Enhancing the sustainable immobilization of laccase by amino-functionalized PMMA-reinforced graphene nanomaterial.

Human health and the environment are negatively affected by endocrine-disrupting chemicals (EDCs), such as bisphenol A. Therefore, developing appropriate remediation methods is essential for efficiently removing phenolic compounds from aqueous solutions. Enzymatic biodegradation is a potential biotechnological approach for responsibly addressing water pollution. With its high catalytic efficiency and few by-products, laccase is an eco-friendly biocatalyst with significant promise for biodegradation. Herein, two novel supporting materials (NH2-PMMA and NH2-PMMA-Gr) were fabricated via the functionalization of poly(methylmethacrylate) (PMMA) polymer using ethylenediamine and reinforced with graphene followed by glutaraldehyde activation. NH2-PMMA and NH2-PMMA-Gr were utilized for laccase immobilization with an immobilization yield (IY%) of 78.3% and 82.5% and an activity yield (AY%) of 81.2% and 85.9%, respectively. Scanning electron microscope (SEM) and Fourier-transform infrared (FTIR) were used to study the characteristics of fabricated material supports. NH2-PMMA-Gr@laccase exhibited an optimal pH profile from 4.5 to 5.0, while NH2-PMMA@laccase exhibited optimum pH at 5.0 compared to a value of 4.0 for free form. A wider temperature ranges of 40-50 °C was noted for both immobilized laccases compared to a value of 40 °C for the free form. Additionally, it was reported that immobilized laccase outperformed free laccase in terms of substrate affinity and storage stability. NH2-PMMA@laccase and NH2-PMMA-Gr@laccase improved stability by up to 3.9 and 4.6-fold when stored for 30 days at 4 °C and preserved up to 80.5% and 86.7% of relative activity after ten cycles of reuse. Finally, the degradation of BPA was achieved using NH2-PMMA@laccase and NH2-PMMA-Gr@laccase. After five cycles, NH2-PMMA@laccase and NH2-PMMA-Gr@laccase showed that the residual degradation of BPA was 77% and 84.5% using 50 µm of BPA. This study introduces a novel, high-performance material for organic pollution remediation in wastewater that would inspire further progress.

Barriers to Effective Cancer Pain Management, Comparing the Perspectives of Physicians, Nurses, and Patients.

BACKGROUND: Pain associated with cancer is one of the most significant concerns for patients, families, and health care providers. Various barriers may hinder optimal pain management. AIM: The study was conducted in specialized cancer center in Jordan and aimed to explore the barriers to effective cancer pain management from the perspectives of physicians, nurses, and patients. METHODS: A quantitative descriptive cross-sectional design was used, with a total sample of 185 participants (55 Physicians, 70 Nurses, and 60 Patients) who completed a demographic datasheet and the Arabic-Barrier Questionnaire II (BQII). RESULTS: The overall BQII of patient score was 2.4 (standard deviation [SD] = 0.7). The harmful effects of pain medications were the highest barrier 2.7 (SD = 1.0), followed by the physiologic effect 2.4 (SD = 0.9), and the communication 2.4 (SD = 1.1) subscales. Nurses and physicians reported an overall BQII of 1.9 (SD = 1.1) and 1.8 (SD = 0.9), respectively. One-way analysis of variance showed that the perspectives of patients, physicians, and nurses differed significantly in the overall BQII F(2, 182) = 6.81, p < .01, communication F(2, 182) = 10.55, p < .01, and harmful effects F(2, 182) = 7.26, p < .01. Multiple pairwise comparisons also showed that the patients significantly perceived higher communication barriers, more concerns of analgesic harmful effects, and higher overall barriers than nurses and physicians. CONCLUSIONS: Significant differences were found in the perspectives of patients, physicians, and nurses toward pain management barriers in the overall barriers, communication, and harmful effect. It is recommended to develop awareness programs for patients about pain management, barriers, use of analgesia, and communication. Nurses and physicians are advised to discuss mutual concerns and pay more attention to overcoming patient concerns.

Chloro-aluminum phthalocyanine-mediated photodynamic therapy in the treatment of stage-II chronic periodontitis among smokers.

