Long-pulsed nd: YAG laser treatment of nail psoriasis: clinical and ultrasonographic assessment.

Nail psoriasis is a chronic, inflammatory condition which is difficult to treat, linked with greater psoriasis severity, and may be associated with anxiety and significant functional impairment of the quality of life. The 1064 nm Nd: YAG laser was reported to yield satisfactory results in the treatment of nail psoriasis.The aim of the study was to assess the clinical and ultrasonographic efficacy of long-pulsed 1064 nm Nd: YAG laser in the treatment of fingernail psoriasis and compare its effect to control fingernails.This intra-patient randomized controlled trial analyzed 86 fingernails collected from 13 patients suffering from cutaneous and nail psoriasis. The nails were randomized into two groups. Group A was treated with Nd: YAG laser once monthly for three sessions while group B served as control. Assessment took place at baseline, 1 and 3 months after the last treatment session. For scoring, the 32-points target NAPSI scoring systems was used. Additionally, two blinded dermatologists' score of improvement, patients' pain assessment by visual analogue score and ultrasonographic assessment were all performed.At the end of follow up, the medians of tNAPSI score, plate definition, matrix thickness, bed thickness and bed vascularity decreased significantly in the Nd: YAG laser treated group in comparison to baseline (p = 0.001, 0.006, 0.039, < 0.001 and 0.010, respectively). While, there was a non-significant reduction in median tNAPSI score in the control group at last follow up, however, ultrasonography recorded a significant reduction in the medians of plate definition, bed thickness and vascularity (p = 0.002, 0.011 and 0.033, respectively) from the baseline. Comparison of the Nd: YAG laser and the control groups showed no significant difference from baseline regarding the medians of tNAPSI, tNAPSI percentile improvement, pits count, blinded evaluation of photographs and ultrasonographic assessments.In conclusion, Nd: YAG laser showed clinical and ultrasonographic improvement in fingernail psoriasis. Ultrasonography is a useful noninvasive tool in diagnosing and monitoring the clinical and even the subclinical changes in nail psoriasis. Nail psoriasis although difficult to treat, may show spontaneous improvement.

Knowledge, perceived needs of continuous professional's development, and associated factors among healthcare workers in East Ethiopia: a multi-health facility-based cross-sectional study.

BACKGROUND: The Ethiopian Ministry of Health (EMOH) has recently introduced a Continuous Professional Development (CPD) program for healthcare workers to ensure they maintain the necessary competencies to meet the community's health needs. However, there is limited information on healthcare workers' knowledge and perceived need for CPD. This study aims to assess healthcare workers' CPD knowledge, perceived needs, and factors associated with these in eastern Ethiopia. METHODS: A health facility-based cross-sectional quantitative study was conducted from September 1, 2022, to October 30, 2022. Health facilities and study participants were selected using a simple random sampling technique. A total of 731 healthcare professionals were randomly selected. Data was collected using a self-administered questionnaire developed from national CPD guidelines. Data analysis was performed using the STATA statistical package version 14. A logistic regression model was used to assess the association between predictors and the outcome variable. Adjusted odds ratios with 95% confidence intervals were calculated to determine the strength of the association. A p-value < 0.05 was considered statistically significant. RESULTS: In this study, 731 healthcare workers participated. Among them, 65.80% (95% CI: 62.35%, 69.24%) had knowledge of CPD, and 79.48% (CI95% 76.54, 82.41) expressed a strong perceived need for CPD. Female healthcare workers [AOR: 0.54 (95% CI: 0.37, 0.78)] and lack of internet access [AOR: 0.68 (95% CI: 0.47-0.97)] were predictors of knowledge of CPD. Age above 35 [AOR: 0.39 (95% CI: 0.17, 0.91)] and being female [AOR: 0.59 (95% CI: 0.40-0.87)] were predictors of a strong perceived need for CPD. CONCLUSION: The study found that there was a low level of knowledge about Continuing Professional Development among healthcare workers. The perceived needs of healthcare workers varied. It is important for health sectors and stakeholders to prioritize developing strategies that address knowledge gaps, particularly among female healthcare workers, improve access to the Internet for CPD resources, and address the diverse needs of professionals for effective CPD implementation.

