Hot carrier relaxation dynamics of an aza-covalent organic framework during photoexcitation: An insight from ab initio quantum dynamics.

In order to develop an efficient metal-free solar energy harvester, we herein performed the electronic structure calculation, followed by the hot carrier relaxation dynamics of two dimensional (2D) aza-covalent organic framework by time domain density functional calculations in conjunction with non-adiabatic molecular dynamics (NAMD) simulation. The electronic structure calculation shows that the aza-covalent organic framework (COF) is a direct bandgap semiconductor with acute charge separation and effective optical absorption in the UV-visible region. Our study of non-adiabatic molecular dynamics simulation predicts the sufficiently prolonged electron-hole recombination process (6.8 nanoseconds) and the comparatively faster electron (22.48 ps) and hole relaxation (0.51 ps) dynamics in this two-dimensional aza-COF. According to our theoretical analysis, strong electron-phonon coupling is responsible for the rapid charge relaxation, whereas the electron-hole recombination process is slowed down by relatively weak electron-phonon coupling, relatively lower non-adiabatic coupling, and quick decoherence time. We do hope that our results of NAMD simulation on exciton relaxation dynamics will be helpful for designing photovoltaic devices based on this two dimensional aza-COF.

Assessing the modifiable and non-modifiable risk factors associated with multimorbidity in reproductive aged women in India.

BACKGROUND: Reproductive span is the foundation of every woman's health in later life. India is currently facing a growing burden of multiple morbidities among the women in their reproductive age group which may further increase over the coming decades. The purpose of the present study aimed to identify different modifiable and non-modifiable risk factors affecting multimorbidity among the women in reproductive age group in Indian context. METHODS: Secondary data were obtained from the Demography and Health Survey (DHS), conducted in India during 2019-2021. A total of 671,967 women aged 15-49 years were selected for this present study. Descriptive, association studies and multinominal logistic regression analyses were performed to accomplish the objectives. RESULTS: Currently, 6.3% of total study participant's reproductive age group women suffered from multimorbidity in India. Never consuming protein, fruits, vegetables and milk increase the chances of developing multimorbidity. Consumption of fried foods, aerated drinks and addiction towards tobacco and alcohol also has a greater influence on the prevalence of multimorbidity. The prevalence of multimorbidity is sharply increased with increasing age and Body Mass Index (BMI). Regionally, the prevalence of multimorbidity was found more among the women hailed from eastern and north-eastern India. CONCLUSION: To reduce the risk of developing multimorbidity, targeted interventions are needed in the form of educating every woman concerning the importance of having minimum health-related knowledge, maintaining healthy lifestyle, weight management and having proper and balanced diet.

Papaya peel extract-mediated green synthesis of zinc oxide nanoparticles and determination of their antioxidant, antibacterial, and photocatalytic properties.

This study describes an effective and eco-friendly approach to the synthesis of zinc oxide nanoparticles (ZnONPs) utilizing papaya fruit peel extract (PPE). The structural evaluation and morphological features of synthesized ZnONPs were examined using various physicochemical analyses. The formulated ZnONPs were spherical to hexagonal in shape with ⁓ 170 nm in diameter. ZnONPs exhibited improved antioxidant potential in terms of DPPH radical scavenging activity (IC50 = 98.74 µg/ml) and ferric-reducing potential compared with PPE. The antibacterial activity of ZnONPs was measured against pathogenic strains of Salmonella typhi, Bacillus subtilis, Staphylococcus aureus, and Escherichia coli. The biosynthesized ZnONPs showed potential antibacterial efficacy against all microbes. In addition, ZnONPs exhibited potential photocatalytic activity in rhodamine B degradation in the presence of sunlight. The results indicated that papaya peels, which are these fruit wastes, could be helpful for the green synthesis of ZnONPs with good dose-responsive antioxidant, antibacterial, and photocatalytic activities.

