Zinc status or supplementation and its relation to soil-transmitted helminthiasis in children: A systematic review.

Soil-transmitted helminths (STHs) parasitic infection is known as one of the most common infections around the world affecting more than a quarter of the world's population. The relationship between STH infections and micronutrient deficiencies are closely related and often coexist among the affected population. The study, therefore, aimed to summarise the available literature focusing on the effect of zinc status/deficiency or supplementation on STH infection or reinfection in children. For this purpose, we adopted a systematic approach and searched the existing literature on PubMed, Scopus, and Cochrane Library databases. A search term was entered to retrieve the available data. A total of 12 articles were included in this review after applying the inclusion/exclusion criteria. Most of the included studies reported a lower zinc status in children affected with any parasitic infection. Regarding the effect of zinc status and supplementation on parasitic infection in children, we found only a few studies (n = 4) with inconsistent result findings. This review reported that children infected with STH have lower zinc levels; however, a limited number of studies showed the effect of zinc supplements on the risk of STH warrants the need for further studies in this regard.

Beyond the curriculum: unveiling medical students' drivers and barriers to research participation at Alfaisal University.

Medical education continually adapts to the needs of future health care professionals, with student motivation in research being a pivotal aspect. This study at Alfaisal University aimed to explore the motivations, benefits, and challenges faced by medical students in extracurricular research activities. Using a mixed-method approach, we combined quantitative surveys with qualitative group interviews. Findings revealed that both extrinsic (e.g., enhancing postgraduate training prospects) and intrinsic (e.g., personal interest and skill refinement) factors significantly motivate students to be involved in research activities. Participants unanimously acknowledged skill enhancement, particularly in literature comprehension, creative ideation, and networking. However, challenges such as conflicts with course scheduling, lack of hands-on experiences, and mentorship issues were identified as potential barriers to research participation. Addressing these barriers and understanding motivations can inform the design of research programs, enhancing the overall student research experience. This study underscores the importance of research in medical education, emphasizing the need for institutions to prioritize addressing challenges and leveraging benefits to prepare medical students for a research-integrated clinical future.NEW & NOTEWORTHY This article examines the motivating factors and obstacles of extracurricular research in Alfaisal University, Saudi Arabia. The study utilizes a mixed methodology of online surveys and in-person group interviews to gain insights from the medical students of the university. We revealed several extrinsic and intrinsic motivators that drove the students; however, there remain several challenges to students during their research journey. Addressing these challenges will help the students obtain a more fruitful, educational research experience.

Spirulina, an FDA-Approved Functional Food: Worth the Hype?

Spirulina, a blue-green microalga is an eminent functional food due to its unique nutritional and disease-mitigating properties. The main objective of this article is to present an overview of the nutritional composition of Spirulina. Along with its therapeutic potential and applications in the food industry. Studies included in this review have suggested spirulina to be a rich source of complete proteins, essential fatty acids (EFAs), vitamins, minerals and various bioactive compounds like carotenoids, chlorophyll, and xanthophylls. This makes Spirulina a promising functional food for the treatment of ailments like diabetes, cancer, cardiovascular disorders (CVDs), COVID-19, neuroinflammatory conditions and gut dysbiosis. Additionally, data from numerous studies suggest its use in food formulations, primarily in sports supplements, bakery products, beverages, dairy products, snack sources and confectionaries. It has also been used by the National Aeronautics and Space Association (NASA) for astronauts on space missions to the Moon and Mars. Furthermore, spirulina's use as a natural food additive possesses enormous potential for further research. Owing to its high nutritional profile and disease-fighting potential, it lends itself to numerous food formulations. Therefore, based on the findings of previous studies, further progress can be made considering spirulina's application in the food additive industry.

Leukemic and Lymphomatous Optic Neuropathy: A Case Series.

