Physician Experiences and Perceived Barriers to Providing Quality Infertility Care in the Greater Accra Region of Ghana.

High-quality, patient-centered care is essential to achieving equity and dignity for individuals with infertility, yet few studies have explored quality of infertility care in sub-Saharan Africa. We interviewed 13 non-specialist physicians and 2 medical school faculty to explore experiences in and perceptions of providing infertility care in Greater Accra, Ghana. We used a patient-centered infertility care model to inform our analysis and results. Individualized care and taking time to counsel and emotionally support patients were perceived as the most important things a physician can do to provide quality infertility care. Financial costs and lack of infertility services within a single facility were the most common barriers reported to providing quality infertility care. To the best of our knowledge, our study is the first to explore quality of infertility care provided by physicians in public sector facilities in Ghana, shedding light on existing barriers and identifying strategies for improvement.

Sequencing of neuroblastoma identifies chromothripsis and defects in neuritogenesis genes.

Neuroblastoma is a childhood tumour of the peripheral sympathetic nervous system. The pathogenesis has for a long time been quite enigmatic, as only very few gene defects were identified in this often lethal tumour. Frequently detected gene alterations are limited to MYCN amplification (20%) and ALK activations (7%). Here we present a whole-genome sequence analysis of 87 neuroblastoma of all stages. Few recurrent amino-acid-changing mutations were found. In contrast, analysis of structural defects identified a local shredding of chromosomes, known as chromothripsis, in 18% of high-stage neuroblastoma. These tumours are associated with a poor outcome. Structural alterations recurrently affected ODZ3, PTPRD and CSMD1, which are involved in neuronal growth cone stabilization. In addition, ATRX, TIAM1 and a series of regulators of the Rac/Rho pathway were mutated, further implicating defects in neuritogenesis in neuroblastoma. Most tumours with defects in these genes were aggressive high-stage neuroblastomas, but did not carry MYCN amplifications. The genomic landscape of neuroblastoma therefore reveals two novel molecular defects, chromothripsis and neuritogenesis gene alterations, which frequently occur in high-risk tumours.

Optimization of permeate flux produced by solar energy driven membrane distillation process using central composite design approach.

Membrane distillation (MD) is considered as a relatively high-energy requirement. To overcome this drawback, it is recommended to couple the MD process with solar energy as the renewable energy source in order to provide heat energy required to optimize its performance to produce permeate flux. In the present work, an original solar energy driven direct contact membrane distillation (DCMD) pilot plant was built and tested under actual weather conditions at Jeddah, KSA, in order to model and optimize permeate flux. The dependency of permeate flux on various operating parameters such as feed temperature (46.6-63.4°C), permeate temperature (6.6-23.4°C), feed flow rate (199-451L/h) and permeate flow rate (199-451L/h) was studied by response surface methodology based on central composite design approach. The analysis of variance (ANOVA) confirmed that all independent variables had significant influence on the model (where P-value <0.05). The high coefficient of determination (R(2) = 0.9644 and R(adj)(2) = 0.9261) obtained by ANOVA demonstrated good correlation between experimental and predicted values of the response. The optimized conditions, determined using desirability function, were T(f) = 63.4°C, Tp = 6.6°C, Q(f) = 451L/h and Q(p) = 451L/h. Under these conditions, the maximum permeate flux of 6.122 kg/m(2).h was achieved, which was close to the predicted value of 6.398 kg/m(2).h.

The Simultaneous Compression of the Median and Ulnar Nerves by Lipoma: A Case Report and Review of the Literature.

Entrapment syndromes in the hand are very common and usually idiopathic. However, it can be the expression of nerve compression by a nearby structure or tumor. Space-occupying lesions are widely reported as a cause of median or ulnar nerve compression in the wrist. Nevertheless, a simultaneous compression of the median and ulnar nerves by a tumor is a rare condition. To the best of our knowledge, only three cases are described in the English literature. Herein, we present a case of a simultaneous compression in the wrist of the median and ulnar nerves by lipoma in a 79-year-old patient while also elucidating the reasons for the rarity of this condition and reviewing its clinical and therapeutic particularities.

Design of a new palladium(ii) halide complex as a bio-active material: synthesis, physico-chemical studies, DFT-computations and evaluation of anti-inflammatory, antioxidant and anti-gastric damage activities.

