Novel S-N/WO3: Optimization of photocatalytic performance of WO3 by simultaneous existence of S and N in WO3 against MB dye.

In this work, pure and S-N/WO3 (1%-7%) nanoparticles (NPs) have been developed for the degradation of MB dye. Optical properties, vibrational analysis, morphology, structural analysis, and photocatalytic activity of the samples have been evaluated using a variety of characterization techniques, including UV-vis, PL, FTIR, SEM, and x-ray diffraction (XRD). The XRD patterns showed that the stability of the orthorhombic phase of WO3 was affected by the concentrations of S and N. In SEM, nanospheres with an average size of 80 nm of NPs have been observed. The PL results showed that the e-, h+ recombination rate for the S-N7%/WO3 sample was the lowest. The degradation of MB dye has also been investigated in order to investigate the photocatalytic performance. Remarkably, S-N7%/WO3 shows the best results, with a maximum degradation of 90% in 120 min. The stability of the improved catalyst was tested using recycling and trapping studies. S-N7%/WO3 catalyst's exceptional photocatalytic activity highlights its potential use in wastewater treatment. This study will be helpful for manufacturing innovation.

Entrustment in physician-patient communication: a modified Delphi study using the EPA approach.

BACKGROUND: Competency based curricula across the globe stress on the importance of effective physician patient communication. A variety of courses have been used to train physicians for this purpose. However, few of them link competencies with practice resulting in confusions in implementation and assessment. This issue can be resolved by treating certain specific patient communication related tasks as acts of entrustment or entrustable professional activities (EPAs). In this study, we aimed to define a competency-based framework for assessing patient physician communication using the language of EPAs. METHODS: A modified Delphi study was conducted in three stages. The first stage was an extensive literature review to identify and elaborate communication related tasks which could be treated as EPAs. The second stage was content validation by medical education experts for clarity and representativeness. The third stage was three iterative rounds of modified Delphi with predefined consensus levels. The McNemar test was used to check response stability in the Delphi Rounds. RESULTS: Expert consensus resulted in development of 4 specific EPAs focused on physician-patient communication with their competencies and respective assessment strategies all aiming for level 5 of unsupervised practice. These include Providing information to the patient or their family about diagnosis or prognosis; Breaking Bad news to the patient or their family; Counseling a patient regarding their disease or illness; Resolving conflicts with patients or their families. CONCLUSIONS: The EPAs for Physician-patient communication are a step toward an integrative, all-inclusive competency-based assessment framework for patient-centered care. They are meant to improve the quality of physician patient interaction by standardizing communication as a decision of entrustment. The EPAs can be linked to competency frameworks around the world and provide a useful assessment framework for effective training in patient communication. They can be integrated into any post graduate curriculum and can also serve as a self-assessment tool for postgraduate training programs across the globe to improve their patient communication curricula.

Time to move from past to future by making present creative: A Scoping review.

Creativity is one of the tools in the toolkit of modern day learners. Scientific progress cannot be accomplished without developing creative capacities of individuals. The Muslim countries, despite their historical achievement in different creative and innovative discoveries and positive encouragement by Islam towards creativity, have paradoxically gone down from their position. Creativity is one of the priorities of modern age due to its role in the progress of humanity and future. The education system is spoon-feeding our learners and killing creativity. The main aim of the current scoping review is to summarise and disseminate research findings pertaining to the evidence on the definition of the concept of creativity, its importance in education, role of teachers and learners in making creativity a part of their educational endeavours, and their implications. Moreover, it provides a broad and detailed outline of the topic and exploring more general questions rather than providing answer to limited questions. It will help to determine how important it is to foster creativity as educators.

Oregano essential oil-infused mucin microneedle patch for the treatment of hypertrophic scar.

Hypertrophic scar (HS) manifests as abnormal dermal myofibroblast proliferation and excessive collagen deposition, leading to raised scars and significant physical, psychological, and financial burdens for patients. HS is difficult to cure in the clinic and current therapies lead to recurrence, pain, and side effects. In this study, a natural amphiphilic polymer mucin is used to prepare a dissolving microneedle (muMN) that is loaded with oregano essential oil (OEO) for HS therapy. muMN exhibits sufficient skin/scar tissue penetration, quick skin recovery time after removal, good loading of natural essential oil, fast dissolution and detachment from the base layer, and good biocompatibility to applied skin. In the rabbit HS model, OEO@muMN shows a significant reduction in scar thickness, epidermal thickness index, and scar elevation index. OEO@muMN also attenuates the mean collagen area fraction and decreases the number of capillaries in scar tissues. Biochemical Assay reveals that OEO@muMN significantly inhibits the expression of transforming growth factor-ß1 (TGF-ß1) and hydroxyproline (HYP). In summary, this study demonstrates the feasibility and good efficacy of using the anti-proliferative and anti-oxidative OEO for HS treatment. OEO@muMN is an efficient formulation that holds the potential for clinical anti-HS application. muMN is an efficient platform to load and apply essential oils transdermally.

