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Abstract Background Antrochoanal polyps (ACPs) are pathologically benign nasal swellings. The maxillary sinus is the commonest reported origin. The polyps are usually unilateral and often exit through the progressively widened maxillary sinus ostium to occupy the choana and may reach the nasopharynx. It is a disease of adolescents and young adults who often present with progressive unilateral nasal obstruction. Encountering bilateral antrochoanal polyps is very rare. Case presentation We report a forty years old male who had progressive bilateral nasal obstruction for 8 years associated with hyposmia and intermittent facial pain and headaches. A nasal mass could be seen on anterior rhinoscopy on both sides, more prominent on the left. Endoscopy revealed bilateral masses hanging down the choanae. Computerized tomography scan of the nose and paranasal sinuses demonstrated bilateral nasal polypi and widening of the maxillary sinus ostia. During endoscopic surgical excision of the lesions, polypi were found to dilate the ostia of both maxillary sinuses. The polypi had antral, nasal, and choanal parts typical of antrochoanal polypi on both sides. The histopathology showed the inflammatory nature characteristic of antrochoanal polyp. Postoperatively, the patient’s symptoms resolved dramatically, and he is on continuous regular scheduled follow-up. Conclusion Bilateral antrochoanal polyps can present with nasal obstruction and can be misdiagnosed as sinusitis; radiological and endoscopic features are useful to reach specific diagnosis; what is special about our presentation is that it is an addition to the literature of a rare disease (bilateral ACPs), and we are reporting it in an older age rather than the common younger age of presentation in the literature reports, which is an addition to the demographic data.

Abstract Background Sinonasal masses are not an uncommon spectrum of diseases. They are frequently encountered in Sudan, sometimes with variability in modalities across the country. The objective of this study is to document the pattern of sinonasal masses in Sudanese patients and to highlight the knowledge of the modalities, clinical presentations, and management. As a consequence, this will raise awareness especially of the general practitioners and family physicians and hence the community locally and regionally. Early diagnosis and appropriate management can reduce the rate of recurrence, fatal complications, and hence morbidity and mortality. Methods This is a prospective descriptive, comparative hospital-based study conducted from January 2020 to January 2021. All patients with sinonasal masses, who came to Khartoum ENT Teaching Hospital seeking medical advice during the above-mentioned period were included in the study provided they satisfy the inclusion criteria. Enrollment was optional with the right to withdraw at any time. Consent was verbal with the reassurance about the aspect of confidentiality, privacy, and consent of the data. Ethical clearance was obtained from the ethical committee (EDC) SMSB and from the research committee of Khartoum teaching hospital. Analysis was done using a computer and the statistical package of social sciences SPSS V.25 Results A total number of 244 patients were studied. The age group of 21–40 years was the most encountered with the disease (42.6%). Two hundred three patients (83%) had a non-neoplastic disease, (9%) benign neoplastic lesions, and (8%) malignant neoplastic lesions. The non-neoplastic group was dominated by nasal polyposis of which the fungal were the most common (50%). Among benign neoplastic lesions, pyogenic granuloma ranked first (24%). Among malignant neoplastic lesions, squamous cell carcinoma dominated the epithelial origin lesions (71%) and Rhabdomyosarcoma dominated the connective tissue cell types (50%). Nasal obstruction is the most common complaint (94.7%) followed by nasal discharge (64.8%) then anosmia (53.3%). Endoscopic surgery was done in (84.4%) of patients, combined approach endoscopic and open surgery in (5.3%) while open surgery alone was done in 2.5%. Radiation and chemotherapy were used in 2% each, while chemo-radiation was used in (2.5%). The rest of the cases (1.3%) were managed by surgery followed by chemoradiation. Conclusion Patients with sinonasal masses in Sudan especially the age group 21–40 years must be seen in specialized Otolaryngology clinics to pick, diagnose and treat significant diseases in an early stage. Radiology and histopathology are a must in sinonasal swellings to diagnose malignant diseases at an early stage. Nasosinus fungal polyposis being the commonest in non-neoplastic lesions, the commonest among all sinonasal masses added together, and a known reported endemic disease in the country must receive special consideration and investigation for early diagnosis and treatment.

