The microbiological profile of isolates recovered from ICU patients with traumatic brain injuries at a tertiary care center, Southern Region, Saudi Arabia.

INTRODUCTION: Traumatic head injury THI is a Neurosurgical condition in which brain function is interrupted as a result of blunt (motor vehicle accidents MVA, falls, and assaults) or penetrating trauma. Nearly half of all injuries are caused by head trauma. Head traumas are a leading cause of death and organ loss in young people, where this population accounts for the vast majority of TBI patients. METHODOLOGY: This retrospective cohort study was conducted at Asir Central Hospital, KSA with data from 2015 to 2019. Records of bacterial cultures and outcomes such as length of stay in the hospital were analyzed. In addition, treatment outcomes were also analyzed. RESULTS: A total of 300 ICU patient samples (69 patients) were included. Patients' ages ranged from 13 to 87 years with a mean age of 32.4 ± 17.5 years old. The most frequently reported diagnosis was RTA (71 %), followed by SDH (11.6 %), The most isolated organisms from the recovered samples were Klebsiella pneumoniae (27 %), followed by Pseudomonas aeruginosa (14.7 %). Regarding susceptibility, Tigecycline was the most sensitive (44 %), followed by Gentamicin (43.3 %). A total of 36 (52.2 %) patients stayed for less than one month, 24 (34.8 %) stayed for 1-3 months, and 7 (10.1 %) stayed for 3-6 months. The mortality rate in our study population was (40.6 %) as 28 patients died. CONCLUSION: The prevalence of pathogens in TBI needs to be determined in different institutions for the establishment of effective empiric antibiotic treatment following infections in traumatic brain injuries. This will ultimately help to improve treatment outcomes. In neurosurgical patients undergoing cranial procedures after trauma, a hospital-standardized antibiotic policy is effective in achieving low rates of bacterial infections especially MDR infections.

Pain, Pattern and Polytrauma - Predictors of Sexual Dysfunction in Pelvic Fractures: A Retrospective Multicenter Analysis.

Objectives: In the local and cultural setting of high trauma rates and a reserved outlook on sexual function, this study examines the incidence and underlying factors of sexual dysfunction (SD) following pelvic fractures. Methods: A Multi-center retrospective cohort analysis performed in two general hospitals and one tertiary orthopedic center with collection between 2017 and 2019. Consecutive patients with pelvic fractures between January 2017 and February 2019 were followed up at 18-24 months to screen for new-onset SD using the International Index of Erectile Function-5 (IIEF-5) and Female-Sexual-Function-Index-6 (FSFI-6). Additional variables include age, sex, Young-Burgess classification, urogenital injury, injury severity score, persisting pain, sacroiliac disruption, intervention and if sexual health was discussed or patient referred for sexual healthcare. Results: One-hundred and sixty-five patients (n = 165) were included, (83%) male, (16%) female with a mean age of 35.1 years (Range 18-55). Fracture patterns included lateral compression (LC) (51.5%), anteroposterior compression (APC) (27.7%), and vertical shear (VS) (20.6%). The urogenital injury occurred in 10.3%. The mean IIEF-5 and FSFI-6 scores were 20.8 and 24.7 in males and females, respectively. A total of 40 males (29%) scored below the 21 cut-off scores for SD, while only one female (3.7%) scored below the corresponding score of 19. Of all participants reporting sexual dysfunction, 56% discussed sexual health with their providers, while 46% of these patients were referred for further management. Significant predictive factors for SD using a multivariate logistic regression model include increasing age (OR-1.093, p = 0.006), APC III (OR 88.887, p = 0.006), VS (OR-15.607, p = 0.020), persisting pain (OR 3.600, p = 0.021) and increasing injury severity score (OR 1.184, p <0.001). Conclusion: SD is common among pelvic fractures, and risk factors include APC or VS type fractures, increasing age, increasing injury severity score, and persisting pain. Providers should ensure patients are screened for SD and referred appropriately as patients may not willingly disclose underlying symptoms.

CO2 Adsorption on Pore-Engineered Carbons Derived from Jute Sticks.

CO2 capture is a practical approach to mitigating the impacts of global warming. Adsorption-based carbon capture is a clean and potentially energy-efficient method whose performance greatly depends on adsorbent design. In this study, we explored the use of jute-derived carbon as a high-performance adsorbent for CO2 capture. The carbons were produced by pyrolyzing powdered jute sticks with NaHCO3 as an activating agent at 500-700 °C. Impressive adsorption capacities of up to 2.5 mmol ⋅ g-1 and CO2 /N2 selectivities of up to 54 were achieved by adjusting the pore size distribution and surface functionalization. Based on the isotherm results, the working capacities, regenerabilities, and potentials for CO2 separation were determined for a practical vacuum swing adsorption process. The adsorbent materials were characterized by XRD, FTIR, Raman, FESEM and N2 sorption at 77 K. This study provides a general approach for designing adsorbents for various gas-separation applications.