PURPOSE: To assess the clinical periodontal, bacterial, and immunological outcomes of chloro-aluminum phthalocyanine-mediated photodynamic therapy (PDT) as an adjunct to dental scaling (DS) versus DS alone among cigarette smokers (CS) and never-smokers (NS). METHODS: A total of 26 patients (13 CS and 13 NS) with clinical and radiographic diagnosis of stage-II chronic periodontitis were recruited. Each patient from both groups were subjected with two parallel therapies (split-mouth): PDT + DS (test side) and DS alone (control side). Periodontal parameters were investigated by evaluating plaque scores (PS), bleeding on probing (BOP), probing depth (PD), clinical attachment loss (CAL), and alveolar bone loss (ABL). Subgingival plaque was collected to detect and quantify Porphyromonas gingivalis and Tannerella forsythia using real-time quantitative polymerase chain reaction (RT-qPCR) assay. Gingival crevicular fluid was sampled for the quantification of interleukin (IL)-1ß and tumor necrosis factor-alpha (TNF-α) using enzyme linked immunosorbent assay. All assessments were performed at baseline, 3 months, and 6 months. RESULTS: Bleeding on probing was significantly reduced at 6 months after PDT + DS in CS groups (p < .05). Mean PD and CAL significantly reduced after both PDT + DS and DS subgroups and among NS and CS groups (p < .05). At 6 months follow-up, the copy number of both P. gingivalis and T. forsythia remained significantly high in CS group (p < .01). Only PDT + DS subgroup in CS significantly reduced the counts of P. gingivalis and T. forsythia at 3 months and 6 months (p < .05). Only at 6 months did PDT + DS showed statistically significantly reduced IL-1ß levels in the NS group (p < .01). TNF-α levels significantly reduced in CS group with PDT + DS and DS alone at both 3 months and 6 months follow-up (p < .01). CONCLUSION: Chloro-aluminum phthalocyanine-mediated PDT helped to improve the non-surgical periodontal therapy outcomes among stage-II chronic periodontitis patients among smokers and never-smokers.

Antimicrobial photodynamic therapy using chloro-aluminum phthalocyanine for treating advanced stage-III periodontitis in smoking patients.

PURPOSE: To evaluate the bacterial, clinical, and cytokine profile of adjunctive photodynamic therapy using chloro-aluminum phthalocyanine (CAP/aPDT) with root surface debridement (RSD) versus RSD alone in cigarette smokers (CS) and never-smokers (NS) during the period of 6 months. METHODS: Twenty-nine patients [CS - 14 and NS - 15] were recruited for the trial having stage-III periodontitis. All candidates from the study groups were subjected to a split-mouth treatment technique receiving CAP/aPDT + RSD and RSD alone. Periodontal parameters including plaque levels (PL), bleeding on probing (BP), probing depth (PD), clinical attachment loss (CAL), and marginal bone loss (MBL) were assessed. Polymerase chain reaction (qPCR) assay was used to analyze the copy numbers of Porphyromonas gingivalis (Pg) and Tannerella forsythia (Tf). Levels of tumor necrosis factor-alpha (TNF-α) interleukin (IL)-6 in the crevicular fluid were evaluated by enzyme-linked immunosorbent assay (ELISA). RESULTS: CAP/aPDT+RSD decreased BP in smokers after 6 months (p < .05). Probing depth and CAL reported statistically significant reductions within both CAP/aPDT+RSD and RSD groups and also within the NS and CS (p < .05). Pg and Tf stayed elevated in smokers at the 6-month evaluation period (p < .01). Only CAP/aPDT+RSD significantly decreased Pg and Tf at 3- and 6-month follow-up in smokers (p < .05). CAP/aPDT+RSD showed decreased IL-6 levels in the NS during the 6-month follow-up (p < .01). TNF-α levels were significantly reduced in the CS group with CAP/aPDT+RSD and RSD alone until 6 months (p < .01). CONCLUSION: CAP-mediated aPDT along with nonsurgical periodontal therapy helped to improve the bacteriological outcomes among smokers and never-smokers with stage-III CP patients.

The Effect of Remote-Based Monitoring and Education Program on Cancer Pain Management in an Outpatient Pain Clinic.

