Design, Synthesis, Anti-Inflammatory Activity, DFT Modeling and Docking Study of New Ibuprofen Derivatives.

A new ibuprofen derivative, (E)-2-(4-isobutylphenyl)-N'-(4-oxopentan-2-ylidene) propane hydrazide (IA), was synthesized, along with its metal complexes with Co, Cu, Ni, Gd, and Sm, to investigate their anti-inflammatory efficacy and COX-2 inhibition potential. Comprehensive characterization, including 1H NMR, MS, FTIR, UV-vis spectroscopy, and DFT analysis, were employed to determine the structural configurations, revealing unique motifs for Gd/Sm (capped square antiprismatic/tricapped trigonal prismatic) and Cu/Ni/Co (octahedral) complexes. Molecular docking with the COX-2 enzyme (PDB code: 5IKT) and pharmacokinetic assessments through SwissADME indicated that these compounds have superior binding energies and pharmacokinetic profiles, including BBB permeability and gastrointestinal absorption, compared to the traditional ibuprofen standalone. Their significantly lower IC50 values further suggest a higher efficacy as anti-inflammatory agents and COX-2 inhibitors. These research findings not only introduce promising ibuprofen derivatives for therapeutic applications but also set the stage for future validation and exploration of this new generation of ibuprofen compounds.

Predicting consequences of COVID-19 control measure de-escalation on nosocomial transmission and mortality: a modelling study in a French rehabilitation hospital.

INTRODUCTION: Infection control measures are effective for nosocomial COVID-19 prevention but bear substantial health-economic costs, motivating their "de-escalation" in settings at low risk of SARS-CoV-2 transmission. Yet consequences of de-escalation are difficult to predict, particularly in light of novel variants and heterogeneous population immunity. AIM: To estimate how infection control measure de-escalation influences nosocomial COVID-19 risk. METHODS: An individual-based transmission model was used to simulate SARS-CoV-2 outbreaks and control measure de-escalation in a French long-term care hospital with multi-modal control measures in place (testing and isolation, universal masking, single-occupant rooms). Estimates of COVID-19 case fatality rates (CFRs) from reported outbreaks were used to quantify excess COVID-19 mortality due to de-escalation. RESULTS: In a population fully susceptible to infection, de-escalating both universal masking and single rooms resulted in hospital-wide outbreaks of 114 (95% CI: 103-125) excess infections, compared with five (three to seven) excess infections when de-escalating only universal masking or 15 (11-18) when de-escalating only single rooms. When de-escalating both measures and applying CFRs from the first wave of COVID-19, excess patient mortality ranged from 1.57 (1.41-1.71) to 9.66 (8.73-10.57) excess deaths/1000 patient-days. By contrast, when applying CFRs from subsequent pandemic waves and assuming susceptibility to infection among 40-60% of individuals, excess mortality ranged from 0 (0-0) to 0.92 (0.77-1.07) excess deaths/1000 patient-days. CONCLUSIONS: The de-escalation of bundled COVID-19 control measures may facilitate widespread nosocomial SARS-CoV-2 transmission. However, excess mortality is probably limited in populations at least moderately immune to infection and given CFRs resembling those estimated during the 'post-vaccine' era.

Transcriptomic and metabolomic changes in postharvest sugarbeet roots reveal widespread metabolic changes in storage and identify genes potentially responsible for respiratory sucrose loss.

Endogenous metabolism is primarily responsible for losses in sucrose content and processing quality in postharvest sugarbeet roots. The genes responsible for this metabolism and the transcriptional changes that regulate it, however, are largely unknown. To identify genes and metabolic pathways that participate in postharvest sugarbeet root metabolism and the transcriptional changes that contribute to their regulation, transcriptomic and metabolomic profiles were generated for sugarbeet roots at harvest and after 12, 40 and 120 d storage at 5 and 12°C and gene expression and metabolite concentration changes related to storage duration or temperature were identified. During storage, 8656 genes, or 34% of all expressed genes, and 225 metabolites, equivalent to 59% of detected metabolites, were altered in expression or concentration, indicating extensive transcriptional and metabolic changes in stored roots. These genes and metabolites contributed to a wide range of cellular and molecular functions, with carbohydrate metabolism being the function to which the greatest number of genes and metabolites classified. Because respiration has a central role in postharvest metabolism and is largely responsible for sucrose loss in sugarbeet roots, genes and metabolites involved in and correlated to respiration were identified. Seventy-five genes participating in respiration were differentially expressed during storage, including two bidirectional sugar transporter SWEET17 genes that highly correlated with respiration rate. Weighted gene co-expression network analysis identified 1896 additional genes that positively correlated with respiration rate and predicted a pyruvate kinase gene to be a central regulator or biomarker for respiration rate. Overall, these results reveal the extensive and diverse physiological and metabolic changes that occur in stored sugarbeet roots and identify genes with potential roles as regulators or biomarkers for respiratory sucrose loss.

