The Coronavirus Disease 2019 (COVID-19) pandemic has caused an unprecedented disruption in medical education and healthcare systems worldwide. The disease can cause life-threatening conditions and it ...presents challenges for medical education, as instructors must deliver lectures safely, while ensuring the integrity and continuity of the medical education process. It is therefore important to assess the usability of online learning methods, and to determine their feasibility and adequacy for medical students. We aimed to provide an overview of the situation experienced by medical students during the COVID-19 pandemic, and to determine the knowledge, attitudes, and practices of medical students regarding electronic medical education. A cross-sectional survey was conducted with medical students from more than 13 medical schools in Libya. A paper-based and online survey was conducted using email and social media. The survey requested demographic and socioeconomic information, as well as information related to medical online learning and electronic devices; medical education status during the COVID-19 pandemic; mental health assessments; and e-learning knowledge, attitudes, and practices. A total of 3,348 valid questionnaires were retrieved. Most respondents (64.7%) disagreed that e-learning could be implemented easily in Libya. While 54.1% of the respondents agreed that interactive discussion is achievable by means of e-learning. However, only 21.1% agreed that e-learning could be used for clinical aspects, as compared with 54.8% who disagreed with this statement and 24% who were neutral. Only 27.7% of the respondents had participated in online medical educational programs during the COVID-19 pandemic, while 65% reported using the internet for participating in study groups and discussions. There is no vaccine for COVID-19 yet. As such, the pandemic will undeniably continue to disrupt medical education and training. As we face the prospect of a second wave of virus transmission, we must take certain measures and make changes to minimize the effects of the COVID-19 outbreak on medical education and on the progression of training. The time for change is now, and there should be support and enthusiasm for providing valid solutions to reduce this disruption, such as online training and virtual clinical experience. These measures could then be followed by hands-on experience that is provided in a safe environment.
Infection with extensive-drug-resistant (XDR) carbapenem-resistant (CR) Gram-negative bacteria (GNB) are viewed as a serious threat to human health because of the limited therapeutic options. This ...imposes the urgent need to find agents that could be used as adjuvants or combined with carbapenems to enhance or restore the susceptibility of XDR CR- GNB. Therefore, this study aimed to examine the effect of propranolol (PR) in combination with Meropenem (MEM) on the susceptibility profile of XDR CR-GNB recovered from severely infected patients as well as to evaluate combining MEM with either tigecycline (TGC) or amikacin (AK).
A total of 59 non-duplicate CR- GNB were investigated for carbapenemase production by the major phenotypic methods. Molecular identification of five major carbapenemase-coding genes was carried out using polymerase chain reactions (PCR). Antimicrobial susceptibility tests were carried out using standard methods. Phenotypic and genotypic relatedness was carried out using the heatmap and ERIC PCR analysis. PR, 0.5 -1 mg/mL against the resulting non-clonal XDR CR-GNB pathogens were evaluated by calculating the MIC decrease factor (MDF). A combination of MEM with either AK or TGC was performed using the checkerboard assay.
A total of 21 (35.6%) and 38 (64.4%) CR-GNB isolates were identified as enterobacterial isolates (including 16 (27.1%) Klebsiella Pneumoniae and 5 (8.5%) Escherichia coli) and non-fermentative bacilli (including, 23 (39%), Acinetobacter baumannii, and 15 (25.4%) Pseudomonas aeruginosa). The heatmap and ERIC PCR analysis resulted in non-clonal 28 XDR CR isolates. PR, at a concentration of 0.5 mg /ml, decreased MICs values of the tested XDR CR isolates (28; 100%) and restored susceptibility of only 4 (14.3%) isolates. However, PR (1 mg/mL) when combined with MEM has completely (28; 100%) restored the susceptibility of the tested XDR CR- GNB to MEM. The MEM + AK and MEM + TGC combination showed mostly additive effects (92.8% and 71.4%, respectively).
PR at a concentration of 1 mg/mL restored the susceptibility of XDR CR- GNB to MEM which is considered a promising result that should be clinically investigated to reveal its suitability for clinical use in patients suffering from these life-threatening pathogens.
This study aims at investigating the linkage between green human resource management bundle practices and green supply chain management (i.e. external and internal practices), as well as their impact ...on the Triple Bottom Lines of sustainability performance (i.e. environmental, social, and economic performance). A quantitative method is applied in which data is collected from a customized survey with 121 firms functioning in the most pollutant manufacturing sectors (i.e. food, chemical, and pharmaceutical sectors) in Palestine. The data analysis was conducted using the partial least squares structural equation modeling. The results from data analysis show that both of green human resource management and green supply chain management practices have a positive effect to sustainable performance in a joint manner. In fact, the results revealed that green human resource management practices have a direct effect on the sustainable performance, with the green supply chain management practices mediating this effect. In particular, internal green supply chain management practices positively mediate between green human resources management practices and sustainable performance, whereas external green supply chain management practices mediate only the relationship between GHRM bundle practices and environmental dimension of sustainable performance, thus suggesting absence of awareness among manufacturers regarding the effectiveness of this type of GSCM practices for an improved economic and social dimensions of sustainable performance, and calling for more attention from green training programs. This study is considered as the first empirical study exploring the impact of green human resource management and green supply chain management on components of sustainable performance in Palestine, adding great value to the current green human resource management-green supply chain management literature via responding to recent calls to test the combined impact of both practices on TBL of sustainability performance. At the end, the theoretical and managerial implications, limitations of the current study and future research directions have been discussed.