The Effect of Colchicine on Myocardial Infarction: An Updated Systematic Review and Meta-analysis of Randomized Controlled Trials.

INTRODUCTION: Myocardial infarction (MI) is associated with a significant post-event inflammatory response which also contributes to post-MI prognosis. Colchicine, an anti-inflammatory agent, has exhibits potential benefits in various cardiovascular conditions such as coronary artery disease, pericarditis and atrial fibrillation. This meta-analysis predominantly aimed to provide an up-to-date evaluation of the efficacy and safety of colchicine in reducing adverse cardiovascular events in patients following acute MI. METHODS: A Systematic and comprehensive search was conducted on PubMed, Cochrane Library, Scopus, Google Scholar and clinicaltrials.gov for randomized controlled trials (RCTs) investigating the effect of colchicine on patients with MI until May 2024. Our primary outcome was a composite of adverse cardiovascular events, while secondary outcomes included all-cause mortality, incidence of stroke, cardiac arrest, hospitalization urgency, adverse gastrointestinal events and levels of high-sensitivity C - reactive protein (Hs-CRP). Risk ratios (RR) and standardized mean differences (SMD) were pooled under the random-effects model. RESULTS: Eleven trials with 7161 patients were included in our analysis out of which 3546 (49.51%) were allocated to colchicine and 3591 (50.14%) received placebo. Colchicine demonstrated statistically significant reduction in the composite of adverse cardiovascular events (RR=0.75, 95% CI: 0.60-0.94, P=0.01, I2= 48%), hospitalization urgency (RR=0.46, 95% CI: 0.31-0.68, P=0.0001, I2=0%) and levels of Hs-CRP (SMD= -0.43, 95% CI:-0.83-0.03, P=0.03, I2=85%) but statistically significant increment in adverse gastrointestinal events (RR=1.86, 95% CI: 1.14-3.02, P=0.01, I2=79%). However, all-cause mortality (RR =1.00, 95% CI: 0.72-1.39, P=0.98, I2=0%), cardiac arrest (RR=0.81, 95% CI: 0.33-1.95, P=0.63, I2=0), incidence of stroke (RR=0.45, 95% CI: 0.17-1.19, P=0.11, I2=36%) and recurrent MI (RR=0.78, 95% CI: 0.57-1.06, P=0.11, I2=11%) remained comparable across the two groups. CONCLUSION: The use of colchicine post-MI reduces the composite of adverse cardiovascular events, levels of Hs-CRP, hospitalization urgency but increases adverse gastrointestinal events. However, colchicine does not impact all-cause mortality, cardiac arrest, stroke incidence and incidence of recurrent MI. Large scale multicenter RCTs especially with longer follow-up duration are warranted to validate these findings.

A chitosan/fucoidan nanoparticle-loaded pullulan microneedle patch for differential drug release to promote wound healing.

Wound healing is a largely unmet medical issue in trauma, burn, and diabetes. In this study, a pullulan-based and nanoparticle-loaded smart microneedle patch is designed to release drugs differentially based on the needs of wound healing. Chitosan and fucoidan are first used to prepare moxifloxacin (MOX)-loaded nanoparticles (MOXNPs) with a diameter of 258.0 ± 10.86 nm, PDI 0.19 ± 0.06, and surface charge 45.1 ± 3.9 mV. MOXNPs, lidocaine (LH), and thrombin (TH) are then incorporated to a 30 % (w/w) pullulan-based microneedle patch (TH + LH + MOXNPs@MN). TH + LH + MOXNPs@MN possesses uniform and cone-shaped microneedles with a length of 725 µm, demonstrating good biocompatibility, sufficient strength for skin penetration, fast skin dissolution within 55 ± 5 min, rapid release of TH and LH within 1 h, and sustained release of MOX for 24 h. TH + LH + MOXNPs@MN heals mice skin wounds completely within 7 days and restores collagen deposition with accelerated cell proliferation, granulation, and reduced pro-inflammatory cytokines. In conclusion, this study utilizes combined polysaccharides to develop a smart multifunctional microneedle platform that achieves rapid hemostasis/analgesia and sustained bactericidal action. The smart and combined therapy is a potential strategy for high-quality wound healing.

