dosing ensured similar MF exposure in children (<12 years) and adults. CONCLUSIONS: PM/MF and SSG/PM efficacies were similar, and adverse drug reactions were as expected given the drugs safety profiles. With 1 less injection each day, reduced treatment duration, and no risk of SSG-associated life-threatening cardiotoxicity, PM/MF is a more patient-friendly alternative for children and adults with primary visceral leishmaniasis in eastern Africa. CLINICAL TRIALS REGISTRATION: NCT03129646.

Recent advances in food applications of phenolic-loaded micro/nanodelivery systems.

The current relevance of a healthy diet in well-being has led to a surging interest in designing novel functional food products enriched by biologically active molecules. As nature-inspired bioactive components, several lines of research have revealed the capability of polyphenolic compounds (phenolics) in the medical intervention of different ailments, i.e., tumors, cardiovascular and inflammatory diseases. Phenolics typically possess antioxidant and antibacterial properties and, due to their unique molecular structure, can offer superior platforms for designing functional products. They can protect food ingredients from oxidation and promote the physicochemical attributes of proteins and carbohydrate-based materials. Even though these properties contribute to the inherent benefits of bioactive phenolics as important functional ingredients in the food industry, the in vitro/in vivo instability, poor solubility, and low bioavailability are the main factors restricting their food/pharma applicability. Recent advances in the encapsulation realm are now offering efficient platforms to overcome these limitations. The application of encapsulation field may offer protection and controlled delivery of phenolics in food formulations. Here, we review recent advances in micro/nanoencapsulation of phenolics and highlight efficient carriers from this decade, which have been utilized successfully in food applications. Although further development of phenolic-containing formulations promises to design novel functional food formulations, and revolutionize the food industry, most of the strategies found in the scientific literature are not commercially applicable. Moreover, in vivo experiments are extremely crucial to corroborate the efficiency of such products.

Sonoprocessing: mechanisms and recent applications of power ultrasound in food.

There is a growing interest in using green technologies in the food industry. As a green processing technique, ultrasound has a great potential to be applied in many food applications. In this review, the basic mechanism of ultrasound processing technology has been discussed. Then, ultrasound technology was reviewed from the application of assisted food processing methods, such as assisted gelation, assisted freezing and thawing, assisted crystallization, and other assisted applications. Moreover, ultrasound was reviewed from the aspect of structure and property modification technology, such as modification of polysaccharides and fats. Furthermore, ultrasound was reviewed to facilitate beneficial food reactions, such as glycosylation, enzymatic cross-linking, protein hydrolyzation, fermentation, and marination. After that, ultrasound applications in the food safety sector were reviewed from the aspect of the inactivation of microbes, degradation of pesticides, and toxins, as well inactivation of some enzymes. Finally, the applications of ultrasound technology in food waste disposal and environmental protection were reviewed. Thus, some sonoprocessing technologies can be recommended for the use in the food industry on a large scale. However, there is still a need for funding research and development projects to develop more efficient ultrasound devices.

Intra-amniotic and systemic administration of methotrexate with concomitant surgical evacuation of 11 + 5 weeks cervical ectopic pregnancy: a case report.

BACKGROUND: Cervical pregnancy is a rare type of ectopic pregnancy. The management of cervical pregnancy is challenging because of the rarity of the condition, late presentation, which is associated with increased risk of failed medical treatment, and excessive post-evacuation bleeding that may require hysterectomy. There is no good evidence in the literature regarding the pharmacological management of living cervical ectopic pregnancy of more than 9 + 0 weeks of gestation, and there is no standard protocol on methotrexate doses in these cases. CASE PRESENTATION: We present this case to describe a concomitant medical and surgical management of a living 11 + 5 weeks cervical pregnancy. The initial beta-human chorionic gonadotropins (ß-hCG) serum level was 108,730 IU/L. The patient received 60 mg of methotrexate intra-amniotically followed by another dose of 60 mg of methotrexate intramuscularly 24 h later. Fetal heartbeats stopped on day 03. On day 07, the ß-hCG was 37,397 IU/L. On day 13, the patient had evacuation of the remaining products of conception with the insertion of an intracervical Foley catheter to minimize the bleeding. On day 34, the ß-hCG was negative. CONCLUSION: The concomitant use of methotrexate to induce fetal demise along with surgical evacuation may be considered in the management of advanced cervical pregnancy to avoid excessive blood loss, and ultimately hysterectomy.