BACKGROUND: Pain is one of the most feared consequences of cancer for patients and their families. Many barriers may hinder optimal pain management. AIM: Examine the effect of remote-based monitoring and education program on cancer pain management, patient-related barriers, and level of adherence to pain medication. METHODS: A sample of 134 patients was assigned to two groups; 68 in the intervention group and 66 in the control. The intervention group received three educational sessions by telephone. Both groups completed questionnaires at baseline and one month after the initial visit. RESULTS: Significant differences were found between the groups in the levels of pain right now (p = .030), pain at its least (p = .016), and in the percentage of achieved pain relief (p = .048). Moreover, the intervention group experienced lower levels of interference with their general activity (p = < .001), mood (p = .011), and normal work (p = .004) post-intervention. The Attitudinal Barriers differences were statistically significant in the total mean (p = < .001), and the subscales of physiological effects (p = < .001), fatalism (p = < .001), communication (p = < .001), harmful effects (p = < .001). Participants in the intervention group exhibited higher adherence levels (p = .001). CONCLUSIONS: Patients suffering from cancer-related pain can benefit from remote-based monitoring and education programs to improve pain management outcomes, overcome barriers, and increase adherence. Further research is needed to investigate the different available educational methods and long-term effects.

Validation of the Arabic Version of the Chemotherapy-Induced Peripheral Neuropathy Assessment Tool.

BACKGROUND: Chemotherapy-induced peripheral neuropathy results in multidimensional neurological and muscular symptoms, which interfere with the patients' daily life. AIM: Examine the psychometric properties of the Arabic version of the chemotherapy-induced peripheral neuropathy assessment tool (CIPNAT) among adult cancer patients. METHOD: A descriptive study design was used. A convenience sample of 210 patients was assigned to two groups: 135 who received chemotherapies of known neurotoxic potential and 75 who served as a comparison group. Translation and back-translation considering cross-cultural issues to produce the Arabic version of CIPNAT was used. Test-retest and internal consistency reliability were used to test the reliability of the tool, whereas for the validity, content and construct validity were assessed. RESULTS: Test-retest scores for the overall scale (r = 0.98, p = < .001), for the symptom experience subscale (r = 0.97, p = <.001), and for the interference subscale (r = 0.96, p = < .001) all showed evidence of reliability. Cronbach α coefficients were 0.97, 0.96, and 0.95 for the total scores, symptoms experience, and interference scales, respectively. Items to total correlation ranged from moderate to strong (0.55-0.81). The Content Validity Index was 0.83. The data support the evidence of discriminant validity, as significant differences were found between the groups with regard to symptom experience (t = 8.51, p = < .001), interference (t = 5.60, p = <.001), and total score (t = 7.88, p = < .001). CONCLUSIONS: The Arabic version of CIPNAT showed adequate reliability and validity to screen for chemotherapy-induced peripheral neuropathy symptoms and their interference in Arab countries. Further studies are needed to evaluate concurrent validity.

Factors Associated with Inadequate Pain Control among Postoperative Patients with Cancer.

Postoperative pain is considered a major, complex and multidimensional problem that affects the clinical and functional outcomes of patients and may contribute to increased postoperative complications. The goal of this study was to determine the prevalence of inadequate pain control and to investigate the factors associated with inadequate pain control among postoperative cancer patients. A descriptive correlational, cross-sectional design was used. The study was conducted at four adult inpatient oncology departments at King Hussein Cancer Center, a nongovernmental, nonprofit, comprehensive hospital for treating cancer patients in Amman, Jordan. The convenience sample of 800 cancer patients selected comprised postoperative patients diagnosed with cancer and aged ≥18 years who were willing to participate and able to use the numeric rating scale. About 32.9% of patients had pain scores higher than 4/10 at rest, and 56.4% of patients had pain scores higher than 4/10 on movement. Data revealed that patients aged between 18 and 63 years (odds ratio [OR] = 0.196, p < .0005, and OR = 0.245, p < .0005) and chronic user patients (OR = 28.029, p < .0005, and OR = 10.332, p < .0005) had increased odds of poor pain control at rest and on movement, respectively. Administration of preemptive medications and of fentanyl and bupivacaine during the postoperative period was significantly associated with decreased odds of poor pain control. The intravenous route was associated with increased odds of poor pain control at rest and on movement (OR = 2.279, p = .016, and OR = 5.393, p = .012) compared with other routes, including combinations of the intravenous and oral or epidural route. Chronic use of pain medications and older age were predictors of inadequate pain control postoperatively. Administration of preemptive medications and of combinations of fentanyl and bupivacaine via the epidural route was associated with better pain control.