Predicting the short and long term effects of food price inflation, armed conflicts, and climate variability on global acute malnutrition in Somalia.

BACKGROUND: Malnutrition poses a substantial challenge in Somalia, impacting approximately 1.8 million children. This critical issue is exacerbated by a multifaceted interplay of factors. Consequently, this study seeks to examine the long-term and short-term effects of armed conflicts, food price inflation, and climate variability on global acute malnutrition in Somalia. METHODS: The study utilized secondary data spanning from January 2015 to December 2022, sourced from relevant databases. Two distinct analytical approaches were employed to comprehensively investigate the dynamics of global acute malnutrition in Somalia. Firstly, dynamic autoregressive distributed lag (ARDL) simulations were applied, allowing for a nuanced understanding of the short and long-term effects of armed conflicts, food price inflation, and climate variability on malnutrition. Additionally, the study employed kernel-based regularized least squares, a sophisticated statistical technique, to further enhance the robustness of the findings. The analysis was conducted using STATA version 17. RESULTS: In the short run, armed conflicts and food price inflation exhibit positive associations with global acute malnutrition, particularly in conflict-prone areas and during inflationary periods. Moreover, climatic variables, specifically temperature and rainfall, demonstrate positive associations. It is important to note that temperature lacks a statistically significant relationship with global acute malnutrition in the short run. In the long run, armed conflicts and food price inflation maintain persistent impacts on global acute malnutrition, as confirmed by the dynamic ARDL simulations model. Furthermore, both temperature and rainfall continue to show positive associations with global acute malnutrition, but it is worth noting that temperature still exhibits a non-significant relationship. The results from kernel-based regularized least squares were consistent, further enhancing the robustness of the findings. CONCLUSIONS: Increased armed conflicts, food price inflation, temperature, and rainfall were associated with increased global acute malnutrition. Strategies such as stabilizing conflict-prone regions, diplomatic interventions, and peace-building initiatives are crucial, along with measures to control food price inflation. Implementing climate adaptation strategies is vital to counter temperature changes and fluctuating rainfall patterns, emphasizing the need for resilience-building. Policymakers and humanitarian organizations can leverage these insights to design targeted interventions, focusing on conflict resolution, food security, and climate resilience to enhance Somalia's overall nutritional well-being.

Assessment of the Implementation of Global Initiative for Asthma (GINA) 2019 Guidelines for Treatment of Mild Asthma Among Pediatric Registrars: A Quasi-Interventional Study.

Background and Aims: It is essential to have proper treatment and management for asthma in order to minimise symptoms, lessen the burden, and lower the chance of exacerbations. To better control asthma, the purpose of this study was to evaluate and enhance paediatric registrars' understanding and application of asthma treatment. Methods: The Sudan Medical Specialisation Board (SMSB) paediatric registrars provided data for this quasi-interventional study between April and September of 2021. Twice, both before to and following the intervention education sessions, the questionnaire was delivered. SPSS version 28 was used to analyse the data after it had been cleaned up in an Excel document. Results: 203 (or 77.8%) of the 261 were women. A substantial rise from 8.1 ± 4.12 SD to 18 ± 5.03 SD in the mean overall knowledge score of registrars between the pre-and post-intervention periods. A significant difference (p=0.001) was observed in the post-intervention phase, with first-year registrars (R1) demonstrating higher scores than their senior colleagues. The registrars' total knowledge scores did not differ significantly from one another during the pre-intervention period. The Global Initiative of Asthma (GINA) guidelines of management were implemented to a certain extent, according to the study. Of the registrars, 148 (56.7%) and 203 (77.8%) evaluated step one management in children ages 5 and under; 66 (25.3%) and 213 (81.6%) evaluated step one management in children ages 6 to 11; and 66 (25.3%) and 213 (81.6%) evaluated step one management in children ages 6 to 11 in pre- and post-intervention, respectively. Conclusion: Given that the intervention in this study greatly increased registrars' knowledge, doctors should obtain training on the GINA 2019 recommendations through conferences, workshops, and academic programmes. To find out why R1 outperforms their older counterparts, more investigation has to be done.