Outcomes of COVID-19 Disease in Comparison with Influenza in Renal Transplant Recipients: Results from a Large Nationwide Research Network in the United States.

COVID-19 infection has worse outcomes in immunocompromised individuals. This includes those with diabetes mellitus, cancer, chronic autoimmune diseases requiring immunomodulatory therapy, and solid-organ transplant recipients on chronic immunosuppression. Using the National Inpatient Sample Database, this study retrospectively compared 14,915 renal transplant recipients who were hospitalized with either COVID-19 or Influenza virus infection in the US at any point between 1st January 2020 and 31st December 2020. We found that compared to renal transplant recipients with influenza infection, recipients with COVID-19 infection were more likely to require mechanical ventilation and vasopressor support and develop acute kidney injury requiring hemodialysis. COVID-19 patients also had significantly longer length of hospital stay. Renal transplant recipients with COVID-19 had significantly higher in-hospital mortality compared to recipients with influenza infection (14.09% vs 2.61%, adjusted odds ratio [aOR] 9.73 [95% CI (5.74-16.52)], P < .001). Our study clearly demonstrates the severe outcomes of high mortality and morbidity in renal transplant recipients with COVID-19. Further research should be undertaken to focus on the key areas noted to reduce morbidity and mortality in this population.

Subpectoral Implant Placement Is Not Protective against Postmastectomy Radiotherapy-Related Complications Compared to Prepectoral Placement.

BACKGROUND: Postmastectomy radiotherapy (PMRT) is associated with altered cosmetic outcomes and higher complication rates in implant-based breast reconstruction (IBR). Conventional wisdom suggests that muscle coverage is somewhat protective against PMRT-related complications. In this study, the authors compared surgical outcomes in patients who underwent two-stage prepectoral versus subpectoral IBR in the setting of PMRT. METHODS: The authors performed a retrospective cohort study of patients who underwent mastectomy and PMRT with two-stage IBR from 2016 to 2019. The primary outcome was breast-related complications, including device infection; the secondary outcome was device explantation. RESULTS: The authors identified 179 reconstructions (101 prepectoral and 78 subpectoral) in 172 patients with a mean follow-up time of 39.7 ± 14.4 months. There were no differences between the prepectoral and subpectoral reconstructions in rates of breast-related complications (26.7% and 21.8%, respectively; P = 0.274), device infection (18.8% and 15.4%, respectively; P = 0.307), skin flap necrosis (5.0% and 1.3%, respectively; P = 0.232), or device explantation (20.8% and 14.1%, respectively; P = 0.117). In adjusted models, compared with prepectoral device placement, subpectoral device placement was not associated with a lower risk of breast-related complications [hazard ratio (HR), 0.75; 95% confidence interval (CI), 0.41 to 1.36], device infection (HR, 0.73; 95% CI, 0.35 to 1.49), or device explantation (HR, 0.58; 95% CI, 0.28 to 1.19). CONCLUSIONS: Device placement plane was not predictive of complication rates in IBR in the setting of PMRT. Two-stage prepectoral IBR provides safe long-term outcomes with acceptable postoperative complication rates comparable to those with subpectoral IBR, even in the setting of PMRT. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Outcomes for 160 Consecutive Lateral Arm Free Flaps for Head and Neck Reconstruction.

OBJECTIVE: Examine outcomes for lateral arm autologous tissue transfer in head and neck reconstruction. STUDY DESIGN: Retrospective cohort study. SETTING: Tertiary cancer center. METHODS: All patients who underwent traditional lateral arm, extended lateral arm, and lateral forearm flaps for head and neck reconstruction from 2012 to 2022 were assessed. Disabilities of the arm, shoulder, and hand (DASH) was measured. Factors associated with complications and enteral or mixed diet were evaluated by multivariable regression. RESULTS: Among 160 patients followed for a median of 2.3 ± 2.1 years, defects were 54% oral tongue, 18% external, 9% maxilla, 8% buccal mucosa, 9% floor of mouth, and 3% pharynx. Flap types (and median pedicle lengths) were 41% traditional lateral arm (8 cm), 25% extended lateral arm (11.5 cm), and 34% lateral forearm (14 cm). All donor sites were closed primarily; 19.6% and 0% of patients had increased DASH scores 2 and 12 weeks after reconstruction. Major complications occurred in 18.1% of patients, including 6.3% reoperation, 6.9% readmission, 3.7% fistula, and 1.8% flap loss. Complications were independently associated with peripheral vascular disease (odds ratio [OR]: 5.71, 95% confidence interval [CI]: 1.5-21.6, P = .01), pharyngeal defects (OR: 11.3, 95% CI: 1.4-94.5, P = .025), and interposition vein grafts (OR: 3.78, 95% CI: 1.1-13.3, P = .037). CONCLUSION: The lateral arm free flap was safe, versatile, and reliable for head and neck reconstruction with low donor-site morbidity. Complications occurred in a fifth of patients and were associated with peripheral vascular disease, pharyngeal defects, and vein grafts.

