Clinico-genomic findings, molecular docking, and mutational spectrum in an understudied population with breast cancer patients from KP, Pakistan.

In this study, we report the mutational profiles, pathogenicity, and their association with different clinicopathologic and sociogenetic factors in patients with Pashtun ethnicity for the first time. A total of 19 FFPE blocks of invasive ductal carcinoma (IDC) from the Breast Cancer (BC) tissue and 6 normal FFPE blocks were analyzed by whole-exome sequencing (WES). Various somatic and germline mutations were identified in cancer-related genes, i.e., ATM, CHEK2, PALB2, and XRCC2. Among a total of 18 mutations, 14 mutations were somatic and 4 were germline. The ATM gene exhibited the maximum number of mutations (11/18), followed by CHEK2 (3/18), PALB2 (3/18), and XRCC2 (1/18). Except one frameshift deletion, all other 17 mutations were nonsynonymous single-nucleotide variants (SNVs). SIFT prediction revealed 7/18 (38.8%) mutations as deleterious. PolyPhen-2 and MutationTaster identified 5/18 (27.7%) mutations as probably damaging and 10/18 (55.5%) mutations as disease-causing, respectively. Mutations like PALB2 p.Q559R (6/19; 31.5%), XRCC2 p.R188H (5/19; 26.31%), and ATM p.D1853N (4/19; 21.05%) were recurrent mutations and proposed to have a biomarker potential. The protein network prediction was performed using GeneMANIA and STRING. ISPRED-SEQ indicated three interaction site mutations which were further used for molecular dynamic simulation. An average increase in the radius of gyration was observed in all three mutated proteins revealing their perturbed folding behavior. Obtained SNVs were further correlated with various parameters related to the clinicopathological status of the tumors. Three mutation positions (ATM p. D1853N, CHEK2 p.M314I, and PALB2 p.T1029S) were found to be highly conserved. Finally, the wild- and mutant-type proteins were screened for two drugs: elagolix (DrugBank ID: DB11979) and LTS0102038 (a triterpenoid, isolated from the anticancer medicinal plant Fagonia indica). Comparatively, a higher number of interactions were noted for normal ATM with both compounds, as compared to mutants.

Prevalence of crimean Congo hemorrhagic fever in Khyber Pakhtunkhwa, Pakistan.

BACKGROUND: CCHFV is well recognized as a major public health threat and its prevalence and epidemiological distribution in Pakistan and specifically in KP province is not well documented. METHODS: We used a gold-standard PCR-based diagnostic assay for confirmation of CCHFV among suspected patients. A total of 150 patients were enrolled from June 2022 to September 2022 and their blood samples were collected for PCR confirmation. RESULTS: The overall positivity rate for CCHFV was 26.67 %, with the virus mostly prevalent in the middle-aged group (21-40 years). In the July of 2022, a significant spike in the prevalence of CCHFV was observed in provincial capital Peshawar with the highest burden (31.57 %). CONCLUSION: Our findings indicate the necessity of strengthening CCHFV monitoring programs and intensifying efforts to identify hotspot regions for effective surveillance and control of CCHFV. The months before the Eid-ul-Adha are crucial in the context of CCHFV control.

Pseudohalide Ions as Ligands to Tune Architecture and Luminescence of Polymetallic CU(I) Assemblies.