Assessment of the condylar response of two differently anchored fixed functional appliances in class II malocclusion in young adult orthodontic patients: A randomized clinical trial.

OBJECTIVE: Measuring the condylar volume changes after treatment with skeletally anchored type IV Herbst appliance vs. Twin Force Bite Corrector (TFBC) in class II malocclusion in young adult patients. MATERIALS AND METHODS: Twenty class II malocclusion participants were randomly involved in our randomized clinical study. They are divided equally into two groups: group I (10 patients with an age range of 16 to 18 years and a mean age of (17.15 ± 0.62) (five males and five females) with a mean Angle formed between (A) point and (Nasion) point and (B) point, to determine anteroposterior relation between maxilla and mandible (ANB) of 6.20 (1.03) and a mean mandibular length of 106.1 (1.7), who were treated by a skeletally anchored type IV Herbst appliance, supported at the mandible by two mini-plates fixed bilaterally at the mandibular symphysis; group II (10 patients with an age range of 15 to 18 years and a mean age of (16.85 ± 0.33) (six males and four females) with a mean ANB of 6.80 (0.89) and a mean mandibular length of 107.3 (2.36), who were treated by a TFBC that was installed just mesial to the tube of the maxillary first permanent molar and distal to the bracket of the lower canine for 4 months. According to the Index of Orthognathic Functional Treatment Need (IOFTN) index, the participants in both groups have grade 4 (great need for treatment) as they have excessive overjet (6-9 mm). Cone-beam computed tomography (CBCT) was taken just before installing fixed functional appliances and after the removal. The condylar volume was measured using Dolphin software. Parametric measurements were performed by the independent t-test, while non-parametric variables (percent change) were compared by the Mann-Whitney U-test. RESULTS: On the right side, the Herbst group recorded a percent increase (median = 1.23%), while TFBC recorded a median percent decrease (-7.85%). This change is statistically significant (P = 0.008). CONCLUSIONS: The difference in the condylar volume was significantly higher with the mini-plate anchored Herbst appliance than with the dentally anchored TFBC group.

Assessment of local complications with preoperative versus postoperative radiotherapy in patients with soft tissue sarcoma in extremities: A randomized comparative clinical trial.

Background: Radiotherapy is considered a cornerstone as adjuvant or neo adjuvant to surgery in extremity soft tissue sarcoma (ESTS). Wound complications are the most agonizing complication that may have an impact on patient's functional outcome following radiotherapy. The best care for ESTS is by combining extensive surgical excision with safety margin and radiotherapy either preoperative (neoadjuvant) or postoperative. Preoperative radiotherapy allows for lower dose of radiation over smaller fields which is supposed to decrease long-term complications. However, several studies have shown that early complications which include wound dehiscence, infection, seroma and burn may be more frequent with preoperative radiotherapy than with postoperative radiotherapy. Most of these studies were retrospective. This study aims to prospectively assess and compare the early complications associated with radiotherapy in both techniques. Hypothesis: Preoperative radiotherapy is not inferior to postoperative radiotherapy regarding early wound complications. Patients and methods: Between January 2021 and June 2022, we prospectively studied 22 patients and categorized them into two groups, group A (preoperative radiotherapy) and group B (postoperative radiotherapy). We included patients with extremity soft tissue sarcoma in skeletally mature patients who were randomized into two groups with follow up 9-12 months. Wound complications, local complications, recurrence, time for wound healing and survival rate were recorded and analyzed using SPSS 25. Results: 22 patients were included, 10 in group A and 12 in group B, their mean age was 46.4 years with mean follow up 9 months. The major wound complications were higher in group A (preoperative radiotherapy). in comparison with group B (postoperative radiotherapy), however, this was not statistically significant. While other local complications were higher in group B, it was also statistically insignificant. Time for wound healing was higher in group A more than group B and was statistically significant (p value = 0.011). Conclusion: No increase in the wound complications rate with preoperative radiotherapy by using low fractionated doses of radiotherapy and increasing interval before surgery to six weeks, although there is increased risk of delayed wound healing time after surgery. The size and site of the tumor may increase the risk of wound complications unrelated to the type of radiotherapy. Level of evidence: II: clinical trial.