The association between Helicobacter pylori and chronic otitis media with effusion.

PURPOSE: Chronic otitis media with effusion (COME) is a common condition in children and a leading cause for hearing loss and ventilation tubes (VT) insertion. Among other risk factors, it is suggested that Helicobacter pylori (H. pylori) infection may have a role in the pathogenesis of COME. Previous studies have reached different results, and therefore, there is a need for further data on the relationship between H. pylori infection and COME development in children. Our objective is to investigate the presence of H. pylori in the middle-ear fluid (MEF) from children with COME. METHODS: A Comparative cross-sectional study. Children ≤ 18 years were included. The study group included children diagnosed with COME and required VT insertion. The control group included children with acute otitis media (AOM) who required myringotomy in the emergency room. Middle-ear fluid samples were sent for both culture and bacterial identification using polymerase chain reaction (PCR) testing. RESULTS: A total of 43 children were included. Eighteen with COME (median age 4 years, IQR 3-6), and 25 with AOM (median age 1 year, IQR 1-2). All samples were cultured for H. pylori. Twenty-two samples underwent H. pylori PCR testing of them, 12 samples from children with COME, and 10 from children with AOM. All cultures and PCR tests results were negative for H. pylori. CONCLUSIONS: Our results suggest that H. pylori does not have a role in the pathogenesis of COME. Future larger studies are needed to investigate whether H. pylori has a role in the pathogenesis of COME.

The impact of eustachian tube function on intra-tympanic steroid administration.

OBJECTIVES: This study investigated the impact of eustachian tube (ET) function (ETF) on therapeutic success on candidates for intra-tympanic administration of steroids (ITAoS), due to idiopathic sudden sensorineural hearing loss (ISSNHL). METHODS: Medical chart review in two university-affiliated medical centers was performed. Included were consecutive adult patients diagnosed with unilateral ISSNHL between 2012 and 2019 who were treated with ITAoS due to incomplete or no recovery following systemic steroidal therapy. ETF was assessed by means tympanometry, before the initiation of ITAoS. The cohort was divided into an ET dysfunction group (ETD(+)) and a functioning ET group (control: ETD(-)). The audiologic response to treatment was recorded at the last follow-up. RESULTS: A total of 64 suitable patients [median (interquartile, IQR) age 49 (38-63) years] were enrolled. The ETD(+) group included 20 patients and the remaining 44 patients served as controls. Demographic and clinical parameters were not significantly different between the two groups at presentation. Hearing thresholds were improved significantly better, at frequencies 250, 500, 1, 2, 4, and 8 kHz (p = 0.001-0.040) in the ETD(+) group. CONCLUSION: ETD(+) is associated with better efficacy of ITAoS.

The impact of error of refraction and retinal nerve fiber layer thickness on cognitive functions in adults with bilateral myopia.

OBJECTIVE: Myopia is considered one of the main causes of visual impairment with increased prevalence. The main objective of this study was to evaluate and characterize cognitive impairment in adult patients with bilateral myopia, in relation to retinal nerve fiber layer (RNFL) thickness. METHODS: Forty patients with bilateral myopia aged 18-40 years, and 40 age- and gender-matched healthy controls were included in the study. For all subjects, cognitive functions were assessed by Paced Auditory Serial Addition Test (PASAT) and Paired Associate Learning test (PALT). Optical coherence tomography (OCT) was done for all included patients and controls. RESULTS: Among the myopic group, 15 patients had mild myopia, 8 patients had moderate myopia and 17 patients had high myopia. There were significant differences between patients and control groups in terms of cognitive performance and RNFL thickness. There was a significant correlation between the scores of cognitive tests and error of refraction and RNFL thickness. CONCLUSION: Adults with bilateral myopia have cognitive impairment, regarding information processing speed and episodic memory. Cognitive impairment is associated with retinal thinning and a higher degree of myopia.