The reaction of preassembled Cu(I) bimetallic units {Cu2(dppm)2} and {Cu2(dppa)2} (dppm: bis(diphenylphosphino)methane and dppa: bis(diphenylphosphino)amine) with pseudohalide linkers (azido, dicyanamide, and tricyanomethanide) allows for the quantitative and selective preparation of three discrete tetrametallic metallacycles of formula [Cu4(µ2-dppm)4(N3)2](PF6)2, [Cu4(µ2-dppm)4(N(CN)2)2](PF6)2, and [Cu4(µ2-dppm)4(C(CN)3)4]. To explore further the impact of the linker on the architecture and dimensionality of the molecular edifice, the study was extended to more sophisticated tetradentate cyanocarbanion ligands (tcnsMe-: 2-(methylthio)-1,1,3,3-propanetetracarbonitrile and tcnsEt-: 2-(ethylthio)-1,1,3,3-propanetetracarbonitrile). Three ladder-like one-dimensional coordination polymers and an octametallic metallacycle have been obtained. The careful comparison of the metric and geometrical intramolecular and intermolecular parameters observed in this series of seven derivatives allows for rationalization of their molecular architectures. The subtle balance between the length and steric hindrance of the ligand and the formation of noncovalent interaction networks greatly influences the topology and dimensionality of the resulting assemblies and will be discussed hereafter. The photophysical properties of these seven polymetallic Cu(I) compounds have also been also studied.

Inhaled versus systemic corticosteroids for acute exacerbations of COPD: a systematic review and meta-analysis.

This meta-analysis compares the efficacy and safety of inhaled versus systemic corticosteroids for COPD exacerbations.Following a pre-registered protocol, we appraised eligible randomised controlled trials (RCTs) according to Cochrane methodology, performed random-effects meta-analyses for all outcomes prioritised in the European Respiratory Society COPD core outcome set and rated the certainty of evidence as per Grading of Recommendations Assessment, Development and Evaluation methodology.We included 20 RCTs totalling 2140 participants with moderate or severe exacerbations. All trials were at high risk of methodological bias. Low-certainty evidence did not reveal significant differences between inhaled and systemic corticosteroids for treatment failure rate (relative risk 1.75, 95% CI 0.76-4.02, n=569 participants); breathlessness (mean change: standardised mean difference (SMD) -0.11, 95% CI -0.36-0.15, n=239; post-treatment scores: SMD -0.18, 95% CI -0.41-0.05, n=293); serious adverse events (relative risk 1.47, 95% CI 0.56-3.88, n=246); or any other efficacy outcomes. Moderate-certainty evidence implied a tendency for fewer adverse events with inhaled compared to systemic corticosteroids (relative risk 0.80, 95% CI 0.64-1.0, n=480). Hyperglycaemia and oral fungal infections were observed more frequently with systemic and inhaled corticosteroids, respectively.Limited available evidence suggests potential noninferiority of inhaled to systemic corticosteroids in COPD exacerbations. Appropriately designed and powered RCTs are warranted to confirm these findings.

Preliminary insights on the mutational spectrum of BRCA1 and BRCA2 genes in Pakhtun ethnicity breast cancer patients from Khyber Pakhtunkhwa (KP), Pakistan.

Gene mutations are a source of genetic instability which fuels the progression of cancer. Mutations in BRCA1 and BRCA2 are considered as major drivers in the progression of breast cancer and their detection indispensable for devising therapeutic and management approaches. The current study aims to identify novel pathogenic and recurrent mutations in BRCA1 and BRCA2 in Pakhtun population from the Khyber Pakhtunkhwa. To determine the BRCA1 and BRCA2 pathogenic mutation prevalence in Pakhtun population from KP, whole exome sequencing of 19 patients along with 6 normal FFPE embedded blocks were performed. The pathogenicity of the mutations were determined and they were further correlated with different hormonal, sociogenetic and clinicopathological features. We obtained a total of 10 mutations (5 somatic and 5 germline) in BRCA1 while 27 mutations (24 somatic and 3 germline) for BRCA2. Five and seventeen pathogenic or deleterious mutations were identified in BRCA1 and BRCA2 respectively by examining the mutational spectrum through SIFT, PolyPhen-2 and Mutation Taster. Among the SNVs, BRCA1 p.P824L, BRCA2 p. P153Q, p.I180F, p.D559Y, p.G1529R, p.L1576F, p.E2229K were identified as mutations of the interaction sites as predicted by the deep algorithm based ISPRED-SEQ prediction tool. SAAFEQ-SEQ web-based algorithm was used to calculate the changes in free energy and effect of SNVs on protein stability. All SNVs were found to have a destabilizing effect on the protein. ConSurf database was used to determine the evolutionary conservation scores and nature of the mutated residues. Gromacs 4.5 was used for the molecular simulations. Ramachandran plots were generated using procheck server. STRING and GeneMania was used for prediction of the gene interactions. The highest number of mutations (BRCA1 7/10, 70 %) were on exon 9 and (BRCA2, 11/27; 40 %) were on exon 11. 40 % and 60 % of the BRCA2 mutations were associated Grade 2 and Grade 3 tumors respectively. The present study reveals unique BRCA1 and BRCA2 mutations in Pakhtun population. We further suggest sequencing of the large cohorts for further characterizing the pathogenic mutations.