Frail but Resilient: Frailty in Autologous Breast Reconstruction is Associated with Worse Surgical Outcomes but Equivalent Long-Term Patient-Reported Outcomes.

BACKGROUND: Frailty is associated with higher risk of complications following breast reconstruction, but its impact on long-term surgical and patient-reported outcomes has not been investigated. We examined the association of the five-item modified frailty index (MFI) score with long-term surgical and patient-reported outcomes in autologous breast reconstruction. PATIENTS AND METHODS: We conducted a retrospective cohort study of consecutive patients who underwent mastectomy and autologous breast reconstruction between January 2016 and April 2022. Primary outcome was any flap-related complication. Secondary outcomes were patient-reported outcomes and predictors of complications in the frail cohort. RESULTS: We identified 1640 reconstructions (mean follow-up 24.2 ± 19.2 months). In patients with MFI ≥ 2, the odds of surgical [odds ratio (OR) 2.13, p = 0.023] and medical (OR 17.02, p < 0.001) complications were higher than in nonfrail patients. We found no significant difference in satisfaction with the breast (p = 0.287), psychosocial well-being (p = 0.119), or sexual well-being (p = 0.314) according to MFI score. Chronic obstructive pulmonary disease was an independent predictor of infection (OR 3.70, p = 0.002). Tobacco use (OR 7.13, p = 0.002) and contralateral prophylactic mastectomy (OR 2.36, p = 0.014) were independent predictors of wound dehiscence. Dependent functional status (OR 2.36, p = 0.007) and immediate reconstruction (compared with delayed reconstruction; OR 3.16, p = 0.026) were independent predictors of skin flap necrosis. Dependent functional status was also independently associated with higher odds of reoperation (OR 2.64, p = 0.011). CONCLUSION: Frailty is associated with higher risk of complications in breast reconstruction, but there is no significant difference in long-term patient-reported outcomes. MFI should be considered in breast reconstruction to improve outcomes in high-risk frail patients.

A comparative assessment of air pollutants of smog in wagah border and other sites in Lahore, Pakistan

Abstract Smog has become the fifth season of Pakistan especially in Lahore city. Increased level of air pollutants (primary and secondary) are thought to be responsible for the formation of smog in Lahore. Therefore, the current study was carried out for the evaluation of air pollutants (primary and secondary) of smog in Wagah border particularly and other sites (Jail road, Gulburg) Lahore. For this purpose, baseline data on winter smog from March to December on primary and secondary air pollutants and meteorological parameters was collected from Environmental Protection Department and Pakistan Meteorological Department respectively. Devices being used in both departments for analysis of parameters were also studied. Collected data was further statistically analyzed to determine the correlation of parameters with meteorological conditions and was subjected to air quality index. According to results, PM 10 and PM 2.5 were found very high above the NEQS. NOx concentrations were also high above the permissible limits whereas SO2 and O3 were found below the NEQS thus have no roles in smog formation. Air Quality Index (AQI) of pollutants was PM 2.5(86-227), PM 10 (46-332), NOx (26-110), O3 (19-84) and SO2 (10-95). AQI of PM 2.5 remained between moderate to very unhealthy levels. AQI of PM 10 remained between good to hazardous levels. AQI of NOx remained between good to unhealthy for sensitive groups levels. AQI of O3 and SO2 remained between good to moderate levels. Pearson correlation showed that every pollutant has a different relation with different or same parameters in different areas. It is concluded from the present study that particulate matter was much more responsible for smog formation. Although NOx also played role in smog formation. So there is need to reduce sources of particulate matter and NOx specifically in order to reduce smog formation in Lahore.