Formulation of silver nanoparticles using Duabanga grandiflora leaf extract and evaluation of their versatile therapeutic applications.

The current research focused on the green synthesis of silver nanoparticles (AgNPs) using Duabanga grandiflora leaf extract. The green synthesis of AgNPs was confirmed by the surface plasmon resonance band at 453 nm in a UV-Visible analysis. The formulated AgNPs had a diameter of around 99.72 nm with a spherical shape. Fourier transform infrared (FTIR) spectrum revealed the bio-reducing potential of phytochemicals present in D. grandiflora, which fundamentally influenced the synthesis of AgNPs. Zeta potential, dynamic light scattering (DLS), scanning electron microscopic (SEM), energy-dispersive X-ray spectroscopic (EDX), X-ray diffraction (XRD), and transmission electron microscopic (TEM) analyses were executed to reveal the physicochemical attributes of the AgNPs. The AgNPs were further investigated for their antioxidant, antidiabetic, anticancer, and antibacterial potential. The DPPH free radical assay revealed the potential radical scavenging capacity (IC50 = 76.73 µg/ml) of green synthesized AgNPs. α-Amylase inhibitory assay displayed significant inhibitory potential (IC50 = 162.11 µg/ml) of this starch-breaking enzyme by AgNPs, revealing the antidiabetic potential of AgNPs. AgNPs exhibited potential cytotoxic activity (IC50 = 244.57 µg/ml) against malignant human kidney cells. In addition, AgNPs showed outstanding antibacterial activity against both Gram-negative (Escherichia coli) and Gram-positive (Staphylococcus aureus) bacterial strains. Interestingly, AgNPs showed cytotoxic and antimicrobial activities at much higher concentrations than radical scavenging and α-amylase inhibitory concentrations. Thus, our finding elaborated the scope of green synthesized AgNPs for diverse therapeutic applications (dose-dependent) for further clinical translation.

A Cross-Sectional Exploratory Study of Cardiovascular Risk Biomarkers in Non-Obese Women with and without Polycystic Ovary Syndrome: Association with Vitamin D.

Vitamin D is proposed to have a protective effect against cardiovascular disease, though the mechanism is unclear. Vitamin D deficiency is common in polycystic ovary syndrome (PCOS), where it is strongly related to obesity, insulin resistance (IR) and risk of cardiovascular disease. To determine if the inherent pathophysiology of PCOS or vitamin D levels are linked to dysregulation of cardiovascular risk proteins (CVRPs), a study in non-obese women with PCOS and without IR was undertaken. Our hypothesis was that the levels of vitamin D3 and its active metabolite would be associated with CVRPs comparably in women with and without PCOS. In women with PCOS (n = 29) and controls (n = 29), 54 CVRPs were determined by Slow Off-rate Modified Aptamer (SOMA)-scan plasma protein measurement and correlated to 25-hydroxyvitamin D3 (25(OH)D3) and the active 1,25-dihydroxyvitamin D3 (1,25(OH)2D3) measured by gold standard isotope-dilution liquid chromatography tandem mass spectrometry. Women with PCOS had comparable IR and systemic inflammation (normal C-reactive protein) to control women, though had higher free androgen index and anti-Mullerian hormone levels. 25(OH)D3 and 1,25(OH)2D3 levels did not differ between groups. Nine CVRPs were higher in PCOS (p < 0.05) (Galectin-9, Brother of CDO, C-motif chemokine 3, Interleukin-18 receptor-1, Thrombopoietin, Interleukin-1 receptor antagonist protein, Programmed cell death 1 ligand-2, Low-affinity immunoglobulin gamma Fc-region receptor II-b and human growth hormone), whilst 45 CVRPs did not differ. 25(OH)D3 correlated with five CVRPs in PCOS and one in controls (p < 0.05). Despite the women with PCOS not exhibiting overt systemic inflammation, 9 of 54 CVRPs were elevated, all relating to inflammation, and 5 of these correlated with 25(OH)D3, suggesting an ongoing underlying inflammatory process in PCOS even in the absence of obesity/IR.