Colorless single crystals of the zero-dimensional hybrid compound, (C6H10N2)2[PdCl6]·2H2O were acquired through the slow evaporation technique. The crystal structure was explored using SC-XRD, which demonstrates that the material crystallizes in the centrosymmetric space group P1̄ of the triclinic system. The density functional theory method at the B3LYP/Lan2mb basis set level was employed to establish the optimized geometry and vibrational frequencies of the title compound. An acceptable correspondence was observed between the results obtained through calculation and the experimental data, including the structure, and IR spectra. The optical characteristics revealed a direct band gap energy of 2.35 eV, validating the semiconductor characteristics of this new material. The results suggest strong agreement with the experimental data and validate the involvement of metal orbitals in defining the HOMO-LUMO boundary. Simultaneous TGA-DTA shows that this material remains solid up to 210 °C. Beyond these temperatures, a gradual decomposition process occurs, extending up to 440 °C and unfolding in several steps. This process entails the liberation of diverse compounds, encompassing organic molecules, and the evaporation of chlorine ions, ultimately leading to the formation of palladium oxide (PdO) as the final product. When given to rats with gastric ulcers at a dose of 100 mg kg-1, these compounds inhibit the key enzyme responsible for neutrophil infiltration as myeloperoxidase (MPO) by 38.7%. The compound also alleviates cellular damage induced by free radicals, demonstrated by a notable 48.3% decrease in thiobarbituric acid reactive substance rates (TBARS) compared to untreated rats. Additionally, these compounds bring about a substantial 30.6% reduction in the surface area of ulcers.

Potential of simple and hybrid nanofluid enhancement in performances of a flat plate solar water heater under a typical North-African climate (Tunisia).

This work aims to quantify the long-term performance improvement of solar water heater system by using both simple and hybrid nanofluids. For this purpose, transient system simulations of a flat plate solar collector have been carried out and discussed using titanium oxide, magnesium oxide, and copper oxide/multiwalled oxide-carbon nanotube nanofluid-based nanoparticles. Tunisian climatic conditions with a typical household need has been considered, and the investigations have been established in terms of energy amounts, solar fractions, and harmful CO2 emission avoidance. Results showed an increase in the collector performances using the considered nanofluids. In particular, using 0.2v% and 0.6v% TiO2 homogeneously dispersed in water reduced the auxiliary energy up to 47.6 and 60.9%, respectively, compared to the reference case using water. The flat plate solar collector has an annual production of 1294 kWh for a need of 1998 kWh, which equates to an annual coverage rate of roughly 65%. Additionally, it was shown that when MgO with MWCNT were used instead of MgO nanofluid-based nanoparticles, the solar fraction increased by 5.14%. The use of 0.6 volume percent TiO2 nanoparticles in water reduces hazardous CO2 emissions by up to 0.829 tons annually.

Energy behaviour and economic analysis of a photovoltaic-thermal (PV/T) collector coupled with a reverse osmosis (RO) desalination unit in Tunisian climatic conditions: a feasibility study.

Water scarcity affects about one billion people in the world. Around two billion people could be living in water-stressed areas by 2050. For this reason, the desalination is always evolving due to the importance of the water resources found in the seas and brackish water. As these systems are generally energy intensive, the use of a renewable energy source is among the most appropriate solution. In this paper, both experimental and numerical investigations have been conducted to evaluate the performances and the economic viability of a photovoltaic-thermal collector intended to supply a reverse osmosis (RO) unit. Experimental study is based on the input-output and dynamic system testing (DST) according to ISO 9459-5 standard method and computations use the energy and mass balances of the PV/T collector and the RO plant. Results of DST testing showed that the loss coefficient of the PV/T, the tank loss coefficient and the total tank heat capacity are 10.46 W.m-2.K-1, 1.596 W.K-1 and 388 MJ.K-1, respectively. The ability to couple the RO technology to PV/T systems has been demonstrated. The complete system has been simulated for a water salinity of 10,000 ppm and climatic data of Borj-Cedria (Tunisia) site (longitude 10° 25' 41″ E and latitude 36° 43' 04″ N). Numerical investigations showed that the electricity needs of a small off-grid desalination unit could be met by using a 6.48 m2 PV/T panel surface area. In this case, the purified water produced has a salinity of 1500 ppm and the flow rate is 24,000 l/day. For a grid connected site, the produced and auxiliary powers are found to be equal to 54% and 21%, respectively. Moreover, the economic cost of adding a PV/T system into an existing RO unit has been evaluated and the results showed that the payback period is 6 years.