Exploring the Landscape of Intracranial Aneurysms in South America: A Comprehensive Narrative Review Intracranial Aneurysms in South America.

Exploring the landscape of intracranial aneurysms in South America unravels a complex interplay of epidemiological factors, clinical manifestations, and therapeutic challenges. The study methodically conducts a comprehensive literature review spanning the years 2003 to 2023, focusing on English-language articles obtained from diverse databases to elucidate the multifaceted nature of intracranial aneurysms in the region. Results and discussions categorize outcomes into positive domains, emphasizing successful treatments, favorable recoveries, and high survival rates, while also shedding light on negative aspects such as residual aneurysms and complications. The research illuminates significant gaps in pathological typing of intracranial aneurysms and exposes challenges in healthcare accessibility, notably the disparities in neurosurgical resources. Management challenges, including constrained infrastructure access, a neurosurgeon shortage, and gender disparities, are underscored. Transitioning to future prospects, the study advocates for strategic interventions, proposing expanded neurosurgical training, multidisciplinary approaches, improved funding, enhanced access to care, and fostering international collaborations. The study concludes by emphasizing the pivotal role of collaborative efforts, intensified training programs, and global partnerships in propelling intracranial aneurysm management forward in South America, ultimately contributing to enhanced patient outcomes across the region.

Can we increase the value of data from bladder diaries? International Consultation on Incontinence-Research Society 2023.

BACKGROUND: Bladder diaries represent a fundamental component in the assessment of patients presenting with lower urinary tract symptoms. Nevertheless, their importance often remains underappreciated and undervalued within clinical practice. This paper aims to conduct a comprehensive review of the existing literature concerning the utility of bladder diaries, underscore the criticality of their precision, elucidate the factors contributing to noncompliance with bladder diary completion, and investigate potential strategies for enhancing patient compliance. MATERIALS AND METHODS: A review of the English-language scientific literature available in the domains of Medline, Embase, Emcare, Midirs, and Cinahl was conducted. This was supplemented by discussion at the International Consultation on Incontinence Research Society Proposal session to define knowledge and identify gaps in knowledge surrounding the utility of bladder diaries. The existing evidence and outcome of the relevant discussion held in the meeting are presented. RESULTS: Bladder diaries (BD) serve to characterize the nature and severity of storage lower urinary tract symptoms (LUTS) and provide an objective record of an individual's urination patterns. They aid in the refinement and customization of treatment strategies based on the clinical responses documented in the diary, optimizing treatment outcomes. Notably, both BD and urodynamic studies (UDS) play complementary yet distinct roles in LUTS evaluation. BD offers a more comprehensive and accessible approach to assessing specific storage LUTS, particularly due to their affordability and widespread availability, especially in resource-limited settings. Nevertheless, the absence of a standardized BD format across global healthcare systems presents a significant challenge. Despite being recognized as reliable, noninvasive, validated, and cost-effective tools for evaluating patients with LUTS, the implementation and completion of BD have proven to be complex. The introduction of automated bladder diaries heralds an era of precise, real-time data collection, potentially enhancing the patient-clinician relationship. Completion of bladder diaries depends on an array of individual, social, and healthcare-specific factors. Compliance with bladder diary completion could be enhanced with clear instructions, patient education, regular follow-ups and positive re-enforcement. This study has identified four critical areas for future research: Addressing healthcare disparities between affluent and developing nations, enhancing the current functionality and effectiveness of bladder diaries, exploring the feasibility of incorporating bladder diaries into the treatment and education process and improving the quality and functionality of existing bladder diaries. CONCLUSION: Bladder diaries play a pivotal role in the evaluation and management of patients with LUTS, providing a holistic perspective. When their complete potential is harnessed, they have the capacity to revolutionize the paradigm of LUTS management, ushering in a patient-centered era of care.

