Paroxysmal nocturnal hemoglobinuria in a patient post COVID-19 virus infection: A case report with literature review.

COVID 19 is a serious infection that originated in Wuhan, China and has resulted in worldwide morbidity and mortality. It continues to be a major health concern in 2022, being associated with multiorgan failure. Although the pathophysiology of the disease and its complications are not well understood, it is believed that a cytokine storm, triggered by complement activation may be responsible for the severity and complications of the disease. As of now, there is no definitive treatment available. Hematological changes associated with COVID-19 include lymphopenia, anemia, thrombocytopenia, disseminated intravascular coagulopathy, and thrombosis. Paroxysmal nocturnal hemoglobinuria (PNH), on the other hand, is an acquired clonal hematopoietic stem cell disorder that occurs due to an acquired PIG-A mutation affecting the hematopoietic stem cells. Interestingly, PNH exhibits some clinical and laboratory manifestations like those seen in COVID-19. In this report, we present a rare case of PNH that developed following a COVID-19 infection.

Assessment of essential and toxic elemental concentrations in tumor and non-tumor tissues with risk of colorectal carcinoma in Pakistan.

BACKGROUND: Colorectal tumor is a major cause of cancer morbidity and mortality both in USA and around the globe. Exposure to environmental toxicants such as toxic trace elements has been implicated in colorectal malignancy. However, data linking them to this cancer are generally lacking. METHODS: Accordingly, the current study was to investigate the distribution, correlation and chemometric evaluation of 20 elements (Ca, Na, Mg, K, Zn, Fe, Ag, Co, Pb, Sn, Ni, Cr, Sr, Mn, Li, Se, Cd, Cu, Hg and As) in the tumor tissues (n = 147) and adjacent non tumor tissues (n = 147) of same colorectal patients which were analyzed by flame atomic absorption spectrophometry employing nitric acid-perchloric acid based wet digestion method. RESULTS: On the average, Zn (p < 0.05), Ag (p < 0.001), Pb (p < 0.001), Ni (p < 0.01), Cr (p < 0.005) and Cd (p < 0.001) showed significantly higher levels in the tumor tissues compared with the non tumor tissues of patients, whereas mean levels of Ca (p < 0.01), Na (p < 0.05), Mg (p < 0.001), Fe (p < 0.001), Sn (p < 0.05) and Se (p < 0.01), were significantly elevated in the non tumor tissues than the tissues of tumor patients. Most of the elements revealed markedly disparities in their elemental levels based on food (vegetarian/nonvegetarian) habits and smoking (smoker/nonsmoker) habits of donor groups. The correlation study and multivariate statistical analyses demonstrated some significantly divergent associations and apportionment of the elements in the tumor tissues and non tumor tissues of donors. Noticeably, variations in the elemental levels were also noted for colorectal tumor types (lymphoma, carcinoids tumor and adenocarcinoma) and stages (I, II, III, & IV) in patients. CONCLUSION: Overall, the study revealed that disproportions in essential and toxic elemental concentrations in the tissues are involved in pathogenesis of the malignancy. These findings provide the data base that helps to oncologist for diagnosis and prognosis of colorectal malignant patients.

Synthesis, DNA binding and biological evaluation of benzimidazole Schiff base ligands and their metal(ii) complexes.