Insight into the molecular mechanism, cytotoxic, and anticancer activities of phyto-reduced silver nanoparticles in MCF-7 breast cancer cell lines.

This contribution insight on the cytotoxic and anticancer activities and molecular mechanism of phyto-reduced silver nanoparticles (AgNPs) in MCF-7 breast cancer cell lines. A simple, entirely green synthesis process was optimized for the phyto-reduction of AgNP (~12.7 nm) using aqueous leaf extracts of Indigofera heterantha. The structural and vibrational properties of biosynthesized AgNPs were extensively characterized using UV-Vis spectrophotometer, x-ray diffraction (XRD), dynamic light scattering (DLS), and Fourier transform Infrared spectroscopy (FTIR), while their shape and morphology was studied through scanning electron microscopy (SEM). The 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) cell viability assay indicates concentration dependent inhibition with IC50, 27.93 ± 2.10 µg/mL against MCF-7 cells and 294.38 ± 3.87 µg/mL against L929 cells. The manifested anticancer mechanism in MCF-7 cells was extensively studied using Acridine orange/ethidium bromide (AO/EB), 4',6-diamidino-2-phenylindole (DAPI) and Annexin-V/propedium iodide fluorescence microscopic assays. The level of reactive oxygen species (ROS) was measured using DCFH-DA fluorescent spectroscopy. Overall, the results show that AgNPs exhibit cytotoxic and apoptotic effect on breast cancer MCF-7 cells by damaging membrane integrity and nuclear fragmentation due to oxidative stress generated by elevated level of ROS. RESEARCH HIGHLIGHTS: Biomimetic synthesis of nano dimension size silver nanoparticles (AgNPs). Characterization of AgNPs through UV-Vis, DLS, XRD, FTIR, and SEM. Cytotoxic and anticancer effects of the biosynthesized AgNPs in L929 fibroblast cells and MCF7 breast cancer respectively. Determination of morphological, and nuclear changes triggered by AgNPs in MCF 7 breast cancer cells using fluorescent microscopy and flow cytometry. Apoptosis induction by AgNPs in cancer cells through oxidative stress generated by reactive oxygen species (ROS).

Dental implant placement with simultaneous localized ridge augmentation using L-shaped titanium mesh in the esthetic zone: a case report.

The aim of this case report is to illustrate a successful technique for dental implant placement in the esthetic zone using simultaneous localized ridge augmentation with L-shaped titanium mesh. A 35-year-old patient presented with a single missing tooth in the esthetic zone requiring dental implant placement. The treatment plan was made to place a dental implant in conjunction with a guided bone regeneration procedure using a prefabricated L-shaped titanium mesh. The procedure achieved successful reconstruction of the deficient ridge, providing ample volume and contour for implant placement. Implant osteointegration was achieved, resulting in a satisfactory functional and esthetically pleasing outcome. The use of L-shaped titanium mesh offers superior stability and biocompatibility, ensuring optimal support and containment of graft material. This case report highlights the feasibility and clinical effectiveness of dental implant placement with simultaneous localized ridge augmentation using L-shaped titanium mesh in the esthetic zone. Further studies are warranted to assess the long-term success and esthetic outcomes of this technique.