Resumo Smog tornou-se a quinta estação do Paquistão, especialmente na cidade de Lahore. Acredita-se que o aumento do nível de poluentes atmosféricos (primários e secundários) seja responsável pela formação de poluição atmosférica em Lahore. Portanto, o presente estudo foi realizado para a avaliação dos poluentes atmosféricos (primários e secundários) do smog na fronteira de Wagah em particular e em outros locais (Jail road, Gulburg) Lahore. Para este propósito, os dados de referência sobre a poluição atmosférica de inverno de março a dezembro sobre poluentes atmosféricos primários e secundários e parâmetros meteorológicos foram coletados do Departamento de Proteção Ambiental e do Departamento Meteorológico do Paquistão, respectivamente. Dispositivos sendo usados em ambos os departamentos para análise de parâmetros também foram estudados. Os dados coletados foram posteriormente analisados estatisticamente para determinar a correlação dos parâmetros com as condições meteorológicas e foram submetidos ao índice de qualidade do ar. De acordo com os resultados, PM 10 e PM 2,5 foram encontrados muito acima do NEQS. As concentrações de NOx também estavam muito acima dos limites permitidos, enquanto SO2 e O3 foram encontrados abaixo do NEQS, portanto, não têm papéis na formação de smog. O índice de qualidade do ar (AQI) de poluentes foi PM 2,5 (86-227), PM 10 (46-332), NOx (26-110), O3 (19-84) e SO2 (10-95). O AQI de PM 2,5 permaneceu entre níveis moderados a muito prejudiciais à saúde. O AQI de PM 10 permaneceu entre níveis bons e perigosos. AQI de NOx permaneceu entre bom e não saudável para os níveis de grupos sensíveis. O AQI de O3 e SO2 permaneceu entre níveis bons a moderados. A correlação de Pearson mostrou que cada poluente tem uma relação diferente com parâmetros diferentes ou iguais em áreas diferentes. Conclui-se do presente estudo que o material particulado foi muito mais responsável pela formação de smog. Embora o NOx também tenha desempenhado um papel na formação do smog. Portanto, é necessário reduzir as fontes de partículas e NOx, especificamente para reduzir a formação de smog em Lahore.

A comparative assessment of air pollutants of smog in wagah border and other sites in Lahore, Pakistan / Uma avaliação comparativa de poluentes do ar do smog na fronteira de wagah e outros sites em Lahore, Paquistão

Abstract Smog has become the fifth season of Pakistan especially in Lahore city. Increased level of air pollutants (primary and secondary) are thought to be responsible for the formation of smog in Lahore. Therefore, the current study was carried out for the evaluation of air pollutants (primary and secondary) of smog in Wagah border particularly and other sites (Jail road, Gulburg) Lahore. For this purpose, baseline data on winter smog from March to December on primary and secondary air pollutants and meteorological parameters was collected from Environmental Protection Department and Pakistan Meteorological Department respectively. Devices being used in both departments for analysis of parameters were also studied. Collected data was further statistically analyzed to determine the correlation of parameters with meteorological conditions and was subjected to air quality index. According to results, PM 10 and PM 2.5 were found very high above the NEQS. NOx concentrations were also high above the permissible limits whereas SO2 and O3 were found below the NEQS thus have no roles in smog formation. Air Quality Index (AQI) of pollutants was PM 2.5(86-227), PM 10 (46-332), NOx (26-110), O3 (19-84) and SO2 (10-95). AQI of PM 2.5 remained between moderate to very unhealthy levels. AQI of PM 10 remained between good to hazardous levels. AQI of NOx remained between good to unhealthy for sensitive groups' levels. AQI of O3 and SO2 remained between good to moderate levels. Pearson correlation showed that every pollutant has a different relation with different or same parameters in different areas. It is concluded from the present study that particulate matter was much more responsible for smog formation. Although NOx also played role in smog formation. So there is need to reduce sources of particulate matter and NOx specifically in order to reduce smog formation in Lahore.

