Comparing the efficacy of intravenous morphine versus ibuprofen or the combination of ibuprofen and acetaminophen in patients with closed limb fractures: a randomized clinical trial.

INTRODUCTION: This study aims to investigate the effectiveness of intravenous ibuprofen or intravenous ibuprofen plus acetaminophen compared to intravenous morphine in patients with closed extremity fractures. METHODS: A triple-blinded randomized clinical trial was conducted at a tertiary trauma center in Iran. Adult patients between 15 and 60 years old with closed, isolated limb fractures and a pain intensity of at least 6/10 on the visual analog scale (VAS) were eligible. Patients with specific conditions or contraindications were not included. Participants were randomly assigned to receive intravenous ibuprofen, intravenous ibuprofen plus acetaminophen, or intravenous morphine. Pain scores were assessed using the visual analog scale at baseline and 5, 15, 30, and 60 min after drug administration. The primary outcome measure was the pain score reduction after one hour. RESULTS: Out of 388 trauma patients screened, 158 were included in the analysis. There were no significant differences in age or sex distribution among the three groups. The pain scores decreased significantly in all groups after 5 min, with the morphine group showing the lowest pain score at 15 min. The maximum effect of ibuprofen was observed after 30 min, while the ibuprofen-acetaminophen combination maintained its effect after 60 min. One hour after injection, pain score reduction in the ibuprofen-acetaminophen group was significantly more than in the other two groups, and pain score reduction in the ibuprofen group was significantly more than in the morphine group. CONCLUSION: The study findings suggest that ibuprofen and its combination with acetaminophen have similar or better analgesic effects compared to morphine in patients with closed extremity fractures. Although morphine initially provided the greatest pain relief, its effect diminished over time. In contrast, ibuprofen and the ibuprofen-acetaminophen combination maintained their analgesic effects for a longer duration. The combination therapy demonstrated the most sustained pain reduction. The study highlights the potential of non-opioid analgesics in fracture pain management and emphasizes the importance of initiation of these medications as first line analgesic for patients with fractures. These findings support the growing trend of exploring non-opioid analgesics in pain management. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05630222 (Tue, Nov 29, 2022). The manuscript adheres to CONSORT guidelines.

The Predictive Value of Point-of-care Ultrasonography versus MRI in Assessing Medial Meniscal Tears in Patients with Acute Knee Injury.

Background: Musculoskeletal ultrasound is increasingly used as the modality of choice in diagnosing many medical situations. The present study aimed to compare the efficacy of point-of-care ultrasonography (POCUS) and magnetic resonance imaging (MRI) to detect acute medial meniscus knee tears. Materials and methods: The prospective study was conducted on patients with a suspected medial meniscus knee tear in the emergency department (ED). In the absence of a knee fracture in the X-ray, POCUS on the knee was done. All patients underwent POCUS and MRI of the knee followed by arthroscopy. POCUS findings were then compared to MRI findings to diagnose medial meniscus tear. Results: Finally, 157 patients with a mean age of 25.04±7.41 years were included. 94 (59.9%) of patients were male. Medial meniscus tears were detected in 89 patients (56.7%) using arthroscopy as the gold standard. The sensitivity, specificity, positive and negative predictive values (PPV and NPV), and accuracy of POCUS to detect medial meniscus tear were 88.8 [95% confidence interval (CI), 80.3 to 94.5], 89.7% [95% CI, 79.9 to 95.8], 91.9% [95% CI, 84.8 to 95.8], 85.9% [95% CI, 77.2 to 91.7], and 89.2% [95% CI, 83.3 to 93.6]. The diagnostic accuracy of MRI to detect medial meniscus injury was 93.0% [95% CI, 87.8 to 96.4). Conclusion: The present study demonstrated that POCUS is an accurate and reliable diagnostic tool alternative to MRI in detecting medial meniscal tears. POCUS had acceptable sensitivity, specificity, and accuracy in detecting meniscal injuries. Therefore, POCUS could be performed as an effective immediate investigation to guide further modalities in patients with acute knee trauma.

