Optimization of different growth parameters for maximum production of bioactive crude metabolites by Aspergillus fumigatus.

Aspergillus fumigatus is a green echinulate with greenish phialides and 2.5-3 mm conidia. The diverse biological functions of A. fumigatus secondary metabolites make them interesting. The ethyl acetate extract of A. fumigatus was tested for antibacterial activity. Culture media, temperature, incubation and pH were optimized for A. fumigatus growth. Continuous 150rpm agitation incubated the fungus at 28°C for 10 days. Potato Dextrose Broth at 28°C in shaking incubator at pH 04 produced the most biomass and secondary metabolites. Metabolite antibacterial activity was tested. Salmonella flexneri had the greatest zone of inhibition at 100µl (25.66mm) while Staphylococcus aureus had the least (16.33mm). At 75µg/mL, S. flexneri showed 23.66mm activity and S. typhi 14.66mm. At 50µg/mL, S. flexneri was 21.33mm and S. typhi 12.33mmMBC was 0.01µg/µl and MIC50 varied. At 100µg/mL, the metabolites showed antifungal efficacy against Penicillium chrysogenum (26.33mm) but not A. flavus (21.33mm). A. oryzae was significantly inhibited at 75µg/mL (26.33mm) and 50µg/mL (20.33mm). 1000µl demonstrated 100% phytotoxicity, 100µl 60% and 10µl 50%. Bactrocera cucurbitae, Sitotroga cerealella and Callosobruchus maculatus were killed at 150, 100 and 75µl. Metabolites and antibiotics synergized well. Metabolites have alkanes, esters and ethers in their infrared spectra.

Synthesis, characterization and biological investigation of zinc nanoparticles using Acacia modesta Wall. leaves.

The study aimed to synthesize zinc nanoparticles (Zn-NPs) using an aqueous extract derived from Acacia modesta Wall. leaves. Several characterization techniques were employed to confirm the successful formation of zinc nanoparticles. UV-visible spectrophotometry indicated a peak at 374 nm, validating the bioreduction process. Scanning electron microscopy (SEM) was utilized to analyze the morphology, transmission electron microscopy (TEM) to determine particle size and shape, X-ray diffraction (XRD) for crystalline structure analysis, energy-dispersive X-ray spectroscopy (EDX) for elemental composition and Fourier-transform infrared spectroscopy (FTIR) to identify functional groups. The synthesized Zn-NPs demonstrated remarkable antibacterial activity against Escherichia coli (95% inhibition) and moderate antifungal activity against Candida albicans (70% inhibition). In phytotoxicity tests, the Zn-NPs exhibited a 55% reduction in the growth of Lamina minor at the highest dilution (1000 µl). Based on these findings, the study concluded that the green-synthesized Zn-NPs hold great potential as effective antibiotics against pathogenic bacteria and could be utilized in various industrial and agricultural applications.

Chloro-aluminum phthalocyanine-mediated photodynamic therapy improves peri-implant parameters and crevicular fluid cytokine levels in cigarette smokers with chronic hyperglycemia.

PURPOSE: This clinical trial aimed to evaluate the effectiveness of chloroaluminum phthalocyanine-mediated photodynamic therapy (CAPC-PDT) as an adjunct to peri­implant mechanical debridement (PID) in the treatment of peri­implantitis in patients with chronic hyperglycemia and cigarette smoking. METHODS: The selected participants with peri­implantitis were divided into two groups: Group I (n = 15) included hyperglycemic patients with no history of smoking and Group II (n = 15) included hyperglycemic patients with a history of smoking cigarettes. Both groups were further divided into two subgroups based on the type of therapy provided: PDT+PID and PID alone. Peri-implant bleeding on probing (PiBOP), peri­implant pocket depth (PiPD), peri­implant plaque scores (PiPS), and crestal bone loss (CBL) were assessed. Peri-implant crevicular fluid (PICF) was sampled for quantification of interleukin (IL)-1ß and tumor necrosis factor-alpha (TNF-α) using an enzyme-linked immunosorbent assay. All assessments were performed at baseline and at three and six months. RESULTS: PDT+PID showed a higher reduction in PiBOP than PID alone in hyperglycemic/non-smoking participants (p<0.01). PDT+PID and PID show a significant reduction in PiBOP in smokers only at 6 months (p<0.05), with comparable differences between PDT+PID and PID (p>0.05). PDT+PID significantly reduced PiPD hyperglycemic/smoking patients at 3 and 6 months (p<0.05), whereas PID only produced a significant reduction in PiPD at 6 months in smoking patients (p<0.05). CBL alone with PDT+PID in both smokers and non-smokers showed a statistically significant reduction at 6 months follow-up (p<0.05). IL-1ß was significantly reduced in hyperglycemic/non-smoking participants at 6 months follow-up with both PDT+PID and PID alone (p<0.01). This trend was also observed in cigarette smokers, with an additional short-term reduction in IL-1ß at 3 months with PDT+PID (p<0.05). Only the PDT+PID group showed a significant reduction in TNF-a among cigarette smoking patients with chronic hyperglycemia at 6 months follow-up (p<0.05) CONCLUSION: Chloroaluminum phthalocyanine-mediated PDT proved effective in improving peri­implant clinical outcomes and reducing cytokine levels in smoking patients with chronic hyperglycemia.