Abstract Background Acute sinusitis is not an uncommon disease that manifests with inflammation of the mucosal lining of the paranasal sinuses. It has varied etiologies including viral, bacterial, fungal, and allergic. Anatomical variations, trauma, auto-immunity, diabetes mellitus, and dental procedures are predisposing factors. With the wide variation in the etiological factors, the management could be tricky. This study is quite relevant with the advent of the relentlessly persisting COVID-19 pandemic which affects the upper respiratory tract as well. Methods This is a descriptive hospital-based prospective study conducted at the Khartoum ENT Teaching Hospital, Ibnsina Teaching Hospital, Omdurman Military Hospital, and Omdurman Teaching Hospital in Khartoum State in the period from March 2020 to February 2021. The study included all patients 18 years and older diagnosed with acute sinusitis. The data was collected by a well-structured questionnaire designed to meet the objectives of the study and analyzed using SPSS 20. Any COVID-19 suspect is excluded from the study. Results The total number of patients was 109; of them, 59 (54.1%) were females and 50 (45.9%) were males, and the female to male ratio was 1.18:1. One hundred seven (98.2%) patients received medical treatment and two patients (1.8%) did take the medications. Eighty-one patients (74.3%) were cured with medical treatment and only 28 patients (25.7%) needed surgical intervention. The age group from 25 to 40 years old was the most affected, accounting for 68 patients (62.4%), and the above 60 years old (3.7%) was the least affected group. Conclusion Acute sinusitis is not an uncommon disease, if addressed properly and timely is medically treatable in most cases apart from complicated cases. This study shows that the active working ages (25-40) were the most affected. Few patients needed surgery (FESS). Negligence could result in complications. Diseases like COVID-19 affect the upper respiratory tract, and there is a similarity in symptoms, and in the advent of the COVID-19 pandemic nowadays, differentiation is of paramount importance.

Integral equations play a crucial role in many scientific and engineering problems, though solving them is often challenging. This paper addresses the solution of multi-dimensional systems of mixed Volterra-Fredholm integral equations (SMVF-IEs) by means of a Legendre-Gauss-Lobatto collocation method. The one-dimensional case is addressed first. Afterwards, the method is extended to two-dimensional linear and nonlinear SMVF-IEs. Several numerical examples reveal the effectiveness of the approach and show its superiority in comparison to other alternative techniques for treating SMVF-IEs. [ABSTRACT FROM AUTHOR]

The passive feature of natural convection encourages continuous investigation on this field. This research work studies the natural convection inside a cavity of wavy vertical surfaces, including a heat source block standing on the base of cavity. The employed liquid is a hybrid water–Cu–Al 2 O 3 nanofluid. The vertical wavy surfaces are fixed at low temperature, while the heat source remains constant at a higher temperature. The Galerkin finite element method is applied to obtain the numerical solutions. Besides the common visualization tools, the heatlines tool is used in this paper as well. It is found from the outcomes that the Nusselt number is purely proportional to the length of the heat source. In addition, the hybrid water–Cu–Al 2 O 3 nanofluid exhibits a higher Nusselt number than that corresponding to a pure water and as well as other regular nanofluids. The percentages of the average heat transfer gained by the hybrid nanofluid at ϕ = 0.02 are 13.7% and 5% higher than those for pure water and other nanofluids. [ABSTRACT FROM AUTHOR]

One of the problems in the numerical analysis of solutions is the nonlinear variable-order fractional convection-diffusion equations for nonsmooth solutions. We offer a numerical technique based on the shifted Legendre Gauss-Lobatto collocation and the shifted Chebyshev Gauss-Radau collocation to solve the problem. The technique with shifted Legendre Gauss-Lobatto and shifted Chebyshev Gauss-Radau nodes is applied to diminish nonlinear variable-order fractional convection-diffusion equations to an easily-solvable system of algebraic equations. Besides, we give numerical test examples to show that the approach can preserve the nonsmooth solution of the underlying problems. [ABSTRACT FROM AUTHOR]