Postoperative Outcomes of Intracapsular Tonsillectomy With Coblation: A Systematic Review and Meta-Analysis.

OBJECTIVE: Following tonsillectomy, postoperative pain and hemorrhage from the tonsillar bed are causes of significant morbidity. Intracapsular tonsillectomy with Coblation is suggested to minimize such morbidity while remaining efficacious in long-term outcomes. This systematic review and meta-analysis assessed short-term morbidity and long-term outcomes from intracapsular tonsillectomy with Coblation, focusing primarily on posttonsillectomy hemorrhage. DATA SOURCES: Medline, Embase, and the Cochrane Library. REVIEW METHODS: Guided by PRISMA guidelines, studies on intracapsular tonsillectomy with Coblation published between December 2002 and July 2022 evaluating frequency of posttonsillectomy hemorrhage were screened. Studies without primary data were excluded. Meta-analysis was conducted using the random-effect model. The primary outcome was the proportion of patients who experienced posttonsillectomy hemorrhage. The secondary outcomes were posttonsillectomy pain, the proportion requiring revision tonsillectomy, and severity of sleep-disordered breathing measured by polysomnography outcomes. RESULTS: From 14 studies there were 9821 patients. The proportion of total posttonsillectomy hemorrhage was 1.0% (95% confidence interval [CI] 0.5%-1.6%, n = 9821). The proportion experiencing primary hemorrhage, secondary hemorrhage, and those requiring further tonsil surgery were 0.1% (95% CI 0.0%-0.1%; study n = 7), 0.8% (95% CI 0.2%-1.4%; study n = 7), and 1.4% (95% CI 0.6%-2.2%; study n = 6), respectively. Mean reduction in apnea-hypopnea index was -16.0 events per hour (95% CI -8.8 to -23.3, study n = 3) and mean increase in oxygen nadir was 5.9% (95% CI 2.6%-9.1%, study n = 3). CONCLUSION: Intracapsular tonsillectomy with Coblation has been demonstrated to have a low rate of posttonsillectomy hemorrhage. Data regarding long-term tonsil regrowth and need for reoperation were encouraging of the efficacy of this technique.

A Novel Topical Formulation of the Leishmaniasis Drug Glucantime as a Nanostructured Lipid Carrier-Based Hydrogel.

Leishmaniasis is a parasitic disease caused by Leishmania parasites. Meglumine antimoniate, or Glucantime, is the primary drug used to treat this disease. Glucantime with a standard painful injection administration route has high aqueous solubility, burst release, a significant tendency to cross into aqueous medium, rapid clearance from the body, and insufficient residence time at the injury site. Topical delivery of Glucantime can be a favorable option in the treatment of localized cutaneous leishmaniasis. In this study, a suitable transdermal formulation in the form of nanostructured lipid carrier (NLC)-based hydrogel containing Glucantime was prepared. In vitro drug release studies confirmed controllable drug release behavior for hydrogel formulation. An in vivo permeation study on healthy BALB/C female mice confirmed appropriate penetration of hydrogel into the skin and sufficient residence time in the skin. In vivo performance of the new topical formulation on the BALB/C female mice showed a significant improvement in reduction of leishmaniasis wound size, lowering parasites number in lesions, liver, and spleen compared with commercial ampule. Hematological analysis showed a significant reduction of the drug's side effects, including variance of enzymes and blood factors. NLC-based hydrogel formulation is proposed as a new topical administration to replace the commercial ampule.

Enzymatically preparation of starch nanoparticles using freeze drying technique - Gelatinization, optimization and characterization.

