Efficiency of magnetic zeolitic imidazolate framework-8 (ZIF-8) modified graphene oxide for lead adsorption.

Simple and efficient removal of Pb(II) ion from aqueous solution through adsorption has accelerated the development of many new composites to improve this popular method. In this study, the composites of graphene oxide (GO), zeolitic imidazolate framework-8 (ZIF-8), and magnetic materials were synthesized via coprecipitation method utilizing a different molar ratio between FeCl2 and FeCl3 of 1:0.5, 2:1, 3:1.5, and 4:2. The ZIF-8/GO was prepared via room temperature synthesis method prior to its further modification with magnetic materials for ease of separation. It was observed that the MZIF-8/GO2 of molar ratio 2:1 showed the best performance in adsorbing Pb(II) ion. As confirmed by FESEM image, it appeared to be ZIF-8 particles that have grown all over the GO platform and overlayed with Fe3O4 granular-shaped particles. The MZIF-8/GO2 successfully achieved 99% removal of Pb(II) within 10 min. The optimum values obtained for the initial concentration of Pb (II) were 100 mg/L, pH of 4 to 6, and adsorbent dosage used was 10 mg. The Langmuir isotherm and the pseudo-second-order kinetic model were deemed suitable to evaluate the adsorption of Pb(II) using MZIF-8/GO2. Results showed that MZIF-8GO2 achieved a maximum adsorption capacity of 625 mg/g of Pb(II) adsorption. All parent materials demonstrated a good synergistic effects, while exhibiting a significant contribution in providing active sites for Pb(II) adsorption. Therefore, this ternary composite of MZIF-8/GO2 is expected to be a promising adsorbent for Pb(II) adsorption from aqueous solution with an added value of ease of post phase separation using external magnetic field.

Neonatal Intensive Care Nurses' Knowledge of Neonatal Pain Assessment in Private and Public Hospitals in Jeddah, Saudi Arabia: A Cross-Sectional Study.

BACKGROUND: Neonatal Intensive Care Unit (NICU) nurses with adequate neonatal pain assessment knowledge are crucial in effective neonatal pain management. There is limited research that assessed the knowledge of NICU nurses in Saudi Arabia regarding neonatal pain assessment. OBJECTIVE: To assess the knowledge of NICU nurses in Saudi Arabia regarding neonatal pain assessment. DESIGN AND METHODS:  A cross-sectional design using an online survey was conducted to capture information regarding neonatal pain assessment knowledge from 125 NICU nurses in Saudi Arabia. Knowledge of pain assessment was assessed using a modified version of the knowledge, attitudes, and practice scale. Knowledge scores were classified as high, average, and low. RESULTS: Participants' knowledge regarding neonatal pain assessment was inadequate (Mean = 63/100). The majority of the participants had a low to average level of knowledge (n= 97, 78%). CONCLUSION: A significant proportion of NICU nurses had inadequate knowledge regarding neonatal pain assessment, which can be improved. Educational interventions are needed to boost these nurses' knowledge regarding neonatal pain assessment.

Nurses' Assessment of Pain in Saudi Neonatal Intensive Care Units.