BACKGROUND: Optic neuropathy in the context of leukemia and lymphoma raises concern for central nervous system involvement or relapse and warrants prompt evaluation and treatment. To date, a gold standard for the diagnosis and management of leukemic optic neuropathy has yet to be established. METHODS: Case series and review of the literature. Two illustrative cases were selected to discuss their treatment course and outcome. RESULTS: We report 7 cases of patients with leukemia or lymphoma presenting with optic nerve infiltration. All patients received steroid therapy for presumed infiltrative optic neuropathy, and 4 patients underwent radiation therapy. Along with systemic chemotherapy, all patients received intrathecal chemotherapy except one. Three patients received chimeric antigen receptor T-cell therapy. CONCLUSIONS: Leukemic and lymphomatous optic neuropathy is difficult to diagnose and treat, and there is no gold standard for diagnosis or treatment in the current literature. We help clarify how this disease should be approached in a multidisciplinary fashion and on an individual basis to correctly diagnose and treat the vision loss, while considering the patient's long-term prognosis based on their systemic disease.

Herpes Simplex Virus 2 Meningoencephalitis-Associated Bilateral Optic Neuritis and Radiculitis.

The most common ocular complication of herpes simplex virus (HSV) is acute retinal necrosis. We present a rare case of a patient with HSV-2 meningoencephalitis that developed severe vision-threatening optic neuritis. The patient was treated with steroids and IVIG, which allowed a rapid improvement in her vision.

Cross-linked pH-sensitive pectin and acrylic acid based hydrogels for controlled delivery of metformin.

The purpose of present study is to load Metformin HCl into pH-sensitive hydrogels to have sustained release over a period of time. The hydrogel was synthesized from naturally occurring polysaccharide pectin and monomer acrylic acid (AA) using ethylene glycol dimethacrylate (EGDMA) as cross-linker under controlled conditions for polymerization at 45°C for one hr, 50°C for two hrs, 55°C for three hrs, 60°C for four hrs and finally 65˚C for 12 hrs. Hydrogels were characterized for dynamic/equilibrium swelling, sol-gel fraction analysis, diffusion coefficient and percentage porosity. Hydrogels were tested by FTIR, XRD and SEM for structure and surface morphology respectively. Experimental in-vitro drug release data was applied to kinetic models. Formation of strong bonding between pectin and AA was supported by FTIR. The intensity of XRD peaks was reduced in non-loaded and loaded hydrogels compared to active drug substance. The non-loaded hydrogel showed discrete porous structure whereas loaded hydrogels were fibrous and smooth. Hydrogels showed higher swelling in the solutions of pH 6.5 and 7.5 as compared to in the solutions of pH 1.2 and 5.5. The diffusion coefficient decreases with the increase of AA and pectin concentrations. It was observed upon increasing the EGDMA concentration porosity decreases. The release of drug from all compositions of hydrogels took place through non-Fickian diffusion mechanism.

High non-compliance rate with anti-tuberculosis treatment: a need to shift facility-based directly observed therapy short course (DOTS) to community mobile outreach team supervision in Saudi Arabia.

BACKGROUND: Tuberculosis (TB) remains a major global public health problem in many developing countries including Kingdom of Saudi Arabia (KSA). Patient compliance with anti-tuberculosis treatment is a determining factor in controlling the spread of TB. This study compares the default rate and the perception of their treatment among TB patients being treated by means of a community mobile outreach approach, with those of patients being treated by means of a facility-based Directly Observed Treatment Short course (DOTS) in the Jeddah region of Saudi Arabia. METHODS: A comparative cross-sectional study of 200 TB patients who presented at the Madain Alfahd Primary Health Care Center (PHCC) Jeddah, between January 2018 and November 2018 was undertaken. In one group, randomly assigned patients were served by mobile outreach teams who administered oral anti-TB treatment under the DOTS regime. In the other group, the patients were treated by means of the traditional facility-based DOTS treatment. A questionnaire measuring patient attitudes and understanding of the disease and their treatment modes was completed by patients at the beginning of their treatment, and again after 3 months. The results were analysed by means of independent and Paired T Tests, along with chi square analysis. RESULTS: We found that the overall default rate among those patients served by our mobile outreach team was only 3%, compared with a 22% default rate among non-mobile team treated patients (p = < 0.001). A major change in the attitude and understanding scores of patients was noted in both groups after 3 months. A significant difference was also noted in the mean compliance scores (mobile team served =58.43 and facility-based =55.55, p < 0.001) after 3 months of treatment. CONCLUSION: Our study indicated that treatment by means of our mobile outreach DOTS can offer an effective strategy for the treatment of TB patients. A reduced patient default rate and a better understanding of the disease and its treatment confirmed a positive impact of mobile outreach teams on these patients. Treating TB patients by means of mobile outreach teams can thus be recommended as a means for the cure and prevention of the further spread of the disease.