Starch nanoparticles (SNPs) in colloidal forms were prepared using enzymatically pretreatment and four different gelatinization methods based on autoclave, microwave, ultrasonication and normal heating with stirring. Furthermore, SNPs in powder form were prepared using freeze drying technique. Results indicated that the formed SNPs using starch solution (1 % W/V) and ultrasonication technique had lowest mean particle size (151 nm) and PDI (0.173), and highest zeta potential (-8.8 mV) values. Optimization procedure using response surface methodology, based on central composite design, indicated that using 1.5 mL of α-amylase and sonication time of 15 min, SNPs with lowest particle size (49.3 nm) and highest zeta potential (-10.8 mV) were produced. Using prepared colloidal solution under optimal conditions, SNPs powder were produced by freeze dryer, adjusted at pressure and temperature of 100 Pa and - 70 °C, for 24 h. Results indicated that formed SNPs powder with squared-shape, had particle size, zeta potential, specific surface area, decomposition temperature of 197 nm, -13.9 mV, 1.9 m2g-1 and 162 °C, respectively. While, for native starch these values were 5018 nm, -6.01 mV, 0.68 m2g-1 and 170.2 °C, respectively. Results revealed that emulsification ability of SNPs powder was three times higher than that of the native starch.

Readability, reliability and credibility of online patient information on skin grafts.

BACKGROUND: Skin grafting reflects a common dermatological procedure for closing skin defects. Patient education is important for managing expectation and optimising skin graft take. While health information is increasingly accessed on the internet, there are no existing studies assessing their quality. METHODS: The first 25 results from Google, Microsoft Bing and Yahoo! search engines using the term 'skin graft' were analysed using a variety of standard instruments. Readability was assessed using the Flesch-Kincaid Grade score (FKG), Gunning Fog Index (GFI), Simple Measure of Gobbledygook (SMOG) and the New Dale-Chall Readability Index (NDC). Reliability was assessed using the DISCERN instrument and credibility with the Journal of the American Medical Association Benchmark Criteria (JAMA). Transparency was identified by presence of the Health On the Net Foundation Code certification (HON-code). RESULTS: Seventy-five websites were identified. After exclusion, forty-three remaining websites were analysed with average FKG, GFI and SMOG scores of 7.8, 10.1 and 10.7, respectively. The average NDC was 5.9. The average reliability was fair with a DISCERN score based on the first 15 questions of the instrument of 42.6. The mean JAMA score was 2, and 9 websites displayed the HON-code certificate. CONCLUSIONS: Readability, reliability and credibility of online health information regarding skin grafting can be improved. Health care providers should critically assess existing online patient information or develop alternative material to educate patients undergoing skin graft surgery.

Point-Of-Care Ultrasonography for Diagnosis of Medial Collateral Ligament Tears in Acute Knee Trauma; a Diagnostic Accuracy Study.

Introduction: The use of point-of-care ultrasonography (POCUS) for identifying medial collateral ligament (MCL) tears has increased in recent years. This study aimed to evaluate the diagnostic accuracy of POCUS in the diagnosis of acute MCL tears of the knee. Methods: This prospective cross-sectional study was performed on patients with suspected MCL tear of the knee in the emergency department (ED). After history taking and primary physical examination, radiographic imaging of the knee was done. If there was no fracture in the knee X-ray, the POCUS examination was done. All of the patients were asked to refer to an orthopedic clinic, 7-10 days after discharge from ED, for Magnetic Resonance Imaging (MRI) evaluation. The second POCUS was done in the orthopedic clinic. Finally, the findings of POCUS and MRI were compared in diagnosing MCL injury. Results: Two hundred and fifty patients with a mean age of 25.05 ± 9.12 years were analyzed (86.8% male). According to the MRI findings, as the gold standard, 55(22.0%) patients had MCL injury. The sensitivity, specificity, positive and negative predictive values (PPV and NPV), and accuracy of ultrasound in detection of MCL injury, in comparison with MRI were 83.64 (95% CI, 71.20 to 92.23), 94.36% (95% CI, 90.13 to 97.15), 80.70% (95% CI, 69.95 to 88.25), 95.34% (95% CI, 91.83 to 97.38), and 92.00% (95% CI, 87.92 to 95.05), respectively. The area under the receiver operating characteristic (ROC) curve of POCUS was 0.890 (95% CI, 0.844 to 0.926). Conclusion: It seems that POCUS can be applied in screening patients with MCL tears following blunt knee trauma.

Management dilemma in metastatic papillary thyroid carcinoma.