BACKGROUND: Research reveals that neonatal pain management in Neonatal Intensive Care Units (NICUs) is suboptimal. There is limited research that assessed NICU nurses' pain assessment practices in Saudi Arabia. AIM: To assess the nurses' pain assessment practices in the NICU in Saudi Arabia. DESIGN: This study used a descriptive cross-sectional design. SETTINGS: Research was conducted using an online survey. PARTICIPANTS/SUBJECTS: This study was carried out on 65 NICU nurses. The participants were recruited from one governmental and one private hospital in Saudi Arabia. METHODS: Data on pain assessment practices were collected, including the frequency of pain assessment, pain assessment scales used for preterm and term neonates, and pain assessment documentation. Data were analyzed using frequencies and percentages. RESULTS: The majority of the participants (94%) routinely assessed pain and documented pain assessment (97%). One-third of the participants assessed pain regularly every hour (32%). The most used pain assessment scales for term neonates were the neonatal infant pain scale (40%) and the cry, required oxygen, increased vital signs, expression, and sleeplessness scale (23%). The most used pain assessment scales for preterm neonates were the neonatal infant pain scale (31%), the cry, required oxygen, increased vital signs, expression, sleeplessness scale (19%), and the premature infant pain profile (17%). CONCLUSIONS: NICU nurses in Saudi Arabia consistently assessed for and documented pain; however, the tools chosen were sometimes suboptimal. A substantial number of NICU nurses used invalid tools to assess pain in term and preterm neonates. An interventional program is needed to enhance the use of evidence-based practice recommendations regarding neonatal pain assessment by nurses in the Neonatal Intensive Care Units in Saudi Arabia.

Association between passive smoking and dental caries status in children: A cross-sectional analytical study.

BACKGROUND: Several risk factors contribute to the development of dental caries in children, including sociodemographic, dietary, oral hygiene-related and other miscellaneous factors. Maternal smoking was highly associated with dental caries when compared to smoking by fathers or other household members. OBJECTIVES: The aim of the study was to determine the prevalence of dental caries and their association with exposure to environmental tobacco smoke (ETS) among 5- to 10-year-old students attending private and government schools. MATERIAL AND METHODS: A cross-sectional analytical study was conducted among schoolchildren. Data was collected from the primary caregivers using a pre-tested form to assess the ETS exposure under 5 domains based on history: antenatal exposure; exposure during the index period; exposure in the school neighborhood; exposure in restaurants/roadside stalls; and exposure in bus stops/railway stations. Dental caries was assessed based on the World Health Organization (WHO) guidelines from 1997. The association was reported using prevalence ratios (PRs) (95% confidence interval (CI)). RESULTS: Data was obtained from 211 schoolchildren attending government (39.8%) and private schools (60.2%). The overall prevalence (95% CI) of dental caries was 49.3% (42.5-56.1%). Among all the risk factors evaluated in the study, exposure to ETS was associated with a significantly increased risk of dental caries. The adjusted prevalence ratio (APR) of ETS exposure varied with the mother's educational status and high sugar exposure, although this was statistically insignificant. CONCLUSIONS: The prevalence of dental caries among schoolchildren aged 5 to 10 years in the city was moderate and similar to the national average. Among the risk factors assessed in the study, antenatal exposure to ETS was found to significantly increase the prevalence of dental caries by 41% after adjusting for other factors. Therefore, it is important to educate parents on the causal role of ETS exposure in dental caries.

Parents' Perception and Use of Skin-to-Skin Care in Jeddah, Saudi Arabia: A Cross-Sectional Study.

BACKGROUND: Skin-to-skin care (SSC) between newborns and their parents provides many positive outcomes for both newborns and their parents. However, there is a lack of research assessing the perception of parents, especially fathers, of SSC in Saudi Arabia. PURPOSE: The aim of the study is to assess parents' perception of SSC in Saudi Arabia. METHODS: This cross-sectional study used an online survey. Data were collected from a convenience sample of 140 parents of hospitalized neonates between January and June 2023. Data were collected from one private hospital (Dr. Soliman Fakeeh Hospital) and one public hospital (King Abdulla Medical Complex) in Jeddah, Saudi Arabia. The parents' perceptions of SSC were assessed using the Parents' Perceptions of SSC tool. An independent t-test was used to compare mothers and fathers in their perceptions of SSC. RESULTS: One hundred and forty parents completed the online survey (70 females and 70 males). The majority of the parents did not use SSC with their babies (n=102, 73%), did not read or hear about the use and benefits of skin-to-skin care (n=100, 71%), and did not receive information or training on SSC from healthcare professionals (n=112, 80%). Mothers' perception of SSC was significantly higher than that of fathers (p ≤ 0.05). CONCLUSION: Fathers' perception of SSC was lower than that of mothers. Awareness and training programs are needed to inform parents, especially fathers, regarding SSC and its benefits in Saudi Arabia.