Effect of intermittent fasting on adriamycin-induced nephropathy: Possible underlying mechanisms.

PURPOSE: Intermittent fasting (IF) has been shown to induce a well-organized adaptive defense against stress inside the cells, which increases the production of anti-oxidant defenses, repair of DNA, biogenesis of mitochondria, and genes that combat inflammation. So, the goal of the current investigation was to identify the effects of IF on rats with adriamycin (ADR)-induced nephropathy and any potential underlying mechanisms. METHODS: Four groups of 40 mature Sprague-Dawley male rats were allocated as follow; control, fasting, ADR, and ADR plus fasting. After 8 weeks of ADR administration urine, blood samples and kidneys were taken for assessment of serum creatinine (Cr), BUN, urinary proteins, indicators of oxidative damage (malondialdehyde (MDA), reduced glutathione (GSH) and Catalase (CAT) levels), histopathological examinations, immunohistochemical examinations for caspase-3, Sirt1, aquaporin2 (AQP2) and real time PCR for antioxidant genes; Nrf2, HO-1 in kidney tissues. RESULTS: IF significantly improved serum creatinine, BUN and urinary protein excretion, oxidative stress (low MDA with high CAT and GSH), in addition to morphological damage to the renal tubules and glomeruli as well as caspase-3 production during apoptosis. Moreover, IF stimulates significantly the expression of Sirt1 and Nrf2/HO-1 and AQP2. CONCLUSION: AQP2, Sirt1, Nrf2/HO-1 signaling may be upregulated and activated by IF, which alleviates ADR nephropathy. Enhancing endogenous antioxidants, reducing apoptosis and tubulointerstitial damage, and maintaining the glomerular membrane's integrity are other goals.

Solution-based Supramolecular Hierarchical Assembly of Frenkel Excitonic Nanotubes Driven by Gold Nanoparticle Formation and Temperature.

Translating nature's successful design principle of solution-based supramolecular self-assembling to broad applications─ranging from renewable energy and information technology to nanomedicine─requires a fundamental understanding of supramolecular hierarchical assembly. Though the forces behind self-assembly (e.g., hydrophobicity) are known, the specific mechanism by which monomers form the hierarchical assembly still remains an open question. A crucial step toward formulating a complete mechanism is understanding not only how the monomer's specific molecular structure but also how manifold environmental conditions impact the self-assembling process. Here, we elucidate the complex correlation between the environmental self-assembling conditions and the resulting structural properties by utilizing a well-characterized model system: well-defined supramolecular Frenkel excitonic nanotubes (NTs), self-assembled from cyanine dye molecules in aqueous solution, which further self-assemble into bundled nanotubes (b-NTs). The NTs and b-NTs inhabit distinct spectroscopic signatures, which allows the use of steady-state absorption spectroscopy to monitor the transition from NTs to b-NTs directly. Specifically, we investigate the impact of temperature (ranging from 23 °C, 55 °C, 70 °C, 85 °C, up to 100 °C) during in situ formation of gold nanoparticles to determine their role in the formation of b-NTs. The considered time regime for the self-assembling process ranges from 1 min to 8 days. With our work, we contribute to a basic understanding of how environmental conditions impact solution-based hierarchical supramolecular self-assembly in both the thermodynamic and the kinetic regime.

Mutational Landscape and In-Silico Analysis of TP53, PIK3CA, and PTEN in Patients with Breast Cancer from Khyber Pakhtunkhwa.