SARS-CoV-2 Papain-like Protease Responsive ZnO/Daclatasvir-Loaded Chitosan/Gelatin Nanofibers as Smart Antimicrobial Medical Textiles: In Silico, In Vitro and Cell Studies.

A significant number of deaths are reported annually worldwide due to microbial and viral infections. The development of protective medical textiles for patients and healthcare professionals has attracted many researchers' attention. Therefore, this study aims to develop smart drug-eluting nanofibrous matrices to be used as a basic material for medical textile fabrication. First, chitosan/gelatin nanofibers were selected as the basic material owing to the wide antimicrobial activity of chitosan and the capability of gelatin to be hydrolyzed in the abundance of the papain-like protease (PLpro) enzyme secreted by SARS-CoV-2. Daclatasvir (DAC), an NS5A inhibitor, was selected as the model drug based on in silico studies where it showed high anti-SARS-CoV-2 potential compared to FDA-approved references. Due to their reported antimicrobial and antiviral activities, ZnO NPs were successfully prepared and incorporated with daclatasvir in chitosan/gelatin nanofibrous matrices through electrospinning. Afterward, an in vitro release study in a simulated buffer revealed the controlled release of DAC over 21 days from the nanofibers compared to only 6 h for free DAC. On the other hand, the abundance of PLpro induced the complete release of DAC from the nanofibers in only 4-8 h. Finally, the nanofibers demonstrated a wide antimicrobial activity against S. aureus, E. coli, and C. albicans.

Antimicrobial and anti-SARS-CoV-2 activities of smart daclatasvir-chitosan/gelatin nanoparticles-in-PLLA nanofibrous medical textiles; in vitro, and in vivo study.

This study aims at the development of electrospun polylactic acid nanofibers (PLLA NFs) incorporating smart daclatasvir-loaded chitosan gelatin nanoparticles to be used as medical textiles. First, smart nanoparticles were prepared through ionic gelation and optimized using Design Expert® software where daclatasvir (DAC), chitosan (CS), and gelatin (GL) amounts were selected to be the independent variables. DAC was used owing to its reported Anti-SARS-CoV-2 activity, CS was chosen due to its antimicrobial activity and GL was used owing to its sensitivity to be hydrolyzed upon exposure to Papain-like protease enzyme (PLpro). The optimum DAC-CS/TAN NPs possessed 109 nm size and 94.44 % entrapment efficiency in addition to sustained drug release for 14 days. Furthermore, upon exposure to PLpro, smart DAC-CS/GL NPs released the whole DAC amount within 3 h. Then, DAC-CS/GL NPs were incorporated within PLLA NFs through electrospinning. Swellability was found to increase gradually reflecting the controlled release of DAC from nanofibers within 3 weeks. Cell viability assessments using human fibroblasts showed that the developed nanofibers possess high biocompatibility. An in-vivo animal model for skin irritation was carried out for two weeks where visual inspection and histopathological investigations showed that neither edema nor erythema were observed.

Efficacy of rituximab in refractory polyarteritis nodosa: a case report.

Polyarteritis nodosa (PAN) is a systemic vasculitis affecting medium and small-sized vessels resulting in multiple organ involvement. Refractory PAN requires a different therapeutic approach. We herein report the case of a 42-year-old male presenting a non-virus-related refractory PAN with a favorable outcome on rituximab. He presented significant weight loss, muscle weakness, peripheral axonal neuropathy, and medium-sized cutaneous vessel necrotizing vasculitis. The patient received high-dose corticosteroids and cyclophosphamide with no significant clinical improvement while developing adverse side effects such as hypertension and diabetes. Rituximab was prescribed as an alternative therapy at 1000 mg on day 0 and day 15. This allowed for complete and rapid control of disease activity with regression of cutaneous injury and substantial improvement of neurological symptoms. In conclusion, using chimeric anti-CD20 monoclonal antibodies, such as rituximab, although rarely reported in refractory non-virus-related PAN, may be an effective alternative therapy, as portrayed in our case.