The capacity analysis under mixed traffic flow conditions considers a dynamic problem. Traffic microsimulation models have been a very effective tool for such problem. Calibration and validation of microsimulation models are essential steps to ensure the reliability of the models. This paper suggests the use of measurable variables for calibrating micro-simulation models. Therefore, the objective of this paper is to estimate the roadway capacity through micro-simulation models calibrated using spot speed distributions. The micro-simulation software VISSIM was used to model and analyze the two-lane and multi-lane roads. The models were calibrated and validated using the data collected in Menoufia Governorate, Egypt. The K-S test was performed to ensure that simulated speed distributions matched the observed distributions. It was found that the models were successfully calibrated and validated. Finally, roadway capacity was estimated based on field data and micro-simulation models through the flow rate-density relationship. The results showed a good match between the field and simulated capacity. [ABSTRACT FROM AUTHOR]

Background: Health care providers, particularly nursing staff, are at risk of physical or emotional abuse from patients. This abuse has been associated with increased use of physical and pharmacological restraints on patients, poor patient outcomes, high staff turnover, and reduced job satisfaction., Methods: In this study, a multidisciplinary team at Tufts Medical Center implemented the Brøset Violence Checklist (BVC), a screening tool administered by nurses to identify patients displaying agitated behavior. Patients who scored high on the BVC received a psychiatry consultation, followed by assessments and recommendations. This tool was implemented in an inpatient medical setting in conjunction with a one-hour de-escalation training led by nursing and Public Safety. The intervention design was executed through a series of three distinct Plan-Do-Study-Act cycles., Results: This study measured the number of BVCs completed and their scores, the number of psychiatric consults placed, the number of calls to Public Safety, the number of staff assaults, nursing restraint use, and staff satisfaction. During the study period, restraint use decreased 17.6% from baseline mean and calls to Public Safety decreased 60.0% from baseline mean. In the staff survey, nursing staff reported feeling safer at work and feeling better equipped to care for agitated patients., Conclusion: The BVC is an effective, low-cost tool to proactively identify patients displaying agitated or aggressive behavior. Simple algorithms for next steps in interventions and training help to mitigate risk and increase feelings of safety among staff. Regular psychiatric rounding and the identification of champions were key components in a successful implementation., (Copyright © 2024 The Joint Commission. Published by Elsevier Inc. All rights reserved.)