A macrophage plasma membrane-coated and DNA structured nanomedicine targets to alleviate rheumatoid arthritis via dual inhibition to TNF-α and NF-κB.

High heterogenicity of rheumatoid arthritis (RA) leads to poor response in many patients. Combined therapies that simultaneously inhibit multiple proinflammatory targets may improve anti-RA efficacy. However, which monotherapies to combine and how to achieve the combination are critical issues. Here, we design a macrophage plasma membrane-coated and DNA structured nanomedicine to achieve a dual inhibitory therapy to Tumor necrosis factor alpha (TNF-α) and NF-κB. An anti-NF-κB decoy oligodeoxynucleotides (dODN) is first conjugated to a DNA cage with precise numbers and locations (Cage-dODN). Meanwhile, an anti-TNF-α siRNA is anchored to extracted macrophage plasma membrane (siRNA@M). Subsequently, siRNA@M is used to encapsulate Cage-dODN to fabricate siRNA@M(Cage-dODN) (siMCO). The size and zeta potential of siMCO are 63.1 ± 15.7 nm and -20.7 ± 3.8 mV respectively. siMCO shows increased intracellular uptake by inflamed macrophages and enhanced accumulation in inflamed mouse paws. siMCO also reduces pro-inflammatory factors at genetic and protein levels, alleviates arthritic symptoms, and shows no influence to major blood components. These results show that siMCO is a potential targeted, efficient, and safe dual inhibitory therapy for the treatment of inflammatory arthritis. The macrophage plasma membrane can be utilized to improve the targeting, stability, and efficacy of DNA structured nanomedicines.

Recent advances on transdermal delivery systems for the treatment of arthritic injuries: From classical treatment to nanomedicines.

Arthritic injuries happen frequently during a lifetime due to accidents, sports, aging, diseases, etc. Such injuries can be cartilage/bone injuries, tendon injuries, ligament injuries, inflammation, pain, and/or synovitis. Oral and injective administration of therapeutics are typically used but cause many side effects. Transdermal administration is an alternative route for safe and efficient delivery. Transdermal formulations of non-steroidal anti-inflammatory drugs have been available on market for years and show promising efficacy in pain relieving, inflammation alleviation, infection control, and so on. Innovative transdermal patches, gels/films, and microneedles have also been widely explored as formulations to deliver therapeutics to combat arthritic injuries. However, transdermal formulations that halt disease progression and promote damage repair are translated slowly from lab bench to clinical applications. One major reason is that the skin barrier and synovial capsule barrier limit the efficacy of transdermal delivery. Recently, many nanocarriers, such as nanoparticles, nanolipids, nanoemulsions, nanocrystals, exosomes, etc., have been incorporated into transdermal formulations to advance drug delivery. The combined transdermal formulations show promising safety and efficacy. Therefore, this review will focus on stating the current development of nanomedicine-based transdermal formulations for the treatment of arthritic injuries. The advances, limitations, and future perspectives in this field will also be provided to inspire future studies and accelerate clinical translational studies. This article is categorized under: Therapeutic Approaches and Drug Discovery > Emerging Technologies Implantable Materials and Surgical Technologies > Nanotechnology in Tissue Repair and Replacement Biology-Inspired Nanomaterials > Lipid-Based Structures.

Paradigm shift in medical education due to the COVID-19 pandemic: guidelines for developing a blended learning curriculum in medical education.

Background: The coronavirus disease 2019 (COVID-19) pandemic has transformed the world's economy, health and education in a blink of an eye. Almost 1 billion learners have been affected across the globe. This has resulted in a paradigm shift to blended learning. Therefore, it was felt necessary to provide practical guidelines for the development of blended curriculum in medical education. It would help to overcome the challenges faced due to unprecedented transformation of medical education on account of pandemic. Methods: Guidelines based on personal experience of the authors and literature search were developed using the complex adapted blended learning system (CALBS) framework. Seven experts developed these guidelines using the nominal group technique. The consent form and literature for CABLS framework was shared with experts. The experts developed the guidelines independently during phase one of the technique. After a given time, phase 2 started with moderator mediated discussion about the individual guidelines developed by the experts. After discussion and mutual consensus four types of guideline ideas were developed. During the third phase the experts ranked the guideline ideas on a scale of 1 to 5. The guideline idea that ranked highest was selected as a final guideline for developing a blended learning curriculum. Results: The group consensus resulted in developing seven guidelines for a blended course or curriculum in medical education. These guidelines are based on a conceptual framework supplemented by expert's own personal experience and current evidence from literature. Conclusions: These guidelines would provide a comprehensive and systematic approach to develop a blended learning curriculum in medical education.