Evaluating the effects of social networking sites addiction, task distraction, and self-management on nurses' performance.

AIMS: The purpose of this study was to explore the relationship of social networking sites (SNSs) addiction on nurses' performance and how this relationship was mediated by task distraction and moderated by self-management. DESIGN: This cross-sectional study is designed to empirically test the relationship of SNSs addiction, task distraction, and self-management with the nurses' performance. METHODS: Data were collected by conducting an online survey on nurses across the world using a web-based questionnaire developed through 'Google Docs' and distributed through Facebook from 13 August 2018 - 17 November 2018. The Facebook groups were searched using the selected key terms. In total, 45 groups were found to have relevance to this research; therefore, request was made to the admins of these groups to participate in this research and to post a link in their groups. Only 19 group admins responded positively by uploading a link of the research instrument on their respective group pages and 461 members of these groups participated in the research. RESULTS: Results of the data collected from 53 different countries indicated that SNSs addiction results in lowering the nurses' performance. This relationship is further strengthened by task distraction introduced as a mediating variable. The results show that self-management mediates the relationship between SNSs addiction and employees' performance. Moreover, the results of the study confirm that self-management reduces the negative impact of SNSs addiction on nurses' performance. CONCLUSION: Social networking sites (SNSs) addiction and task distraction reduce the nurses' performance, whereas self-management enhances nurses' performance. IMPACT: This study addresses the problem of using SNSs at the workplace and its potential effect on nurses' performance. Results demonstrate that SNSs addiction reduces the performance which is further decreased by task distraction; however, self-management of nurses can enhance the nurses' performance. The research has numerous theoretical and practical implications for hospital administration, doctors, and nurses.

Medial Orbital Wall Reconstruction to Facilitate Endoscopic Sinus Surgery for Erosive Polypoidal Sinus Disease.

The authors report the use of a 0.35-mm-thickness nylon implant for medial orbital wall reconstruction to facilitate functional endoscopic sinus surgery (FESS) for severe erosive polypoidal sinus disease while minimizing iatrogenic injuries to the orbital contents. A retrospective chart review identified 4 patients with extensive polypoidal sinus disease who underwent medial orbital wall reconstruction in the setting of FESS. All patients underwent successful reconstruction of bilateral eroded medial orbital walls using a 0.35-mm Supramid Foil Nylon Implant immediately followed by FESS. There were no permanent complications or iatrogenic injuries to the orbital contents due to FESS. All patients experienced improvement in sinus symptoms. Medial orbital wall reconstruction in the setting of erosive polypoidal sinus disease is a useful tool to help facilitate FESS. It allows the sinus surgeon to clear sinus disease aggressively with the orbits being protected from iatrogenic injury.

Enhancement of Dissolution and Skin Permeability of Pentazocine by Proniosomes and Niosomal Gel.

Proniosomes (PN) are the dry water-soluble carrier systems that may enhance the oral bioavailability, stability, and topical permeability of therapeutic agents. The low solubility and low oral bioavailability due to extensive first pass metabolism make Pentazocine as an ideal candidate for oral and topical sustained release delivery. The present study was aimed to formulate the PNs by quick slurry method that are converted to niosomes (liquid dispersion) by hydration, and subsequently formulated to semisolid niosomal gel. The PNs were found in spherical shape in the SEM and stable in the physicochemical and thermal analysis (FTIR, TGA, and XRD). The quick slurry method produced high recovery (> 80% yield) and better flow properties (θ = 28.1-37.4°). After hydration, the niosomes exhibited desirable entrapment efficiency (44.45-76.23%), size (4.98-21.3 µm), and zeta potential (- 9.81 to - 21.53 mV). The in vitro drug release (T100%) was extended to more than three half-lives (2-4 h) and showed good fit to Fickian diffusion indicated by Korsmeyer-Peppas model (n = 0.136-0.365 and R2 = 0.9747-0.9954). The permeation of niosomal gel was significantly enhanced across rabbit skin compared to the pure drug-derived gel. Therefore, the PNs are found promising candidates for oral as dissolution enhancement and sustained release for oral and topical delivery of pentazocine for the management of cancer pain.