Herein, we report the mutational spectrum of three breast cancer candidate genes (TP53, PIK3CA, and PTEN) using WES for identifying potential biomarkers. The WES data were thoroughly analyzed using SAMtools for variant calling and identification of the mutations. Various bioinformatic tools (SIFT, PolyPhen-2, Mutation Taster, ISPRED-SEQ, SAAFEQ-SEQ, ConSurf, PROCHECK etc.) were used to determine the pathogenicity and nature of the SNVs. Selected interaction site (IS) mutations were visualized in PyMOL after building 3D structures in Swiss-Model. Ramachandran plots were generated by using the PROCHECK server. The selected IS mutations were subjected to molecular dynamic simulation (MDS) studies using Gromacs 4.5. STRING and GeneMANIA were used for the prediction of gene-gene interactions and pathways. Our results revealed that the luminal A molecular subtype of the breast cancer was most common, whereas a high percentage of was Her2 negatives. Moreover, the somatic mutations were more common as compared to the germline mutations in TP53, PIK3CA, and PTEN. 20% of the identified mutations are reported for the first time from Khyber Pakhtunkhwa. In the enrolled cohort, 23 mutations were nonsynonymous SNVs. The frequency of mutations was the highest in PIK3CA, followed by TP53 and PTEN. A total of 13 mutations were found to be highly pathogenic. Four novel mutations were identified on PIK3CA and one each on PTEN and TP53. SAAFEQ-SEQ predicted the destabilizing effect for all mutations. ISPRED-SEQ predicted 9 IS mutations (6 on TP53 and 3 on PIK3CA), whereas no IS mutation was predicted on PTEN. The TP53 IS mutations were TP53R43H, TP53Y73X, TP53K93Q, TP53K93R, TP53D149E, and TP53Q199X; whereas for PIK3CA, the IS mutations were PIK3CAL156V, PIK3CAM610K, and PIK3CAH1047R. Analysis from the ConSurf Web server revealed five SNVs with a highly conserved status (conservation score 9) across TP53 and PTEN. TP53P33R was found predominant in the grade 3 tumors, whereas PTENp.C65S was distributed on ER+, ER-, PR+, PR-, Her2+, and Her2- patients. TP53p.P33R mutation was found to be recurring in the 14/19 (73.6%) patients and, therefore, can be considered as a potential biomarker. Finally, these mutations were studied in the context of their potential association with different hormonal and social factors.

Effectiveness of educational materials on levels of knowledge of thyroid associated orbitopathy in an endocrinology clinic.

Objective: We aim to assess and quantify basic knowledge about TAO in patients presenting to an endocrinology clinic and the effect of different educational materials on patients' knowledge. Methods: This study was conducted in a tertiary care center involving 255 patients presenting to an endocrinology clinic. The study was divided into three consecutive phases: 1. a control phase without any educational materials in the waiting room, 2. exposure to educational posters, and 3. exposure to educational pamphlets. Results: In the control population, only 16.5% of patients reported having knowledge of TAO, with a low average TAO-K score of 29.8 (out of 100). After the poster and pamphlet interventions, the percentage of patients having any knowledge of TAO increased across the control, poster and pamphlet phases: 16.5%, 25.9%, 63.5% respectively (p < 0.001). Similarly, the mean TAO-K score increased: 29.8, 45.8, 63.2 respectively (p < 0.001). Conclusion: This study confirms that patients with thyroid dysfunction have a low level of awareness and depth of knowledge of TAO. Innovation: We suggest the dissemination of educational material to increase the knowledge of TAO in thyroid patients. This will help with early symptom detection and ensure proper management of this interdisciplinary condition.

Phyto-fabrication of ultrafine nanoscale holmium oxide HT-Ho2O3 NPs and their biomedical potential.