Resumo Smog tornou-se a quinta estação do Paquistão, especialmente na cidade de Lahore. Acredita-se que o aumento do nível de poluentes atmosféricos (primários e secundários) seja responsável pela formação de poluição atmosférica em Lahore. Portanto, o presente estudo foi realizado para a avaliação dos poluentes atmosféricos (primários e secundários) do smog na fronteira de Wagah em particular e em outros locais (Jail road, Gulburg) Lahore. Para este propósito, os dados de referência sobre a poluição atmosférica de inverno de março a dezembro sobre poluentes atmosféricos primários e secundários e parâmetros meteorológicos foram coletados do Departamento de Proteção Ambiental e do Departamento Meteorológico do Paquistão, respectivamente. Dispositivos sendo usados ​​em ambos os departamentos para análise de parâmetros também foram estudados. Os dados coletados foram posteriormente analisados ​​estatisticamente para determinar a correlação dos parâmetros com as condições meteorológicas e foram submetidos ao índice de qualidade do ar. De acordo com os resultados, PM 10 e PM 2,5 foram encontrados muito acima do NEQS. As concentrações de NOx também estavam muito acima dos limites permitidos, enquanto SO2 e O3 foram encontrados abaixo do NEQS, portanto, não têm papéis na formação de smog. O índice de qualidade do ar (AQI) de poluentes foi PM 2,5 (86-227), PM 10 (46-332), NOx (26-110), O3 (19-84) e SO2 (10-95). O AQI de PM 2,5 permaneceu entre níveis moderados a muito prejudiciais à saúde. O AQI de PM 10 permaneceu entre níveis bons e perigosos. AQI de NOx permaneceu entre bom e não saudável para os níveis de grupos sensíveis. O AQI de O3 e SO2 permaneceu entre níveis bons a moderados. A correlação de Pearson mostrou que cada poluente tem uma relação diferente com parâmetros diferentes ou iguais em áreas diferentes. Conclui-se do presente estudo que o material particulado foi muito mais responsável pela formação de smog. Embora o NOx também tenha desempenhado um papel na formação do smog. Portanto, é necessário reduzir as fontes de partículas e NOx, especificamente para reduzir a formação de smog em Lahore.

Assessing the ecological and health risks associated with heavy metal pollution levels in sediments of Big Giftun and Abu Minqar Islands, East Hurghada, Red Sea, Egypt.

This study assessed pollution levels, ecological and health risk, and spatial distribution of eight heavy metals in sediments of Big Giftun and Abu Minqar Islands, Red Sea, Egypt. Iron (Fe) and manganese (Mn) had the highest contents in both island sediments, while cobalt (Co) in Big Giftun and cadmium (Cd) in Abu Mingar had the lowest values. The obtained PCA data exhibited positively significant loadings of Cd, Co, copper (Cu), nickel (Ni), and zinc (Zn) with 51.03 % of data variance in Big Giftun, and lead (Pb), Cu, Mn, Ni, Zn, and Fe (37.7 %) in Abu Minqar sediments. The contamination factor (CF) showed low contamination for all metals, except cadmium; Cd (moderate). The geo-accumulation index (Igeo) values showed uncontaminated (Cd, Co), moderately (Cu), extremely contaminated (Fe, Mn) (Igeo > 5) in Big Giftun, and uncontaminated (Cd), moderately to strongly contaminated (Cu, Ni), and extremely contaminated (Fe, Mn, and Zn) in Abu Minqar sediments. The pollution load index (PLI) values indicated baseline level of contamination (PLI <1), and degree of contamination (DC) indicated low degree of contamination (DC < n) in all sediments. Nemerow pollution index (NPI) showed unpolluted sediments in Abu Minqar (NPI ≤1) and slight pollution (1 < NPI ≤2) in Big Giftun. Cd showed moderate potential ecological risk (40 ≤ Eri < 80) in Big Giftun sediments. Potential ecological risk index (PERI) indicated low risk sediments (PERI <150). Mean effects range median quotient (MERMQ) indicated low-priority risk of toxicity (MERMQ ≤0.1), and toxic risk index (TRI) showed no toxic risk in all sediments (TRI <5). The modified hazard quotient (mHQ) indicated very low severity of contamination (mHQ <0.5). The hazard quotient (HQ) levels of all metals were below the safe value (HQ <1). The hazard index (HI) levels indicated that no chronic risks occur (HI <1). The total cancer risk (TCR) for all metals were below the safe level (1 × 10-4) of the United States Environmental Protection Agency (U.S. EPA) guidelines.

Surgical Outcomes of Vertical Rectus Abdominis Myocutaneous Flap Pelvic Reconstruction.

BACKGROUND: The vertical rectus abdominis myocutaneous (VRAM) flap has emerged as the workhorse flap for perineal and pelvic reconstruction. We aimed to evaluate outcomes of VRAM flap over a 20-year period and the role of mesh abdominal wall reinforcement following VRAM flap-based reconstruction. METHODS: We conducted a retrospective review of all consecutive patients who underwent pelvic reconstruction with a VRAM flap between January 2001 and March 2021. Our primary outcome measure included recipient and donor surgical site occurrences (SSOs). RESULTS: We identified a total of 546 patients (55% females) with a mean age was 58 years and mean BMI was 27 kg/m 2. Mesh was used at the time of VRAM reconstruction to reinforce the abdominal donor site in 36% of patients. Recipient-site SSOs occurred in 38% of patients while donor-site SSOs occurred in 17% of patients. Hernia was identified in 9.9% of patients while bulge developed in 6.4% of patients. Cox proportional hazards regression model for hernia occurrence identified age, BMI, tobacco use (HR 2.03, 95% CI [1.02 - 4.04]) and use as an extended VRAM (HR 2.13, 95% CI [1.04 - 4.36]). The use of mesh or component separation were not independent protective factors for hernia occurrence. CONCLUSION: The pedicled VRAM flap is versatile and is our preferred flap for reconstruction of pelvic and perineal defects. The use of mesh/component separation to allow for fascial closure was not shown to reduce donor site hernia occurrence.