Papillary thyroid cancer is the most common type of well-differentiated thyroid cancer. It is associated with a survival rate greater than 95% with appropriate treatment, particularly in younger patients. We present the unique case of a 25-year-old male with severe Autistic spectrum disorder (ASD) with a right level V neck mass of several months. Due to his severe ASD, his first assessment was conducted in the hospital foyer, and every subsequent clinical assessment and blood test required a general anaesthetic (GA). He was subsequently diagnosed with T2 N1b M0 (Stage I) papillary thyroid cancer. He required extensive multidisciplinary team (MDT) input to determine the goal for his treatment whilst taking into consideration perioperative care, wound management, compliance with exam and blood tests, radioactive iodine administration and lifelong medication requirements if total thyroidectomy was considered. Following multiple MDT and family meetings, the decision was made to proceed with right hemi-thyroidectomy, right level I-V and central neck dissection. He required one-week stay in the intensive care unit under sedation post-operatively, and was discharged from hospital a further six days later with no complications. He is currently being followed-up every six months which presents its own challenges. This case highlights the extraordinary challenges and considerations that need to be made when dealing with surgical pathology in a patient with severe intellectual disability, even in the setting of a relatively common surgical pathology.

COVID-19 vaccine associated cervical lymphadenopathy: a case series.

BACKGROUND: COVID-19 is an evolving worldwide pandemic causing significant morbidity and mortality. COVID-19 vaccinations have been developed to increase immunity against the virus. In New Zealand, the Pfizer BioNTech mRNA vaccine has been provisionally approved for use. Axillary lymphadenopathy is a recognized side effect of the mRNA vaccine, however cervical lymphadenopathy has also been reported. Due to a wide range of differential diagnoses, the finding of cervical lymphadenopathy requires thorough investigation which can include imaging and invasive diagnostic procedures. METHODS: Five patients were identified by otorhinolaryngology (ORL) consultants at Whangarei Base Hospital and Waikato Hospital between 15/7/2021 and 21/12/2021 after being investigated through high suspicion of cancer triage pathways set by the New Zealand Ministry of Health. Inclusion criteria were adult patients with cervical lymphadenopathy following vaccination. Exclusion criteria were no history of vaccination or lymphadenopathy present before vaccination. RESULTS: All patients were identified to have cervical lymphadenopathy on radiological imaging and a recent history of COVID-19 vaccination with the Pfizer BioNTech vaccine. Interval vaccination to fine needle aspiration time ranged between 41 and 76 days. All patients had cytological or histological diagnosis showing reactive findings or interval imaging showing resolution of lymphadenopathy. CONCLUSION: With increasing levels of COVID-19 vaccination and booster vaccinations we will continue to see cases of COVID-19 vaccine associated cervical lymphadenopathy. We highlight the importance of taking a COVID-19 vaccination history and including COVID-19 associated cervical lymphadenopathy in the differential diagnosis of presentation with a neck lump.

The effects of high dose vitamin D supplementation as a nutritional intervention strategy on biochemical and inflammatory factors in adults with COVID-19: Study protocol for a randomized controlled trial.

Introduction: Low serum vitamin D has been shown to be a risk factor for Coronavirus 2019 (COVID-19). The aim of this study was to assess the effects of high dose vitamin D supplementation on hs-CRP, ESR and clinical outcomes, including duration of hospitalization, quality of life and New York Heart Association (NYHA) Functional Classification, in adults with COVID-19. Methods: This double-blind, randomized control trial will be conducted on patients with RT-PCR and/or chest CT scan diagnosis of COVID-19 admitted in Imam Reza Hospital, Mashhad, Iran. Participants will be randomized into control and intervention groups based on randomization sampling. The intervention group will receive soft gel containing 50,000 IU vitamin D on the first day followed by 10,000 IU/day through a supplement drop daily for 29 days. The control group will receive 1000 IU vitamin D daily through supplement drop and a placebo soft gel. All participants will undergo laboratory assessment including inflammatory markers, serum 25)OH)D, complete blood count (CBC), liver and renal profile, lipid profile and erythrocyte sedimentation rate (ESR) at baseline and at day 30. The mortality rate will be recorded in both groups. Results: Data will be presented using descriptive statistics. Comparison of changes in study parameters over the study period will be performed using analysis of covariance adjusting for possible confounders. Conclusions: The findings of this will provide evidence on the effects of high dose vitamin D supplementation on inflammatory markers in hospitalized COVID-19 patients.