Modern PID/FOPID controllers for frequency regulation of interconnected power system by considering different cost functions.

This article presents frequency regulation of an interconnected three-area power system (Thermal + Wind + Hydro). Fractional Order PID (FOPID) and Proportional-Integral-Derivative (PID) controllers are applied as subsidiary regulators to control the electrical power interconnected system at the time of sudden load variation. To accomplish this study, Genetic Algorithm (GA), Grey Wolf Optimizer (GWO), Sine Cosine Inspired Algorithm (SCIA) and Atom Search Inspired Algorithm (ASIA) are implemented to optimize the secondary regulators' gains (PID and FOPID) by considering various cost functions such as Integral Absolute Error (IAE), Integral Time Absolute Error (ITAE), Integral Square Error (ISE), and Integral Time Square Error (ITSE). Performance analysis in this work is conducted using various cost functions based on GA, GWO, SCIA and ASIA. The comparative analysis of the attained results reveals that GWO-PID and ASIA-PID settle at (83.83 s) and (30.31 s), respectively and ASIA-FOPID at (25.12 s). The controllers based on ITSE as a cost function outperform the comptrollers with other cost functions (ISE, IAE and ITAE). In addition, the ISE-based GA-PID and SCIA-PID settle at (113.92 s) and (35.1 s), respectively and SCIA-FOPID at (24.78 s). The ISE-based regulators yield improved response equated to other cost functions (ITSE, IAE and ITAE) optimized controllers. The robustness test also is carried out to validate the effectiveness of the proposed optimization techniques by changing the system parameters within ± 25% and ± 50% from their nominal values as well as changing the load pattern.

Echocardiographic Assessment Of Left Ventricular Function After COVID-19 Vaccination In Adults.

Objectives: To assess left ventricular function by conventional and speckle tracking echocardiography in subjects having received coronavirus disease-2019 vaccine. Method: The cohortstudy was conducted from April 2021 to April 2022 at the Department of Cardiology, Kafrelsheikh University Hospital, Egypt, and comprised adults of either gender who had received coronavirus disease-2019 vaccine. Detailed history was noted before clinical assessment, electrocardiogram and echocardiography, which were done at baseline and after two weeks of the last vaccine dose. Apical 4, apical 3 and apical 2 strains were obtained to get the global longitudinal strain. Data was analysed using SPSS 20. RESULTS: Of the 100 subjects, 50(50%) each were males and females. The overall mean age was 39.20±14.57 years. There were 16(16%) subjects with diabetes mellitus and 21(21%) with hypertension. Regarding vaccine distribution, 34(34%) had received AstraZeneca AZD1222, 31(31%) had BioNTech Pfizer vaccine BNT162B2 and 35(35%) had Sinopharm Beijing Institute of Biological Products BBIBP-CorV. The global longitudinal strain before and after vaccination did not show a significant difference (p<0.063). There was no significant variation in global longitudinal strain between the various vaccination types (p=0.584). CONCLUSIONS: The studied vaccines had similarly acceptable safety profiles regarding left ventricular functions.

A Science-Based Methodology Framework for the Assessment of Combination Safety Risks in Clinical Trials.

Multiple components factor into the assessment of combination safety risks when two or more novel individual products are used in combination in clinical trials. These include, but are not limited to, biology, biochemistry, pharmacology, class effects, and preclinical and clinical findings (such as adverse drug reactions, drug target and mechanism of action, target expression, signaling, and drug-drug interactions). This paper presents a science-based methodology framework for the assessment of combination safety risks when two or more investigational products are used in clinical trials. The aim of this methodology framework is to improve prediction of the risks, to enable the appropriate safety risk mitigation and management to be put in place for the combination, and the development of the project combination safety strategy.