Two novel benzimidazole ligands (E)-2-((4-(1H-benzo[d]imidazole-2-yl)phenylimino)methyl)-6-bromo-4-chlorophenol (L1) and (E)-1-((4-(1H-benzo[d]imidazole-2-yl)phenylimino)methyl)naphthalene-2-ol (L2) with their corresponding Cu(ii), Ni(ii), Pd(ii) and Zn(ii) complexes were designed and synthesized. The compounds were characterized by elemental, IR, and NMR (1H & 13C) spectral analyses. Molecular masses were determined by ESI-mass spectrometry, and the structure of ligand L1 was confirmed by single crystal X-ray diffraction analysis. Molecular docking was carried out for the theoretical investigation of DNA binding interactions. The results obtained were verified experimentally by UV/Visible absorption spectroscopy in conjunction with DNA thermal denaturation studies. It was observed that ligands (L1 and L2) and complexes (1-8) were moderate to strong DNA binders, as evident from the binding constants (K b). The value was found to be highest for complex 2 (3.27 × 105 M-1) and lowest for 5 (6.40 × 103 M-1). A cell line study revealed that breast cancer cells were less viable to the synthesized compounds compared to that of standard drugs, cisplatin and doxorubicin, at the same concentration. The compounds were also screened for in vitro antibacterial activity for which complex 2 showed a promising broad-spectrum effect against all tested strains of bacteria, almost in the proximity of the reference drug kanamycin, while the rest of the compounds displayed activity against selected strains.

Carbon Nanotube Fiber-Based Flexible Microelectrode for Electrochemical Glucose Sensors.

Electrochemical sensors are gaining significant demand for real-time monitoring of health-related parameters such as temperature, heart rate, and blood glucose level. A fiber-like microelectrode composed of copper oxide-modified carbon nanotubes (CuO@CNTFs) has been developed as a flexible and wearable glucose sensor with remarkable catalytic activity. The unidimensional structure of CNT fibers displayed efficient conductivity with enhanced mechanical strength, which makes these fibers far superior as compared to other fibrous-like materials. Copper oxide (CuO) nanoparticles were deposited over the surface of CNT fibers by a binder-free facile electrodeposition approach followed by thermal treatment that enhanced the performance of non-enzymatic glucose sensors. Scanning electron microscopy and energy-dispersive X-ray analysis confirmed the successful deposition of CuO nanoparticles over the fiber surface. Amperometric and voltammetric studies of fiber-based microelectrodes (CuO@CNTFs) toward glucose sensing showed an excellent sensitivity of ∼3000 µA/mM cm2, a low detection limit of 1.4 µM, and a wide linear range of up to 13 mM. The superior performance of the microelectrode is attributed to the synergistic effect of the electrocatalytic activity of CuO nanoparticles and the excellent conductivity of CNT fibers. A lower charge transfer resistance value obtained via electrochemical impedance spectroscopy (EIS) also demonstrated the superior electrode performance. This work demonstrates a facile approach for developing CNT fiber-based microelectrodes as a promising solution for flexible and disposable non-enzymatic glucose sensors.

Investigation of Andrographolide Effect on Non-Infected Red Blood Cells Using the 1H-NMR-Based Metabolomics Approach.

Andrographolide (AG) has been shown to have several medicinal and pharmaceutical effects, such as antimicrobial, anti-inflammatory, antioxidant, anti-diabetic, and anti-malarial activities. Moreover, studies to assess the pharmacological effect of AG on the metabolic changes of uninfected red blood cells (uRBCs) have not yet been investigated. This study aims to evaluate the pharmacological effects of AG compared to chloroquine (CQ) on the metabolic variations of uRBCs in vitro using a proton nuclear magnetic resonance (1H-NMR)-based metabolomics approach coupled with multivariate data analysis (MVDA). Forty-one metabolites were successfully identified by 1H-NMR. The results of the unsupervised data analysis principal component analysis (PCA) showed ideal differentiation between AG and CQ. PC1 and PC2 accounted for 71.4% and 17.7% of the explained variation, respectively, with a total variance of 89.10%. Based on S-plot and VIP values, a total of 28 and 32 metabolites were identified as biomarkers in uRBCs-AG and uRBCs-CQ, respectively. In uRBCs treated with AG, ten metabolic pathways were determined to be disturbed, including riboflavin metabolism, d-glutamate and d-glutamine metabolism, phenylalanine metabolism, glutathione metabolism, proline and arginine metabolism, arginine biosynthesis, citrate cycle, glycolysis/gluconeogenesis, and pyruvate metabolism as well as alanine, aspartate, and glutamate metabolism. In contrast, in CQ-treated uRBCs, nine affected metabolic pathways were determined, which involved the same metabolic pathways for uRBCs-AG, except for glutathione metabolism. These findings suggest an evident relationship between AG and CQ associated with metabolic changes in intact RBCs after being exposed to the treatment. The metabolomics results could allow useful comprehensive insights into the underlying mechanism of the action of AG and CQ on red blood cells. Consequently, the 1H-NMR-based metabolomics approach was successfully utilized to identify the pharmacological effects of AG and CQ on the metabolic variations of uRBCs.