Symptoms, Electrolyte Disturbances and Serum Albumin Levels in Palliative Oncology Patients Admitted Through Emergency: Characteristics and Survival Outcomes.

Objectives: Our research aimed to examine the characteristics of palliative oncology patients hospitalised through an emergency to look for the symptom profile, characteristics of dyselectrolytemia and blood investigations, and possible associations with mortality. Materials and Methods: After institutional review board approval, a retrospective, observational study of patients hospitalised in our tertiary care specialty oncology hospital was undertaken. Records of hospitalised cancer patients admitted from the emergency department under palliative care from January 2019 to October 2021 were examined. As all admissions during this period were through emergency due to institution COVID-19 protocols, all elective admissions were excluded from the study. Data collected included patient characteristics, blood investigations, and comorbid history of systemic diseases and factors that could be associated with electrolyte imbalance. Results: There were 157 emergency admissions during the study period. A majority were patients with solid tumours (92.4%). Pain was the most frequent cardinal symptom, along with other symptoms (68/157) or in isolation (33/157), followed by reduced oral intake (32/157) and altered sensorium (24/157). sixty-six patients died within the hospitalisation period. On long-term follow-up, only 8 (5.1%) were surviving. Hyponatraemia (43%), Hypoalbuminaemia (66%), and altered renal function (33.1%) were prevalent. We observed a weak positive correlation between sodium levels and outcome (r = 0.199, P = 0.016) and a strong positive correlation between albumin levels and survival outcomes (r = 0.329, P = 0.000). Patients with normal albumin had a higher chance of survival (odds ratio: 33.1225, 95% confidence interval: 3.415-321.20, P = 0.003). Conclusion: Pain-reduced oral intake and altered sensorium are common emergency symptoms in oncology palliative care. Mortality is high in these patients. Hyponatraemia, hypoalbuminaemia, and deranged renal functions were commonly seen. Normal sodium and albumin levels were associated with higher chances of survival, and the association was strong for serum albumin levels. This may have prognostic utility.

Molecular insights into hereditary elliptocytosis and pyropoikilocytosis: NGS uncovers multiple potential candidate genes.

Hereditary elliptocytosis (HE) and pyropoikilocytosis (HPP) are considered a group of hemolytic anemias (HE/HPP) due to inherited abnormalities of erythrocyte membrane proteins with a worldwide distribution. Most cases are associated with molecular abnormalities linked to spectrin, band 4.1, and ankyrin. The present study aimed to identify significant molecular signatures on a target panel of 8 genes using whole exome sequencing (WES) in 9 Bahraini patients with elliptocytosis. Case selection was based on presence of anemia not associated with iron deficiency or hemoglobinopathy and demonstrating > 50% elliptocytes in blood smears. The c.779 T > C mutation of SPTA1 (Spectrin alpha), which is a known deleterious missense mutation that inhibits normal association of spectrin molecules to form tetramers, was seen in 4 patients in homozygous (n = 1) and heterozygous (n = 3) states. The αLELY abnormality in association with compound heterozygous mutations in SPTA1 was present in 5 patients (2 associated with the SPTA1 c.779 T > C variant; 3 with c.3487 T > G and various other SPTA1 mutations of uncertain/unknown significance). Seven patients had SPTB (Spectrin beta) mutations, predicted as likely benign by in silico analysis. A novel EPB41 (Erythrocyte Membrane Protein Band 4.1) mutation with potential deleterious impact was also seen. Finally, 2 cases showed an InDel (insertion-deletion mutations) abnormality in the gene that codes for the mechanosensitive ion-channel PIEZO (Piezo Type Mechanosensitive Ion Channel Component 1). PIEZO mutations are reported to cause red cell dehydration but have not been previously described in HE/HPP. Results of this study confirm the involvement of previously reported abnormalities in SPTA1 and suggest possible involvement of other candidate genes in a disorder involving polygenic interactions.