In this study holmium oxide nanoparticles (Ho2O3 NPs) are fabricated using Hyphaene thebaica extracts as a bioreductant. The XRD pattern of HT-Ho2O3 NPs (product from phyto-reduction) suggested that the nanoparticles are crystalline with no impurities. Scherrer approximation revealed grain sizes of ∼10 nm. The HR-TEM revealed HT-Ho2O3 NPs possessed a quasi-spherical morphology complemented by SEM and the particle sizes were in the range of 6-12 nm. The infrared spectra revealed characteristic Ho-O bonding at ∼603 cm-1. Raman spectra indicated five main peaks positioned at 156 cm-1, 214 cm-1, 328 cm-1, 379 cm-1 and 607 cm-1. Eg (optical bandgap) was found to be 5.1 eV. PL spectra indicated two major peaks at 415 nm and 607 nm. EDS spectra confirmed the elemental presence of holmium (Ho). Spotty rings were obtained during the SAED measurement which indicated crystallinity of HT-Ho2O3 NPs. The HT-Ho2O3 NPs were further analyzed for their antioxidant, anti-angiogenic and cytotoxic properties. The antioxidant potential was moderate i.e., 43.40 ± 0.96% at 1000 µg mL-1 which decreased in a dose dependent manner. Brine shrimp lethality was highest at 1000 µg mL-1 with the LC50 320.4 µg mL-1. Moderate anti-angiogenic potential was observed using in ova CAM assay. MTT bioassay revealed that the HT-Ho2O3 NPs inhibited the 3T3 cells (IC50 67.9 µg mL-1), however, no significant inhibition was observed against MCF-7 cells. α-Amylase and ß-glucosidase inhibition revealed that the HT-Ho2O3 NPs can be of use in controlling blood glucose levels. Overall, it can be concluded that biosynthesis using aqueous extracts can be a suitable alternative in finding ecofriendly paradigms for the synthesis of nanoparticles. We suggest extended research into the bioreduced Ho2O3 NPs for establishing their biomedical potential and toxicity.

Evaluation of the efficacy of horizontal distraction osteogenesis using expansion screws in the repair of the acquired jaw bone defects.

Restoration of the segmental defects of the maxilla presents a reconstructive dare to obtain a perfect osseous form and height. A variety of prosthetic and surgical bone grafts exists, that produces less than optimal results. Bone transport distraction is a dependable procedure in several maxillofacial bone defects reconstruction techniques. This study aimed to evaluate the effectiveness of horizontal distraction osteogenesis (DO) using expansion screws for the treatment of atrophic and deficient bone, which is caused by acquired malformations. Material and methods: A total of eight patients ( age 17-36 years) who came with atrophy of the maxilla were treated by horizontal DO. The used device consisted of two parts: one was an orthodontic expander and the other was a screw-ring. The expansion screws were set on the transport bone, which was osteotomized and fixed to the segments using microscrews. Radiographical documentation of the patients was obtained with cone beam computed tomography prior to the surgery and after 4 months of the distraction phase. Results: The average of the actual bone gain at the end of the consolidation period was 7 mm (range 5-9 mm). Intraoral DO failed in one patient. The average bone density in the distraction gap after 4 months of the DO was 460.40. The average bone density of the bone defect region after 4 months of the DO was 487.90. Conclusion: Our results confirm that horizontal DO using expansion screws is a predictable and effective regenerative procedure for patients with acquired bone defects in the jaw.

Influence of implant protrusion length and initial bone height on intrasinus bone gain in transalveolar sinus floor elevation without bone graft: a 2-year retrospective study.

A transalveolar sinus lift is a safe and predictable long-term surgical approach. Several factors affect clinical and radiographic outcomes. This study aimed to evaluate the correlation between intrasinus bone gain (IBG) with the implant protrusion length (IPL) and the initial bone height (IBH) in transalveolar sinus floor elevation (TSFE) without bone graft procedures. Materials and methods: This retrospective cohort study was carried out on patients who had reported to the department of oral and maxillofacial surgery at Tishreen University between January 2020 and September 2022. The sample consisted of patients who had a transalveolar sinus lift with simultaneous dental implants placement. TSFE was performed using motorized threaded bone expanders. The IBH, the IPL, and the IBG height were analyzed using CBCT scans that were taken preoperatively and 6 months postoperatively. Statistical analysis was performed to assess the relationship of the IBG with the IPL and the IBH. The P values < 0.05 were considered to be statistically significant. Results: A total of 34 implants were placed using motorized threaded bone expanders in 29 patients who were included in the study. Three membrane perforations were observed out of 34 procedures (8.82%). The survival rate for all implants was 100%. The mean IBH was 6.37±0.85 mm, the mean IPL was 2.01±0.55 mm, and the mean IBG was 1.69±0.44 mm. A strong positive correlation was found between bone gain and IPL. No correlation was found between bone gain and IBH. Conclusions: According to the result of this study, the IPL is a critical factor in TSFE and dental implant placement simultaneously without bone graft procedures.