Composite films based on carboxy methyl cellulose and sodium alginate incorporated Thymus vulgaris purified leaves extract for food application: Assessment, antimicrobial and antioxidant properties.

The current study was conducted to develop biodegradable films with matrix composed from carboxymethyl cellulose (CMC), sodium alginate (SA) and different concentrations from Thymus vulgaris purified leaves extract (TVE). The color properties, physical properties, shape of surface, manners of crystallinity, mechanical properties and thermal properties of produced films were investigated. The continuous addition of TVE up to 1.6 % inside films matrix imparted the yellow color of extract that increased opacity to 2.98 and reduced moisture, swelling, solubility and water vapor permeability (WVP) of films up to 10.31 %, 30.17 %, 20.18 % and (1.12× 10-10 g.m-1 s-1 pa-1), respectively. Furthermore, the surface micrographs showed smoother surface after using small concentrations of TVE and turned to irregular with rough surface at higher concentrations. The FT-IR analysis indicated typically bands that demonstrated physical interaction between TVE extract and CMC/SA matrix. The fabricated films showed suitable thermal stability with decreasing trend by incorporation of TVE inside CMC/SA films. Furthermore, the developed CMC/SA/TVE2 showed significant effects on preserving the levels of moisture content, titrable acidity, force to puncture and sensory properties of cheddar cheese during cold storage days compared with commercial packaging materials.

Three-Dimensional Assessment of Radiographic Changes after Indirect Pulp Capping Using Silver Diamine Fluoride with or without Potassium Iodide in Young Permanent Teeth (12-Month RCT).

The aim of this study was to conduct a three-dimensional (3D) evaluation of radiographic changes after indirect pulp capping (IPC) with silver diamine fluoride (SDF) with or without potassium iodide (KI) and resin-modified glass ionomer cement (RMGIC) in deep carious young permanent molars using cone-beam computed tomography (CBCT). 108 first permanent molars with deep occlusal cavitated caries lesions, in forty-nine 6- to 9-year-old children, were randomly allocated to one of 3 groups (n = 36) and treated with SDF+KI, SDF, and RMGIC as IPC materials. CBCT scans were taken at 0 and 12 months to assess tertiary dentin formation (volume and grey level intensity), increase in root length, and pathological changes such as secondary caries, periapical radiolucency, internal resorption, and obliteration of the pulp. The 3D image analysis procedures were performed using ITK-SNAP and 3D Slicer CMF. Comparisons were made using analysis of variance with a fixed effect for treatment and random effects for patient and patient-by-treatment to account for within-patient correlations. A two-sided 5% significance level was used. There were no significant differences among the three groups regarding tertiary dentin volume (p = 0.712) and grey level intensity (p = 0.660), increase in root length (p = 0.365), prevention of secondary caries (p = 0.63), and periapical radiolucency (p = 0.80) in the analysed 69 CBCT scans. The study did not find differences among the groups regarding quality and quantity of tertiary dentin formed, increase in root length, absence of secondary caries, and other signs of failure as shown by CBCT. Clinical Significance: The results show no significant differences in radiographic outcomes (quality and quantity of tertiary dentin formed, increase in root length, absence of secondary caries, and other signs of failure) when using SDF+KI, SDF, and RMGIC in IPC. The results of this study can help guide treatment decision-making regarding use of SDF and SDF+KI as IPC materials in deep cavitated lesions.

Effect of some agricultural treatments on the Egyptian alfalfa weevil, Hypera brunneipennis and their economic evaluation on yield and yield components in Egypt.