Accuracy of different dental age assessment methods to determine chronological age among children with special needs.

AIM: This study aimed to validate the accuracy of dental age (DA) based on the dental development of permanent teeth in children with special needs using Demirjian, Willems, and London Atlas methods and to correlate the dental and chronological age (CA) of children with special needs in Malaysia. MATERIALS AND METHODS: The panoramic radiographic images belonging to children with special needs from the two teaching dental hospitals in Malaysia aged between 5 and 16 years were included in the study. The evaluation was performed by two observers using three methods (London Atlas, Demirjian, and Willems methods) to estimate the accurate DA. The outcome was determined by comparing the mean of the DA and CA. RESULTS: A total of 52 panoramic radiographs were available for the analysis. The London Atlas and Demirjian methods overestimated the DA with a mean of 0.05 and 0.20 years, respectively, while the Willems method underestimated by 0.19 years. The London Atlas method was highly precise and accurate, while Demirjian and Willems methods were the least precise and accurate. CONCLUSION: The London Atlas method of DA estimation is highly accurate and valid for children with special needs in the Malaysian population, followed by the Willems and Demirjian methods.

KCO: Balancing class distribution in just-in-time software defect prediction using kernel crossover oversampling.

The performance of the defect prediction model by using balanced and imbalanced datasets makes a big impact on the discovery of future defects. Current resampling techniques only address the imbalanced datasets without taking into consideration redundancy and noise inherent to the imbalanced datasets. To address the imbalance issue, we propose Kernel Crossover Oversampling (KCO), an oversampling technique based on kernel analysis and crossover interpolation. Specifically, the proposed technique aims to generate balanced datasets by increasing data diversity in order to reduce redundancy and noise. KCO first represents multidimensional features into two-dimensional features by employing Kernel Principal Component Analysis (KPCA). KCO then divides the plotted data distribution by deploying spectral clustering to select the best region for interpolation. Lastly, KCO generates the new defect data by interpolating different data templates within the selected data clusters. According to the prediction evaluation conducted, KCO consistently produced F-scores ranging from 21% to 63% across six datasets, on average. According to the experimental results presented in this study, KCO provides more effective prediction performance than other baseline techniques. The experimental results show that KCO within project and cross project predictions especially consistently achieve higher performance of F-score results.

Removal of multiple pesticides from water by different types of membranes.

Pesticides are used in agriculture to protect crops from pathogens, insects, fungi and weeds, but the release of pesticides into surface/groundwater by agriculture runoff and rain has raised serious concerns not only for the environment but also for human health. This study aimed to investigate the impact of surface properties on the performance of seven distinct membrane types utilized in nanofiltration (NF), reverse osmosis (RO) and forward osmosis (FO) processes in eliminating multiple pesticides from spiked water. Out of the membranes tested, two are self-fabricated RO membranes while the rest are commercially available membranes. Our results revealed that the self-fabricated RO membranes performed better than other commercial membranes (e.g., SW30XLE, NF270, Duracid and FO) in rejecting the targeted pesticides by achieving at least 99% rejections regardless of the size of pesticides and their log Kow value. Despite the marginally lower water flux exhibited by the self-fabricated membrane compared to the commercial BW30 membrane, its exceptional ability to reject both mono- and divalent salts renders it more apt for treating water sources containing not only pesticides but also various dissolved ions. The enhanced performance of the self-fabricated RO membrane is mainly attributed to the presence of a hydrophilic interlayer (between the polyamide layer and substrate) and the incorporation of hydrophilic nanosheets in tuning its surface characteristics. The findings of the work provide insight into the importance of membrane surface modification for the application of not only the desalination process but also for the removal of contaminants of emerging concern.

Revolutionizing tropical fruits preservation: Emerging edible coating technologies.