Mortality Following Simultaneous Versus Staged Bilateral Total Knee Arthroplasty: A Systematic Review and Meta-Analysis.

Bilateral total knee arthroplasty (BTKA) is a common intervention for bilateral knee osteoarthritis, and the choice between simultaneous (SimBTKA) and staged (StaBTKA) procedures remains a critical decision. This meta-analysis systematically reviews and analyzes the existing literature to compare mortality outcomes associated with SimBTKA and StaBTKA. A comprehensive search was conducted across major databases for studies reporting mortality outcomes in SimBTKA and StaBTKA. Inclusion criteria encompassed studies published up to the cutoff date of January 2023, and a total of 37 studies were included in the quantitative synthesis. Meta-analysis was performed using a random-effects model to calculate odds ratios (ORs) with 95% confidence intervals (CIs) using the Review Manage 5.4 software. The meta-analysis included 86,333 SimBTKA cases and 115,146 StaBTKA cases. The overall mortality rate in SimBTKA was 0.66%, while StaBTKA's was 0.43%. The pooled OR for mortality in SimBTKA versus StaBTKA was 1.55 [1.16, 2.08], indicating a statistically significant higher mortality risk in SimBTKA. Our findings suggest that SimBTKA is associated with an increased risk of mortality compared to StaBTKA. This meta-analysis provides valuable insights into the comparative mortality outcomes of SimBTKA and StaBTKA. While SimBTKA may offer potential advantages, including a single anesthesia event and shorter recovery time, clinicians should consider the increased mortality risk associated with this approach. Future research should focus on prospective studies with standardized reporting to further elucidate the nuanced factors influencing mortality outcomes in bilateral knee arthroplasty.

A Saudi Hospital's Experience in the Management of Well-Appearing Neonates at Increased Risk for Early-Onset Bacterial Sepsis.

BACKGROUND: Early-onset neonatal bacterial sepsis (EOS) is a serious medical condition where pathogenic bacterial species are isolated from the blood of newborns within the first 72 hours of life. Neonatal healthcare providers face challenges in managing well-appearing newborns born at 35 weeks gestational age or more who are at an increased risk of developing EOS. The American Academy of Pediatrics (AAP) has recommended three approaches for managing EOS. One of these approaches includes enhanced observation to observe the progression of the newborn's clinical condition within the first 48 hours after birth. The AAP recommends that birth centers should adopt institutional approaches that are tailored to their specific local resources and structures. It recommends that the chosen approach is evaluated to identify infrequent negative outcomes and to confirm its effectiveness. AIMS: To report our experience in managing EOS in newborns born at 35 weeks gestation or later with an increased risk for EOS. METHODS: This was a review of electronic medical records from the past five years. We included a sample of newborns born at or after 35 weeks gestational age who were at increased risk of EOS and appeared to be healthy. We implemented universal antenatal culture-based screening for Group B streptococcus (GBS). We followed the recommendations of the AAP in 2012 to manage these newborns. We performed a complete blood count (CBC) with differential and C-reactive protein (CRP) tests to predict EOS. We also considered the newborns symptomatic if they displayed any clinical signs of EOS. RESULTS: A total of 806 newborns were included in the study, out of which 27 (3.3%) of them had symptoms of EOS, while the remaining 782 newborns appeared healthy. Predictive blood tests were performed on 281 (34.9%) of the newborns, out of which 126 (44.8%) of them had a positive test result. However, blood cultures were obtained from 134 (16.6%) of the total cohort. Intravenous antibiotics were administered to 33 (4.1%) of the newborns. All symptomatic newborns had a positive predictive blood test result, and two of them had culture-proven EOS. Blood cultures obtained from the remaining 107 asymptomatic newborns were negative. In this context, 140 newborns needed to be pricked for positive predictive blood tests to predict one case of EOS. However, if the positive predictive blood tests were only performed on symptomatic newborns, then only 14 newborns would need to be pricked to predict one case of EOS. CONCLUSION: Based on the present study, it is advised to follow the current AAP recommendation against predicting EOS by solely relying on CBC with differential or CRP. The study suggests that the enhanced observation approach is a more sensible option for managing EOS, but this needs to be confirmed in a larger study.