The Relationship Between e-Health Literacy and Breast Cancer Literacy Among Saudi Women.

Breast cancer is the most common cancer in women and represents a significant burden among women worldwide. The concept of health literacy is relatively new to the Gulf states, particularly to Saudi Arabia. Research on this topic is scarce, and no study has empirically explored the influence of e-health literacy on breast cancer literacy. The purpose of this study was to measure the impact of e-health literacy on breast cancer literacy among Saudi women in Riyadh city, Saudi Arabia. A cross-sectional survey was conducted online in a cohort of 336 women and disseminated via social media using the e-Health Literacy Scale (eHEALS) and Breast Cancer Literacy Assessment Tool (Breast-CLAT). Multiple regression analysis was executed to identify the sociodemographic factors that influence the e-health literacy and breast cancer literacy of participants. The participants showed high level of e-health literacy with total eHEALS score of 28.79, and better breast cancer literacy with total Breast-CLAT score of 23.44. This study yielded three significant findings: (1) e-health literacy is influenced by age and education which implies that youngest participants showed higher eHEALS scores than their older counterparts and that having increased education level reflected increased eHEALS scores, (2) breast cancer literacy is predicted by education and income which suggests that those who have higher levels of education and higher monthly incomes have increased levels of breast cancer literacy, and (3) breast cancer literacy and e-health literacy were associated which shows that participants with higher eHEALS scores were more likely have increased level of breast cancer literacy. The study revealed that the participants had high level of e-health literacy which correlated to their increased level of breast cancer literacy. The study findings implied that it is important for Saudi women to possess high levels of e-health literacy about breast cancer as more breast cancer educational resources are online nowadays.

Attitudes, Knowledge, and Skills Toward Adopting Evidence-Based Practice in Clinical Decision-Making of Registered Nurses in Saudi Arabia.

BACKGROUND AND PURPOSE: Evidence-based practice (EBP) is generally recognized as a fundamental tenet of cost-effective and high-quality patient care. Nurses must be engaged with the appropriate attitude and educated with essential competencies to implement EBP systematically into their daily practice. This study assessed the attitudes, knowledge, and skills of registered nurses toward the adoption of EBP in making clinical decisions in their practice. METHODS: This quantitative, crosssectional study surveyed a convenience sample of 312 nurses from five regions in Saudi Arabia from October 2019 to December 2019. RESULTS: The majority of nurses were unknowledgeable about the acceptable definition of EBP. The highest overall mean score was reported in the motivation subscale, followed by the skill and barrier subscales. The attitude subscale received the lowest overall mean score, which denotes a positive attitude. The nationality, level of nursing education, and years of experience had significant multivariate effects on nurses' EBP skills. Consequently, designation and EBP training had significant multivariate effects on nurses' perceived barriers to EBP adoption. IMPLICATIONS FOR PRACTICE: Nurses lack EBP knowledge. Nonetheless, they are motivated with positive attitudes to implement EBP in their professional practice if they are given adequate training and resources, sufficient time and managerial support, and mentoring from nurses with adequate EBP experience. Heightening the understanding and utilization of the best available scientific resources about EBP into nurses' daily clinical decision and practice is essential.

Spatiotemporal nexus between vegetation change and extreme climatic indices and their possible causes of change.