Tropical fruits, predominantly cultivated in Southeast Asia, are esteemed for their nutritional richness, distinctive taste, aroma, and visual appeal when consumed fresh. However, postharvest challenges have led to substantial global wastage, nearly 50 %. The advent of edible biopolymeric nanoparticles presents a novel solution to preserve the fruits' overall freshness. These nanoparticles, being edible, readily available, biodegradable, antimicrobial, antioxidant, Generally Recognized As Safe (GRAS), and non-toxic, are commonly prepared via ionic gelation owing to the method's physical crosslinking, simplicity, and affordability. The resulting biopolymeric nanoparticles, with or without additives, can be employed in basic formulations or as composite blends with other materials. This study aims to review the capabilities of biopolymeric nanoparticles in enhancing the physical and sensory aspects of tropical fruits, inhibiting microbial growth, and prolonging shelf life. Material selection for formulation is crucial, considering coating materials, the fruit's epidermal properties, internal and external factors. A variety of application techniques are covered such as spraying, and layer-by-layer among others, including their advantages, and disadvantages. Finally, the study addresses safety measures, legislation, current challenges, and industrial perspectives concerning fruit edible coating films.

Prioritizing patients for hip fracture surgery: the role of frailty and cardiac risk.

Introduction: The number of patients with hip fractures continues to rise as the average age of the population increases. Optimizing outcomes in this cohort is predicated on timely operative repair. The aim of this study was to determine if patients with hip fractures who are frail or have a higher cardiac risk suffer from an increased risk of in-hospital mortality when surgery is postponed >24 h. Methods: All patients registered in the 2013-2021 TQIP dataset who were ≥65 years old and underwent surgical fixation of an isolated hip fracture caused by a ground-level fall were included. Adjustment for confounding was performed using inverse probability weighting (IPW) while stratifying for frailty with the Orthopedic Frailty Score (OFS) and cardiac risk using the Revised Cardiac Risk Index (RCRI). The outcome was presented as the absolute risk difference in in-hospital mortality. Results: A total of 254,400 patients were included. After IPW, all confounders were balanced. A delay in surgery was associated with an increased risk of in-hospital mortality across all strata, and, as the degree of frailty and cardiac risk increased, so too did the risk of mortality. In patients with OFS ≥4, delaying surgery >24 h was associated with a 2.33 percentage point increase in the absolute mortality rate (95% CI: 0.57-4.09, p = 0.010), resulting in a number needed to harm (NNH) of 43. Furthermore, the absolute risk of mortality increased by 4.65 percentage points in patients with RCRI ≥4 who had their surgery delayed >24 h (95% CI: 0.90-8.40, p = 0.015), resulting in a NNH of 22. For patients with OFS 0 and RCRI 0, the corresponding NNHs when delaying surgery >24 h were 345 and 333, respectively. Conclusion: Delaying surgery beyond 24 h from admission increases the risk of mortality for all geriatric hip fracture patients. The magnitude of the negative impact increases with the patient's level of cardiac risk and frailty. Operative intervention should not be delayed based on frailty or cardiac risk.

Knowledge, Awareness, and Practice of Safety and Emergency Response Among Scuba Divers in Malaysia: Questionnaire Development and Validation.