Background: Recently, a major manufacturer recalled several lots of iron assay reagent due to positive bias of roughly 15%-30% and the cause remains unknown. This study investigated the root cause of this positive bias and evaluated a simple practical approach to improve the assay., Methods: Performance comparison of recalled and unimpacted iron assay kits was done utilizing calibrators, quality control (QC) materials, and 42 remnant patient samples. Spectral scan and trace elements analysis of R1 and R2 reagents was performed. Copper (Cu) and thiourea (TU) spiking experiments were utilized to elucidate the cause and prevention of positive bias seen with recalled lots., Results: Iron measurements in QC materials and patient samples using recalled reagents generated a positive bias of 17.5% and 21%, respectively. Correspondingly, the recalled R2 reagents, but not R1, showed a rise in basal absorbance along with an unanticipated presence of Cu (22.7 µg/dL) and lead (7.5 µg/L). Cu spiking to recalled and unimpacted R2 reagent intensified the reagent color besides falsely increasing its absorbance, calibration factor, and patient iron measurements. Interestingly, addition of TU (65 mmol/L) to R2 reagent from unimpacted lot prevented the short-term and prolonged Cu-induced spurious rise in calibration factor and patient iron estimations., Conclusions: We conclude that accidental copper contamination of R2 reagent during manufacturing could be a reason underlying the positive bias in the recalled iron reagent lots. Addition of TU in ferene-containing R2 reagent is a simple and effective means to prevent Cu-induced false elevation in iron values., (© Association for Diagnostics & Laboratory Medicine 2024. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Objective: The Friedewald equation is the commonly used method of low-density lipoprotein cholesterol (LDL-C) calculation, requiring reflex to direct LDL-C measurement when triglycerides (TG) ≥ 400 mg/dL. Recently formulated Sampson and extended Martin/Hopkins methods have been validated with TG up to 800 mg/dL and thus have the potential to replace direct LDL-C measurement. Given the growing prevalence of childhood dyslipidemia, the objective of this study was to compare Sampson and extended Martin/Hopkins methods of LDL-C calculation with the direct measurement in a pediatric cohort with 400 ≤ TG ≤ 799 mg/dL., Methods: This study retrieved standard lipid panels and corresponding direct LDL-C measurements of 131 patients with 400 ≤ TG ≤ 799 mg/dL from a pediatric population. Following the application of Sampson and extended Martin/Hopkins calculations, calculated values were compared with direct LDL-C measurements using ordinary least squares linear regression analysis and bias plotting., Results: Both Sampson and extended Martin/Hopkins LDL-C calculations exhibited a strong correlation with the direct measurements (Pearson r = 0.89) in patients with 400 ≤ TG ≤ 800 mg/dL. Average percentages of bias of 45% and 21% were found between the direct LDL-C measurements and Sampson or extended Martin/Hopkins calculations, respectively., Conclusion: Both Sampson and extended Martin/Hopkins calculations are applicable as clinical alternatives of direct LDL-C measurement in pediatric patients given 400 ≤ TG ≤ 799 mg/dL., (© The Author(s) 2023. Published by Oxford University Press on behalf of American Society for Clinical Pathology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: Spinal cord stimulation (SCS) is a modern neuromodulation technique extensively proven to be an effective modality for treatment of chronic neuropathic pain. It has been mainly studied for complex regional pain syndrome (CRPS) and failed back surgery syndrome (FBSS) and recent data almost uniformly establishes its statistically significant positive therapeutic results. It has also been compared with other available treatment modalities across various studies. However, long term data on maintenance of its efficacious potential remains less explored. Few studies have reported data on long follow-up times (>= 12 months) and have compared its efficacy with other treatment options for chronic pain, respectively. Our study pools and analyzes the available data and compares SCS with other treatment options. It also analyzes the efficacy of SCS in long term management of patients with chronic pain., Evidence Acquisition: We reviewed all the data available on MEDLINE, Embase and Cochrane CENTRAL using a search strategy designed to fit our pre-set inclusion and exclusion criteria. Both single-arm and double-arm studies were included. The primary outcome was defined as decrease of visual analogue scale (VAS) by >50% at 6, 12 and/or 24 months after SCS., Evidence Synthesis: According to the pooled data of double-arm studies, SCS has unanimously proven its superiority over other treatment options at 6 months follow-up; however it fails to prove statistically significant difference in results at longer treatment intervals. Dorsal root ganglion stimulation, a relatively recent technique with the same underlying physiologic mechanisms as SCS, showed far more promising results than SCS. Single-arm studies show around 70% patients experiencing greater than 50% reduction in their VAS scores at 6 and 12 months., Conclusions: SCS is a viable option for management of chronic neuropathic pain secondary to FBSS and CRPS. However, data available for its long term efficacy remains scarce and show no further statistically significant results.

This Perspective presents the Modular-Integrative Modeling approach, a novel framework in neuroscience for developing brain models that blend biological realism with functional performance to provide a holistic view on brain function in interaction with the body and environment., (© The Author(s) 2023. Published by Oxford University Press on behalf of China Science Publishing & Media Ltd.)