A nitrogen-rich two dimensional covalent organic framework with multiple carbonyls as a highly efficient anchoring material for lithium-sulfur batteries.

Lithium-sulfur (Li-S) batteries, as next generation energy storage systems, have gained considerable attention due to their high energy density, low cost, and environmental friendliness. However, the practical applications of Li-S batteries are presently hindered by several issues, such as the low conductivity of sulfur species, the shuttle effect of polysulfides, and poor conversion efficiency in discharging/charging processes. In this study, using density functional theory (DFT)-based computations, we propose a two dimensional (2D) covalent organic framework (COF) with triquinoxalinylene (TQ) and benzoquinone (BQ) units in its skeleton, namely, TQBQCOF, as a promising sulfur host material for high-performance Li-S batteries. We have found that the TQBQCOF is a semiconductor with a band gap of 1.16 eV. After the adsorption of LiPSs the TQBQCOF becomes metallic in nature, which ensures its excellent electronic conductivity. The moderate adsorption energies of the TQBQCOF to the soluble LiPSs can effectively suppress the shuttle effect of polysulfides. Notably, the TQBQCOF also shows high catalytic activity for the sulfur reduction reactions (SRR) in the discharge process and Li2S decomposition in the charging process of Li-S batteries. The Gibbs free energy barrier for the SRR is 0.22 eV, while the decomposition barrier of a Li2S molecule on the TQBQCOF is only 0.04 eV, ensuring the rapid charging and discharging processes of Li-S batteries.

Preparation of silver nanoparticles by Osbeckia stellata aqueous extract via green synthesis approach: Characterization and assessment of their antioxidant, antidiabetic, cytotoxicity, and antibacterial properties.

Silver nanoparticles (Ag NPs) via green synthesis using medicinal plants have been widely used in natural product research due to the economical and eco-friendly properties of NPs. The plant-derived Ag NPs biosynthesis comprises the interaction between silver nitrate (precursor) and bioactive components of plant extract (reducing agents). In this work, Ag NPs were biosynthesized using Osbeckia stellata leaves aqueous extract. Characterization of Ag NPs was done by using ultraviolet-visible absorption (UV-Vis) spectroscopy, dynamic light scattering (DLS), Fourier transform infrared spectroscopy (FTIR), X-ray powder diffraction (XRD), scanning electron microscopy (SEM), transmission electron microscopy (TEM), and energy-dispersive X-ray analysis (EDX). Further, antioxidant, antidiabetic, cytotoxicity, and antimicrobial activities were evaluated to establish the pharmacological properties of Ag NPs. UV-Vis spectroscopy and FTIR showed an absorption peak of Ag NPs due to the surface plasmonic resonance. In contrast, the particle size in the nanometer range was analyzed by XRD and DLS. The size of the particle was confirmed by the SEM, TEM, and EDX in the nanometer range. This study showed the spherical shape and crystalline nature of NPs. Zeta potential was used to determine the stability of Ag NPs. Biosynthesized Ag NPs showed significantly potent antioxidant, antidiabetic, and cytotoxicity activity. Ag NPs also showed effectiveness against gram-positive (Escherichia coli) and gram-negative (Staphylococcus aureus) bacteria in the antimicrobial activity study. The result concluded that these Ag NPs might be used in biomedical and pharmacological fields.

Impact of ultrasound-assisted extraction of polyphenols and caffeine from green tea leaves using high-performance thin-layer chromatography.