Structural, Optical and Electrical Properties of Cu0.6CoxZn0.4-xFe2O4 (x = 0.0, 0.1, 0.2, 0.3, 0.4) Soft Ferrites.

A series of cobalt-inserted copper zinc ferrites, Cu0.6CoxZn0.4-xFe2O4 (x = 0.0, 0.1, 0.2, 0.3, 0.4) having cubic spinel structure were prepared by the coprecipitation method. Various characterization techniques, including XRD, FTIR, UV-vis and I-V were used to investigate structural optical and electrical properties, respectively. The lattice constant was observed to be decreased as smaller ionic radii Co2+ (0.74 Å) replaced the higher ionic radii Zn2+ (0.82 Å). The presence of tetrahedral and octahedral bands was confirmed by FTIR spectra. Optical bandgap energy was determined in the range of 4.44-2.05 eV for x = 0.0 to 0.4 nanoferrites, respectively. DC electrical resistivity was measured and showed an increasing trend (5.42 × 108 to 6.48 × 108 Ω·cm) with the addition of cobalt contents as cobalt is more conductive than zinc. The range of DC electrical resistivity (108 ohm-cm) makes these nanomaterials potential candidates for telecommunication devices.

Rate of Rebleed and Retreatment of Previously Treated Intracranial Aneurysms.

BACKGROUND: Intracranial aneurysms (IAs) can be treated through endovascular treatment (EVT) or microsurgery (MS). Treated IAs can recanalize, which can lead to rupture or retreatment. OBJECTIVE: The aim of our study was to evaluate the natural history of previously treated IA, by evaluating the risk of rupture and the risk of retreatment. METHODS: All patients treated for an IA between 2007 and 2017 in 4 hospitals were included. The rate of (recurrent) hemorrhage and the rate of prophylactic retreatment were retrospectively evaluated. Kaplan-Meier survival analysis with log-rank tests was used to compare the rates of rupture or retreatment. Patients with ruptured and unruptured aneurysms were separated, and we compared the risk of retreatment between EVT and the surgical treatment. RESULTS: A total of 4997 IAs were included in the study, corresponding to 20,489 patient-years. Overall, 28 (0.6%) aneurysms that had been previously treated demonstrated hemorrhage. Moreover, 237 (4.7%) aneurysms were retreated for recanalization without hemorrhage. The rate of retreatment was higher in the EVT-treated IAs as compared with the MS-treated IAs (LogRank: P < 0.0001) and higher in the previously ruptured IAs versus unruptured IAs (LogRank: P < 0.0001). However, the rate of posttreatment hemorrhage/IA rupture was similar for both groups. CONCLUSIONS: The rate of IA retreatment is low; however, the rate of hemorrhage/rupture from treated IAs is even lower. A higher rate of retreatment was noted in EVT-treated IAs versus MS-treated IAs and in ruptured IAs versus unruptured IAs; however, the rate of hemorrhage or rerupture was comparable between the groups.

Synthesis, characterization and biological evaluation of novel benzimidazole derivatives.