Knowledge and practices of critical care health professionals related to ventilator associated pneumonia in tertiary care hospitals of Islamabad and Rawalpindi.

OBJECTIVE: To assess knowledge and practices of critical care health professionals related to ventilator associated pneumonia. METHODS: This cross-sectional survey was conducted at eight tertiary care public and private hospitals of Islamabad/Rawalpindi, Pakistan, from September 2015 to March 2016, and comprised healthcare professionals. Stratified random sampling was used. Data was collected using close-ended validated questionnaire. SPSS 22 was used for data analysis. RESULTS: Of the 153 participants, 45(29.4%) were doctors, 91(59.4%) were nurses and 17(11.1%) were respiratory therapists. The overall mean age was 31±8.14 years. The overall mean knowledge and practice scores regarding prevention of ventilator-associated pneumonia were 11.14±3.12 and 8.83±1.53, respectively. The mean knowledge score was 11.77±3.84 for physicians, 10.84± 2.91 for nurses and 10.82±1.94 for respiratory therapists. However, the best practice scores were seen in the respiratory therapists 9.64±0.78 (p=0.008). CONCLUSIONS: The majority of the participants had adequate knowledge and even better practices, particularly respiratory therapists.

Assessment of caregiver burden of patients receiving dialysis treatment in Rawalpindi.

OBJECTIVE: To determine the burden on the caregivers of patients receiving dialysis treatment. METHODS: This cross-sectional study was carried out in four different dialysis centres of Rawalpindi, Pakistan, from June 1 to December1, 2015, and comprised attendants of patients receiving dialysis. The data was collected from the attendants of patients receiving dialysis, and caregiver burden was measured using the Zarit Burden Interview questionnaire. SPSS 22 was used for data analysis. RESULTS: Of the 164 subjects, 97(59%) were females. The majority of caregivers reported stress for caring (2.28±1.31), patients asking for more help than needed (2.14±1.13), health problems (1.03±1.11), financial constraints (1.70±1.15) and little time for self-care (2.15±1.21). Besides, 107(65%) caregivers perceived the burden of their patients as mild to moderate. A positive correlation was found between the duration of a person on dialysis, daily hours of care-giving and the total burden score of his/her caregiver (p<0.05 each). CONCLUSIONS: Care-giving can create enormous burdens on caregivers, affecting their physical and psychological health.

KNOWLEDGE, ATTITUDES AND PRACTICES OF HEPATITIS B AND C AMONG BARBERS OF URBAN AND RURAL AREAS OF RAWALPINDI AND ISLAMABAD.

BACKGROUND: Hepatitis B and Hepatitis C are serious global public health problems with a prevalence of 10-15% with majority of the cases seen in the developing countries including Pakistan. It is a blood borne infection transmitted by infected blood and blood products through transfusions, contaminated needles, vertical transmission, unsafe sex and reuse of razors by barbers. The literature search so far did not reveal any study comparing knowledge, attitude and practices of hepatitis B & C in barbers working in Urban and rural areas. METHODS: A comparative cross sectional survey was carried out among barbers of urban and rural areas of Rawalpindi and Islamabad. A structured close ended questionnaire was filled from total of 202 barbers by non-probability convenience sampling technique. Comparative data analysis was done including variables like age, education, knowledge about hepatitis B & C, mode of transmission, role of the blades and media etc. RESULTS: Knowledge about hepatitis B & C was good in urban areas (92%) as compared to those working in the rural areas (68%). Using new blade for every customer was seen in urban (100%) and rural (93%) area. However barbers knowledge about symptoms of the disease (urban 81% & rural 93%) and vaccination trend of Hepatitis B was low. CONCLUSION: This study showed a marked difference in the knowledge, attitude and practices of the barbers working in the urban and the rural areas. Main focus should be on launching Health education programs and behaviour change communication campaigns for the barbers. Strict regulatory monitoring must be done against unlicensed street barbers.