An in vitro study measuring marginal gaps of inlay restorations fabricated from different CAD-CAM materials after thermocycling.

BACKGROUND: Many monolithic machined materials have been introduced and provided a suitable mechanical and physical properties for inlay restorations. However, there is shortage in the studies evaluating the marginal adaptation using these materials. PURPOSE: This study aimed to compare the effect of fabricating inlay restorations from 3 different CAD-CAM materials on marginal gaps before and after thermocycling. MATERIALS AND METHODS: Sixty human premolars were randomly divided into 3 groups (n = 20) according to the material used: (e.max CAD, Ivoclar AG, Schaan, Liechtenstein), (HC, Shofu, Koyoto, Japan) and (Brilliant Crios, Coltene, Altstätten, Switzerland) (n = 20). A scanning electron microscope (SEM) (JSM- 6510 lv, JEOL, Tokyo, JAPAN) was used to for measuring the marginal gaps after cementation of inlay restorations. The magnification was adapted to 250x. Marginal gaps were revaluated with SEM after thermocycling. The temperatures of baths were 5 and 55 °C was applied for a total of 5000 cycles. All data were statistically analyzed by using ANCOVA to demonstrate if there were any statistically significant differences between the gap measures after thermocycling of the three independent (unrelated) groups. A Bonferroni adjustmen was used to perform post hoc analysis (α = 0.05). RESULTS: Post-intervention marginal gap was statistically significantly lower in group EX (110.8 µm) which was statistically significant compared with group SF (112.5 µm) (mean difference=-1.768, P = .007) and group BR (113 µm) (mean difference=-2.272, P = .001), however, in. comparing SF and BR groups, there was no significant difference (mean difference=-0.5, P = .770). CONCLUSIONS: Thermocycling affected the marginal gaps of composite based restoration and resin-modified ceramics widely. However, it had a very small effect on glass ceramics marginal adaptation. CLINICAL IMPLICATIONS: The marginal gaps of CAD-CAM inlays varied according to material used (ceramic based, combination, or resin based). Thermocycling has a minor effect on the marginal adaptation of lithium disilicate glass-ceramic inlays, where it affected the margin of resin-modified ceramic and composite based inlays greatly. Using lithium disilicate glass-ceramic might improve the clinical longevity of inlay restored teeth.

Outcomes Of Mesh Fixation Versus Non Fixation In Laparoscopic Transabdominal Preperitoneal Inguinal Hernia Repair: A Randomized Clinical Study.

Objectives: The present study aimed to compare the results of laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair with and without mesh fixation regarding postoperative pain, recurrence, operative time, and complications. METHODS: This randomized controlled clinical trial included 100 patients who underwent TAPP inguinal hernia with mesh fixation (group A) or a fixation-free procedure (group B) for early onset inguinal hernia at the General Surgery Department, Kafrelsheikh University Hospital, from January 2021 to June 2022. RESULTS: The parameters for pain assessment (NRS) in the first week (mean 7 (5 - 8)), the first month (mean 3 (1 - 5)), and after three months(mean 0 - (70% of patients), (mean 1- (30% of patients) were significantly higher in the fixation group (p<0.001). The fixation group had significantly more operative time than non fixation, with a mean (69.34±13.55, 60.92±10.18) respectively. Recurrence rate and postoperative complications did not show any significant difference between the studied groups. CONCLUSIONS: Mesh non-fixation for laparoscopic TAPP hernia repair is safe, practical, and effective with minimal postoperative pain and no increased risk of recurrence.

Oncoplastic Volume Displacement Surgical Techniques For Early Primary Breast Cancer: A Case Series.

Oncoplastic breast surgery (OPS) is a new strategy for expanding breast-conserving surgical options, lowering mastectomies rates, and preventing deformities. OPS is based on the use of plastic surgical reconstruction after breast cancer removal. The study aims to assess volume displacement oncoplastic procedures for early primary breast cancer in terms of recurrence and cosmoses. A case series study was done on 20 patients with early breast cancer who underwent oncoplastic volume displacement techniques in the period from March 2019 to March 2021 in Kafrelsheikh University Hospital, Egypt. OPS techniques included were Racquet, Benelli, Batwing and Grisotti technique. The study concluded that OPS are oncologically safe (100%) with no recurrence and a better aesthetic outcome (90%).