Brownian motion of soft particles near a fluctuating lipid bilayer.

The dynamics of a soft particle suspended in a viscous fluid can be changed by the presence of an elastic boundary. Understanding the mechanisms and dynamics of soft-soft surface interactions can provide valuable insights into many important research fields, including biomedical engineering, soft robotics development, and materials science. This work investigates the anomalous transport properties of a soft nanoparticle near a visco-elastic interface, where the particle consists of a polymer assembly in the form of a micelle and the interface is represented by a lipid bilayer membrane. Mesoscopic simulations using a dissipative particle dynamics model are performed to examine the impact of micelle's proximity to the membrane on its Brownian motion. Two different sizes are considered, which correspond to ≈10-20nm in physical units. The wavelengths typically seen by the largest micelle fall within the range of wavenumbers where the Helfrich model captures fairly well the bilayer mechanical properties. Several independent simulations allowed us to compute the micelle trajectories during an observation time smaller than the diffusive time scale (whose order of magnitude is similar to the membrane relaxation time of the largest wavelengths), this time scale being hardly accessible by experiments. From the probability density function of the micelle normal position with respect to the membrane, it is observed that the position remains close to the starting position during ≈0.05τd (where τd corresponds to the diffusion time), which allowed us to compare the negative excess of mean-square displacement (MSD) to existing theories. In that time range, the MSD exhibits different behaviors along parallel and perpendicular directions. When the micelle is sufficiently close to the bilayer (its initial distance from the bilayer equals approximately twice its gyration radius), the micelle motion becomes quickly subdiffusive in the normal direction. Moreover, the temporal evolution of the micelle MSD excess in the perpendicular direction follows that of a nanoparticle near an elastic membrane. However, in the parallel direction, the MSD excess is rather similar to that of a nanoparticle near a liquid interface.

Profile and Outcome of Prospective Non-Septic Lateral Sinus Thrombosis Patients from a Stroke Unit of a Developing Country.

Background: Due to effective treatment of middle ear infections there is a change in etiologies causing lateral sinus thrombosis (LST) and outcome. There is a paucity of literature describing homogenous group of patients with nonseptic LST (NS-LST). Objective: To describe the clinical profile, risk factors, outcome of patients of NS-LST seen at a single center from South India. Methods and Materials: Prospective, observational study of 100 patients of NS-LST patients, diagnosed by magnetic resonance imaging (MRI) seen at the stroke unit. Results: During 2 years, 100 patients of NS-LST (isolated: combined: 27:73) (male: female: 44:56), mean age: 31.45 ± 11.13 years, were seen. Subacute presentation (74%) with headache, seizures, focal deficits, and features of raised intracranial pressure were presenting features. Hyperhomocysteinemia (61%), anemia (57%), postpartum state (41%), OCP use (37%), and low VitB12 (32%) were commonly seen risk factors. Imaging with MRI compared withcomputerized tomography (CT) had better diagnostic sensitivity (100% vs. 67%), detection of parenchymal (81% vs. 67%)/hemorrhagic (79% vs. 74%) lesions, and cortical vein thrombosis (31% vs. 15.46%). Treatment with anticoagulation and supportive therapy resulted in good outcome (mRS (0-2)) at 3 months in 81%.There were four deaths, all during admission (one - isolated, three - combined) and 11 patients underwent decompressive surgery. Patients with low GCS level of sensoriumat admission, hemiparesis, combined LST, cerebellar involvement, and decompressive craniectomy had a poor outcome. Conclusion: This single-center large cohort study of NS-LST patients brings out the clinical features, risk factors (peculiar to developing countries), and the superiority of MRI in the diagnosis. Majority of patients have good outcome, with low mortality with 10% requiring decompressive surgery.

Outcomes of Complex Abdominal Wall Reconstruction with Biologic Mesh in Patients with 8 Years of Follow-Up.