Unveiling the Web: Exploring the Multifaceted Role of Neutrophil Extracellular Traps in Ocular Health and Disease.

Neutrophil extracellular traps (NETs) play an essential role in antimicrobial defense. However, NETs have also been shown to promote and mediate a wide spectrum of diseases, including cancer, diabetes mellitus, cardiovascular diseases, and ocular diseases. Data regarding NETs in ocular diseases remain limited. In physiological conditions, NETs protect the eye from debris and cleave proinflammatory cytokines, including several interleukins. On the other hand, NETs play a role in corneal diseases, such as dry eye disease and ocular graft-versus-host disease, where they promote acinar atrophy and delayed wound healing. Additionally, NET levels positively correlate with increased severity of uveitis. NETs have also been described in the context of diabetic retinopathy. Although increased NET biomarkers are associated with an increased risk of the disease, NETs also assist in the elimination of pathological blood vessels and the regeneration of normal vessels. Targeting NET pathways for the treatment of ocular diseases has shown promising outcomes; however, more studies are still needed in this regard. In this article, we summarize the literature on the protective roles of NETs in the eye. Then, we describe their pathogenetic effects in ocular diseases, including those of the cornea, uvea, and retinal blood vessels. Finally, we describe the therapeutic implications of targeting NETs in such conditions.

Self-nanoemulsifying drug delivery system for nebulization: fabrication and evaluation for systemic delivery of atorvastatin.

The study undertakes the development of an atorvastatin-loaded self-nanoemulsifying drug delivery system (SNEDDS) to improve its bioavailability. The SNEDDS were fabricated using oleic acid, Tween 80, and Span 80 by spontaneous emulsification. The SNEDDS were assessed for their particle size distribution, zeta potential, morphology, drug content, surface tension, viscosity, and drug release. The aerodynamic performance of the SNEDDS was evaluated using an Andersen cascade impactor, while the lipid-lowering potential of the SNEDDS was determined in Wistar rats using the analyzer "Microlab 300." The particle size of the SNEDDS ranged from 36 to 311 nm, with a polydispersity index (PDI) of 0.25-0.40. The zeta potential of the SNEDDS fluctuated from - 29.22 to - 38.26 mV, which declined to - 4.55 mV in the case of F5. The chitosan-coated formulation (F5) exhibited a higher viscosity (22.12 mPa s) and lower surface tension (0.056 dyne/cm) than other formulations (F1-F4). The non-coated formulation exhibited a significantly higher burst drug release, followed by a sustained drug release pattern (p ≤ 0.05) as compared to the coated formulation (F5). The nebulized SNEDDS achieved a dispersed fraction of 87 to 97%, where notably higher aerosol dispersion from F4 was attributed to its smaller particle size and circularity. The inhaled fraction of nebulized SNEDDS was 74-87%. The size of the SNEDDS droplets was the primary determinant affecting the aerodynamic performance of the SNEDDS during nebulization. The chitosan-coated SNEDDS achieved a higher antihyperlipidemic effect than marketed tablets, which shows the suitability of F5 for effective systemic delivery of atorvastatin through the lung.

Use of fracture size and soft tissue herniation on computed tomography to predict diplopia in isolated orbital floor fractures.

PURPOSE: To determine the role of fracture size and soft tissue herniation as measured by computed tomography in predicting the development of persistent diplopia in patients with isolated orbital floor fractures. METHODS: A retrospective chart review identified patients presenting between March 2009 and 2012 with isolated orbital floor fractures. Computed tomographic scans were assessed for transverse fracture size and absence or presence of soft tissue herniation and rectus involvement. Presence of diplopia at 6-10 days, decision for surgical repair, and presence of diplopia were recorded. RESULTS: Fifty-six patients fulfilled inclusion criteria. Eighteen of 56 patients (32%) had preoperative diplopia. In Type A fractures, 0/9 (0%) small, 1/8 (12.5%) medium, and 2/14 (14%) large fractures had diplopia. For Type B fractures, 3/4 (75%) small, 9/13 (69%) medium, and 4/8 (50%) large fractures had diplopia. Type B fractures were significantly more likely to cause diplopia than Type A fractures in the small (p = 0.003) and medium (p = 0.007) size groups but not in the large groups (p = 0.07). CONCLUSION: Transverse fracture size and presence of soft tissue herniation on CT imaging can predict development of persistent diplopia in isolated orbital floor fractures. Small and medium sized fractures with soft tissue herniation are more likely to cause diplopia than large sized fractures. We recommend early repair or closer observation of small and medium sized orbital floor fractures with soft tissue herniation due to the high risk of diplopia.