Management of peripheral neuropathy induced by chemotherapy in adults with cancer: a review.

AIM: To identify which of the examined agents or modalities were effective in the management of chemotherapy-induced peripheral neuropathy (CIPN). METHODS: PubMed, CINAHL, Medline, Science Direct and Ovid databases were used to search keywords. The literature search identified 59 potentially relevant studies; after removing duplicates and reviewing titles a total of 26 articles were examined. In the end, a total of 18 studies met the inclusion criteria. FINDINGS: The preliminary data for using lafutidine, acupuncture and sweet bee venom pharmacopuncture indicate that they may be useful in CIPN management. The use of duloxetine was effective and supported as a management of CIPN; likewise the use of scrambler therapy significantly decreased CIPN pain. However, the use of electroacupuncture and topical amitriptyline and ketamine was not supported. CONCLUSION: The use of duloxetine was effective in CIPN management. Further studies with larger sample size are needed.

Postoperative Pain Among Patients After Day-Case Surgery.

Postoperative pain occurs at a high incidence after day-case surgery, with many patients reporting moderate to severe pain. A cross-sectional design was used in this study to estimate the prevalence of postoperative pain in the early postoperative period after day-case surgery and to determine whether there is a relationship between demographic and clinical variables. A convenient sample of 300 patients, aged between 18 and 80 years, was selected from all postoperative patients after day-case surgery over a period of 6 months. At the first 2 hr after surgery, about 70% of patients had either no pain or mild pain at rest and about 30% of patients had moderate to severe pain. About one third of these patients (103; 35.8%) reported mild pain, and about 43% of patients had moderate to severe pain on movement in the first 2 hr after surgery. Furthermore, 25.3% and 41.3% of the patients reported moderate to severe pain during the first 24 hr after hospital discharge at rest and on movement, respectively. Female patients had significantly higher pain scores than male patients (p < .001). Significant decrease in pain scores was reported in the first 2 hr after surgery (mean = 2.2, SD = 2) and within the first 24 hr after discharge (mean = 1.8, SD = 2.2, t(288) = 4.3, p =. 005) at rest. The prevalence of pain among postoperative patients after day-care surgery in Jordan is high. Young adult and female patients have higher pain scores after day-case surgery.

Analysis of transcriptional response to heat stress in Rhazya stricta.

BACKGROUND: Climate change is predicted to be a serious threat to agriculture due to the need for crops to be able to tolerate increased heat stress. Desert plants have already adapted to high levels of heat stress so they make excellent systems for identifying genes involved in thermotolerance. Rhazya stricta is an evergreen shrub that is native to extremely hot regions across Western and South Asia, making it an excellent system for examining plant responses to heat stress. Transcriptomes of apical and mature leaves of R. stricta were analyzed at different temperatures during several time points of the day to detect heat response mechanisms that might confer thermotolerance and protection of the plant photosynthetic apparatus. RESULTS: Biological pathways that were crosstalking during the day involved the biosynthesis of several heat stress-related compounds, including soluble sugars, polyols, secondary metabolites, phenolics and methionine. Highly downregulated leaf transcripts at the hottest time of the day (40-42.4 °C) included genes encoding cyclin, cytochrome p450/secologanin synthase and U-box containing proteins, while upregulated, abundant transcripts included genes encoding heat shock proteins (HSPs), chaperones, UDP-glycosyltransferase, aquaporins and protein transparent testa 12. The upregulation of transcripts encoding HSPs, chaperones and UDP-glucosyltransferase and downregulation of transcripts encoding U-box containing proteins likely contributed to thermotolerance in R. stricta leaf by correcting protein folding and preventing protein degradation. Transcription factors that may regulate expression of genes encoding HSPs and chaperones under heat stress included HSFA2 to 4, AP2-EREBP and WRKY27. CONCLUSION: This study contributed new insights into the regulatory mechanisms of thermotolerance in the wild plant species R. stricta, an arid land, perennial evergreen shrub common in the Arabian Peninsula and Indian subcontinent. Enzymes from several pathways are interacting in the biosynthesis of soluble sugars, polyols, secondary metabolites, phenolics and methionine and are the primary contributors to thermotolerance in this species.