Role of point-of-care ultrasonography (POCUS) in the diagnosing of acute medial meniscus injury of knee joint.

BACKGROUND: In recent years, musculoskeletal ultrasound has increasingly become the common method for diagnosis for many medical specialties. Therefore, the present study was performed to evaluate the diagnostic value of point-of-care ultrasonography (POCUS) as a primary triage tool in the diagnosis of the acute medial meniscus injury of the knee. MATERIALS AND METHODS: The present cross-sectional study was performed on patients with a suspected medial meniscus injury of the knee in the emergency department (ED). After history taking and primary physical examination, radiographic imaging of the knee was done. If there was no fracture in the knee X-ray, the POCUS examination on the knee was carried out. All the patients were asked to refer to an orthopedic clinic 2 weeks after discharge from ED for the Magnetic Resonance Imaging (MRI) evaluation. Finally, the POCUS findings were compared with the MRI findings in diagnosing medial meniscus injury. RESULTS: Fifty-five patients with a mean age of 35.48 ± 11.58 years were analyzed in the study (69.1% male). In comparison with MRI scan, the sensitivity and specificity of POCUS in the detection of medial meniscus injury were 85.0 [95% confidence interval (CI), 54.0 to 98.9] and 65.7% [95% CI 42.2 to 85.7], respectively. Its positive and negative predictive values were 58.6% [95% CI 33.8 to 81.5] and 88.5% [95% CI 62.1 to 99.3], respectively. (Area under the ROC curve = 0.726, P value = 0.003). CONCLUSION: The present study demonstrated that POCUS can reasonably be applied in comparison with MRI to evaluate medial meniscus injury. POCUS is an effective initial diagnostic modality in patients with suspected medial meniscus injuries.

Evaluation of readability and reliability of online patient information for intracranial aneurysms.

INTRODUCTION: Intracranial aneurysms are common. Receiving this diagnosis can have a profound impact on patients and their families and this is compounded by the nuanced complexities around their management. An overwhelming majority of patients research health information using the internet. Patient-centred care and informed consent requires patients to have access to information that is readable and reliable. The aim of this study was to assess the readability and reliability of online health information about intracranial aneurysms. METHOD: A Google search was conducted using the terms 'brain aneurysm', 'cerebral aneurysm', and 'intracranial aneurysm' and the first 75 websites were screened for assessment. The readability of each website was assessed using the Flesch reading ease score (FRE), the Flesch-Kincaid grade level (FKGL), the gunning fog index (GFI) and the simple measure of gobbledygook (SMOG) indices. Reliability was assessed using the DISCERN instrument and the Journal of the American Medical Association benchmark criteria (JAMA). RESULTS: Following exclusion, 36 websites were analyzed. The websites collectively scored as 'difficult' readability and 'poor' reliability on average. Statistically significant differences in readability were observed between websites categorized as patient health information and commercial compared with academic and physician. Differences in readability were also observed between search results of 'brain aneurysm' compared with 'intracranial aneurysm'. CONCLUSION: The readability and reliability of online health information about intracranial aneurysms is suboptimal. Health professionals must ensure their patients are well informed which includes directing them to high quality resources which are readable and reliable and use layperson-oriented language during the consultation.

Physiologic Scoring Systems versus Glasgow Coma Scale in Predicting In-Hospital Mortality of Trauma Patients; a Diagnostic Accuracy Study.