INTRODUCTION: Safety has become paramount to ensure that scuba diving continues to expand into new markets, with minimal risks, and that scuba diving translates into a safe and relaxed adventure in response to growing market demands. Research focusing on assessing the knowledge, awareness, and practices (KAP) regarding safety and emergency response among scuba divers has been limited, and there is a need for validated assessment tools in this area. METHODS: This study involved 555 scuba divers in Malaysia, and the questionnaire underwent a thorough development and validation process, including content and face validity assessments, as well as exploratory factor analysis. The validation of the knowledge domain was conducted using Item Response Theory (IRT) analysis, while awareness and practice were validated through exploratory and confirmatory factor analyses (EFA and CFA). RESULTS: The content validity of the instrument was confirmed, with all items scoring over 80% for Item Content Validity Index (I-CVI), Scale Content Validity Index (S-CVI), and Scale Content Validity Index/Average (S-CVI/AVE). The initial draft comprises three domains: knowledge, awareness, and practice. Knowledge items were analyzed using IRT and demonstrated acceptable difficulty and discrimination levels. For the awareness and practice domains, EFA showed a Kaiser-Meyer-Olkin measure (KMO) of 0.83 and 0.79, respectively, with a significant Bartlett's test of Sphericity (P < 0.001). EFA yielded three factors for both awareness and practice domains with a total of 12 items for awareness and 13 items for practice, with satisfactory factor loadings (≥0.3). The final model of CFA showed good fits for both awareness and practice domains in terms of absolute, parsimonious, and comparative measures. The composite reliability of awareness was acceptable with Raykov's rho of 0.71, whereas the practice domain fell slightly below the acceptable threshold at 0.55. This was attributed to low factor loading and a limited number of items within each factor. The final questionnaire now consists of 20 items for knowledge, 10 items for awareness, and 12 items for the practice domain. CONCLUSION: The results of this validation and reliability study indicate that the newly developed questionnaire possesses favorable psychometric properties for assessing KAP related to safety and emergency response in the scuba diving context. This research is essential for harmonizing the perspectives of crucial stakeholders within the recreational scuba diving industry.

Impact of class II and class III skeletal malocclusion on pharyngeal airway dimensions: A systematic literature review and meta-analysis.

Background: This study is a pioneer systematic review and meta-analysis aimed at comparing the influence of Class II and Class III skeletal malocclusions on pharyngeal airway dimensions. It stands as the inaugural comprehensive assessment to collate and analyze the disparate findings from previously published articles on this topic. The objective of this study was to identify published articles that compare the effects of class II and class III skeletal malocclusion on the pharyngeal airway dimensions. Methods: An all-inclusive search for existing published studies was done to identify peer-reviewed scholarly articles that compared the influence of class II and class III skeletal malocclusion on pharyngeal airway dimensions. The search was done via five electronic databases: Cochrane Library, EMBASE, Scopus, Web of Science, and PubMed. Screening of the articles was done and the eligible studies were critically assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist. Results: The initial search yielded 476 potential articles of which, nine were finally included in this study for a total of 866 patients. Three studies were of cross-sectional design and six were of retrospective study design. Following a critical analysis and review of the studies, class III skeletal malocclusion had significantly larger volume and area measurements compared to class II skeletal malocclusion. Conclusion: Research in the field of literature has established that variations in skeletal classifications have a discernible effect on the size of the pharyngeal airways. With the advancement of skeletal malocclusions to a class III, there is an observed increase in both the volume and cross-sectional area of the airways.

The relationship between internet addiction and stress, anxiety, and depression in adolescents in Saudi Arabia.

BACKGROUND: There is an increasing rate of Internet addiction among adolescents that may lead to many negative psychological outcomes. This study assessed the relationship between Internet addiction and stress, anxiety, and depression in adolescents in Saudi Arabia. METHODS: A correlational online survey captured data on Internet use and psychological outcomes from 462 adolescents between March and May 2022. Young's Internet Addiction Scale assessed the degree of Internet addiction. The Depression, Anxiety, and Stress Scale (DASS21) assessed the perceived level of stress, anxiety, and depression. Bivariate and multivariate analyses determined the relationship between Internet addiction and depression, anxiety, and stress. RESULTS: Sixty-eight percent of adolescents had mild to severe Internet addiction. Sixty percent of the adolescents perceived mild to extremely severe depression, 58% perceived mild to extremely severe anxiety, and 44% perceived mild to extremely severe stress. Adolescents with more Internet addiction scores perceived more stress, anxiety, and depression (p ≤ 0.05). CONCLUSIONS: The Internet addiction rate is high among adolescents in Saudi Arabia. Adolescents with more Internet addiction scores are prone to perceive higher levels of stress, anxiety, and depression. APPLICATION TO PRACTICE: Interventional multidisciplinary programs are needed to make adolescents, parents, schoolteachers, and school nurses in Saudi Arabia aware of Internet addiction and methods to reduce the dependence of those adolescents on the Internet. School nurses should provide adolescents and parents with means to reduce their Internet dependence.

