Synthesis and characterization of phenothiazine sensor for spectrophotometric and fluorescence detection of cyanide.

A sensitive and selective phenothiazine-based sensor (PTZ) has been successfully synthesized. The sensor PTZ displayed specific identification of CN- 'turn-off' fluorescence responses with a quick reaction and strong reversibility in an acetonitrile:water (90:10, V/V) solution. The sensor PTZ for detecting CN- exhibits the marked advantages of quenching the fluorescence intensity, fast response time (60 s), and low value of the detection limit. The concentration that is authorized for drinking water by the WHO (1.9 µM) is far higher than the detection limit, which was found to be 9.11 × 10-9 . The sensor displays distinct colorimetric and spectrofluorometric detection for CN- anion due to the addition of CN- anion to the electron-deficient vinyl group of PTZ, which reduces intramolecular charge transfer efficiencies. The 1:2 binding mechanism of PTZ with CN- was validated by fluorescence titration, Job's plot, HRMS, 1 H NMR, FTIR analysis, and density functional theory (DFT) investigations, among other methods. Additionally, the PTZ sensor was successfully used to precisely and accurately detect cyanide anions in actual water samples.

Aloe vera extract: A novel antimicrobial and antibiofilm against methicillin resistant Staphylococcus aureus strains.

Bacterial infectious maladies are the leading cause of death worldwide. Microbial drug resistance boosts the severity of the maladies. In the present study, the antibacterial impact of Aloe vera leaf aqueous extract against six strains of methicillin resistant Staphylococcus aureus (LN872136, LN872137, LN871238, LN871239, LN872140, LN871241) was investigated in vitro. The effect of different concentrations (5-20mg/ ml) of the plant extract on bacterial growth was evaluated by estimating the dry weight of bacterial biomass obtained from cultures at 24 and 48 h after exposure to the plant extract. The results revealed that the plant extract at concentrations of 15-20mg/ml, markedly reduced the dry weights of most S. aureus strains after 24 and/or 48 h exposure periods. The effects of the plant extract (20mg/ml) on the inhibition zones and biofilm formation by S. aureus six strains were also investigated. The largest inhibition zone was recorded against S. aureus (LN871241) and confirmed by scanning electron microscope. The plant extract could also block the biofilm formation by most S. aureus strains. In conclusion, the current results may support the use of A. vera extract as antibacterial agent against methicillin resistant S. aureus infections.

Green Synthesis and Antibacterial Activity of Ag/Fe2O3 Nanocomposite Using Buddleja lindleyana Extract.

In the study reported in this manuscript, silver/iron oxide nanocomposites (Ag/Fe2O3) were phytosynthesized using the extract of Buddleja lindleyana via a green, economical and eco-friendly strategy. The biosynthesized Ag/Fe2O3 nanocomposites were characterized using UV-Vis spectrophotometry, FTIR, XRD, TEM, DLS and SEM-EDX analyses. The particulates showed a triangular and spherical morphology having sizes between 25 and 174 nm. FTIR studies on the nanoparticles showed functional groups corresponding to organic metabolites, which reduce and stabilize the Ag/Fe2O3 nanocomposite. The antimicrobial efficacy of the phytosynthesized Ag/Fe2O3 against bacterial pathogens was assessed. In addition, Ag/Fe2O3 exhibited broad spectrum activities against B. subtilis, S. aureus, E. coli, and P. aeruginosa with inhibition zones of 23.4 ± 0.75, 22.3 ± 0.57, 20.8 ± 1.6, and 19.5 ± 0.5 mm, respectively. The Ag/Fe2O3 composites obtained showed promising antibacterial action against human bacterial pathogens (S. aureus, E. coli, B. subtilis and P. aeruginosa), making them candidates for medical applications.

Statistical analysis plan for the Steppedwedge Cluster Randomized trial of Electronic Early Notification of sepsis in hospitalized ward patients (SCREEN).