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•First empirical study exploring the impact of GHRM and GSCM on sustainable performance.•Int-GSCM positively mediates between GHRM bundle and sustainable performance.•Ext-GSCM practices mediate only the relationship between GHRM bundle and EP.•GHRM is a valid mechanism that can be utilised to enhance GSCM implementation.
Background: This study aimed to produce, purify, structurally elucidate, and explore the biological activities of metabolites produced by Streptomyces (S.) griseus isolate KJ623766, a recovered soil ...bacterium previously screened in our lab that showed promising cytotoxic activities against various cancer cell lines. Methods: Production of cytotoxic metabolites from S. griseus isolate KJ623766 was carried out in a 14L laboratory fermenter under specified optimum conditions. Using a 3-(4,5-dimethylthazol-2-yl)-2,5-diphenyl tetrazolium-bromide assay, the cytotoxic activity of the ethyl acetate extract against Caco2 and Hela cancer cell lines was determined. Bioassay-guided fractionation of the ethyl acetate extract using different chromatographic techniques was used for cytotoxic metabolite purification. Chemical structures of the purified metabolites were identified using mass, 1D, and 2D NMR spectroscopic analysis. Results: Bioassay-guided fractionation of the ethyl acetate extract led to the purification of two cytotoxic metabolites, R1 and R2, of reproducible amounts of 5 and 1.5 mg/L, respectively. The structures of R1 and R2 metabolites were identified as β- and γ-rhodomycinone with CD50 of 6.3, 9.45, 64.8 and 9.11, 9.35, 67.3 µg/mL against Caco2, Hela and Vero cell lines, respectively. Values were comparable to those of the positive control doxorubicin. Conclusions: This is the first report about the production of β- and γ-rhodomycinone, two important scaffolds for synthesis of anticancer drugs, from S. griseus.
Objective
To assess the analgesic efficacy of ropivacaine infiltration in the tonsillar fossa among pediatric patients undergoing tonsillectomy.
Data Sources
PubMed, Scopus, Web of Science, and ...CENTRAL.
Review Methods
Eligible randomized controlled trials (RCTs) were assessed for bias using Cochrane's risk of bias tool (version 2). Our primary outcome was postoperative pain within 24 h, and secondary outcomes included operative time, intraoperative blood loss, time to first analgesia, bleeding, and nausea/vomiting. Data were pooled as mean difference, standardized mean difference, and risk ratio with a 95% confidence interval.
Results
Our review included 11 RCTs, with a total of 712 patients. The quality of studies varied and included low risk (n = 8 RCTs), some concerns (n = 2 RCTs), and high risk (n = 1 RCT) of bias. The primary endpoint of postoperative pain across all time points was significantly reduced in the ropivacaine group compared with the placebo group. Trial sequential analysis (TSA) of the postoperative pain depicted conclusive evidence and unnecessity for further RCTs. The mean operative time was significantly reduced in the ropivacaine group compared with the placebo group. However, there was no significant difference between both groups regarding additional clinical (i.e., mean intraoperative blood loss and mean time to first analgesia) and safety (i.e., rates of bleeding and nausea/vomiting) outcomes.
Conclusion
This systematic review and meta‐analysis demonstrated the safety and postoperative analgesic efficacy of ropivacaine versus placebo among pediatric patients undergoing tonsillectomy. There was no significant difference between both groups regarding intraoperative blood loss, time to first analgesia, and rate of postoperative bleeding.
Level of Evidence
1 Laryngoscope, 134:3018–3029, 2024
This systematic review and meta‐analysis demonstrated the safety and postoperative analgesic efficacy of ropivacaine versus placebo among pediatric patients undergoing tonsillectomy. There was no significant difference between both groups regarding intraoperative blood loss, time to first analgesia, and rate of postoperative bleeding.
Rain attenuation is the main practical problem that confronts wireless signals specifically when it uses millimeter-waves for fifth-generation (5G) communication systems. In addition, due to that the ...urban environments are characterized by many high buildings act as diffraction objects can block the signal path and produce non-line of sight (NLOS) situations. These diffraction materials can cause further considerable losses that disturb the received power at the 5G receiver. This paper proposes a new model can investigate the influence of both precipitation and diffraction phenomena on wireless point to point (PPT) communication systems. This new research work utilizes measured rainfall data and actual scenarios in an urban environment to simulate the wireless PPT system and examine the influence of rainfall and knife-edge diffraction (KED) on the performance of the PPT system and signal strength at the receiver. Several durations of exceedances of rain rates and various operation scenarios have been employed to study and analyze the status of 5G wireless system links. The results indicated that there is an exchange of the effect of rain and KED diffraction in the lower millimeter-waves compared to the higher millimeter-waves. This study declares that at higher frequency bands the rain attenuation is observed to be greater, the diffraction loss is higher, and the path loss is also larger compared to the effect of these three factors seen at lower frequency bands. Furthermore, specific carrier frequencies, as in the case of 60 GHz, undergo extra huge atmospheric absorption loss which can diminish the communication coverage of the PPT system link.