Iatrogenic giant subclavian artery pseudoaneurysm following clavicle fracture repair: A case report.

Subclavian artery aneurysms are infrequently observed in clinical settings, and are divided into intrathoracic and extra-thoracic segments. Atherosclerosis, cystic necrosis of the tunica media, trauma, or infections are more common. Blunt trauma or piercing is more frequently the cause of pseudoaneurysms, and broken bones following surgery should be evaluated. A 78-year-old woman attended the vascular clinic with a closed mid-clavicular fracture due to plant trauma before 2 months. Physical examination revealed a well-healed wound and no palpable pain, but a massive pulsating mass with normal overlying skin in the superior side of the clavicle. Thoracic CT angiography and a neck ultrasound revealed a distal right subclavian artery pseudoaneurysm of 50 × 49 mm. Arterial injuries were repaired by a ligature and bypass. The recovery from surgery was successful, and a 6-month follow-up examination revealed a right upper limb that was symptom-free and well-perfused.

Correlation of the ultrasound thyroid imaging reporting and data system with cytology findings among patients in Uganda.

BACKGROUND: Ultrasonography is a noninvasive modality for the initial assessment of thyroid nodules. The American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) has demonstrated good performance in differentiating malignant thyroid nodules. However, the combination of ACR TI-RADS categories and cytology has not been studied extensively, in Uganda. The study aims to correlate ACR TI-RADS with cytology among patients referred for US-guided fine-needle aspiration at Mulago National Referral Hospital. METHODS: This was a hospital-based cross-sectional study that recruited 132 patients with thyroid nodules. Spearman's correlation was used to establish a relationship between TI-RADS and cytology findings. The diagnostic accuracy of TI-RADS was assessed using sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios. RESULTS: Of 132 study participants, 90% (n = 117) were females, and the mean age was 41 ± 13 years. One hundred sixty-one thyroid nodules were analyzed. More than half of the thyroid nodules (54.7%, n = 87) were solid or almost solid, 96.9% (n = 154) were shaped wider than tall, 57.2% (n = 91) had smooth margins, 83.7% (n = 133) were hyperechoic or isoechoic, and 88.7% (n = 141) had no echogenic foci. TI-RADS 3 was the most common at 42.9% (n = 69). The proportions of malignancy for TI-RADS 4 and TI-RADS 5 were 73.3% and 85.7%, respectively. The correlation between ACR TI-RADS and the Bethesda system of thyroid classification scores was r = 0.577. The sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios of ACR TI-RADS were 90.9%, 98.5%, 90%, 99.3%, 62.3, and 0.1, respectively. CONCLUSION: We found that ACR TI-RADS classification is an appropriate and noninvasive method for assessing thyroid nodules in routine practice. It can safely reduce the number of unnecessary fine-needle aspiration in a significant proportion of benign thyroid lesions. Thyroid nodules classified as TI-RADS 3 should be followed routinely. ACR TI-RADS should be standardized as the screening tool in resource-limited areas.

OTX2 directly activates cell cycle genes and inhibits differentiation in medulloblastoma cells.

The transcription factor OTX2 has been implicated as an oncogene in medulloblastoma, which is the most common malignant brain tumor in children. It is highly expressed in most medulloblastomas and amplified in a subset of them. To study the role OTX2 has in medulloblastoma we investigated the downstream pathway of OTX2. We generated D425 medulloblastoma cells in which endogenous OTX2 can be silenced by inducible shRNA. Silencing of OTX2 strongly inhibited cell proliferation and resulted in a neuronal-like differentiation. Expression profiling of time courses after silencing showed a progressive change in gene expression for many cellular processes. Downregulated genes were highly enriched for cell cycle and visual perception genes, while upregulated genes were enriched for genes involved in development and differentiation. This shift is reminiscent of expression changes described during normal cerebellum development where proliferating granule progenitor cells have high OTX2 expression, which diminishes when these cells exit the cell cycle and start to differentiate. ChIP-on-chip analyses of OTX2 in D425 cells identified cell cycle and perception genes as direct OTX2 targets, while regulation of most differentiation genes appeared to be indirect. The expression of many directly regulated genes correlated to OTX2 expression in primary tumors, suggesting the in vivo relevance of these genes and their potential as targets for therapeutic intervention. These analyses provide more insight in the molecular network of OTX2, demonstrating that OTX2 is essential in medulloblastoma and directly drives proliferation by regulation of cell cycle genes.