INTRODUCTION: In recent years, several scoring systems have been developed to assess the severity of trauma and predict the outcome of trauma patients. This study aimed to compare Rapid Emergency Medicine Score (REMS), Modified Early Warning Score (MEWS), Injury Severity Score (ISS), and Glasgow Coma Scale (GCS) in predicting the in-hospital mortality of trauma patients. METHODS: This diagnostic accuracy study was done on adult patients admitted to the emergency department (ED) between June 21, 2019, and September 21, 2020, following multiple trauma. Patients were followed as long as they were hospitalized. The REMS, MEWS, GCS, and ISS were calculated after data gathering and comprehensive assessment of injuries. Receiver operating characteristics (ROC) analysis was performed to examine the prognostic performance of the four different tools. RESULTS: Of the 754 patients, 32 patients (4.2%) died and 722 (95.8%) survived after 24 hours of admission. The mean age of the patients was 38.54 ± 18.58 years (78.9% male). The area under the ROC curves (AUC) of REMS, MEWS, ISS, and GCS score for predicting in-hospital mortality were 0.942 (95% CI [0.923-0.958]), 0.886 (95% CI [0.861-0.908]), 0.866 (95% CI [0.839-0.889]), and 0.851 (95% CI [0.823-0.876]), respectively. The AUC of REMS was significantly higher than GCS (p=0.035). The sensitivities of GCS ≤ 11, ISS ≥ 13, REMS ≥ 4, and MEWS ≥ 3 scores for in-hospital mortality were 0.56, 0.97, 0.81, and 0.94, respectively. Also, the specificities of GCS, ISS, REMS, and MEWS scores for in-hospital mortality were 0.93, 0.82, 0.81, and 0.85, respectively. CONCLUSION: It seems that REMS is more accurate than GCS, ISS, and MEWS in predicting in-hospital mortality ≥ 24 hours of multiple trauma patients.

COVID-19 management in the emergency ward.

The confirmed and suspected cases of the 2019 novel coronavirus disease (COVID-19) have increased in the entire world. There is still no vaccine or definitive treatment for this virus due to its unknown pathogenesis and proliferation pathways. Optimized supportive care remains the main therapy, and the clinical efficacy for the subsequent agents is still under investigation. Enormous demand for handling the COVID-19 outbreak challenged both the health-care personnel and medical supply system. As outbreaks of COVID-19 develop, prehospital workers, emergency medical services personnel, and other emergency responders are potentially asked to follow specific practice guidelines to mitigate the effects of an escalating pandemic. In this article, we have summarized the current guidance on potential COVID-19 management options. The recent experience with COVID-19 provided lessons on strategy and policymaking that the government and ministry of health should be on the alert and concentrate more on capacity to manage an outbreak like COVID-19. It is important to consider the new data that emerge daily regarding clinical characteristics, treatment options, and outcomes for COVID-19.

Sensitivity and specificity of ultrasound in the diagnosis of traumatic ankle injury.

BACKGROUND: This study was performed to determine the sensitivity and specificity of ultrasound in the diagnosis of traumatic ankle injury in comparison with magnetic resonance imaging (MRI). MATERIALS AND METHODS: This cross-sectional study was performed on 31 patients with soft-tissue injury or fracture, referring to the MRI imaging center of Alzahra and Kashani Hospitals in Isfahan from October 2018 to March 2019. After an MRI, an ultrasound of the affected ankle was performed for all patients. Sonography and MRI were performed by two radiologists who were blinded to the results of each other's reports. The sensitivity, specificity, positive predictive value, and negative predictive value of sonography were determined. RESULTS: In this study, 31 patients with ankle trauma were studied. The mean age of the patients was 30.73 ± 10.15 years; 32.3% were male and 67.7% were female. The sensitivity of ultrasound relative to MRI to detect damage to the anterior talofibular ligament (ATFL), posterior talofibular ligament (PTFL), and calcaneofibular ligament (CFL) was 66.67%, 50%, and 100%, respectively, and the corresponding specificity was 92.86%, 93.10%, and 93.10%, respectively. According to Kappa test, the agreement between ultrasound and MRI methods for detecting injury to ATFL (κ = 0.51), PTFL (κ = 0.35), and CFL (κ= 0.63) was statistically significant (P < 0.05). CONCLUSION: Ultrasound is an appropriate modality for the diagnosis of injuries to CFL and ATFL and has shown acceptable results for PTFL. It could be used as an alternative in cases where access to MRI is not available.

Impact of Shave Biopsy on Diagnosis and Management of Cutaneous Melanoma: A Systematic Review and Meta-Analysis.