Preparation of Highly Stable and Electrochemically Active Three-dimensional Interconnected Graphene Frameworks from Jute Sticks.

Over the past few years, the environmentally friendly synthesis of nanomaterials, including graphene using green chemistry, has attracted tremendous attention due to its easy handling, low cost, and biocompatibility. Here we demonstrate a facile and efficient green synthesis route for producing highly stable and electrochemically active three-dimensional interconnected graphene frameworks (3DIGF) from jute sticks. Initially, jute sticks derived three-dimensional amorphous activated carbon nanosheets (3DAACNs) were prepared at low temperatures (i. e., 850 °C) in an inert environment. The resultant 3DAACNs were then heat treated at a high temperature (i. e., 2700 °C) under an inert environment, resulting in 3DIGF. The prepared carbonaceous materials were fully characterized, and various experimental techniques confirmed the preparation of 3DIGF. The prepared 3DIGF shows a highly stable nature in thermal and chemical environments and demonstrates a highly dynamic nature for the electrooxidation of sulfide. This study could be considered a vital contribution towards the economic and simple approach for preparing 3DIGF from biomass.

Date-Leaf Carbon Particles for Green Enhanced Oil Recovery.

Green enhanced oil recovery (GEOR) is an environmentally friendly enhanced oil recovery (EOR) process involving the injection of green fluids to improve macroscopic and microscopic sweep efficiencies while boosting tertiary oil production. Carbon nanomaterials such as graphene, carbon nanotube (CNT), and carbon dots have gained interest for their superior ability to increase oil recovery. These particles have been successfully tested in EOR, although they are expensive and do not extend to GEOR. In addition, the application of carbon particles in the GEOR method is not well understood yet, requiring thorough documentation. The goals of this work are to develop carbon nanoparticles from biomass and explore their role in GEOR. The carbon nanoparticles were prepared from date leaves, which are inexpensive biomass, through pyrolysis and ball-milling methods. The synthesized carbon nanomaterials were characterized using the standard process. Three formulations of functionalized and non-functionalized date-leaf carbon nanoparticle (DLCNP) solutions were chosen for core floods based on phase behavior and interfacial tension (IFT) properties to examine their potential for smart water and green chemical flooding. The carboxylated DLCNP was mixed with distilled water in the first formulation to be tested for smart water flood in the sandstone core. After water flooding, this formulation recovered 9% incremental oil of the oil initially in place. In contrast, non-functionalized DLCNP formulated with (the biodegradable) surfactant alkyl polyglycoside and NaCl produced 18% more tertiary oil than the CNT. This work thus provides new green chemical agents and formulations for EOR applications so that oil can be produced more economically and sustainably.

Predicting Bond Strength between FRP Rebars and Concrete by Deploying Gene Expression Programming Model.

Rebars made of fiber-reinforced plastic (FRP) might be the future reinforcing material, replacing mild steel rebars, which are prone to corrosion. The bond characteristics of FRP rebars differ from those of mild steel rebars due to their different stress-strain behavior than mild steel. As a result, determining the bond strength (BS) qualities of FRP rebars is critical. In this work, BS data for FRP rebars was investigated, utilizing non-linear capabilities of gene expression programming (GEP) on 273 samples. The BS of FRP and concrete was considered a function of bar surface (Bs), bar diameter (db), concrete compressive strength (fc'), concrete-cover-bar-diameter ratio (c/d), and embedment-length-bar-diameter ratio (l/d). The investigation of the variable number of genetic parameters such as number of chromosomes, head size, and number of genes was undertaken such that 11 different models (M1-M11) were created. The results of accuracy evaluation parameters, namely coefficient of determination (R2), mean absolute error (MAE), and root mean square error (RMSE) imply that the M11 model outperforms other created models for the training and testing stages, with values of (0.925, 0.751, 1.08) and (0.9285, 0.802, 1.11), respectively. The values of R2 and error indices showed that there is very close agreement between the experimental and predicted results. 30 number chromosomes, 9 head size, and 5 genes yielded the optimum model. The parametric analysis revealed that db, c/d, and l/d significantly affected the BS. The FRP rebar diameter size is greater than 10 mm, whereas a l/d ratio of more than 12 showed a considerable decrease in BS. In contrast, the rise in c/d ratio revealed second-degree increasing trend of BS.

A case of horizontal gaze palsy with progressive scoliosis.