Experimental and theoretical study of o-substituent effect on the fluorescence of 8-hydroxyquinoline.

The synthesis and characterization of different ether and ester derivatives of 8-hydroxyquinoline have been made. UV-visible and fluorescence spectra of these compounds have revealed spectral dependence on both solvent and O-substituent. The fluorescence intensity of ether derivatives revealed higher intensity for 8-octyloxyquinoline compared with 8-methoxyquinoline, whereas those of ester derivatives had less fluorescence than 8-hydroxyquinoline. Theoretical calculations based on Time-dependent density functional theory (TD-DFT) were carried out for the quinolin-8-yl benzoate (8-OateQ) compound to understand the effect of O-substituent on the electronic absorption of 8-hydroxyquinaline (8-HQ). The calculations revealed comparable results with those obtained from the experimental data. Optimized geometrical structure was calculated with DFT at B3LYP/6-311++G** level of theory. The results indicated that 8-OateQ is not a coplanar structure. The absorption spectra of the compound were computed in gas-phase and solvent using B3LYP and CAM-B3LYP methods with 6-311++G ** basis set. The agreement between calculated and experimental wavelengths was very good at CAM-B3LYP/6-311++G** level of theory.

Utilization of services and referrals through dental outreach programs in rural areas of India. A two year study.

BACKGROUND: Oral health care services are often sparse and inconsistent in India therefore it is often difficult for poor people to get access to the oral health care services. The approach by dental institutions with the help of community outreach programs is a step ahead in overcoming this situation. OBJECTIVES: The study was conducted to evaluate the number of patients, disease pattern and the services provided in the outreach programmes and also effectiveness of patient referral. METHODS: A retrospective study was conducted and the data were obtained from records of outreach programs conducted, in last 2 years by Pacific Dental College and Hospital. The data were analysed using descriptive statistics for the computation of percentages Chi-square test was applied to know the association of effectiveness of referral with age and gender. Confidence level and level of significance was fixed at 95% and 5% respectively. RESULTS: A total of 22982 individuals in the age group of 4-80 years attended the outreach program. Dental caries (42.3%), periodontal diseases (63.2-69.0%) and dental fluorosis (33.7-35.0%) were commonly observed diseases. Effectiveness of referral was significantly high among the middle age adults and females (P<0.05). The effectiveness of referral was highly improved in 2013 after establishment of certain guidelines and strategies. CONCLUSION: The approaches by dental institutions with the help of community outreach programs can spread awareness and disseminate treatment and thereby enhancing access to care and eliminating access to care within the rural communities.

Carbon nanobelts as a novel sensing platform for fluorescence-enhanced DNA detection.

The present communication demonstrates for the first time that carbon nanobelts (CNBs) were facilely synthesized on a large scale via pyrolysis of a 1,8-diaminonaphthalene (DAN)-NiCl2·6H2O mixture under Ar followed by acid leaching. We further demonstrate that such CNBs can be used as a novel effective fluorescent sensing platform for DNA. This sensing platform exhibits high selectivity and sensitivity with a detection limit of 5 nM.

5-Acetyl-3-(5-phenyl-1H-pyrazol-3-yl)-1,3,4-thia-diazol-2(3H)-one monohydrate.

In the title hydrate, C13H10N4O2S·H2O, the dihedral angles between the central pyrazole ring and its pendant phenyl and thia-diazole rings are 9.93 (8) and 4.56 (7)°, respectively. In the crystal, the components are linked by N-H⋯O, O-H⋯N and O-H⋯O hydrogen bonds, generating [100] chains incorporating R 4 (4)(10) loops. A weak C-H⋯O inter-action helps to consolidate the packing.