In the current era, a chemical, industrial, or production process may not be devoid of heat transfer processes through fluids. This is seen in evaporators, distillation units, dryers, reactors, refrigeration and air conditioning systems, and others. On the other hand, the micropolar model effectively simulates microstructured fluids like animal blood, polymeric suspensions, and crystal fluid, paving the way for new potential applications based mainly on complex fluids. This investigation attempts to figure out and predict the thermal behavior of a polar fluid in motion across a solid sphere while considering the Lorentz force and mixed convection. To support the original fluid's thermophysical characteristics, two types of ternary hybrid ferro-nanomaterials are used. The problem is modelled using a single-phase model. Then, using the Keller box approximation, a numerical finding is obtained. The study reveals that Increasing the volume fraction of the ternary hybrid nonsolid results in optimized values of Nusselt number, velocity, and temperature. The presence of Lorentz forces effectively mitigates flow strength, skin friction, and energy transfer rate. The mixed convection factor contributes significantly to enhanced energy transfer and improved flow scenarios. For maximum heat transfer efficiency, employing Fe 3 O 4 -Cu-SiO 2 is recommended over Fe 3 O 4 -Al 2 O 3 -TiO 2 ., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Phosphonium-based compounds gain attention as promising photofunctional materials. As a contribution to the emerging field, we present a series of donor-acceptor ionic dyes, which were constructed by tailoring phosphonium (A) and extended π-NR 2 (D) fragments to an anthracene framework. The alteration of the π-spacer of electron-donating substituents in species with terminal - + PPh 2 Me groups exhibits a long absorption wavelength up to λ abs =527 nm in dichloromethane and shifted the emission to the near-infrared (NIR) region (λ=805 nm for thienyl aniline donor), although at low quantum yield (Φ<0.01). In turn, the introduction of a P-heterocyclic acceptor substantially narrowed the optical bandgap and improved the efficiency of fluorescence. In particular, the phospha-spiro moiety allowed to attain NIR emission (797 nm in dichloromethane) with fluorescence efficiency as high as Φ=0.12. The electron-accepting property of the phospha-spiro constituent outperformed that of the monocyclic and terminal phosphonium counterparts, illustrating a promising direction in the design of novel charge-transfer chromophores., (© 2023 The Authors. Chemistry - A European Journal published by Wiley-VCH GmbH.)

Two dimensional wavy walls rectangular cavity with inclined magnetohydrodynamic has been examined in mixed convection configurations. Triple fins arranged in the upwards ladder were filled within alumina nanoliquid in the cavity. Vertical sinusoidal walls were heated, and the other side was kept cold while both horizontal walls were kept adiabatic. All walls were motionless except the top cavity that was driven to the right. The diversified range of control parameter in Richardson number, Hartmann number, number of undulations, length of the cavity has been performed in this study. The analysis was simulated using finite element method by employing the governing equation formula, and the results were delineated in the form of streamlines, isotherms, heatlines, and comparisons on several relationships between the local velocity in the y-axis line of 0.6, local and average Nusselt number along the heated surface and dimensionless average temperature. The findings revealed that high concentration nanofluids boost the rate of heat transfer without the need to apply any magnetic field. Results found that the best heat mechanisms are natural convection with significant-high Richardson number as well as constructing two waves on the vertical walls in the cavity., (© 2023. The Author(s).)