BACKGROUND: Melanoma is the most lethal skin cancer. Excision biopsy is generally recommended for clinically suspicious pigmented lesions; however, a proportion of cutaneous melanomas are diagnosed by shave biopsy. A systematic review was undertaken to investigate the impact of shave biopsy on tumor staging, treatment recommendations, and prognosis. METHODOLOGY: The MEDLINE, Embase, and Cochrane Library databases were searched for relevant articles. Data on deep margin status on shave biopsy, tumor upstaging, and additional treatments on wide local excision (WLE), disease recurrence, and survival effect were analyzed across studies. RESULTS: Fourteen articles from 2010 to 2020 were included. In total, 3713 patients had melanoma diagnosed on shave biopsy. Meta-analysis revealed a positive deep margin in 42.9% of shave biopsies. Following WLE, change in tumor stage was reported in 7.7% of patients. Additional treatment was recommended for 2.3% of patients in the form of either further WLE and/or sentinel lymph node biopsy. There was high heterogeneity across studies in all outcomes. Four studies reported survival, while no studies found any significant difference in disease-free or overall survival between shave biopsy and other biopsy modalities. CONCLUSIONS: Just over 40% of melanomas diagnosed on shave biopsy report a positive deep margin; however, this translated into a change in tumor stage or treatment recommendations in relatively few patients (7.7% and 2.3%, respectively), with no impact on local recurrence or survival among the studies analyzed.

Glioblastoma: assessment of the readability and reliability of online information.

INTRODUCTION: Glioblastoma Multiforme (GBM) represents one of the most common and most aggressive forms of brain tumours with a poor prognosis. There is often uncertainty around diagnosis and prognosis amongst patients diagnosed with cancer. Most patients rely on internet to access health-related information. The aim of this study was to assess the readability and reliability of online information on GBM. METHODS: The terms 'Glioblastoma' and 'GBM' were used to search Google and the first 50 websites identified were screened. For each website, the quality of each website was assessed using the DISCERN instrument, the Journal of the American Medical Association (JAMA) benchmark criteria and the Health on the Net Foundation code certification (HON-code). The readability was assessed using the Flesch Reading Ease Score (FRE), the Flesch-Kincaid grade level (FKGL) and the Gunning Fog Index (GFI). The relevant patient information by 4 International patient information websites were also assessed. RESULTS: Following screening, 31 websites met the inclusion criteria with only four websites displaying the HON-code (12.9%). The median DISCERN score was 43 (range: 17-70) corresponding to 'fair' quality, and the median JAMA benchmark criteria score was 1. Display of the HON-code certificate or the publication date was associated with higher quality websites. The median FRE score corresponded to 'difficult' to read (34.4). The median GFI score (15.9) and FKGL score (13.3) corresponded to a 'college' level of education reading ability. The Cancer Australia online information was the most readable website while Cancer Research UK had the highest quality information. CONCLUSION: The readability and reliability of online information relating to GBM is inadequate. Health professionals need to provide or guide patients to information that is both readable and reliable.

Green approach in food nanotechnology based on subcritical water: effects of thyme oil and saponin on characteristics of the prepared oil in water nanoemulsions.

Thyme oil in water nanomulsion was prepared under subcritical water conditions using water and saponin, as solvent and emulsifier, respectively. Gas chromatography revealed that there were 44 bioactive components in the extracted thyme essential oil which, thymol and carvacrol were two mains of them. Experiments were designed based on central composite design and effects of amounts of saponin and thyme essential oil were evaluated on particle size, polydispersity index (PDI) and zeta potential of the prepared nanoemulsions using response surface methodology. Obtained results revealed that more desirable thyme oil nanoemulsions with minimum particle size (184.51 nm) and PDI (0.514), and maximum zeta potential (- 22.51 mV) were prepared using 0.94 g of saponin and 0.28 mL of thyme essential oil. Furthermore, results indicated that prepared nanoemulsion using obtained optimum production conditions had relatively high antioxidant activity (24%) and high antibacterial and antifungal activities against Staphylococcus aureus and Penicillium digitatum.