Effect Of Laparoscopic Sleeve Gastrectomy On Vitamin D, Parathormone Hormone, And Serum Calcium Levels.

Objectives: To evaluate the effect of laparoscopic sleeve gastrectomy on vitamin D status, parathyroid hormone,serum calcium and the effectiveness of vitamin D supplementation. Method: The prospective study was conducted at the General Surgery Department of Kafrelsheikh University Hospital, Egypt, in November 2019, and comprised morbidly obese patients of either gender who were managed with laparoscopic sleeve gastrectomy. Serum levels of vitamin D, calcium and parathyroid hormone were assessed at baseline and at 6 and 12 months after the surgery. All subjects were given 400 IU/day of vitamin D. If the level of vitamin D was <30ng/ml, further doses of calcifediol 200,000 IU were added every two weeks. Data was analysed using SPSS 22. RESULTS: Of the 40 patients, 28(70%) were females and 12(30%) were males. The overall mean age was 33.9±10.8, mean weight was 136±18.29kg and mean body massindex was 50±4.9kg/m2 . The mean operative time was 64.5±13.6 minutes, and the mean hospitalstay was 1.8±1.1 days. There wassignificant reduction in body massindex values after the surgery (p<0.05). Vitamin D level was 19.2±3.2 ng/ml at baseline, which rose to 21.4±2.7 ng/ml at 6 months and 26.6±2.8 ng/ml at 12 months post-surgery (p<0.05). Preoperative parathyroid hormone level was 58.3±7.8 pg/ml , which went down to 48.6±7.4 pg/ml at 6 months, and 41.3±6.5 pg/ml at 12 months postoperatively (p<0.05). The mean serum calcium level at baseline was 9±0.4mg/dL, which rose to 9.2 ±0.3mg/dL and 9.5±0.4 mg/dL at 6 and 12 months post-surgery (p<0.05). CONCLUSIONS: Low vitamin D complications could be decreased postoperatively by administering vitamin D as a routine treatment. Postoperative monitoring of vitamin D, parathyroid hormone and serum calcium levels is essential.

COVID-19 and H1N1 Influenza: Are They 2 Sides of the Same Coin?

Background: Swine flu (H1N1) and Coronavirus diseases (COVID-19) have been compared in the past few months. Both pandemics sparked a worldwide major panic. Although both have some common symptoms and diagnoses, they are quite different in many aspects. The current study aimed to investigate the differences in clinical and viral behaviors between H1N1 Influenza and COVID-19 pneumonia. Methods: This was a retrospective study of adult patients hospitalized with H1N1 influenza pneumonia between January 2019 and February 2020, and patients hospitalized with COVID-19 during the outbreak. A demographic and clinical characteristic of H1N1 influenza and COVID-19 patients were recorded. Both groups were compared-using an independent samples student t test for continuous variables and a chi-square test for categorical data-to identify significantly different parameters between the 2 diseases. Results: A total of 78 patients were included and divided into 2 groups: 33 patients (42.3%) with H1N1 and 45 patients (57.7%) with COVID-19. The mean age of the patients was 43.3 ± 10.6 years. Bronchial asthma was significantly higher among patients with H1N1, while diabetes mellitus was significantly higher among patients with COVID-19. Right lower lobe affection was significantly present among those with H1N1 than those with COVID (100% vs 0%). The monocytic count was significantly higher among those with H1N1 than COVID-19 (11.63 ± 1.50 vs 7.76 ± 1.68; P < 0.001). Respiratory rates of more than 22 c/min significantly increased in patients with HINI than in those with COVID-19 (18.2% vs 4.4%; P = 0.05). Mortality increased in patients with HINI than in those with COVID-19 (18.2% vs 6.7%). However, the difference did not reach statistical significance (P = 0.15). Conclusion: Clinically, it is difficult to distinguish between H1N1 and COVID-19. Thus, a polymerase chain reaction is recommended for all patients suffering from influenza-like symptoms to rule out influenza A subtype H1N1 and/or SARS-CoV2.