Prevalence of Chronic Postsurgical Pain among Cancer Patients: A Cross-Sectional Study.

Background: Cancer patients accept surgeries as part of their treatment. They may not be aware of the possibility of surgical pain persisting long after the surgery. Understanding chronic postsurgical pain is essential for effective pain management. Aims: We aimed to assess the prevalence of chronic postsurgical pain in cancer patients and the associated symptom burden. Settings and Design: This study was carried out at a tertiary cancer center. It was a cross-sectional study. Materials and Methods: Participants who underwent surgeries were asked to provide feedback on the MD Anderson Symptom Inventory at 3 months. Statistical Analysis Used: Descriptive statistics were used. Statistical tests included Kruskal-Wallis test, Chi-square test, Fisher's exact test, and Spearman's correlation. Logistic regression was used to assess the influence of variables on the presence or absence of chronic postsurgical pain. Results: Nine hundred and eighteen participants completed the study. Ninety-two percent (n = 840) were asymptomatic. Eight percent (n = 78) had postsurgical pain. Chronic postsurgical pain was influenced by the type of surgery (P = 0.01), specifically orthopedic and thoracic surgeries. Patients who receive epidurals are three times less likely to continue to have pain at 3 months. Conclusions: The prevalence of chronic postsurgical pain at 3 months in this study is lower than the rates in the literature. It is still associated with symptom burden that interferes with daily life. The risk of developing chronic postsurgical pain increases with thoracic and orthopedic surgeries. The risk may be lowered with epidural analgesia.

Serum Myeloperoxidase as a Biomarker of Asthma Severity Among Adults: A Case Control Study.

Background: The contribution of neutrophils is still indistinct in the inflammatory response of bronchial asthma (BAs). Myeloperoxidase (MPO) is an enzyme released from the primary azurophilic granules of the neutrophils. The study aimed to evaluate the levels of serum MPO as a biomarker for the assessment of the level of asthma control. Methods: The study participants included 94 asthmatic patients and 86 healthy controls. The identification of asthma severity had assessed using the ''Global Initiative for Asthma guidelines''. Asthmatic adults had divided into three groups: Good (n= 22), partial (n= 30), and poor control (n= 44). Also, patients have been divided again into two groups (treated and untreated) for BAs. Results: The predicted FEV1% and the peak expiratory flow (PEF/L) of all participants had verified by spirometry. The mean patients' age was 31.9±15.1 year, with a predominance of females. The mean asthma duration was 10.5±8.6 years. Mean spirometric parameters (FEV1 and PEF) were significantly lower among the patients (0.00). Significant higher MPO levels had observed among BAs patients (p-0.00). The MPO levels have not differed significantly with asthma levels and had significant differences with the history of treatment. There was a nonsignificant negative correlation between the mean MPO levels and the spirometry variables among the patients. ROC curves revealed a sensitivity, specificity, accuracy for MPO (80.9%, 72.1%, and 84.3%), respectively to predict asthmatic severity. Conclusion: There were significantly higher MPO levels compared to healthy controls. Levels of serum MPO had a non-significant positive correlation with levels of asthma control, but a negative non-significant correlation with spirometric results.

4-(3,7-Dimethyl-4-oxo-4,5-dihydro-isoxazolo[4,5-d]pyridazin-5-yl)benzene-sulfonamide.

The nine-membered fused-ring system of the title pyridazine derivative, C(13)H(12)N(4)O(4)S, is approximately planar (r.m.s. deviation 0.027 Å), and the benzene ring of the phenyl-sulfamide substituent is aligned at 43.5 (1)° to the fused-ring system. The amine group of the sulfonamide substituent forms an N-H⋯O hydrogen bond to the ketonic O atom of two neigboring mol-ecules to generate a chain running along the c axis.

Effectiveness of Education Program on Nursing Knowledge and Attitude toward Pain Management.