Aim: Hirschsprung's disease (HD) is a congenital bowel disorder resulting in functional dysmotility. Advancement in surgical techniques has improved outcomes, but recent studies have identified problems having significant impact on patient's quality of life. The aim of this study is to analyze postoperative functional outcome after definitive surgery for Hirschsprung's disease., Method: A retrospective study was conducted at the Department of Pediatric Surgery, The Children's Hospital Lahore. The record of 64 patients was reviewed from the year 2009 to 2019. Parents were interviewed on phone calls and a predesigned questionnaire was filled. Degree of constipation, incontinence and voluntary bowel movements was analyzed according to Krickenbeck classification., Results: Median age at initial presentation was 11 days, with male to female ratio of 3.9:1. Most common presentation was delayed passage of meconium (38%). Diagnosis was made on biopsy in 70.3%, but contrast enema and biopsy in 29.7%. Aganglionosis was limited to short segment in 81.3% and long segment in 14.5%. Decompressing enterostomy was made in 63% at a mean age of 191 days. Definitive surgery included Duhamel pull-through in 89.1%. Mean age at follow-up was 10.6 ± 4.19 years and alive patients were 95.4%. Postoperative enterocolitis was reported by 27%, while 35.5% reported fecal incontinence and 16.1% complained of constipation. 80% could voluntarily hold bowel movement, among which 5% had a feeling of urge and 15% had the capacity to verbalize. In 25% of the patients, fecal incontinence was a constant social problem and in 25% of these patients constipation was resistant to diet and laxatives., Conclusion: On long-term follow-up, fecal incontinence was more worrisome, affecting quality of life and requiring help of the bowel management program. Such patients need close follow-up after definitive procedure, so that they have normal stooling habits in their adulthood and lead a normal life., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Neuro-ophthalmological emergencies require prompt assessment and management to avoid vision or life-threatening sequelae. The decision to perform a neuroimaging procedure is based on the clinical judgment of the medical team, without defined indications. This study aims to identify presenting symptoms and physical exam findings associated with relative positive findings on neuroimaging studies. Electronic medical records of patients presenting to the emergency department (ED) with isolated neuro-ophthalmologic complaints between January 1, 2013 and September 30, 2019 were reviewed. We collected data on the clinical presentation, neuroimaging procedures and results, consults, and diagnoses. Two hundred eleven patients' charts were reviewed. Most presented with unilateral eye complaints (53.6%), and the most common symptoms were blurred vision (77.3%) and headaches (42.2%). A total of 126 imaging procedures were performed of which 74.6% were normal, while 25.4% showed relevant abnormal findings. Complaining of blurry vision (P = .038) or visual field changes (P = .014) at presentation as well as having a visual field defect (P = .016), abnormal pupil reactivity (P = .028), afferent pupillary defect (P = .018), or abnormal optic disc exam (P = .009) were associated with positive findings on imaging. Neuroimaging is more likely to yield positive findings in patients presenting to the ED with visual field irregularities, afferent pupillary defects, or abnormal optic discs. These findings - when combined with the proper clinical setting - should lower the threshold to proceed with neuroimaging in the emergency department. Based on our results, larger-scale studies might lead to a well-structured algorithm to be followed by ED physicians in decision making., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Among the five major classes of lipoprotein particles, low-density lipoprotein-cholesterol (LDL-C) is the primary lipoprotein risk factor for the development of cardiovascular diseases (CVD) through the promotion of atherosclerotic pathogenesis. Therefore, it is of paramount importance to accurately measure the plasma concentration of LDL-C using an appropriate method to examine the risk of CVD and determine the efficacy of therapeutic interventions to reduce the cholesterol level and examine the risk assessment strategy. At present, there is a wide variety of methods available for LDL-C measurement. In this review, we have outlined the commonly used methods of LDL-C measurement. These methods have been classified into non-automated analytical methods, calculation methods, and automated direct measurement of LDL-C. We have also described some recently proposed promising calculation methods which are being considered for clinical adoption. This current review could assist the clinicians to have a better understanding regarding the measurement techniques and comparative utilities of different methods of LDL-C measurement and guide them to select an appropriate method based on accuracy, turnaround time, and cost of test., (Copyright © 2022 International Federation of Clinical Chemistry and Laboratory Medicine (IFCC). All rights reserved.)

A new prenylated kaempferol, conglomeratin ( 1 ), alongside 7 known compounds including flavonoids ( 2 and 3 ), ellagic acid derivatives ( 4 and 5 ), triterpenoids ( 6 and 7 ), and a coumarin ( 8 ) were isolated from the leaves ( 1 - 5 ) and stem bark ( 6 - 8 ) of Macaranga conglomerata . Their structures were elucidated using spectroscopic and spectrometric techniques. The antibacterial assay was performed using disc diffusion method against Gram-positive and Gram-negative microorganisms. Compound 1 was significantly active against Pseudomonas aeruginosa ATCC 27853 (MIC = 7.8 µg/mL) and moderately active towards Staphylococcus aureus ATCC 25923, Escherichia coli ATCC 25922 and Klebsiella pneumoniae ATCC 31488 (MIC = 62.5 µg/mL). Compound 2 showed potency against P. aeruginosa ATCC 27853 (MIC = 1.0 µg/mL) while 4 and 7 were selective towards K. pneumoniae ATCC 31488 (MIC = 7.8 and 1.0 µg/mL, respectively). These findings suggest that prenylation of flavonoids may contribute to improving their broad-spectrum antimicrobial activities.