In search of achieving less toxic and more potent chemotherapeutics, three novel heterocyclic benzimidazole derivatives: 2-(1H-benzo[d]imidazol-2-yl)-4-chlorophenol (BM1), 4-chloro-2-(6-methyl-1H-benzo[d]imidazol-2-yl)phenol (BM2) and 4-chloro-2-(6-nitro-1H-benzo[d]imidazol-2-yl)phenol (BM3) with DNA-targeting properties, were synthesized and fully characterized by important physicochemical techniques. The DNA binding properties of the compounds were investigated by UV-Visible absorption titrations and thermal denaturation experiments. These molecules exhibited a good binding propensity to fish sperm DNA (FS-DNA), as evident from the high binding constants (Kb) values: 1.9 × 105, 1.39 × 105 and 1.8 × 104 M‒1 for BM1, BM2 and BM3, respectively. Thermal melting studies of DNA further validated the absorption titration results and best interaction was manifested by BM1 with ΔTm = 4.96 °C. The experimental DNA binding results were further validated theoretically by molecular docking study. It was confirmed that the molecules (BM1-BM3) bind to DNA via an intercalative and groove binding mode. The investigations showed a correlation between binding constants and energies obtained experimentally and through molecular docking, indicating a binding preference of benzimidazole derivatives with the minor groove of DNA. BM1 was the preferential candidate for DNA binding because of its flat structure, π-π interactions and less steric hindrance. To complement the DNA interaction, antimicrobial assays (antibacterial & antifungal) were performed. It was observed that compound BM2 showed promising activity against all bacterial strains (Micrococcus luteus, Staphylococcus aureus, Enterobacter aerogenes and Escherichia coli) and fungi (Aspergillus flavus, Aspergillus fumigatus and Fusarium solani), while rest of the compounds were active against selective strains. The MIC values of BM2 were found to be in the range of 12.5 ± 2.2-25 ± 1.5 µg/mL. Thus, the compound BM2 was found to be the effective DNA binding antimicrobial agent. Furthermore, the preliminary cytotoxic properties of synthesized compounds were evaluated by brine shrimps lethality assay to check their nontoxic nature towards healthy normal cells.Communicated by Ramaswamy H. Sarma.

Phytochemicals and Potential Therapeutic Targets on Toxoplasma gondii Parasite.

Identification of drug target in protozoan T. gondii is an important step in the development of chemotherapeutic agents. Likewise, exploring phytochemical compounds effective against the parasite can lead to the development of new drug agent that can be useful for prophylaxis and treatment of toxoplasmosis. In this review, we searched for the relevant literature on the herbs that were tested against T. gondii either in vitro or in vivo, as well as different phytochemicals and their potential activities on T. gondii. Potential activities of major phytochemicals, such as alkaloid, flavonoid, terpenoids and tannins on various target sites on T. gondii as well as other related parasites was discussed. It is believed that the phytochemicals from natural sources are potential drug candidates for the treatment of toxoplasmosis with little or no toxicity to humans.

Long-term follow-up of motor function deterioration following microsurgical resection of middle third parasagittal and falx meningioma.

BACKGROUND: Incidence of parasagittal meningioma varies in literature; it ranges from 16.8% to 25.6% of intracranial meningioma. Parafalcine meningioma accounts for about 8.5% of intracranial meningioma. Based on their relation to the superior Sagittal sinus and falx, these tumors had been classified into 3 groups; anterior third located between crista galli and coronal suture, middle third located between coronal and lambdoid sutures, and posterior third located posterior to lambdoid suture. METHODS: Seventeen cases of middle third parasagittal and falx meningioma operated between 2010 and 2014 were retrospectively reviewed; extent of resection was expressed according to Simpson's classification. Medical Research Council Grading System was used for assessment and evaluation of motor power during preoperative, postoperative, and long-term follow-up, and patients were divided into two groups: group A, no preoperative motor deficit, and group B, patients with preoperative motor deficit. Based on this grading system, we classified motor function into three categories as follows: no disability, partial disability but independent, and complete disability. Follow-up period ranged between 14 and 48 months with mean period 32 months. RESULTS: Total number of patients was 17, 10 females and 7 males. Age ranged between 38 and 63 with the mean age 47. Twelve cases were parasagittal meningioma and 5 cases were falx meningioma. All located at the middle one third. Family history was negative in all cases. Duration of presenting symptoms varied between 3 and 28 months; presenting symptoms were as follows: seizures 64.7% (11 patients), headache 52.9% (9 patients), motor weakness 47% (8 cases), and disturbed conscious level 5.9% (1 case). According to Simpson's classification, grade I resection was obtained in 4 patients and grade II in 13 patients. Intraoperative sinus invasion was present in 3 patients. In early postoperative outcome regarding motor function, 9 cases (53%) showed deterioration of motor function in group A: 4 patients out of 9, and group B: 4 patients out of 8. On long-term follow-up of patients with deteriorated motor function, 6 patients out of 9 improved (66%). CONCLUSIONS: Parasagittal and falx meningioma involving the middle third is associated with a higher incidence of motor function deterioration either as a presenting symptom or during postoperative period. Adobting the microsurgical techniques during surgical resection and preservation of integrity of the venous system and cerebral cortex, deterioration of motor function is transient in most of cases with a favorable outcome on long-term follow-up.