BACKGROUND: The Egyptian alfalfa weevil, Hypera brunneipennis causes damage on different parts of alfalfa plants. Therefore, four agricultural treatments are carried out included calcium super phosphate addition (15.5% P2 O5 ), potassium sulphate addition (50% K2 O), microelements spraying and hand removing of weeds to reduce the population of the Egyptian alfalfa weevil and increase both the final yield and obtain a healthy plant. RESULTS: The treatment of calcium super phosphate (15.5% P2 O5 ), potassium sulphate (50% K2 O), microelements spraying and hand removing of weeds gave less infestation of Egyptian alfalfa weevil [4.38 and 4.89 (larvae and adults/m2 )] and the highest total fresh (70.08 and 74.52 ton/feddan), dry yield (19.37 and 19.70 ton/feddan) and plant height yield (60.00 and 61. 17 cm) in first and second seasons, respectively, with significant differences compared with the other treatments and the untreated check. Also, the same treatment gave the highest net benefit over untreated check 29.06 and 31.93 (thousand L.E./feddan) and net benefit/costs ratio/feddan (1.77 and 2.22) in first and second seasons, respectively. CONCLUSIONS: Good agricultural treatments of calcium super phosphate addition (15.5% P2 O5 ), potassium sulphate addition (50% K2 O), microelements spraying and hand removing of weeds play an important role in obtaining a healthy plant, reducing Egyptian alfalfa weevil infestation, and increasing total fresh yield, total dry yield, and plant height of alfalfa. © 2023 Society of Chemical Industry.

Toxicity assessment of polyethylene microplastics in combination with a mix of emerging pollutants on Physalaemus cuvieri tadpoles.

Studies in recent years have shown that aquatic pollution by microplastics (MPs) can be considered to pose additional stress to amphibian populations. However, our knowledge of how MPs affect amphibians is very rudimentary, and even more limited is our understanding of their effects in combination with other emerging pollutants. Thus, we aimed to evaluate the possible toxicity of polyethylene MPs (PE-MPs) (alone or in combination with a mix of pollutants) on the health of Physalaemus cuvieri tadpoles. After 30 days of exposure, multiple biomarkers were measured, including morphological, biometric, and developmental indices, behavioral parameters, mutagenicity, cytotoxicity, antioxidant and cholinesterase responses, as well as the uptake and accumulation of PE-MPs in animals. Based on the results, there was no significant change in any of the parameters measured in tadpoles exposed to treatments, but induced stress was observed in tadpoles exposed to PE-MPs combined with the mixture of pollutants, reflecting significant changes in physiological and biochemical responses. Through principal component analysis (PCA) and integrated biomarker response (IBR) assessment, effects induced by pollutants in each test group were distinguished, confirming that the exposure of P. cuvieri tadpoles to the PE-MPs in combination with a mix of emerging pollutants induces an enhanced stress response, although the uptake and accumulation of PE-MPs in these animals was reduced. Thus, our study provides new insight into the danger to amphibians of MPs coexisting with other pollutants in aquatic environments.

Development and validation of a daily assessment tool for critically ill patients.

BACKGROUND: Patients in intensive care units require comprehensive care. Hence, improving health care quality depends on accurate assessment and documentation. AIM: To develop and validate the content of an assessment sheet for critically ill patients. STUDY DESIGN AND METHODS: A Delphi design study was conducted between January and March 2020. The content validity index (CVI) was used to calculate the degree of agreement among the experts to analyse the instrument and the entire set of items. Content validity was determined by seven experts (three critical care nursing professionals, two critical care doctors, and two anaesthesiologists) using a four-point Likert scale. They evaluated the items in terms of the following: 1 = "irrelevant," 2 = "somewhat relevant if the phrasing is profoundly adjusted," 3 = "relevant with some adjustment as to phrasing," and 4 = "very relevant." The CVI was applied, and the accepted value was ≥0.50. RESULTS: Three rounds of evaluation were required to achieve the minimum index. The items were reviewed for content and face validity. The instrument was validated with 86 items with a total CVI of 0.90, a face validity of 1, and a scale-level content validity index/universal agreement calculation method (S-CVI/UA) value of 0.813. CONCLUSION: This instrument can help nurses, doctors, academics, and students assess patients in intensive care units. RELEVANCE TO CLINICAL PRACTICE: The daily assessment tool may provide a systematic and consistent approach to critically ill patients' assessment to guide interventions.