Finite element analysis of the dynamic behavior of a laminated windscreen with frequency dependent viscoelastic core.

This paper presents numerical and experimental validation of results obtained by a shell finite element, which has been developed for modeling of the dynamic behavior of sandwich multilayered structures with a viscoelastic core. The proposed shell finite element is very easy to implement in existing finite element solvers, since it uses only the displacements as degrees of freedom at external faces and at inter-layer interfaces. The displacement field is linearly interpolated in the thickness direction of each layer, and analytical integration is made in the thickness direction in order to avoid meshing of each sandwich layer by solid elements. Only the two dimensional mid-surface of reference is meshed, facilitating the mesh generation task. A simplified modal approach using a real modal basis is also proposed to efficiently calculate the dynamic response of the sandwich structure. The proposed method reduces the memory size and computing time and takes into account the frequency-dependence of the polymer core mechanical properties. Results obtained by the proposed element in conjunction with the simplified modal method have been numerically and experimentally validated by comparison to results obtained by commercial software codes (MSC/NASTRAN and ESI/RAYON-VTM), and to measurements done on automobile windscreens.

Experience with the distally based sural flap: a review of 25 cases.

The reconstruction of soft tissue defects in the distal areas of the lower extremity remains a challenge. The distally based sural neurocutaneous flap based on the sural nerve and the superficial sural artery has been used for skin defect reconstruction of the distal third of the leg, the hindfoot, ankle, and heel. We describe our experience and evaluate the reliability of this surgical technique. From 2004-2010, 25 patients with an average age of 32.5 (6 to 70) years were treated using the distally based sural flap for reconstruction of skin defects of the lower third of the leg, the heel, the ankle, and the hindfoot. The skin defect was secondary to trauma in 20 patients (80%) and compromised tendon or bone in all cases. One venous congestion and 2 partial flap necroses were observed. The mean follow-up was 25 (9 to 46) months. The plastic result was assessed as satisfactory in all patients. The donor site morbidity was minimal. The sural flap is a good way to reconstruct soft tissue defects of the lower extremity; this surgical technique provides an alternative to microsurgical reconstruction.

Should Pharmacists Lead Medication Reconciliation in Critical Care? A One-Stem Interventional Study in an Egyptian Intensive Care Unit.

OBJECTIVES: The main objective was to compare physician-obtained medication histories to the practice of medication reconciliation undertaken by a pharmacist in the intensive care unit (ICU). METHODS: A one-stem interventional study involving 500 adults 18 years and older admitted to the ICU (50 beds) of an Egyptian Joint Commission International-accredited reference hospital was conducted. The primary outcome measure was the proportion of ICU patients with missing medications in the cohorts of physician versus pharmacist-led medication reconciliation. The secondary outcome measure was the percentage of patients who had at least one clinical condition or adverse event (AE) that was left untreated during hospitalization of the 2 arms of patients after reconciliation. RESULTS: A total of 500 patients received reconciliation. Medication discrepancies in the cohort of physician-led reconciliation were greater than that of the pharmacist (26.1% versus 2.6%, P = 0.001). The most common discrepancy was indication with no medication, which was found to be greater in the physician-led cohort of patients than that of the pharmacist cohort (25.2% versus 2.6%, P = 0.001). Untreated AEs in the former cohort were present in 9.1% of cases versus 1.5% in the pharmacist-led reconciliation cohort ( P = 0.001). CONCLUSIONS: The present study revealed that pharmacist-led medication reconciliation in ICU has dramatically decreased medication discrepancies and AEs in adults with acute ICU admissions.

The mediating role of gender in social media shopping acceptance: from the WOM perspective.