Association of human leukocyte antigen DQ-rs3920AG genotype with Helicobacter pylori recurrence in Kafrelsheikh, Egypt.

AIMS: The aim was to evaluate the role of HLA-DP/DQ single-nucleotide polymorphisms (SNPs) in Helicobacter pylori infection in Kafrelsheikh governorate, Egypt. METHODS AND RESULTS: The study enrolled 120 persons; 48 naïve H. pylori-infected patients, 42 relapsers and 30 H. pylori-free controls. Gastroscopy, H. pylori stool antigen, anti-CagA and anti-VacA antibodies were determined. Genotyping of HLA-DPA1rs3077 (A/G) SNP and HLA-DQ-rs3920(A/G) SNP was done using real-time PCR. The antibody profile against H. pylori showed that 85.7% of patients with recurrent infection have IgG against CagA (p = 0.001*). There was a significant association between the occurrence of H. pylori infection and both HLA-DPA1rs3077AA and HLA-DQ-rs3920AG genotypes. Concerning H. pylori relapse, the HLA-DQ-rs3920AG genotype was detected in 78.6% of patients with recurrent infection (p = 0.002*). Patients carrying this genotype tend to be relapsers 9.8 times more than patients carrying other genotypes. CONCLUSIONS: HLA-DPA1rs3077AA and/or HLA-DQ-rs3920AG genotypes could be risk factors for the occurrence of H. pylori infection. HLA-DQ-rs3920AG genotype is markedly linked to recurrent H. pylori infection. SIGNIFICANCE AND IMPACT OF THE STUDY: Host factors as HLA gene polymorphism could be a predisposing factor for susceptibility, recurrence or chronicity of H. pylori and should be studied in different ethnic groups.

A comprehensive review on preparation, functionalization and recent applications of nanofiber membranes in wastewater treatment.

The direct discharge of significant amounts of polluted water into water bodies causes adverse ecological and human health effects. This severe deterioration in water quality creates significant challenges to meet the growing demand for clean water. Therefore, the world urgently needs environmentally friendly advanced technology to overcome this global crisis. In this regard, nanofiber-based membrane filtration is a promising technique in wastewater remediation because of their huge surface area, extremely porous structure, amenable pore size/pore size distribution, variety of material choices, and flexibility to modification with other functional materials. However, despite their unique properties, fouling, poor mechanical properties, shrinkage, and deformation are major drawbacks of nanofiber membranes for treating wastewater. This review presents a comprehensive overview of nanofiber membranes' fabrication and function in water purification applications as well as providing novel approaches to overcoming/alleviating the mentioned disadvantages. The review first presents nanofiber membrane preparation methods, focusing on electrospinning as a versatile and viable technique alongside discussing the parameters controlling nanofiber morphology. Afterward, the functionalization of nanofiber membranes by combining them with other nanomaterials, such as metal and metal-oxide nanoparticles, carbon nanotubes, metal-organic frameworks, and biomolecules, were demonstrated and discussed. In addition, nanofiber membranes functionalized with microorganisms were highlighted. Finally, we introduced and discussed in detail the most relevant and recent advances in nanofiber applications in wastewater treatment in the context of removing different pollutants (e.g., heavy metals, nutrients, radioactive elements, pharmaceuticals, and personal care products, dyes, and pesticides). Moreover, the promising antimicrobial ability of nanofiber membranes in removing microorganisms from wastewater has been fully underscored. We believe this comprehensive review could provide researchers with preliminary data and guide both researchers and producers engaged in the nanofiber membrane industry, letting them focus on the research gaps in wastewater treatment.

STRESS LEVELS REGARDING COVID-19 PANDEMIC AMONG NURSING STUDENTS AT UNIVERSITY OF SULAIMANI, KURDISTAN REGION, IRAQ.