Horizontal gaze palsy with progressive scoliosis is a rare entity with few cases in the literature. Despite the fact the patient will not present with typical symptoms of this syndrome, clinical suspicion should be raised particularly in terms of imaging findings. Imaging findings are characteristic to flag the possibility of this syndrome. Keeping in mind such congenital abnormalities on magnetic resonance imaging particularly for radiologists might help in the management process. Multidisciplinary teams play a crucial role in terms of communication to find the clinical, radiological and genetic studies to reach the diagnosis.

A case of bilateral posterior mediastinal myelolipoma.

A 71-year-old female presented with chronic shortness of breath and underwent routine examination at the emergency department. A plain chest radiograph revealed a large lobulated posterior mediastinal mass that was incidentally found to be unrelated to the main complaint. Further cross-sectional images were obtained to characterize the lesion, which revealed bilateral involvement of a prevertebral mixed attenuation large mass with minimal enhancement postcontrast administration. Images were not conclusive in which the patient underwent ultrasound-guided biopsy and further histopathological examination, which revealed a myelolipoma of the posterior mediastinum, a rare entity to be seen at that location. Here, we present the case of posterior mediastinal myelolipoma.

Preparation of Hierarchical Porous Activated Carbon from Banana Leaves for High-performance Supercapacitor: Effect of Type of Electrolytes on Performance.

We demonstrate a facile efficient way to fabricate activated carbon nanosheets (ACNSs) consisting of hierarchical porous carbon materials. Simply heating banana leaves with K2 CO3 produce ACNSs having a unique combination of macro-, meso- and micropores with a high specific surface area of ∼1459 m2 g-1 . The effects of different electrolytes on the electrochemical supercapacitor performance and stability of the ACNSs are tested using a two-electrode system. The specific capacitance (Csp ) values are 55, 114, and 190 F g-1 in aqueous 0.5 M sodium sulfate, organic 1 M tetraethylammonium tetrafluoroborate in acetonitrile, and pure ionic liquid 1-butyl-3-methylimidazolium hexafluorophosphate ([BMIM][PF6 ]) electrolytes, respectively. The ACNSs also shows the largest potential window of 3.0 V, the highest specific energy (59 Wh kg-1 ) and specific power (750 W kg-1 ) in [BMIM][PF6 ]. A mini-prototype device is prepared to demonstrate the practicality of the ACNSs.

Physico-chemical properties and toxicological effects on plant and algal models of carbon nanosheets from a nettle fibre clone.

Carbon nanosheets are two-dimensional nanostructured materials that have applications as energy storage devices, electrochemical sensors, sample supports, filtration membranes, thanks to their high porosity and surface area. Here, for the first time, carbon nanosheets have been prepared from the stems and leaves of a nettle fibre clone, by using a cheap and straight-forward procedure that can be easily scaled up. The nanomaterial shows interesting physical parameters, namely interconnectivity of pores, graphitization, surface area and pore width. These characteristics are similar to those described for the nanomaterials obtained from other fibre crops. However, the advantage of nettle over other plants is its fast growth and easy propagation of homogeneous material using stem cuttings. This last aspect guarantees homogeneity of the starting raw material, a feature that is sought-after to get a nanomaterial with homogeneous and reproducible properties. To evaluate the potential toxic effects if released in the environment, an assessment of the impact on plant reproduction performance and microalgal growth has been carried out by using tobacco pollen cells and the green microalga Pseudokirchneriella subcapitata. No inhibitory effects on pollen germination are recorded, while algal growth inhibition is observed at higher concentrations of leaf carbon nanosheets with lower graphitization degree.

Impact of Family Medicine Training on the Quality of Care for patients of diabetes in Saudi Arabia.

INTRODUCTION: Diabetes mellitus (DM) is one of the challenging health problems worldwide. Primary care centers manage and treat most of DM cases. Diabetes requires ongoing, and evidence-based health care which should be provided by highly qualified physicians. AIM: This study aims at evaluating the Family Medicine training efficacy on the quality of care for diabetic patients. METHODOLOGY: This is a cross-sectional study conducted among patients with DM at the AlJafer training center situated in AlAhssa, Saudi Arabia. The data of diabetic patients who were followed up initially with general practitioners (GPs) and later with family physicians (FPs) collected from the patients' electronic files. Clinical parameters including HbA1c, blood pressure, total cholesterol, LDL, and statin, aspirin initiation measured during initial visits and follow-ups to compare the quality of diabetic care between the two groups (FPs vs. GPs). All statistical analyses carried using SPSS version 21. RESULTS: Eighty-three patients were included in the study. Regarding the measurement process, FPs more likely to measure HbA1c twice a year than GPs (P:<0.001). The number of patients with HbA1c level >8% decreased significantly during the period of follow-up with FPs (P:<0.001). Furthermore, a significant number of patients meet the BP target ≤130/85 during the follow-up period with FPs. The statin initiation is substantially achieved more by FPs (P < 0.001). CONCLUSION: Family medicine training has a significant influence on the clinical outcomes of patients with DM. This study's findings suggest that FPs ensure a better quality of care in terms of clinical and process measures.