Valorization and Repurposing of Citrus limetta Fruit Waste for Fabrication of Multifunctional AgNPs and Their Diverse Nanomedicinal Applications.

Herein we propose an ecofriendly process for the biofabrication of AgNPs by applying fruit waste of Citrus limetta. The aqueous extracts from the peels of the fruit were used as green chelating and stabilizing agents. Structural, optical, vibrational, morphological, and magnetic properties were established using UV-Vis (ultraviolet visible spectroscopy), XRD (X-rays diffraction), FTIR (Fourier transformed infrared spectroscopy), EDS (energy dispersive spectroscopy), SEM (scanning electron microscopy), ESR (electron spin resonance), and PPMS (physical property management system), while the thermal properties were established using TGA/DTG (thermal gravimetric analysis/derivative thermogravimetry). XRD pattern revealed intense peaks with single-phase purity, while the Debye-Scherrer approximation revealed an average crystallite size of 33.18 nm. The W-H plot revealed the size of 55.2 nm and strain 2.68 × 10-4. FTIR spectra revealed the involvement of different functional groups and major IR vibrations were observed at 2329 cm-1, 2092 cm-1, 1794 cm-1, 1268 cm-1, and 754 cm-1. TGA/DTG revealed major weight loss events at 240 °C and 360 °C. SEM revealed spherical or quasi-spherical morphology, while EDS confirmed the presence of elemental silver. The M-H behavior for all measurement temperature shows diamagnetic behavior. Electron spin resonance (ESR) revealed a high proportion of free electrons. Furthermore, the pharmacognostic and nanomedicinal potential CL-AgNPs was established using multiple in vitro and in vivo bioassays. The in vivo wound healing assays in mice revealed excellent healing potential which were similar to positive control. The percent wound healing is reported to be 93% on the 14th day of incision after application of CL-AgNPs. Bioassays were performed to assess enzyme inhibition potential of the CL-AgNPs for Alzheimer disease and antidiabetic applications. The AChE and BChE potential of the CL-AgNPs was highest at 1000 µg mL-1, i.e., 92% and 56%, respectively. The α-glucosidase inhibition potential for the CL-AgNPs was higher as compared to the α-glucosidase, while the DPPH free radical scavenging was reported to be 70% to 11% at varying concentrations between 1000 and 62.5 µg mL-1. Overall, our results indicate that the waste fruit peels can be a sustainable and eco-friendly resource of synthesis of the multifunctional nanoparticles.

Ophthalmic injuries from the beirut blast: Managing long-term consequences.

The 2020 Beirut Port explosion was one of the largest non-nuclear urban explosions in history, and resulted in a plethora of oculofacial injuries. In this retrospective study, we present the two year follow up ophthalmic outcomes of the survivors of the blast. Only 16 out of 39 patients continued follow up at our center, with 13 having delayed complications and 7 requiring further surgery. The most common delayed complications related to the eyelid, lacrimal system, and orbit. Treatment of disfiguring facial and peri-ocular scarring with laser-assisted drug delivery of topical 5-fluorouracil showed great promise and significantly improved patients' functional and well as cosmetic outcomes.

Evaluation of human growth hormone (somatropin) in socket healing: a split-mouth randomized controlled trial.