From vaccines to nanovaccines: A promising strategy to revolutionize rheumatoid arthritis treatment.

Rheumatoid arthritis (RA) is a joint-related autoimmune disease that is difficult to cure. Most therapeutics act to alleviate the symptoms but not correct the causes of RA. Novel strategies that specifically target the causes are highly needed for RA management. Currently, early interruption of RA is increasingly suggested but the corresponding therapeutics are not available. Vaccines that have shown great success to combat infection, cancer, degenerative diseases, autoimmune diseases, etc. are ideal candidates for a new generation of anti-RA therapeutics to correct the causes and prevent RA or interrupt RA in early phases. Anti-RA vaccines can be divided into two major categories. One is to induce neutralizing antibodies and the other is to induce antigen-specific immune tolerance. The vaccines are inherently linked to nanotechnology because they usually need a biomacromolecule or carrier to provoke sufficient immune responses. In the past decade, designed nanocarriers such as nanoparticles, liposomes, nanoemulsion, etc., have been applied to optimize the vaccines for autoimmune disease treatment. Nanotechnology endows vaccines with a higher biostability, tunable in vivo behavior, better targeting, co-delivery with stimulatory agents, regulatory effects on immune responses, etc. In this review, unmet medical needs for RA treatment and anti-RA vaccinology are first introduced. The development of anti-RA therapies from vaccines to nanovaccines are then reviewed and perspectives on how nanotechnology promotes vaccine development and advancement are finally provided. In addition, challenges for anti-RA vaccine development are summarized and advantages of nanovaccines are analyzed. In conclusion, nanovaccines will be a promising strategy to revolutionize the treatment of RA by correcting the causes in an early phase of RA.

Co-delivery of triamcinolone acetonide and verapamil for synergistic treatment of hypertrophic scars via carboxymethyl chitosan and Bletilla striata polysaccharide-based microneedles.

Hypertrophic scar (HS) is a frequently diagnosed skin disease that is difficult to treat. HS is usually associated with itching and pain and causes both physical and psychological issues. In this study, a safe, convenient, and efficient therapy for HS is developed. Carboxymethyl chitosan (CMCH) and Bletilla striata polysaccharide (BSP) are used to prepare microneedles (MN) via a micro-molding method. Hydroxypropyl ß-cyclodextrin (HP-ß-CD) is used to encapsulate triamcinolone acetonide (TA) and the obtained inclusion is co-loaded with verapamil (VRP) to MN. The MN is then attached to an Ethyl cellulose (EC) base layer to obtain a MN patch. The MN patch has uniform needles, sufficient mechanical strength, good penetration and dissolution in skin, and low cytotoxicity. It also significantly decreases the thickness of HS, and hydroxyproline (HYP) and transforming growth factor-beta 1 (TGF-ß1) expression in HS, improves collagen fiber arrangement, and reduces dermis congestion and hyperplasia.

Novel approaches of the nanotechnology-based drug delivery systems for knee joint injuries: A review.

The knee joint is one of the largest, most complex, and frequently utilized organs in the body. It is very vulnerable to injuries due to activities, diseases, or accidents, which lead to or cause knee joint injuries in people of all ages. There are several types of knee joint injuries such as contusions, sprains, and strains to the ligament, tendon injuries, cartilage injuries, meniscus injuries, and inflammation of synovial membrane. To date, many drug delivery systems, e.g. nanoparticles, dendrimers, liposomes, micelles, and exosomes, have been used for the treatment of knee joint injuries. They aim to alleviate or reverse the symptoms with an improvement of the function of the knee joint by restoring or curing it. The nanosized structures show good biodegradability, biocompatibility, precise site-specific delivery, prolonged drug release, and enhanced efficacy. They regulate cell proliferation and differentiation, ECM synthesis, proinflammatory factor secretion, etc. to promote repair of injuries. The goal of this review is to outline the finding and studies of the novel strategies of nanotechnology-based drug delivery systems and provide future perspectives to combat the challenges of knee joint injuries by using nanotechnology.

Range contraction of snow leopard (Panthera uncia).

Snow Leopard (Panthera uncia) is native to mountain ranges of Central and South Asia, where it occurs from 3,000-4500 m elevation. The species is enlisted as "Endangered" by IUCN and its populations are reportedly declining. In the current study, we compared the past and current distribution ranges of the species using spatial analysis. We used Quantum Geographical Information System (QGIS) software to reconstruct and quantify its past distribution range and compare with its current one. Snow leopard was found more widely distributed in the past having a distribution range of approximately 10.47 million km2 against the current 3.20 million km2. Range contraction of the species approximates 69%. A total of 719 terrestrial protected areas of Asia (out of total 7209) had this species in the past whereas at current, only 311 protected areas support this species. The results emphasize escalating conservation efforts to save its remaining distribution range.