Effect of chemical treatments of arundo donax L. fibre on mechanical and thermal properties of the PLA/PP blend composite filament for FDM 3D printing.

Arundo donax L. is investigated in this study as a suitable reinforcing agent for PLA/PP waste blend 3D printing filament. To improve the compatibility of the fibre and polymer, the Arundo fibre was chemically modified using alkali and silane treatment. Untreated and treated fibres were extruded with Polymer blends before being 3D printed. Effect of chemical treatment on thermal, mechanical, and morphological properties of the composites was investigated. The tensile, Izod impact, and water absorption of the 3D printed specimens were also tested. The Alkali treated (ALK) and combination of alkali and silane treatment (SLN) composites displayed good results. Tensile strength and modulus of the materials increased, as well as their maintained stability in the Izod impact test, demonstrating that the incorporation of ArF did not result in a loss in performance. SEM examination supported these findings by confirming the creation of beneficial interfacial contacts between the matrix and fibre components, as demonstrated by the lack of void between the matrix and the fibre surface. Furthermore, the alkali treatment of the ArF resulted in a considerable reduction in water absorption inside the biocomposite, with a 64% reduction seen in ALK composite comparison to the untreated composite (Un). After the 43-day assessment period.

Harnessing the photocatalytic potential of bismuth ferrite-activated carbon nanocomposite (BFO-AC) for Staphylococcus aureus decontamination under visible light.

In response to the escalating global issue of microbial contamination, this study introduces a breakthrough photocatalyst: bismuth ferrite-activated carbon (BFO-AC) for visible light-driven disinfection, specifically targeting the Gram-positive bacterium Staphylococcus aureus (S. aureus). Employing an ultrasonication method, we synthesized various BFO-AC ratios and subjected them to comprehensive characterization. Remarkably, the bismuth ferrite-activated carbon 1:1.5 ratio (BA 1:1.5) nanocomposite exhibited the narrowest band gap of 1.86 eV. Notably, BA (1:1.5) demonstrated an exceptional BET surface area of 862.99 m2/g, a remarkable improvement compared to pristine BFO with only 27.61 m2/g. Further investigation through FE-SEM unveiled the presence of BFO nanoparticles on the activated carbon surface. Crucially, the photocatalytic efficacy of BA (1:1.5) towards S. aureus reached its zenith, achieving complete inactivation in just 60 min. TEM analysis revealed severe damage and rupture of bacterial cells, affirming the potent disinfection capabilities of BA (1:1.5). This exceptional disinfection efficiency underscores the promising potential of BA (1:1.5) for the treatment of contaminated water sources. Importantly, our results underscore the enhanced photocatalytic performance with an increased content of activated carbon, suggesting a promising avenue for more effective microorganism inactivation.

The role of sheet-like TiO2 in polyamide reverse osmosis membrane for enhanced removal of endocrine disrupting chemicals.