Effect of containing silica fume on cytotoxicity of white mineral trioxide aggregate.

BACKGROUND: Mineral trioxide aggregate (MTA) has a high biocompatibility and its physical properties could be improved by adding the containing silica fume an amorphous silicon dioxide (condensed silica fume [CSF]). The aim of this study was to evaluate the cytotoxicity of MTA mixed with CSF on the viability of L929 mouse fibroblast cell using 3-(4,5-dimethylthiazol-2-Yl)-2,5-diphenyltetrazolium bromide reduction assay (MTT assay). MATERIALS AND METHODS: In this in vitro study white MTA was mixed with distilled water according to the manufacturer's instructions. Mixtures of White MTA with 10%, 15%, and 20% CSF by weight were prepared and mixed with distilled water. Cytotoxicity of mixtures was compared with MTT assay on L929 mouse fibroblast cell line after 24, 48, and 72 h. Differences in cytotoxicity were assessed by one-way analysis of variance (ANOVA). RESULTS: Mean ± SD of vital cell counts cultured in MTA, MTA + 10% CSF, MTA + 15% CSF, and MTA + 20% CSF were 98% ± 6%, 97% ± 6%, 94% ± 4%, and 98% ± 4%, respectively. One-way ANOVA did not reveal any statistically significant difference between the groups (P > 0.05). CONCLUSION: It may be concluded that addition of CSF to MTA may not influence its cytotoxicity.

A Measure of Barriers Toward Medical Disclosure Among Health Professionals in the United Arab Emirates.

BACKGROUND: There has been a growing awareness that patients are subject to injuries that can be prevented as a direct consequence of health care. Error disclosure is an effective technique to restore the lost trust with the health care system. OBJECTIVE: The current study aimed to develop a valid and reliable scale to determine the factors facilitating the disclosure of health professionals in health organizations. METHODS: This study had a cross-sectional design that consisted of 722 responses (response rate of 68.3%) from 1 private and 1 public hospital in Sharjah, United Arab Emirates. The data collection tool included 23 items rated on a Likert scale ranging from 5, strongly agree, to 1, strongly disagree.The internal consistency was established through calculating the split-half reliability for part 1 (12 items), which had a Cronbach coefficient of 0.65, and part 2 (11 items), which had a Cronbach coefficient of 0.62. Scale validity was assessed with the Kaiser-Meyer-Olkin measure of sampling adequacy, which had a value of 0.62, and the Bartlett test of sphericity (approximated χ = 13012.2, P = 0.0001) supported the factorability of the correlation matrix. The varimax rotation revealed 5 components that explained 77.8% of the total variance. RESULTS: The varimax rotation revealed 21 items loaded on the following 5 factors: fear of disclosure and provider image consequences (factor 1), apology (factor 2), organizational culture toward patient safety (factor 3), professional ethics and transparency (factor 4), as well as patient and provider education (factor 5). CONCLUSIONS: The disclosure of medical mistakes requires preliminary considerations to effectively and compassionately disclose these events to patients. The validity and reliability of the results support the use of this scale at hospitals as part of the health care providers' disclosure processes.

Uncommon presentation of adult-form scimitar syndrome associated with single left pulmonary vein in a pregnant woman.