Porous tal palm carbon nanosheets: preparation, characterization and application for the simultaneous determination of dopamine and uric acid.

A novel porous tal palm carbon nanosheet (PTPCN) material was synthesized from the leaves of Borassus flabellifer (tal palm) and used for developing an electrochemical sensor through modifying a glassy carbon electrode (GCE) simply by drop-casting on it a solution of the material for the sensitive simultaneous detection of dopamine (DA) and uric acid (UA), even in the presence of interfering species. The drop-casting solution was prepared by simply dispersing the PTPCNs in ethanol without using any other binding materials (e.g. Nafion). The surface morphologies of the PTPCNs were studied through field-emission scanning electron microscopy (FESEM), transmission electron microscopy (TEM) and high resolution TEM (HRTEM). Energy dispersive X-ray spectroscopy (EDS) and X-ray diffraction spectroscopy (XPS) studies revealed the chemical composition of the PTPCNs' surface. Their structural properties were studied using X-ray diffraction (XRD) and Raman spectroscopy. Brunauer-Emmett-Teller (BET) analysis confirmed the surface area and pore volume to be 1094.53 m2 g-1 and 0.74 cm3 g-1, respectively, while Barrett-Joyner-Halenda (BJH) pore-size distribution showed the average pore size to be 22 nm. The sufficiently large surface area and pore-size distribution suggested better electrocatalytic properties compared to the average modifying materials. The modified electrode (PTPCNs/GCE) was characterized through impedimetric and CV techniques in standard potassium ferricyanide solution for evaluating their charge-transfer resistance and electrochemical properties. The limits of detection (S/N = 3) were 0.17 µM and 0.078 µM and the sensitivities were 1.2057 µA µM-1 cm-2 and 2.693 µA µM-1 cm-2 for UA and DA, respectively. The possible interactions that took place between the PTPCNs and the analytes that aided in the enhancement of the electroanalytical performance of the PTPCNs/GCE are discussed based on the experimental findings and established theoretical concepts. The PTPCNs/GCE was successfully employed for analyzing real samples, like dopamine injection and urine.

Inherited haemochromatosis with C282Y mutation in a patient with alpha-thalassaemia: a treatment dilemma.

A Caucasian 24-year-old female patient suffers from two hereditary disorders: alpha-thalassaemia, which is prevalent in Asia and rare in Europe, and haemochromatosis, which is prevalent among northern Europe and rare in Asia. The clinical presentation and management of one of these diseases is controversial for the other. She presented 5 years ago with a clinical picture of refractory iron-deficiency anaemia secondary to menorrhagia. On treating her with the standard iron therapy, her anaemia persists although with adquate iron stores. This prompted further investigations that revealed in addition to hereditary haemochromatosis, alpha-thalassaemia because of abnormal blood indices. The treatment of thalassaemia with either iron or blood transfusion is not advisable in haemochromatosis, while standard treatment of haemochromatosis with venesection will worsen the anaemia. As iron chelating agents were not approved in Australia for haemochromatosis, haematinics support was commenced with a satisfactory improvement of anaemia thus allowing for further venesection.

Visual versus fully automated assessment of left ventricular ejection fraction.

INTRODUCTION: The aim of this study is to compare three different echocardiographic methods commonly used in the assessment of left ventricle (LV) ejection fraction (EF). METHODS: All patients underwent full echocardiography including LVEF assessed using M-mode, automated EF (Auto-EF), and visual estimation by two readers. RESULTS: We enrolled 268 patients. Auto-EF measurement was feasible in 240 (89.5%) patients. The averaged LVEF was (52% ± 12) with the visual assessment, (51% ± 11) with Auto-EF and (57% ± 13) with M-mode. Using Bland-Altman analysis, we found that the difference between the mean visual and the Auto-EF was not significant (-0.3% [-0.5803-0.0053], P = 0.054). However, the mean EF was significantly different when comparing visual versus M-mode and Auto-EF versus M-mode with the mean differences: (-2.4365 [-2.9946--1.8783], P < 0.0001) and (-2.1490 [-2.7348--1.5631], P < 0.0001) respectively. Inter-observer variability analysis of the visual EF assessment between the two readers showed that intraclass correlation coefficient was 0.953, (95% confidence interval: 0.939-0.965, P < 0.0001), with excellent correlation between the two readers: R = 0.911, P < 0.0001). CONCLUSION: The two-dimensional echocardiographic methods using Biplane Auto-EF or visual assessment were significantly comparable, whereas M-mode results in an overestimation of the LVEF.