BACKGROUND: It is unclear whether screening for sepsis using an electronic alert in hospitalized ward patients improves outcomes. The objective of the Stepped-wedge Cluster Randomized Trial of Electronic Early Notification of Sepsis in Hospitalized Ward Patients (SCREEN) trial is to evaluate whether an electronic screening for sepsis compared to no screening among hospitalized ward patients reduces all-cause 90-day in-hospital mortality. METHODS AND DESIGN: This study is designed as a stepped-wedge cluster randomized trial in which the unit of randomization or cluster is the hospital ward. An electronic alert for sepsis was developed in the electronic medical record (EMR), with the feature of being active (visible to treating team) or masked (inactive in EMR frontend for the treating team but active in the backend of the EMR). Forty-five clusters in 5 hospitals are randomized into 9 sequences of 5 clusters each to receive the intervention (active alert) over 10 periods, 2 months each, the first being the baseline period. Data are extracted from EMR and are compared between the intervention (active alert) and control group (masked alert). During the study period, some of the hospital wards were allocated to manage patients with COVID-19. The primary outcome of all-cause hospital mortality by day 90 will be compared using a generalized linear mixed model with a binary distribution and a log-link function to estimate the relative risk as a measure of effect. We will include two levels of random effects to account for nested clustering within wards and periods and two levels of fixed effects: hospitals and COVID-19 ward status in addition to the intervention. Results will be expressed as relative risk with a 95% confidence interval. CONCLUSION: The SCREEN trial provides an opportunity for a novel trial design and analysis of routinely collected and entered data to evaluate the effectiveness of an intervention (alert) for a common medical problem (sepsis in ward patients). In this statistical analysis plan, we outline details of the planned analyses in advance of trial completion. Prior specification of the statistical methods and outcome analysis will facilitate unbiased analyses of these important clinical data. TRIAL REGISTRATION: ClinicalTrials.gov NCT04078594 . Registered on September 6, 2019.

Electronic early notification of sepsis in hospitalized ward patients: a study protocol for a stepped-wedge cluster randomized controlled trial.

BACKGROUND: To evaluate the effect of screening for sepsis using an electronic sepsis alert vs. no alert in hospitalized ward patients on 90-day in-hospital mortality. METHODS: The SCREEN trial is designed as a stepped-wedge cluster randomized controlled trial. Hospital wards (total of 45 wards, constituting clusters in this design) are randomized to have active alert vs. masked alert, 5 wards at a time, with each 5 wards constituting a sequence. The study consists of ten 2-month periods with a phased introduction of the intervention. In the first period, all wards have a masked alert for 2 months. Afterwards the intervention (alert system) is implemented in a new sequence every 2-month period until the intervention is implemented in all sequences. The intervention includes the implementation of an electronic alert system developed in the hospital electronic medical records based on the quick sequential organ failure assessment (qSOFA). The alert system sends notifications of "possible sepsis alert" to the bedside nurse, charge nurse, and primary medical team and requires an acknowledgment in the health information system from the bedside nurse and physician. The calculated sample size is 65,250. The primary endpoint is in-hospital mortality by 90 days. DISCUSSION: The trial started on October 1, 2019, and is expected to complete patient follow-up by the end of October 2021. TRIAL REGISTRATION: ClinicalTrials.gov NCT04078594 . Registered on September 6, 2019.

The Implementation Experiences of an Endoscopy Information System (EIS) on the Improvement of Workflow Processes in a Saudi Endoscopy Department.

The objective of this paper is to investigate the experiences in implementing a smart capsule system for a Saudi endoscopy department. The study was conducted at a leading Saudi healthcare institution located in Riyadh, Saudi Arabia. A case study approach was used in the study. Endoscopy Information System (EIS) system data documentation, key informant interviews, and meeting documents were the data collection sources used in the study. A thematic analysis of the data was conducted. Preliminary data showed improvements in hospital clinical workflow as a result of implementing the new EIS. Although the findings of this study are preliminary, more work is needed to evaluate the overall impact of the new EIS on clinical workflow, patient wait times, usability, and data accuracy.

Remote Patient Monitoring System Implementation at a Cardiac Care Centre in Saudi Arabia.

The objective of this paper is to report the implementation experiences of a remote patient monitoring system at a cardiac care center in Saudi Arabia. Key informant interviews, meeting documents, and experience of the researcher were part of the data collection sources used in the study. A thematic analysis of the data was conducted. Our preliminary work shows improvements in patient monitoring within the cardiac care center as a result of the new patient monitoring system. Lessons learned are also reported as well as study limitations. Future work will further investigate the impacts of the patient monitoring system on physician and patient satisfaction and health outcomes.

Vagal Nerve Stimulation (VNS) Therapy System Implementation at a Neurology Department in Saudi Arabia.

The objective of this paper is to report on the implementation of a Vagal Nerve Stimulation (VNS) Therapy System at a neurology department in Saudi Arabia. Key informant interviews, meeting documents, and experience of the researcher were part of the data collection sources used in the study. A thematic analysis of the data was conducted. The preliminary work shows improvements in epilepsy treatment within the neurology department as a result of the new Vagal Nerve Stimulation (VNS) therapy system. We discuss the lessons learned and identify the limitations of the study. Future work will further investigate the impacts of the VNS system on physician and patient satisfaction and health outcomes.