Climate extremes have a significant impact on vegetation. However, little is known about vegetation response to climatic extremes in Bangladesh. The association of Normalized Difference Vegetation Index (NDVI) with nine extreme precipitation and temperature indices was evaluated to identify the nexus between vegetation and climatic extremes and their associations in Bangladesh for the period 1986-2017. Moreover, detrended fluctuation analysis (DFA) and Morlet wavelet analysis (MWA) were employed to evaluate the possible future trends and decipher the existing periodic cycles, respectively in the time series of NDVI and climate extremes. Besides, atmospheric variables of ECMWF ERA5 were used to examine the casual circulation mechanism responsible for climatic extremes of Bangladesh. The results revealed that the monthly NDVI is positively associated with extreme rainfall with spatiotemporal heterogeneity. Warm temperature indices showed a significant negative association with NDVI on the seasonal scale, while precipitation and cold temperature extremes showed a positive association with yearly NDVI. The DEA revealed a continuous increase in temperature extreme in the future, while no change in precipitation extremes. NDVI also revealed a significant association with extreme temperature indices with a time lag of one month and with precipitation extreme without time lag. Spatial analysis indicated insensitivity of marshy vegetation type to climate extremes in winter. The study revealed that elevated summer geopotential height, no visible anticyclonic center, reduced high cloud cover, and low solar radiation with higher humidity contributed to climatic extremes in Bangladesh. The nexus between NDVI and climatic extremes established in this study indicated that increasing warm temperature extremes due to global warming might have severe implications on Bangladesh's ecology and the environment in the future.

Adopting the Triple Aim Framework in the Saudi Healthcare System: A Delphi Study.

PURPOSE: Helping healthcare systems to optimize performance using particular metrics through objective monitoring will positively impact an organization's progress toward strategic goals and objectives. The Institute of Healthcare Improvement introduced the Triple Aim framework for guiding new or transforming health systems, concurrently improving population health and patients' care experience, and reducing per capita cost. Consensus to determine applicable and appropriate measures to monitor this transformation within the scope of the three objectives is required. Thus, the study aimed to adopt the Triple Aim measures and reach a consensus among experts in healthcare systems on the applicability of the measures in the health system of Saudi Arabia. METHODS: A two-round Delphi study was conducted with 17 invited experts who were knowledgeable and experienced in healthcare systems and administration, quality improvement, and strategic planning. These rounds were based on the measures of the three objectives, where they were introduced as statements and grouped under each respective aim. The experts were instructed to score each measure using a 5-point Likert scale and were invited to formulate new measures related to the same aim. Statements reaching a consensus level of 80% were considered applicable measures for the Saudi health system. RESULTS: A total of 17 measures were circulated among experts; out of which, 16 measures reached a consensus. The 16 measures represent the three main domains of the Triple Aim model, ie, population health, experience of care, and cost per capita. The measure that failed to reach a consensus was the predictive model scores because it requires medical knowledge, where the majority of the experts were non-physicians. CONCLUSION: A Delphi study was used to reach consensus among experts on the Triple Aim measures as a first step to building a solid foundation for the population management required to implement these initiatives in the future.

Quality of Palliative Care: Perspective of Healthcare Providers at a Tertiary Hospital in Riyadh, Saudi Arabia.

This study aimed to measure the quality of palliative care from the perspective of healthcare professionals at a tertiary hospital in Riyadh, Saudi Arabia. A cross-sectional survey was distributed to 80 healthcare professionals working at the palliative care department. The questionnaire assessed the dimensions that measure the quality of palliative care (Structure and Aspects of Care, Cultural Aspects of Care, Care of the Imminently Dying Patient, Ethical Issues), overall quality of care, ethical Processes of Care, Physical Aspects of Care, Psychological/Psychiatric Aspects dilemmas occurring in the practice setting, and barriers to the provision of optimal end-of-life care. The total mean for the quality for care was 4.26 (SD = 0.45), indicating that all participants' perceptions regarding all dimensions tended to skew toward agree and strongly agree. However, the score on the psychological/psychiatric aspects of care was the lowest compared to other dimensions, with a mean of 3.7, which means it needs more consideration. Moreover, participants' mean rate of agreement on the quality of palliative care services was 4.62 out of 5. The majority of the participants agreed that they and their colleagues provided high-quality end-of-life care. Regarding barriers to the provision of optimal end-of-life care, with a mean score of 3.22 out of 5, participants agreed that such barriers existed in the palliative department. The present findings indicate that healthcare providers considered the overall quality of palliative care to be high, but the psychological/psychiatric aspects of care needed further consideration. Further, the occurrence of ethical dilemmas and barriers to the provision of optimal end of life needs to be managed appropriately.