Tea is the most popular daily drink consumed globally, with a high concentration of caffeine and polyphenols. In this study, the effects of ultrasonic-assisted extraction and quantification of caffeine and polyphenols from green tea were investigated and optimized using 23 -full factorial design and high-performance thin-layer chromatography. Three parameters were optimized to maximize the concentration of caffeine and polyphenols extracted using ultrasound: crude drug-to-solvent ratio (1:10-1:5), temperature (20-40°C), and ultrasonication time (10-30 min). The optimal conditions achieved from the model for tea extraction were as follows: crude drug-to-solvent ratio, 0.199 g/ml; temperature, 39.9°C; and time, 29.9 min; the extractive value was found to be 16.8%. Images from scanning electron microscopy showed that the matrix underwent a physical alteration and cell wall disintegration, which intensified and accelerated the extraction. This process might be simplified using sonication, which results in a higher extractive yield and a significant concentration of caffeine and polyphenols than the traditional approach, with a smaller quantity of solvent and faster analytical times. The result of high-performance thin-layer chromatography analysis proves a significant positive correlation between extractive value and caffeine and polyphenol concentrations.

Glyceraldehyde-3-phosphate dehydrogenase present in extracellular vesicles from Leishmania major suppresses host TNF-alpha expression.

Glyceraldehyde-3-phosphate dehydrogenase (GAPDH) fulfills various physiological roles that are unrelated to its glycolytic function. However, to date, the nonglycolytic function of GAPDH in trypanosomal parasites is absent from the literature. Exosomes secreted from Leishmania, like entire parasites, were found to have a significant impact on macrophage cell signaling and function, indicating cross talk with the host immune system. In this study, we demonstrate that the Leishmania GAPDH (LmGAPDH) protein is highly enriched within the extracellular vesicles (EVs) secreted during infection. To understand the function of LmGAPDH in EVs, we generated control, overexpressed, half-knockout (HKO), and complement cell lines. HKO cells displayed lower virulence compared with control cells when macrophages and BALB/c mice were infected with them, implying a crucial role for LmGAPDH in Leishmania infection and disease progression. Furthermore, upon infection of macrophages with HKO mutant Leishmania and its EVs, despite no differences in TNFA mRNA expression, there was a considerable increase in TNF-α protein expression compared with control, overexpressed, and complement parasites as determined by ELISA, RT-PCR, and immunoblot data. In vitro protein translation studies suggest that LmGAPDH-mediated TNF-α suppression occurs in a concentration-dependent manner. Moreover, mRNA binding assays also verified that LmGAPDH binds to the AU-rich 3'-UTR region of TNFA mRNA, limiting its production. Together, these findings confirmed that the LmGAPDH contained in EVs inhibits TNF-α expression in macrophages during infection via posttranscriptional repression.

Theoretical investigation of a tetrazine based covalent organic framework as a promising anode material for sodium/calcium ion batteries.

Nowadays, great attention is being directed towards the development of promising electrode materials for non-lithium rechargeable batteries such as sodium and calcium ion batteries (SIBs and CIBs), due to their large abundance, storage capacity and charge/discharge rate. Using density functional theory (DFT) based computations we have predicted that the recently synthesized bilayer s-tetrazine based covalent organic framework (bilayer TZACOF) may be a promising anode material for sodium and calcium ion batteries. The electronic band structure calculations suggest that the bilayer TZACOF is an indirect band gap semiconductor with a band gap of 0.95 eV. The sodium and calcium atoms are adsorbed on the bilayer TZACOF at the most energetically favorable adsorption sites with adsorption energies of -1.37 eV and -2.27 eV, respectively. Moreover, the diffusion energy barriers for the migration of sodium and calcium atoms on the bilayer TZACOF are 0.19 eV and 0.63 eV, respectively, which indicates the fast ion mobility and charge/discharge rate. The theoretical specific capacity (TSC) of the bilayer TZACOF as the electrode material for SIBs and CIBs is 618.69 and 412.46 mA h g-1, respectively. Furthermore, the average voltage of the bilayer TZACOF as the electrode material for SIBs and CIBs is found to be 0.96 and 1.13 V, respectively. Based on the results of rich electronic properties, low diffusion barriers, high storage capacity, and low average voltage, we can reach at the conclusion that the bilayer TZACOF may be a suitable candidate for use as an anode material for sodium and calcium ion batteries (SIBs and CIBs).