OBJECTIVE: The aim: The study aimed to assess prevalence levels of stress among undergraduate college of nursing students at university of Sulaimani, Kurdistan Region/Iraq. PATIENTS AND METHODS: Materials and methods: A total of 60 nursing students were selected from college of nursing Sulaimani University by convenience sampling used in their cross-sectional study. The perceived stress scale (PSS-10), and socio-demographic characteristics included in the self-reported questionnaire. The period of data collection started from October 25th, 2021 to November 25th, 2021. The data analysis performed by using SPSS version 25. Ethical approval was considered. RESULTS: Results: The results of this study showed that the overall prevalence rate of stress was determined as 53.3 % of students at moderate level which was more prevalent among fresh man students within age 18-19 years old 93.4 %, while low level of stress observed among senior students within age 20-21 year old (25%) (p<0.01). The other socio-demographic factors were not associated with levels of stress. The finding indicated that 40% of the students were infected with covid-19 in last period while the pandemic is still ongoing. CONCLUSION: Conclusions: nursing students were experienced moderate to low level of stress regarding covid-19 pandemic regardless of socio-demographic characteristic, only age factor significantly associated with the variance of stress.

Visiting and Communication Policy in Intensive Care Units during COVID-19 Pandemic: A Cross-sectional Survey from South Asia and the Middle East.

Purpose: The coronavirus disease-2019 (COVID-19) pandemic had affected the visiting or communicating policies for family members. We surveyed the intensive care units (ICUs) in South Asia and the Middle East to assess the impact of the COVID-19 pandemic on visiting and communication policies. Materials and method: A web-based cross-sectional survey was used to collect data between March 22, 2021, and April 7, 2021, from healthcare professionals (HCP) working in COVID and non-COVID ICUs (one response per ICU). The topics of the questionnaire included current and pre-pandemic policies on visiting, communication, informed consent, and end-of-life care in ICUs. Results: A total of 292 ICUs (73% of COVID ICUs) from 18 countries were included in the final analysis. Most (92%) of ICUs restricted their visiting hours, and nearly one-third (32.3%) followed a "no-visitor" policy. There was a significant change in the daily visiting duration in COVID ICUs compared to the pre-pandemic times (p = 0.011). There was also a significant change (p <0.001) in the process of informed consent and end-of-life discussions during the ongoing pandemic compared to pre-pandemic times. Conclusion: Visiting and communication policies of the ICUs had significantly changed during the COVID-19 pandemic. Future studies are needed to understand the sociopsychological and medicolegal implications of revised policies. How to cite this article: Chanchalani G, Arora N, Nasa P, Sodhi K, Al Bahrani MJ, Al Tayar A, et al. Visiting and Communication Policy in Intensive Care Units during COVID-19 Pandemic: A Cross-sectional Survey from South Asia and the Middle East. Indian J Crit Care Med 2022;26(3):268-275.

Nitro-Substituted Benzaldehydes in the Generation of Azomethine Ylides and Retro-1,3-Dipolar Cycloadditions.

1,3-Dipolar cycloaddition of 2- and 3-nitrobenzaldehydes with 2-aminomethylpyridine and ethyl (2E)-2-cyano-3-(4-nitrophenyl)prop-2-enoate yielded endo-cycloadducts as the sole products under various reaction conditions. Fortuitously, 4-nitrobenzaldehyde behaved differently in three- and four-component cascades to produce a mixture of endo- and exo'-cycloadducts. This reaction is solvent- and temperature-dependent, and consequently, both the endo- and exo'-cycloadducts were synthesized in an excellent regio-, stereo-, and chemoselective fashion. Retro-1,3-dipolar cycloadditions of the endo-cycloadducts were conducted under mild reaction conditions, and the generated syn-dipoles were stereomutated into anti-dipoles which recycloadded with the dipolarophiles to provide the exo'-cycloadducts. Mechanistic studies were carried out to support the proposed mechanisms. Unprecedentedly, particular arylidene scaffolds participated as aldehyde or activated methylene precursors. Density functional theory calculations were performed to shed light on the importance of AcOH in the generation and isomerization of dipoles and to explain the high selectivity and the possibility of retro-cycloaddition.