Scimitar syndrome is the constellation of malformations including an abnormal venous drainage of the right lung into the inferior vena cava, associated with the right lung and systemic supply to the right lung. The anomalous vein looks like the curved, Turkish sword (scimitar), hence the name.The adult form of scimitar syndrome is rare, and it is usually an incidental diagnosis based on the characteristic finding on radiological imaging since the patients are usually asymptomatic or with minimal symptoms.Our patient presented with a rare presentation of scimitar syndrome, which is tachyarrhythmia (sinus tachycardia, with episodes of supraventricular tachycardia). The diagnosis of scimitar syndrome was made based on the typical radiological finding of the anomalous venous drainage on CT angiography. Our patient does not have the full spectrum of the scimitar syndrome; therefore, she did not suffer from the usual complication (pulmonary hypertension). She was treated with ablation without surgical intervention.

Obligation towards medical errors disclosure at a tertiary care hospital in Dubai, UAE.

OBJECTIVE: The study aimed to identify healthcare providers' obligation towards medical errors disclosure as well as to study the association between the severity of the medical error and the intention to disclose the error to the patients and their families. DESIGN: A cross-sectional study design was followed to identify the magnitude of disclosure among healthcare providers in different departments at a randomly selected tertiary care hospital in Dubai. SETTING AND PARTICIPANTS: The total sample size accounted for 106 respondents. Data were collected using a questionnaire composed of two sections namely; demographic variables of the respondents and a section which included variables relevant to medical error disclosure. RESULTS: Statistical analysis yielded significant association between the obligation to disclose medical errors with male healthcare providers (X2 = 5.1), and being a physician (X2 = 19.3). Obligation towards medical errors disclosure was significantly associated with those healthcare providers who had not committed any medical errors during the past year (X2 = 9.8), and any type of medical error regardless the cause, extent of harm (X2 = 8.7). Variables included in the binary logistic regression model were; status (Exp ß (Physician) = 0.39, 95% CI 0.16-0.97), gender (Exp ß (Male) = 4.81, 95% CI 1.84-12.54), and medical errors during the last year (Exp ß (None) = 2.11, 95% CI 0.6-2.3). CONCLUSION: Education and training of physicians about disclosure conversations needs to start as early as medical school. Like the training in other competencies required of physicians, education in communicating about medical errors could help reduce physicians' apprehension and make them more comfortable with disclosure conversations.

Effect of Resin Cement Pre-heating on the Push-out Bond Strength of Fiber Post to Root Canal Dentin.

Background and aims. Various factors influence the interfacial bond between the fiber posts and root canal dentin. The aim of the present study was to evaluate the effect of pre-warming of resin cement on the push-out bond strength of fiber posts to various segments of root canal dentin. Materials and methods . In this in vitro study, 40 single-rooted human premolars were decoronated and underwent root canal treatment along with post space preparation. The samples were randomly divided into two groups: In group 1, Panavia F 2.0 cement was used at room temperature; in group 2, the same cement was warmed to 55‒60°C before mixing. After fiber posts were placed and cemented in the root canals, 3 dentin/post sections (coronal, middle and apical) with a thickness of 3 mm were prepared. A universal testing machine was used to measure push-out bond strength in MPa. Data was analyzed using two-factor ANOVA and a post hoc Tukey test at α=0.05. Results. The mean value of push-out bond strength was high at room temperature, and the differences in the means of push-out bond strength values between the resin cement temperatures and between different root segments in each temperature were significant (P<0.05). Conclusion. Pre-warming of Panavia F 2.0 resin cement up to 55-60°C reduced push-out bond strength to root canal dentin. In addition, in each temperature group bond strengths decreased from coronal to apical segments.

Over-the-counter medication patterns in households in Sharjah, United Arab Emirates.