Women's contribution to medicine in Bahrain: leadership and workforce.

BACKGROUND: Women make up a significant proportion of workforce in healthcare. However, they remain underrepresented in leadership positions relating to healthcare for a multitude of reasons: balancing personal and work duties, favoritism toward men, lack of support from colleagues and mentors, as well as other factors. This study aims to recognize the contribution made by women in the Bahraini healthcare sector by determining the gender distribution in Bahrain's medical schools, government hospitals, Ministry of Health, and National Health Regulatory Authority. METHODS: Data were collected from the Bahraini Ministry of Health, National Health Regulatory Authority, Salmaniya Medical Complex, King Hamad University Hospital, Bahrain Defence Force Royal Medical Services, the College of Medicine and Medical Sciences in the Arabian Gulf University, and the Royal College of Surgeons in Ireland-Bahrain. Only physicians who held a Bachelor of Medicine and Surgery and a valid license to practice from NHRA were eligible to participate. Descriptive statistics were used to derive the frequencies and percentages of physicians with the following leadership positions: (1) top administrative positions (e.g., Chief executive officer); (2) heads of departments; (3) heads of committees; and (4) academic positions (e.g., Professor). Data were also collected from the two medical schools in Bahrain to see the trend in female enrollment into medical schools since 2004. RESULTS: The results of the study indicated that leadership positions were mostly held by males in Bahrain (59.4% vs. 40.6%). However, Bahraini males and females equally dominated academic positions. Male physicians also dominated surgical specialties; however, female Bahraini physicians slightly surpassed male Bahraini physicians at the specialist and consultant levels (female to male: 11.9% vs. 10.4% and 33.2% vs. 30.4%, respectively). Furthermore, more females were reported to have general licenses. A trend analysis since 2004 showed that female medical students' representation was higher than males over the years. CONCLUSIONS: This study highlights the increasing trend of women's participation and contribution to medicine in Bahrain. The data indicated continued growth in the number of female medical students and physicians. As such, it is likely that females will have a bigger impact on healthcare in the future with potential to hold more leadership positions in Bahrain.

High-performance thin-layer chromatography coupled attenuated total reflectance-Fourier-transform infrared and NMR spectroscopy-based identification of α-amylase inhibitor from the aerial part of Asparagus racemosus Willd.

INTRODUCTION: α-Amylase inhibitors from natural sources are of interest for new drug development for the treatment of diabetes mellitus (DM). High-performance thin-layer chromatography (HPTLC) coupled bioassay guided isolation of bioactive compounds has been improved within last few years. OBJECTIVE: A microchemical derivatised HPTLC-coupled attenuated total reflectance-Fourier-transform infrared (ATR-FTIR) and nuclear magnetic resonance (NMR) spectroscopy was employed for profiling α-amylase inhibitor from the aerial part of Asparagus racemosus Willd. METHODOLOGY: Asparagus racemosus Willd. aerial part extracted with different solvents (n-hexane, chloroform, ethyl acetate, and methanol) and assayed to detect free radical scavengers and α-amylase inhibitor by 2,2-diphenyl-1-picrylhydrazyl (DPPH) assay and starch-iodine assay method, respectively. HPTLC-coupled ATR-FTIR and NMR spectroscopy was used to identify the α-amylase inhibitor. RESULTS: Methanolic extract of A. racemosus showed highest antioxidant activity (21.99 µg GAE/µL) where n-hexane extract showed lowest antioxidant activity (5.87 µg GAE/µL). The α-amylase inhibition was recorded as highest and lowest in ethyl acetate extract (13.13 AE/µL) and n-hexane extract (3.92 AE/µL), respectively. The deep blue zone of α-amylase sprayed TLC plate of extracts with hRF = 72 analysed for ATR-FTIR and NMR spectroscopy which revealed the presence of stigmasterol is responsible for α-amylase inhibition. CONCLUSION: The present work establishes the α-amylase inhibiting properties of A. racemosus maintaining its use for the treatment of DM as a traditional medicine. Bioassay guided isolation through HPTLC-coupled ATR-FTIR and NMR spectroscopy offers an effective method for the exploration of bioactive compounds such as α-amylase inhibitor from complex plant extracts.