Thin film composite (TFC) reverse osmosis (RO) membrane shows good promise for treating wastewater containing endocrine disrupting chemical (EDC) pollutants. The incorporation of functional materials with exceptional structural and physico-chemical properties offers opportunities for the membranes preparation with enhanced permselectivity and better antifouling properties. The present study aims to improve the EDC removal efficiency of TFC RO membrane using two-dimensional titania nanosheets (TNS). RO membrane was prepared by incorporating TNS in the dense layer of polyamide (PA) layer to form thin film nanocomposite (TFN) membrane. The TNS loading was varied and the influences on membrane morphology, surface hydrophilicity, surface charge, as well as water permeability and rejection of EDC were investigated. The results revealed that the inclusion of TNS in the membrane resulted in the increase of water permeability and EDC rejection. When treating the mixture of bisphenol A (BPA) and caffeine at 100 ppm feed concentration, the TFN membrane incorporated with 0.05% TNS achieved water permeability of 1.45 L/m2·h·bar, which was 38.6% higher than that of unmodified TFC membrane, while maintaining satisfactory rejection of >97%. The enhancement of water permeability for TFN membrane can be attributed to their hydrophilic surface and unique nanochannel structure created by the nanoscale interlayer spacing via staking of TiO2 nanosheets. Furthermore, the 0.05TFN membrane exhibited excellent fouling resistance towards BPA and caffeine pollutants with almost 100% flux recovery for three cycles of operations.

Neonatal Intensive Care Unit Nurses' Knowledge and Use of Sucrose for Neonatal Pain Management in Saudi Arabia.

Introduction: Sucrose is an evidence-based intervention used for short-term pain management and distress from minor procedures. Limited research exists on nurses' knowledge and use of sucrose in Neonatal Intensive Care Units in Saudi Arabia. Objective: To assess nurses' knowledge and use of sucrose in Neonatal Intensive Care Units in Saudi Arabia. Methods: A cross-sectional online survey was used to collect data from a convenience sample of 68 neonatal intensive care nurses in Saudi Arabia. A modified tool assessed the knowledge and use of sucrose. Logistic regression analysis was used to find the predictors for sucrose use. Results: Most respondents never used sucrose for neonatal pain management and did not receive any training on sucrose. The mean knowledge of nurses regarding sucrose and its use was very low (38%): 16% had a high level of knowledge regarding sucrose, 13% moderate, 19% low, and 52% very low. Nurses who received training on sucrose use and nurses who read or heard about sucrose predicted the use of sucrose. Conclusion: Nurses' knowledge and use of sucrose were inadequate. Interventional programs are needed to enhance the nurses' knowledge regarding sucrose and its use and to enhance the utilization of sucrose as a pain management intervention in the Neonatal Intensive Care Units in Saudi Arabia.

Investigating the link between frailty and outcomes in geriatric patients with isolated rib fractures.

Background: Studies have shown an increased risk of morbidity in elderly patients suffering rib fractures from blunt trauma. The association between frailty and rib fractures on adverse outcomes is still ill-defined. In the current investigation, we sought to delineate the association between frailty, measured using the Orthopedic Frailty Score (OFS), and outcomes in geriatric patients with isolated rib fractures. Methods: All geriatric (aged 65 years or older) patients registered in the 2013-2019 Trauma Quality Improvement database with a conservatively managed isolated rib fracture were considered for inclusion. An isolated rib fracture was defined as the presence of ≥1 rib fracture, a thorax Abbreviated Injury Scale (AIS) between 1 and 5, an AIS ≤1 in all other regions, as well as the absence of pneumothorax, hemothorax, or pulmonary contusion. Based on patients' OFS, patients were classified as non-frail (OFS 0), pre-frail (OFS 1), or frail (OFS ≥2). The prevalence ratio (PR) of composite complications, in-hospital mortality, failure-to-rescue (FTR), and intensive care unit (ICU) admission between the OFS groups was determined using Poisson regression models to adjust for potential confounding. Results: A total of 65 375 patients met the study's inclusion criteria of whom 60% were non-frail, 29% were pre-frail, and 11% were frail. There was a stepwise increased risk of complications, in-hospital mortality, and FTR from non-frail to pre-frail and frail. Compared with non-frail patients, frail patients exhibited a 87% increased risk of in-hospital mortality [adjusted PR (95% CI): 1.87 (1.52-2.31), p<0.001], a 44% increased risk of complications [adjusted PR (95% CI): 1.44 (1.23-1.67), p<0.001], a doubling in the risk of FTR [adjusted PR (95% CI): 2.08 (1.45-2.98), p<0.001], and a 17% increased risk of ICU admission [adjusted PR (95% CI): 1.17 (1.11-1.23), p<0.001]. Conclusion: There is a strong association between frailty, measured using the OFS, and adverse outcomes in geriatric patients managed conservatively for rib fractures.