Techniques for preserving alveolar bone after tooth extraction are becoming a part of the usual clinical practice of clinicians. These techniques aim at minimizing postextraction bony resorption, hence, minimizing subsequent follow-up for implant insertion. This randomized clinical study aimed to measure and compare alveolar bone and soft tissue healing between extraction sockets treated with somatropin to untreated sockets. Methods: The study is designed as a split-mouth randomized clinical trial. The selected patients were indicated for bilateral symmetrical tooth extraction, where each patient had an indication to extract two symmetrical teeth in anatomy and number of roots. Somatropin was applied to the tooth socket of the randomly selected side after tooth extraction by gel foam, and the control side was filled with gel foam only. A clinical follow-up of the soft tissue was done 7 days after tooth extraction to evaluate clinical aspects of the healing process. Radiographic follow-up was performed using a cone-beam computed tomography scan to assess volumetric changes of alveolar bone in the extraction area prior to and 3 months after the surgical procedure. Results: A total of 23 patients (aged 29.1±9.5 years) participated. The results showed a statistically significant association between somatropin application and better preservation of the bony dimensions of the alveolar ridge. Bone loss was -0.691±0.628 mm for the buccal plate on the study side compared to -2.008±1.175 mm on the control side. The level of the lingual/palatal plate bone loss was -1.052±0.855 mm on the study side compared to -2.695±1.878 mm on the control side. The bone loss of alveolar width was -1.626±1.061 mm on the study side compared to -3.247±1.543 mm on the control side. The results also showed better healing of covering soft tissues (P<0.05), as well as bone density in the socket where somatropin was applied, which has been statistically significant. Conclusion: The data from this study demonstrated that the application of somatropin in tooth sockets postextraction showed an effective contribution to reducing alveolar bone resorption and improving bone density following extraction, in addition to better healing of covering soft tissue.

Marsupialization and peripheral ostectomy for the management of large odontogenic keratocyst: a case report.

Odontogenic keratocyst has been of particular interest due to its distinctive behavior and its tendency to frequently recurrence and the diversity of treatment methods. Researchers have differed over the past decades about the nature of this lesion, sometimes it was classified as a cyst and sometimes it was classified as a tumor because of its specific histopathologic features, high recurrence rate and aggressive behavior. We discuss a case of a large odontogenic keratocyst (OKC) that was treated by marsupialization followed by peripheral ostectomy. Based on our findings, we conclude that the marsupialization followed by peripheral ostectomy was a conservative and effective option for the management of large OKC.

Increased bladder injury rate during emergency and repeat cesarean section

Objective: Bladder injury is one of the complications of cesarean section (CS). It is reported that the overall incidence of bladder injury is 0.22-0.44% of CS. It is, however, unclear what factors influence this rate. The aim of this study was to determine if there is a difference in bladder injury rate between scheduled and emergency CS, as well as in primary and repeat CS at a large metropolitan hospital that serves a population at high risk for obstetric complications. In addition, the use of urology consultation following bladder injury and whether demographic factors and labor characteristics affect the rate of bladder injury were investigated. Material and Methods: A total of 8,488 records were reviewed (4,292 primary CS and 4,196 repeat CS) from January 1, 2013 to December 31, 2020. The incidence of bladder injury was calculated and the rate of intraoperative urology/urogynecology consultation was recorded. Then the association between bladder injury and intraoperative urology/urogynecology consultation and between bladder injury and maternal age, body mass index (BMI), and gestational age were compared. Results: There was a significant increase in risk of bladder injury in repeat CS versus primary CS (p=0.01). There was also a significant increase in risk of bladder injury in emergency CS versus scheduled CS (p=0.04). Intraoperative urogynecology/urology consultations were significantly higher in the bladder injury versus no bladder injury groups (p<0.0001). Both emergency CS and repeat CS are predictors of bladder injury with odd ratios of 5.7 and 7.4, respectively. Conclusion: These results add to the existing evidence that bladder injury is a rare complication in CS that may occur more often in women undergoing repeat or emergency CS than primary or scheduled CS. Given that the risk increases with repeat or emergency CS, patients should be made aware of such risks and surgeons should make careful intraoperative considerations with close postoperative follow-ups.