Equity, Diversity, and Inclusion in Academic American Surgery Faculty: An Elusive Dream.

BACKGROUND: In the context of shifting population demographics in the United States, a diverse workforce in health care can lead to improved patient outcomes and enhance access to culturally competent care for minorities. The objective of this study was to analyze and quantify the relationship of gender, race, and academic rank, tenure status, and degree in American academic surgical faculty. MATERIALS AND METHODS: A 12-y retrospective cross-sectional analysis of the data from the Association of American Medical Colleges was performed. The distribution of race and gender across academic ranks, tenure, and degree types were recorded from 2007-2018. Simple descriptive statistics and chi-square analysis was used to analyze the time trends and association between gender and race across academic rank, tenure status, and degree types. RESULTS: When averaged over the 12 y of this study, there were significantly more whites (69.8%) and males (74.5%) among the academic surgery faculty compared with other races and females, respectively (P value <0.05). Asians and females experienced the greatest increase in proportional representation across all academic ranks with an absolute increase of 7% and 5% in full professor, 5% and 6% in associate professor, and 7% and 3% in chairperson (P value <0.05), respectively. No significant association was observed between gender and race with tenure status or degree type. CONCLUSIONS: Female and Asians are increasing in proportional representation; however, racial and gender disparities remain prevalent at higher academic ranks and positions of leadership, especially among black and Hispanic academic surgeons.

High-performance thin-layer chromatography based approach for bioassay and ATR-FTIR spectroscopy for the evaluation of antioxidant compounds from Asparagus racemosus Willd. aerial parts.

Asparagus racemosus Willd. is widely used to combat various diseases owing to its medicinal properties. In this study, arial parts of A. racemosus were investigated for their total phenolic content, total flavonoid content and antioxidative potential. A high-performance thin-layer chromatography (HPTLC) method combined with effect-directed-analysis was also developed to screen the antioxidant effects of A. racemosus and quantify biologically active compounds on chromatograms from A. racemosus. Total phenolics (154 mg gallic acid equivalent/g), flavonoid contents (497 mg quercetin/g) and IC50 (15.25 µg/ml) were found to be higher in methanolic extract of A. racemosus than in n-hexane, chloroform and ethyl acetate extracts. HPTLC hyphenated with chemical derivatizations (DPPH•, p-anisaldehyde/sulfuric acid, and ferric chloride) was used to evaluate antioxidant activity and the presence of phytosterols, terpenoids and polyphenolic contents. The same compounds at 100*retention factor = 58, 68, 74 and 65 in extracts were responsible for antioxidant activity. Hyphenated HPTLC allowed a rapid characterization of the active compound with a combination of effect-directed-analysis and attenuated total reflectance-Fourier transform infrared spectroscopy. Spectral analysis of the band from attenuated total reflectance identified myricetin, quercetin, p-coumaric acid and caffeic acid as responsible for the antioxidant activity.

Discharge against medical advice from the emergency department in a university hospital.