High levels of fluoride contamination in groundwater of the semi-arid alluvial aquifers, Pakistan: evaluating the recharge sources and geochemical identification via stable isotopes and other major elemental data.

Hydrogeochemical methods were integrated to delineate the geochemical factors controlling fluoride (F-) contamination in groundwater at four sites in the districts of Lahore (Samada) and Kasur (Sari Chimba, Kot Maiga, and Chah Fatehwala) in Panjab province of Pakistan. Hydrochemical data and stoichiometric ratios indicate Na-Cl and Na-HCO3 as the dominant water types with silicate weathering influencing overall hydrogeochemistry of the study area. The groundwater F- concentrations ranged between 0.54 mg/L and 17.5 mg/L, with more than 70% samples having F- concentrations above the World Health Organization (WHO) provisional drinking water guideline (1.5 mg/L). Saturation indices determined that 100% samples were saturated with respect to calcite and 96% samples were undersaturated with respect to fluorite, indicating the influence of calcite precipitation on fluoride enrichment. A positive correlation was observed between fluoride with pH, Na+, and HCO3-, confirming that high fluoride concentrations were the result of weathering of silicate minerals and the exchange of OH- on clay surface under the alkaline pH conditions. The isotopic values of δ18O and δ2H in groundwater ranged from 9.14 to - 5.51‰ and 56.57 to - 39.5‰, respectively. The stable isotope data indicated the meteoric origin of groundwater with some evaporative effect, which is partly influencing groundwater quality such as high pH and salinity, as a result facilitating anion exchange (OH- for F-) on clays surface. The research indicates that the groundwater quality of the study area is not recommendable for drinking due to its high total dissolved solids (TDS) and elevated fluoride concentrations.

Hydrogeochemical and isotopic evaluation of groundwater with elevated arsenic in alkaline aquifers in Eastern Punjab, Pakistan.

Geochemical investigation was carried out for delineating factors responsible for the mobilization of arsenic (As) from aquifer material into the groundwater. Four sites along Ravi River, (Samada, Sarai Chimba, Kot Maiga and Chah Fatehwala), were selected based on the blanket survey. Groundwater-rock interaction and evaporation were the key phenomena controlling groundwater chemistry, as shown by the hydrogeochemical data. Groundwater was predominantly Na-Cl type, with other principle facies being Na-HCO3, Na-Ca-HCO3 and Ca-Mg-Cl. The groundwater As concentration ranged between below detection level (2 µg/L) to 548 µg/L with 59% samples exceeding the World Health Organization (WHO) guidelines for As in drinking water (10 µg/L) and 31% having higher concentrations than the National Environmental Quality Standard (NEQS, 50 µg/L). Moderate to high concentrations of SO4-2 averaged at 244 mg/L and moderate NO3- concentrations averaged at 8 mg/L, together with alkaline pH (7.3-8.8) and high Eh values (113-402 mV) suggest partial oxidizing nature of the aquifers. The values for δ 18O and δ 2H in groundwater varied between -9.14 and -5.51‰, and -56.57 to -39.5‰ respectively, and suggests meteoric origin of the groundwater with some evaporative loss. This effect could be partly responsible for elevated levels of pH and salinity in groundwater. Based on geochemical and isotopic composition of groundwater, desorption of As from metal surfaces under alkaline environment might be the factor causing As enrichment in study area.

A 15-day-old male infant presenting with jerking movements of the limbs.

This 15-day-old Caucasian male infant presented to the clinic with his mother for a well-child visit. During the visit, the mother mentioned that she had observed jerking movements of the limbs, arms more than legs. Various tests were performed and observation in the ward helped determine the characteristics of the seizure-like movements. The infant was born by vaginal delivery with vacuum extraction with a history of possible perinatal asphyxia. After seizures were observed in the ward, the patient was referred to neurology where an EEG was performed. It was normal, excluding epilepsy states. A normal newborn screen excluded most metabolic disorders. After history and examination, investigations and observation, benign sleep myoclonus was diagnosed. Benign sleep myoclonus is a benign disorder that consists of jerking movements of the limbs, usually involving the upper limbs more than the lower limbs and usually occurring during sleep. The seizures spontaneously stopped when the infant was approximately 1.5 months old. This was consistent with the final diagnosis of neonatal sleep myoclonus.