BACKGROUND: Self-medication and acquisition of over-the-counter (OTC) medications are emerging community health issues. Besides being a cheap alternative for treating common illnesses, the behavior entails serious ramifications, such as medication wastage, increasing pathogen resistance, and adverse drug reactions. The present study was conducted to explore the extent of OTC medications in households in Sharjah, United Arab Emirates (UAE), including native UAE and expatriate families. METHODS: The study employed a population-based, cross-sectional, analytical study design. The study population included native and expatriate households residing in the Emirate of Sharjah, UAE. The snowball sampling technique was used, and the sample included a total of 335 households. RESULTS: Expatriate households acquired more OTC medications than did native households (adjusted odds ratio [aOR]=1.7). The demographic determinants for expatriate households were number of family members (aOR=1.6), age of children in the family (aOR=1.8), and annual income (aOR=0.5). Expatriate households purchased more OTC medication practices than did native households (aOR=2.2). In the statistical sense, expatriate household practices were buying medication upon relatives' advice (aOR=0.3), storage condition of medication (aOR=2.4), and disposal of expired medication (aOR=0.6). The highest percentages of OTC medications in native and expatriate households were those related to gastric and ear, nose, and throat illnesses. CONCLUSION: The presence of OTC medications in expatriate households was two-fold more common than in native households in Sharjah, UAE. There were significant associations for behaviors related to the reasons why OTC medications were purchased and stored within the household for both native and expatriate families.

Does Langenskiold staging have a good prognostic value in late onset tibia vara?

BACKGROUND: Although many literature studied the effect of many factors on the prognosis of the early-onset Blount disease, studies that were written on the prognostic factors affecting late onset tibia vara are still limited. PURPOSE: The aim of this study is to evaluate the prognostic value of the Langenskiold classification system for late onset tibia vara. METHODS: Twenty children from the Sporting Health Insurance Student Reference Hospital-Alexandria, with a diagnosis of late onset tibia vara were evaluated for the effect of the Langenskiold staging system on the prognosis after they all had been treated by gradual correction by Ilizarov technique using the so called "juxta-articular hinge assembly" after a mean follow-up period of 4.9 years (range : 4-6, SD 0.75). RESULTS: The difference in varus recurrence rates between the "low grade group" and "high grade group" was found to be statistically significant (p = 0.008) as will be discussed later. There was no statistically significant relation between the age of the patients at the time of operation, sex, length of the follow up period and the degree of pre-operative varus deformity angle (DA) and the recurrence (p > 0.05). CONCLUSION: We concluded that Langenskiold staging system is a reliable, reproducible and a good prognostic factor for late onset tibia vara.

1,3-Benzothia-zole-oxalic acid (2/1).

The asymmetric unit of the title compound, C(7)H(5)NS·0.5C(2)H(2)O(4), contains one benzothia-zole mol-ecule and half an oxalic acid mol-ecule, the complete mol-ecule being generated by inversion symmetry. The benzothia-zole mol-ecule is essentially planar, with a maximum deviation of 0.007 (1) Å. In the crystal, the benzothia-zole mol-ecules inter-act with the oxalic acid mol-ecules via O-H⋯N and C-H⋯O hydrogen bonds generating R(2) (2)(8) (× 2) and R(4) (4)(10) motifs, thereby forming supra-molecular ribbons along [101].

Nurses' knowledge of prevention and management of pressure ulcer at a health insurance hospital in Alexandria.

Nurses' knowledge of pressure ulcer prediction, prevention and management plays a very important role in the incidence and prevalence of pressure ulcers in health-care systems. The aim of the current study was to assess the nurse's knowledge about prevention and management of pressure ulcer at one of the largest health insurance hospitals in Alexandria. A descriptive cross-sectional study using an interview questionnaire format to assess the nurses' knowledge (n = 122) regarding prevention of pressure ulcers. The overall mean per cent score for nurses was below the minimum acceptable level. The mean per cent score for nurses was below 70% for nine measures of the 15 correct measures, which accounted for 60% of the measures of pressure ulcer prevention. Correct answers for non-useful measures for preventing pressure ulcers accounted for 66% of the non-useful measures on the questionnaire. It had been concluded that the nurses' knowledge regarding pressure ulcer prevention is below the acceptable levels.