Apocynin (APO), a specific nicotinamide adenine dinucleotide phosphate-oxidase (NADPH-oxidase, NOX) inhibitor, has recently emerged as a bioactive phytochemical with eminent anti-inflammatory and anti-oxidant activities. To our knowledge, no research has been conducted to fabricate a mucoadhesive nanostructured delivery system of APO that targets the liver. Accordingly, chitosan (CS) surface decorated polymeric nanoparticulate delivery system (PNDS) was victoriously fabricated by double emulsion-solvent evaporation method. Herein, a randomized full 3 3 factorial design was employed to assess the impact of the independently processing parameters (IPPs) namely; (poly(d,l-lactide-co-glycolide) (PLGA) amount (A)), (polyvinyl alcohol (PVA) concentration (B)), and (CS concentration (C)), on different dependently measured attributes (DMAs). The optimal APO-loaded chitosan-coated poly(d,l-lactide-co-glycolide) nanoparticles (APO-loaded CS-coated PLGA NPs) formula (F19) would be extensively appraised through meticulous in vitro-in vivo studies. Crucially, the results revealed that oral pre-treatment with the optimal formula evoked a prodigious in vivo hepatoprotective efficacy against lipopolysaccharide (LPS)/D-(+)-galactosamine (D-GalN) induced fulminant hepatitis (FH) in BALB/c mice when compared with pure APO, uncoated F19, and plain NPs (P NPs) pretreated groups. In conclusion, APO-loaded CS-coated PLGA NPs could be considered as a promising oral mucoadhesive phytopharmaceutical PNDS to open new prospects for therapeutic intervention in inflammatory based liver diseases., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

In our search for simple synthetic routes to N -heterocyclic carbene (NHC)-metal complexes and their derivatives, we herein report an operationally simple, expedient and scalable method to obtain the widely used NHC-metal-diketonates. The reported complexes are synthesized for the first time under mild, aerobic conditions and in excellent yields in a sustainable manner. The protocol is general with regards to the anionic co-ligand and the ancillary carbene ligands. The spectroscopic and crystallographic characterization of the complexes reveal a bidentate binding mode of the diketonate ligand to copper while the gold-congener is C-bound. Finally, the reported Au complex was shown to be an efficient pre-catalyst for the hydrocarboxylation of alkynes.

A straightforward synthetic protocol leading to carbene-metal-amido (CMA) complexes (metal=Au, Cu) using a mild base and an environmentally desirable solvent (EtOH) has been explored, with a focus on complexes bearing backbone-substituted N-heterocyclic carbene (NHC) ligands, including BIAN-NHCs (BIAN=bis(imino)acenaphthene). The novel CMAs were structurally characterized, and gold-based CMAs bearing diverse NHCs were screened as simple, Brønsted-basic precatalysts. The readily accessible complexes display high catalytic activity in the intermolecular and intramolecular hydrocarboxylation of internal alkynes and alkynoic acids respectively, while the screening reveals the ancillary ligand effect of NHCs in these catalytic systems., (© 2022 Wiley-VCH GmbH.)

Purpose: To compare the long-term surgical outcomes of patients with horizontal strabismus whose surgery was performed in an outpatient department (OPD) setting (by residents-in-training) to those whose surgery was performed in a private clinic (PC) setting (by staff-ophthalmologists) in the same operating room/institution., Methods: Two hundred and forty-four patients' charts who had horizontal strabismus surgeries from January 2007 to 2020 were reviewed retrospectively. A total of 92 patients were operated on by residents and followed in OPD, and 152 patients by staff-surgeons and followed in PC. Demographic data and eye exam parameters were collected. Distance and near deviation (in prism diopters, PD) were extracted and compared between groups at baseline and postoperatively (6 months and yearly for up to 6 years). Success was defined as a postoperative motor alignment of 10PD or less., Results: The mean age of the 244 patients was 10.5 ± 11.7 years, with no significant differences between groups. A longer follow-up duration was reported in the PC group (34.9 ± 24.3 months vs 25.3 ± 20.2 months). Patients had similar success rates in both groups in the early postoperative period (6 months and 1 year); however, a higher success rate was observed in the PC group compared to OPD at 3, 5 and 6 years with the following respective values: 72.2% vs 50% (p < .001), 75% vs. 66.7% (p = .02), and 68.6% vs. 66.7% (p = .03). The difference was more pronounced in the esotropia subgroup mostly at 3 years follow-up., Conclusion: This study showed a similar success rate of horizontal strabismus surgery performed in a PC setting by staff surgeons as compared to that performed in an OPD setting by residents at 6 months and 1 year. A significantly higher success rate was observed at long term follow-up (after 2 years) in the PC group compared to the OPD group, possibly related to the difference in compliance with post-operative follow-up management and not to surgery itself.