Today, online consumers' shopping experiences are wholly transformed because of technology to maximize consumer shopping experiences. However, even after increased online shopping after the Covid-19 outbreak, no study has examined the role of demographics in online shopping acceptance. Thus, we filled this gap by employing a cross-sectional design in the UAE and conducting Structural Equation Modelling (SEM). For data gathering purposes, we used structured questionnaires and randomly selected a sample of n = 320 respondents from Al Ain city. Findings revealed strong relationships between Online Shopping, Social Media Usage, and Electronic Word of Mouth (p > 0.000, p > 0.000). Despite the relationships between Social Media Usage, Electronic Word of Mouth, and online shopping acceptance remaining insignificant (p < .384, p < .425), the relationship between Social Media Usage, Online Shopping Acceptance (p > .004) remained significant. Finally, we conducted the mediating analyses and found a substantial mediation of gender between Social Media Usage, Online Shopping Acceptance (p > .000), and Electronic Word of Mouth and Online Shopping Acceptance (p >. 001). Hence, we conclude that people from Al-Ain city primarily rely on online shopping. For this purpose, they consider different factors, including their demographics, i.e., gender, as highly influential on their online shopping acceptance. However, the major limitations of the current study involve selecting gender as the only mediating variable, rejection o two prominent hypotheses, and geographical generalizability of results. Finally, we recommend that future researchers examine the impact of other demographical variables, i.e., age, income, qualification, residence, and others, to examine their impacts on consumer online shopping acceptance.

Myxoid Dermatofibrosarcoma Protuberans of the Scrotum: Rare Tumor in an Uncommon Location.

Background: Dermatofibrosarcoma protuberans (DFSP) is an uncommon tumor that involves the skin with a low metastatic rate; however, this tumor has a tendency to recur locally. Myxoid DFSP is a rare variant, with a few cases mentioned in the literature, and may present diagnostic difficulties on histopathological examination. Case Presentation: We present a 9-year-old male with a history of a left scrotal mass for 3 years. An enhanced computed tomography (CT) scan of the pelvis showed a heterogeneously enhancing mass in the scrotum with extension into both inguinal regions. Histology showed spindle-shaped cells forming a storiform pattern in the hypercellular area and myxoid stroma with prominent thin-walled vessels. Immunohistochemically, the cluster of differentiation 34 (CD34) was positive. The mass was removed by surgical excision with negative resection edges, and then adjuvant radiotherapy of 60 Gy was given. The patient had a good outcome with treatment and was doing well on follow-up. Conclusion: This variant of sarcoma is rare and often presents a diagnostic challenge. Early detection is crucial to prevent both undertreatment and overtreatment.

Hyaluronic acid-entecavir conjugates-core/lipid-shell nanohybrids for efficient macrophage uptake and hepatotropic prospects.

Drug covalently bound to polymers had formed, lately, platforms with great promise in drug delivery. These drug polymer conjugates (DPC) boosted drug loading and controlled medicine release with targeting ability. Herein, the ability of entecavir (E) conjugated to hyaluronic acid (HA) forming the core of vitamin E coated lipid nanohybrids (EE-HA LPH), to target Kupffer cells and hepatocyte had been proved. The drug was associated to HA with efficiency of 93.48 ± 3.14 % and nanohybrids loading of 22.02 ± 2.3 %. DiI labelled lipidic nanohybrids improved the macrophage uptake in J774 cells with a 21 day hepatocytes retention post intramuscular injection. Finally, in vivo biocompatibility and safety with respect to body weight, organs indices and histopathological alterations were demonstrated. Coating with vitamin E and conjugation of E to HA (a CD44 ligand), could give grounds for prospective application for vectored nano-platform in hepatitis B.

Non-traumatic myositis ossificans circumscripta in the anterior abdominal wall of a seven-year-old Ugandan child: A case report.

Myositis ossificans circumscripta (MOC) is a benign and self-limiting heterotopic ossification in the subcutaneous fat, tendons, muscles, and nerves. It is commonly due to trauma and is frequently encountered in the arm, shoulder, thigh, and hand which are prone to trauma. Non-traumatic MOC arising from the abdominal muscles is extremely rare. We report a case of 7-year-old male child with a three-year history of progressive painless abdominal swelling in the left hypochondria region with no history of associated trauma. CT scan of the abdomen showed a well-defined hyperdense mass in the left external oblique muscle. Histological diagnosis confirmed myositis ossificans of the external oblique muscle. The mass was removed surgically with no immediate or late complications.