Posterior conjunctival plication to correct secondary ptosis after eyelid retraction repair in Graves disease.

PURPOSE: To describe the results of posterior conjunctival plication for the treatment of secondary eyelid ptosis after eyelid retraction repair in Graves disease. METHODS: Case series. All patients were evaluated preoperatively by routine eye examination and eyelid measurements including Margin Reflex Distance 1 and levator function. Two eyes of 2 patients who presented with ptosis following eyelid retraction repair were corrected with posterior conjunctival plication. RESULTS: Posterior conjunctival plication for secondary ptosis following eyelid retraction repair was successful in 2 eyelids of 2 patients with Graves disease. Follow up period ranged from 6-10 months over which no sign of recurrent ptosis was observed. CONCLUSIONS: Posterior conjunctival plication is an effective surgical technique for the correction of secondary ptosis following eyelid retraction repair in patients with Graves disease.

Old drug, new tricks: polymer-based nanoscale systems for effective cytarabine delivery.

Cytarabine, an antimetabolite antineoplastic agent, has been utilized to treat various cancers. However, because of its short half-life, low stability, and limited bioavailability, achieving an optimal plasma concentration requires continuous intravenous administration, which can lead to toxicity in normal cells and tissues. Addressing these limitations is crucial to optimize the therapeutic efficacy of cytarabine while minimizing its adverse effects. The use of novel drug delivery systems, such as polymer-based nanocarriers have emerged as promising vehicles for targeted drug delivery due to their unique properties, including high stability, biocompatibility, and tunable release kinetics. In this review, we examine the application of various polymer-based nanocarriers, including polymeric nanoparticles, polymeric micelles, dendrimers, polymer-drug conjugates, and nano-hydrogels, for the delivery of cytarabine. The article highlights the limitations of conventional cytarabine administration which often lead to suboptimal therapeutic outcomes and systemic toxicity. The rationale for using polymer-based nanocarriers is discussed, highlighting their ability to overcome challenges by providing controlled drug release, improved stability, and enhanced targeting capabilities. In summary, this review offers a valuable resource for drug delivery scientists by providing insights into the design principles, formulation strategies, and potential applications of polymer-based nanocarriers that can enhance the therapeutic efficacy of cytarabine.

A comparison of primary and secondary eye removal after open globe injury: A multi-centre study.

BACKGROUND/OBJECTIVES: Our goal was to compare the characteristics and surgical outcomes of patients who underwent primary eye removal surgery after open globe injury with those who underwent secondary eye removal surgery after open globe repair. SUBJECTS/METHODS: This was a retrospective review of subjects who underwent evisceration or enucleation within 3 months of an open globe injury, at three Level I trauma centres in three U.S. cities between July 2014 and July 2020. RESULTS: 19 patients underwent primary eye removal and 20 underwent secondary eye removal. The most common mechanism of trauma in patients who underwent primary eye removal was gunshot. Compared to the secondary eye removal group, patients who underwent primary eye removal were significantly more likely to be male; have longer hospital stays; be discharged to another care facility rather than home; have facial fractures; suffer intracranial injury; and be unable to consent themselves for surgery. Both groups had a low surgical complication rate with one case of socket contracture in each group. CONCLUSIONS: The standard of care for an open globe injury is prompt repair, but there are occasions when the globe is so damaged that it is deemed unrepairable. We found that globes that required primary eye removal were more often due to gunshot wounds, and that there was greater morbidity associated with these injuries. The authors' preferred surgical approach was evisceration with placement of a silicone sphere; patient outcomes demonstrate that this method was found to be safe, with a low complication and infection rate.