Assessment of quality of life determinants in hemodialysis patients of a developing country: A cross-sectional study during ongoing COVID-19 pandemic.

BACKGROUND AND OBJECTIVES: Patients of end-stage renal disease are prone to have a very low quality of life (QoL). Variety of factors influence the QoL among sufferers of chronic kidney disease comprising of type of dialysis, sufficiency/adequacy of dialysis, and associated burden of disease. We conducted this study amidst the pandemic to determine the associated factors for poor QoL in hemodialysis patients during the ongoing pandemic. PATIENTS AND METHODS: This cross-sectional study was conducted in a hemodialysis unit of a tertiary care hospital. A total of 118 participants responded to the validated questionnaire of Quality of Life Index-dialysis version-III (QLI). Higher scores signify good QoL, total scores are further categorized into subgroups desirable, relatively desirable and undesirable. RESULTS: The mean age of the participants was 57.36 ± 10.03 years and mean body mass index of 26.73 ± 5.54 kg/m2. The mean total QoL of the study population was found quite low (12.99 ± 5.89). Majority of respondents fell in undesirable category of QoL (49.2%). Total QoL (P = 0.004) and subscale health/functioning (P = 0.003) were significantly lower in females. All the subscales along with total QoL scores were found lower in twice-weekly dialyzed patients (P < 0.001). Marital status (P = 0.049) and twice-weekly dialysis (P < 0.001) were found significant with undesirable QoL. On multivariate analysis, significant determinants of undesirable QoL were twice-weekly dialysis (P = 0.001), catheter access (P = 0.034), phosphate (P = 0.005) and uric acid (P = 0.006). CONCLUSION: Inadequate dialysis due to lesser frequency per week leading to poorly cleared toxic substances were most significant contributors of poor QoL in our study.

Innovative Earth-Friendly UV-Spectrophotometric Technique for In Vitro Dissolution Testing of Miconazole Nitrate and Nystatin in Their Vaginal Suppositories: Greenness Assessment.

BACKGROUND: The combined mixture of miconazole nitrate (MIC) and nystatin (NYS) has proven its efficiency as a prodigious remedy to cure women's frequent infections: vaginal mycosis and vaginal candidiasis. OBJECTIVE: A novel green spectrophotometric technique, namely the Fourier self-deconvolution method (FSD), was employed for the quantitative determination of MIC and NYS in their pure and pharmaceutical forms without prior separation. Moreover, the proposed technique was first employed to study the dissolution profile of the cited drugs in their pharmaceutical formulation according to FDA recommendations without excipient interference. METHOD: The FSD method is based on a simple mathematical manipulation of zero-order spectra of the cited drugs, which suffered from severe overlapping, so zero-order spectra of the cited drugs were deconvoluted using the Fourier wavelet function in spectrophotometer software. The deconvoluted amplitudes for MIC and NYS were measured at 255 nm and 320 nm, respectively. RESULTS: Linearity ranges were 70-700 µg/mL for MIC and 1-25 µg/mL for NYS. The greenness of the proposed technique was assessed using two assessment tools, namely eco-scale scoring and green analytical procedure index (GAPI), revealing the excellent greenness of this technique. The proposed technique was validated consistent with ICH guidelines and statistically compared to the reported method with no significant differences between them. CONCLUSIONS: The proposed technique has advantages of being simple, time-saving, and noting need any modification to be suitable for quantitative analysis of MIC and NYS in both pharmaceutical and laboratory mixtures. HIGHLIGHTS: An innovative FSD method was developed for quantitative analysis of MIC and NYS in their synthetic and pharmaceutical mixtures and applied for in vitro dissolution testing of their pharmaceutical mixture, producing satisfactory results.