A novel smart biochromic textile sensor was developed by immobilizing anthocyanin extract into electrospun cellulose acetate nanofibers to detect bacteria for numerous potential uses, such as ...healthcare monitoring. Red-cabbage was employed to extract anthocyanin, which was then applied to cellulose acetate nanofibers treated with potassium aluminum sulfate as a mordant. Thus, nanoparticles (NPs) of mordant/anthocyanin (65-115 nm) were generated in situ on the surface of cellulose acetate nanofibrous film. The pH of a growing bacterial culture medium is known to change when bacteria multiply. The absorbance spectra revealed a bluish shift from 595 nm (purple) to 448 nm (green) during the growth of Gram-negative bacteria (E. coli) owing to the discharge of total volatile basic amines as secretion metabolites. On the other hand, the absorption spectra of a growing bacterial culture containing Gram-positive bacteria (L. acidophilus) showed a blue shift from 595 nm (purplish) to 478 nm (pink) as a result of releasing lactic acid as a secretion metabolite. Both absorbance spectra and CIE Lab parameters were used to determine the color shifts. Various analytical techniques were utilized to study the morphology of the anthocyanin-encapsulated electrospun cellulose nanofibers. The cytotoxic effects of the colored cellulose acetate nanofibers were tested.
Objectives
To evaluate the analgesic and anti‐haemorrhagic efficacy of platelet‐rich plasma (PRP) among patients undergoing tonsillectomy.
Design
A systematic review and meta‐analysis of randomised ...controlled trials (RCTs).
Setting
PubMed, Scopus, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL) and Google Scholar databases were screened from inception until July 2021, and updated in December 2021.
Participants
Patients undergoing tonsillectomy.
Main outcome measures
The efficacy endpoints of postoperative pain and haemorrhage were summarised as standardised mean difference (SMD) and risk ratio (RR), respectively, with 95% confidence interval (CI).
Results
Seven RCTs Seven RCTs were analysed, comprising a total of 392 patients. Risk of bias evaluation showed an overall high risk in one RCT, low risk in four RCTs and some concerns in two RCTs. The pooled results revealed that the mean postoperative pain score was significantly reduced in favour of the PRP group compared with the control group (SMD = −1.38, 95% CI −1.91, −0.85, p < 0.001). Subgroup analysis showed the effect estimate was statistically significant for early postoperative pain (Day 0 to Day 3), without substantial difference between both groups on late postoperative pain (Days 5 and 7). Moreover, the rate of postoperative haemorrhage was significantly reduced in favour of the PRP group compared with the control group (RR = 0.16, 95% CI 0.05, 0.50, p = 0.001). Subgroup analysis showed the effect estimate was statistically significant for the rate of primary and secondary haemorrhage.
Conclusion
PRP was associated with significant reduction in postoperative pain and haemorrhage among patients undergoing tonsillectomy.
The coronavirus disease 2019 (COVID-19) pandemic may have a potentially serious effect on mental health and increase the risk of anxiety, depression, and post-traumatic stress disorders in people. In ...this study, we aimed to determine the prevalence of psychological illness and the impact of the COVID-19 pandemic on the Libyan population's mental health.
A cross-sectional survey, conducted in both online and paper modes and consisting of five sections, was completed in more than 30 cities and towns across Libya. The first section consisted of questions on basic demographic characteristics. The second section contained a survey related to the lockdown status, activities, related stress levels, and quarantine. The third section comprised the self-administered 9-item Patient Health Questionnaire (PHQ-9). The fourth section contained the 7-item Generalized Anxiety Disorder Scale (GAD-7), and the fifth section contained the Impact of Event Scale-Revised (IES-R).
Of the 31,557 respondents, 4,280 (13.6%) reported severe depressive symptoms, with a mean standard deviation (SD) PHQ-9 score of 8.32 (5.44); 1,767 (5.6%) reported severe anxiety symptoms, with a mean (SD) GAD-7 score of 6 (4.6); and 6,245 (19.8%) of the respondents reported post-traumatic stress disorder (PTSD), with a mean (SD) score of 15.3 (18.85). In multivariate analysis, young age, being female, unmarried, educated, or victims of domestic violence or abuse, work suspension during the pandemic, and having increased workload, financial issues, suicidal thoughts, or a family member with or hospitalized due to COVID-19 were significantly associated with a high likelihood of depressive and anxiety symptoms, as well as PTSD. Internal displacement due to civil war was also associated with PTSD.
To our knowledge, this is the first study to analyze the psychological impacts of the COVID-19 pandemic and civil war in Libya. Further study on the development of strategies and interventions aimed at reducing the mental disease burden on the Libyan population is warranted.
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