OBJECTIVE: Nurses have an integral role in pain assessment and management. Adequate knowledge and positive attitudes toward pain management are essential to provide high-quality nursing care for cancer pain. The purposes of this study are to evaluate nurses' knowledge and attitude toward cancer-related pain and to assess the effectiveness of a pain management education program on nurses' knowledge and attitude toward pain. METHODS: A quantitative, experimental design was used. RESULTS: The total number of participants who were surveyed at three measurement points was 131, with a completion rate of 87.3%. Findings revealed that the score of knowledge and attitude toward cancer-related pain ranged from 14 to 35, with a mean of 23.6 (standard deviation [SD] = 4.38). The mean scores of the intervention group and the control group at two measurement points regarding knowledge and attitude toward cancer-related pain were 32.7 (SD = 2.8) and 32.8 (SD = 4.3) and 23 (SD = 5.5) and 22.2 (SD = 3.8), respectively. There were significant differences at three measurement points among the intervention group (F = 114.3, P < 0.0005). There were no differences in the three measurement points among the control group (F = 3.4, P = 0.055). CONCLUSIONS: Nurses have essential roles in cancer pain. A pain management education program can improve nurses' knowledge and attitude toward cancer-related pain.

Developing Adult Sepsis Protocol to Reduce the Time to Initial Antibiotic Dose and Improve Outcomes among Patients with Cancer in Emergency Department.

OBJECTIVE: Sepsis is a common cause of noncancer-related deaths among oncology patients. Delay in the initiation of efficient antimicrobial therapy will decrease the survival rate. This study aims to develop a sepsis protocol for adult oncology patients to decrease the time needed to receive the initial dose of antibiotic in an emergency department (ED), improve the early recognition of sepsis, and decrease the in-hospital mortality rate due to sepsis. METHODS: A quasi-experimental research design was used. A total of 168 participants were assigned into pre- and post-intervention groups (n = 85) and (n = 83), respectively. The quick Sequential Organ Failure Assessment screening tool was used to screen patients in the triage room. RESULTS: There was a significant difference in the proportions of receiving the initial antibiotic dose whether ≤1 h or >1 h between pre- and post-intervention groups. The results also showed that 89.4% of the postintervention group received their initial antibiotic dose in <1 h compared with 10.8% of the preintervention group. The median time needed for administering the initial antibiotic dose was decreased from 95 min to 45 min. The results of the changes in mortality rates are promising as it decreased 11.7% after applying the adult sepsis protocol. CONCLUSIONS: Applying an adult sepsis protocol in the ED significantly decreased the time needed to initiate antibiotic treatment. It is recommended to utilize a multidisciplinary and systematic approach in screening and treating sepsis.

Gene Expression Profiling to Delineate the Anticancer Potential of a New Alkaloid Isopicrinine From Rhazya stricta.

Background:Rhazya stricta has been used as a folkloric medicinal herb for treating various diseases such as diabetes, inflammatory disorders, and sore throat. Several studies have revealed the potential of this plant as an important source of phytochemicals with anticancer properties. Objective: The present study was designed to isolate a novel anticancer compound from Rhazya stricta and elucidate its mechanism of action using genomics approach. Methods:Rhazya stricta leaves extract was prepared, and several alkaloids were purified and characterized. These alkaloids were screened for their anticancer potential. One of the alkaloids, termed as isopicrinine, showed efficient cytotoxicity against MCF7 breast cancer cell line and was selected for further analysis. RNA-Seq transcription profiling was conducted to identify the affected genes and cellular pathways in MCF7 cells after treatment with isopicrinine alkaloid. Results: In vitro studies revealed that newly identified isopicrinine alkaloid possess efficient anticancer activity. Exposure of MCF7 cells with isopicrinine affected the expression of various genes involved in p53 signaling pathway. One of the crucial proapoptotic genes, significantly upregulated in MCF7 after exposure to alkaloid, was PUMA (p53 upregulated modulator of apoptosis), which is involved in p53-dependent and -independent apoptosis. Moreover, exposure of sublethal dose of isopicrinine alkaloid in breast cancer cell line led to the downregulation of survivin, which is involved in negative regulation of apoptosis. Besides, several genes involved in mitosis and cell proliferation were significantly downregulated. Conclusion: In this article, we report the determination of a new alkaloid isopicrinine from the aerial parts of Rhazya stricta with anticancer property. This compound has the potential to be developed as a drug for curing cancer.