Cardiac risk stratification and adverse outcomes in surgically managed patients with isolated traumatic spine injuries.

INTRODUCTION: As the incidence of traumatic spine injuries has been steadily increasing, especially in the elderly, the ability to categorize patients based on their underlying risk for the adverse outcomes could be of great value in clinical decision making. This study aimed to investigate the association between the Revised Cardiac Risk Index (RCRI) and adverse outcomes in patients who have undergone surgery for traumatic spine injuries. METHODS: All adult patients (18 years or older) in the 2013-2019 TQIP database with isolated spine injuries resulting from blunt force trauma, who underwent spinal surgery, were eligible for inclusion in the study. The association between the RCRI and in-hospital mortality, cardiopulmonary complications, and failure-to-rescue (FTR) was determined using Poisson regression models with robust standard errors to adjust for potential confounding. RESULTS: A total of 39,391 patients were included for further analysis. In the regression model, an RCRI ≥ 3 was associated with a threefold risk of in-hospital mortality [adjusted IRR (95% CI): 3.19 (2.30-4.43), p < 0.001] and cardiopulmonary complications [adjusted IRR (95% CI): 3.27 (2.46-4.34), p < 0.001], as well as a fourfold risk of FTR [adjusted IRR (95% CI): 4.27 (2.59-7.02), p < 0.001], compared to RCRI 0. The risk of all adverse outcomes increased stepwise along with each RCRI score. CONCLUSION: The RCRI may be a useful tool for identifying patients with traumatic spine injuries who are at an increased risk of in-hospital mortality, cardiopulmonary complications, and failure-to-rescue after surgery.

Experimental and density functional theory studies on some metal oxides and the derived nanoclusters: a comparative effects on human ferritin.

A comprehensive investigation into the green synthesis of metal oxide nanoparticles (NPs) has garnered significant attention due to its commendable reliability, sustainability, and environmentally friendly attributes. Green synthesis methods play a crucial role in mitigating the adverse effects associated with conventional approaches employed for nanostructure preparation. This research endeavors to examine the impact of ginger plant extract-assisted green synthesis of metal oxides NPs on the serum ferritin levels of anemic diabetic patients in vitro, focusing specifically on α-Fe2O3 and ZnO NPs. Sixty diabetic volunteers with anemia (35-50 years) and thirty healthy volunteers were enrolled as controls. The assessment was conducted using the VIDAS Ferritin (FER) assay. Photoluminescence (PL) spectroscopy measurements were performed to elucidate the intrinsic and extrinsic transitions of these NPs, affirming the successful formation of α-structured iron oxide. Density functional theory (DFT) calculations were carried out at the B3LYP/6-311++G(d,2p) level of theory to investigate the geometry optimization and molecular electrostatic potential maps of the NPs. Furthermore, TD-DFT calculations were employed to explore their frontier molecular orbitals and various quantum chemical parameters. The binding affinity and interaction types of ZnO and α-Fe2O3 NPs to the active site of the human H-Chain Ferritin (PDB ID: 2FHA) target were determined with the help of molecular docking. Results unveiled the crystalline structure of ZnO and the α-structure of α-Fe2O3. Analysis of the frontier molecular orbitals and dipole moment values demonstrated that ZnO (total dipole moment (D) = 5.80 µ) exhibited superior chemical reactivity, biological activity, and stronger molecular interactions with diverse force fields compared to α-Fe2O3 (D = 2.65 µ). Molecular docking of the metal oxides NPs with human H-chain ferritin provided evidence of robust hydrogen bond interactions and metal-acceptor bonds between the metal oxides and the target protein. This finding could have a great impact on using metal oxides NPs-ferritin as a therapeutic protein, however, further studies on their toxicity are required.