BACKGROUND: Patients discharged against medical advice (DAMA) act as a high-risk population for the Emergency Department (ED), regardless of their presentations, and can pose a serious burden for the hospital. This study examines the prevalence, demographic and clinical characteristics, reasons, and clinical outcomes of a small sample of DAMA patients in a teaching university hospital, including readmission, morbidity, and mortality. METHODS: A prospective, descriptive cross-sectional study was conducted in the ED of King Hamad University Hospital (KHUH) with 98,992 patient visits during a 1-year period from June 2018 to June 2019. Consenting DAMA patients were asked to complete a data collection form. RESULTS: Patients (n = 413) had a mean age of 44.1 years with a female majority (57.1%). The majority were categorized as triage level-3 (87.7%). The main reasons for DAMA included refusal of the procedure/operation (23.2%), long ED waiting time (22.2%), subjective improvement with treatment (17.7%), and children at home (14.8%), whereas the least selected reason was dissatisfaction with medical care (1.2%). Follow-up of DAMA patients revealed that 86 cases (20.8%) were readmitted to the ED within 72 h of which 41 (47.7%) cases were morbidity and 2 (2.3%) were mortality. Marital status was a predictor of DAMA patients who revisit the ED within 72 h. CONCLUSION: The results act as a pilot study to examine a small sample of DAMA patients' characteristics, diagnosis, and ED revisits. Hospitals should investigate further the DAMA population on a larger scale, reasons for refusing procedures, and utilize this knowledge to improve the healthcare process.

Healthcare providers' perspectives on family presence during resuscitation in the emergency departments of the Kingdom of Bahrain.

BACKGROUND: Worldwide, policies exist on family presence during resuscitation (FPDR), however, this is still lacking in the Gulf Corporation Countries (GCC) in general and in the Kingdom of Bahrain in particular. The aim of this study is to assess the perspectives of healthcare providers (HP) on FPDR among those working in the emergency departments (EDs) in the Kingdom. METHODS: A self-administered anonymous electronic survey was collected from 146 HPs (emergency physicians and nurses) working in the three major EDs in the Kingdom of Bahrain. Besides demographic data, 18 items measuring HPs' perceptions of FPDR were generated using the 5-point Likert scale. RESULTS: Surveys (n = 146) from physicians and nurses were analysed (45.9% vs. 54.1%, respectively). There were significant differences between physicians and nurses in terms of personal beliefs, FPDR enhancing professional satisfaction and behaviour, and the importance of a support person and saying goodbye (p < 0.001). However, general responses demonstrated that the majority of HPs encouraged and supported FPDR, but with greater support from physicians than nurses. CONCLUSION: The study reflects that many HPs in EDs participated in and are familiar with FPDR, with the majority of ED physicians supporting it. Further studies should investigate the reasons for the lack of support from nurses. Results may contribute to the development of hospital ED policies that allow FPDR in the region.

Loss of virulence in NAD(P)H cytochrome b5 oxidoreductase deficient Leishmania major.

Leishmania promastigotes have the ability to synthesize essential polyunsaturated fatty acids de novo and can grow in lipid free media. Recently, we have shown that NAD(P)H cytochrome b5 oxidoreductase (Ncb5or) enzyme in Leishmania acts as the redox partner for Δ12 fatty acid desaturase, which catalyses the conversion of oleate to linoleate. So far, the exact role of Leishmania derived linoleate synthesis is still incomplete in the literature. The viability assay by flow cytometry as well as microscopic studies suggests that linoleate is an absolute requirement for Leishmania promastigote survival in delipidated media. Western blot analysis suggested that infection with log phase linoleate deficient mutant (KO) results in increased level of NF-κBp65, IκB and IKKß phosphorylation in RAW264.7 cells. Similarly, the log phase KO infected RAW264.7 cells show dramatic increment of COX-2 expression and TNF-α secretion, compared to control or Ncb5or complement (CM) cell lines. The activation of inflammatory signaling pathways by KO mutant is significantly reduced when the RAW264.7 cells are pre-treated with BSA bound linoleate. Together, these findings confirmed that the leishmanial linoleate inhibits both COX-2 and TNF-α expression in macrophage via the inactivation of NF-κB signaling pathway. The stationary phase of KO promastigotes shows avirulence after infection in macrophages as well as inoculation into BALB/c mice; whereas CM cell lines show virulence. Collectively, these data provide strong evidence that de novo linoleate synthesis in Leishmania is an essential for parasite survival at extracellular promastigote stage as well as intracellular amastigote stage.