BACKGROUND: While many studies evaluated outcomes of abdominal wall reconstruction with biologic mesh, long-term data is lacking. In this study, we sought to analyze the outcomes of complex AWR with biologic mesh in a robust cohort of patients with a mean follow up of 8 years. METHODS: We conducted a longitudinal study of AWR patients from 2005 to 2019. Hernia recurrence was the primary outcome, and surgical site occurrence was the secondary outcome. Predictive/protective factors were identified using a Cox proportional hazards regression models. RESULTS: We identified 109 consecutive patients who met the inclusion criteria. Patient's mean (± SD) age was 57.5 ± 11.8 years, mean body mass index was 30.7 ± 7.2 kg/m2, and mean follow-up time was 96.2 ± 15.9 months. Fifty-six percent had clean defects, 34% had clean-contaminated defects, and 10% had contaminated/infected defects. Patients had a mean defect size of 261 ± 199.6 cm2 and mean mesh size of 391.3 ± 160.2 cm2. Nineteen patients (17.4%) developed HR at the final follow-up date. Obesity was independently associated with a four-fold higher risk of HR (hazard ratio, 3.98; 95%CI, 1.34 to 14.60, p = 0.02). SSOs were identified in 24.8% of patients. A prior hernia repair was associated with a three-fold higher risk of SSOs (Odds ratio, 3.13; 95%CI, 1.10 to 8.94, p = 0.03). No patient developed mesh infection. CONCLUSION: These longitudinal data demonstrate that complex AWR with biologic mesh provides long-term durable outcomes with acceptable HR and SSO rates despite high contamination levels, patients complexity, and large defect size.

Gastroprotective effect of zafirlukast against indomethacin induced gastric ulcer in rats via PGE2 and anti-inflammatory pathways.

Objectives: To evaluate the gastroprotective potential of zafirlukast against indomethacin-induced gastric ulcers in rats. Materials and Methods: Thirty-two male Wistar rats were included in this study and randomly divided into 4 equal groups (n=8); control (normal) group, indomethacin group, Ranitidine group, and Zafirlukast group. Indomethacin was given as a single oral dose of (20 mg/kg) for the induction of ulcers. Both ranitidine (50 mg/kg) and zafirlukast (20 mg/ kg) were given orally for seven days after inducing the ulcer. All animals were sacrificed by an overdose of anesthesia at the end of the experimental period and their gastric tissues have been collected for histopathological and biological assay. Levels of prostaglandin E2 (PGE2), thiobarbituric acid reactive substances (TBARS), and interleukin 1ß (IL-1ß ) were measured as well as a histopathological study to evaluate the effect of zafirlukast on gastric tissues. Results: Significant abnormalities were found in both the histological and biochemical parameters of the indomethacin group reflecting the changes seen with gastric ulcers. Significant improvement was found in the Zafirlukast group as reflected by the morphological improvement seen in the gastric tissues. An effect that was associated with an increase in the PGE2 levels along with reductions in IL-1ß expression and TBARS concentrations. Conclusion: As per the results of this study, zafirlukast shows promising gastroprotective properties possibly through enhancement of PGE2 levels as well as having anti-inflammatory and anti-oxidant properties.

The Skin Necrosis Conundrum: Examining Long-term Outcomes and Risk Factors in Implant-Based Breast Reconstruction.

BACKGROUND: Mastectomy skin flap necrosis (MSFN) is a common complication following mastectomy that causes significant distress to patients and physicians and also compromises oncologic, surgical, and quality-of-life outcomes. OBJECTIVES: We sought to investigate the long-term outcomes of MSFN following implant-based reconstruction (IBR) and determine the rates and predictors of post-MSFN complications. METHODS: This was a 20-year analysis of consecutive adult (>18 years) patients who developed MSFN following mastectomy and IBR from January 2001 to January 2021. Multivariable analyses were performed to identify factors associated with post-MSFN complications. RESULTS: We identified 148 reconstructions, with a mean follow-up time of 86.6 ± 52.9 months. The mean time from reconstruction to MSFN was 13.3 ± 10.4 days, and most cases (n = 84, 56.8%) were full-thickness injuries. Most cases (63.5%) were severe, 14.9% were moderate, and 21.6% were mild. Forty-six percent (n = 68) developed a breast-related complication, with infection being the most common (24%). An independent predictor of overall complications was longer time from reconstruction to MSFN (odds ratio [OR], 1.66; P = .040). Aging was an independent predictor of overall complications (OR, 1.86; P = .038); infection (OR, 1.72; P = .005); and dehiscence (OR, 6.18; P = .037). Independent predictors of dehiscence were longer interval from reconstruction to MSFN (OR, 3.23; P = .018) and larger expander/implant size (OR, 1.49; P = .024). Independent predictors of explantation were larger expander/implant size (OR, 1.20; P = .006) and nipple-sparing mastectomy (OR, 5.61; P = .005). CONCLUSIONS: MSFN is associated with high risk of complications following IBR. Awareness of the timing and severity of MSFN and the predictors of post-MSFN complications is crucial for guiding evidence-based decision-making and improving outcomes.