Background: Generally, the healthcare workers have a stressful job and it includes both physical and mental stress. We conducted this study to determine the burnout among postgraduate residents (PGR's). ., Methods: This cross-sectional study was conducted at The Children's Hospital and The Institute of Child's Health, Lahore over a period of 3 months. A total of 113 PGR's participated in this study. Burnout was measured using Copenhagen Burnout Inventory (CBI). Questionnaire was filled by participants on paper. Results were analyzed through SPSS-26., Results: In this study, most of the participants (n=70) were females. Mean age of the participants was 28.6±2.035 years. More than 50% participants suffer from moderate to severe burnout. Nine percent of participants had high personal and client related burnout. The highest mean score was for personal burnout scale. When burnout scores were categorized according to demographic details, personal burnout was significantly higher among those who considered that they are burnout (p=0.000) and work burnout was significantly higher among those who travelled to the workplace by their cars (p=0.025). Burnout was higher among females, those who have long duration to travel from their homes to the hospital and whose parents were doctors; however, the difference was not significant. The scale showed a good overall internal reliability (Cronbach's alpha=0.697)., Conclusions: This study showed a high rate of burnout among PGR's that needs to be addressed and adequate measures should be taken to reduce it.

Background: Laparoscopic inguinal hernia repair (LIHR) has many benefits like less frequency of metachronous contralateral hernias, minimum complications, comparatively less duration of operation and better cosmetic outcome as compared to the open technique. Objective of the study was to compare the outcome of laparoscopic percutaneous extra-peritoneal closure (LPEC) and open repair for paediatric inguinal hernia in terms of contralateral metachronous hernia, operative time and recurrence., Methods: A randomized controlled trial was conducted at the Department of Paediatric Surgery, Children Hospital Lahore. Non-probability purposive sampling was used, and 296 cases were divided into group-1(managed with conventional open repair) and group-2 (managed with laparoscopic Percutaneous Extra-peritoneal closure). After taking informed consent, data was collected, and cases were studied for operative time, contralateral metachronous hernia and recurrence till 6 months postoperatively. Data analysis was done through SPSS 22.0. Chi-square and independent sample t-test was used for comparison. p-value ≤0.05 was taken as significant., Results: The mean operative time was statistically less in the LPEC group (24.79±3.44 minutes) when compared to the open repair group (28.71±4.54 minutes), p-value <0.001. In the Open repair group, there were 19 (12.8%) cases that had contralateral metachronous hernia, while in the LEPC group, 2 (1.4%) cases had contralateral metachronous hernia p-value <0.001. In the Open repair group, 4(2.7%) cases had a recurrence, while in LPEC group 1 (0.7%) cases had a recurrence, with statistically same recurrence rate, p-value >0.05., Conclusions: The LPEC technique is better than conventional open repair in terms of CMIH, operative time, and recurrence rate.

The aim of this review was to report the existing literature on the incidence, risk factors, treatment, and outcomes of scleral perforation as a vision-threatening complication of strabismus surgery. The current literature reported an incidence range of scleral perforation/penetration between 3 in 1,000 and 7.8%. Rectus muscle recession was the most commonly mentioned risk factor among the studies. Other risk factors were myopia, previous extraocular muscle surgery, surgeon experience, S-24 needle use, muscle reattachment posterior to the original insertion site, operating on a horizontal rectus muscle, and young age. Different views existed in the literature regarding scleral perforation management. Some ophthalmologists advocated management by cryopexy or indirect ophthalmoscopic laser uniformly, whereas others reserved it for more complicated cases. Antibiotic therapy for endophthalmitis prophylaxis was recommended by one study and shown to be practiced by some ophthalmologists. [ J Pediatr Ophthalmol Strabismus . 2022;59(4):214-223.] .