The need to develop alternative treatment approaches to acne vulgaris and other skin infections is becoming increasingly urgent due to the rising prevalence of antibiotic resistance in Cutibacterium acnes (a key pathogen related to such conditions). Nanoparticles (NPs) have shown great potential as antimicrobial agents that could improve the effectiveness of traditional antibiotics when administered together. This research examines antibacterial activity of silver NPs (Ag-NPs) and zinc oxide NPs (ZnO-NPs), both independently and when used collaboratively with common anti-acne antibiotics used to treat C. acnes. Ag-NPs and ZnO-NPs were biosynthesized using aqueous Peganum harmala extract as a reducing and stabilizing agent. The synthesized nanoparticles were characterized using UV–Vis spectroscopy, X-ray diffraction (XRD), scanning/transmission electron microscopy (SEM/TEM), and dynamic light scattering (DLS). This research examined two C. acnes clinical isolates (P1 and P2) and one reference strain (NCTC747) were used in this research. Broth microdilution assays were employed to determine minimum inhibitory concentrations (MICs). Checkerboard assays and fractional inhibitory concentration index (FICI) analysis were performed to explore synergy between antibiotics and NPs. A successful formation of spherical Ag-NPs and hexagonal ZnO-NPs has been confirmed, with average crystallite sizes of approximately 13–14 nm and 53–55 nm, respectively. Both Ag-NPs and ZnO-NPs were found to exhibit strong antibiotic activity. The MICs of the tested antibiotics were significantly reduced when used in combination with AgNPs. The reduction was up to 2–8 fold compared to antibiotic monotherapy. Moreover, most Antibiotic-Ag-NPs combinations exhibited synergistic interactions in the FICI analysis (FICI ≤ 0.5). Meanwhile, there are increased moderate effects resulted from the ZnO-NP combinations. The Antibiotic MIC generally values reduced two-to-four-fold. The relevant FICI values suggested that the interactions were primarily additive (FICI ≈ 0.75), although there was some evidence of strain-dependent variations. A two-way ANOVA test showed that the MIC values reductions for both antibiotics and nanoparticles were statistically significant (p < 0.001). The potential of biosynthesized NPs as adjunct therapeutic agents for the management of acne-associated infections was suggested by their promising antibacterial and antibiotic-enhancing effects against C acnes.
The palmaris longus (PL) muscle is a superficial flexor muscle that exhibits a notable anatomical variability and is frequently used in reconstructive surgery. Its absence or morphological differences may influence surgical planning. This study aims to determine the prevalence and morphological variation of PL in the Jordanian population, and assess its relationship with sex, hand dominance and parental origin. A cross-sectional study of 403 University of Jordan students was conducted. PL presence was assessed bilaterally using multiple tests (Schaeffer’s, Thompson’s, Mishra’s test I and II, and Pushpakumar’s tests). Photographs of the forearm were taken and independently reviewed to classify the PL morphology into normal, bifurcated, radial deviation, ulnar deviation, reversed, or absent. PL was present bilaterally in 228 participants (56.5%), absent bilaterally in 92 (22.8%), and unilaterally absent in 83 (20.6%). Unilateral absence was more frequent in the left (12.9%) than the right (7.7%). Sex was significantly associated with PL presence, while parental origin (mother’s origin), (father’s origin) and hand dominance were not. Most Jordanians in this study had bilaterally present PL, with notable morphological diversity. Females were more likely to have an absent PL than males, whereas hand dominance and parental origin did not influence its presence. The novel classification of PL variations proposed here may assist surgeons in preoperative evaluation for tendon grafting.
Background: Stroke is a frequent manifestation of non-bacterial thrombotic endocarditis (NBTE), yet current knowledge largely stems from case reports and small series. This systematic review aimed to comprehensively describe stroke presentation, imaging features, management, and outcomes in NBTE patients. Methods: A comprehensive search of EMBASE, PubMed, MEDLINE, Web of Science and PsycINFO databases was conducted through September 2023. Studies reporting individual cases or case series of NBTE-related stroke were included. Extracted data included demographics, vascular risk factors, stroke presentation, imaging features, NBTE etiology, treatment modalities (unfractionated heparin/low molecular weight heparin (UFH/LMWH), warfarin, direct oral anticoagulants (DOACs), and valvular intervention), stroke recurrence, and mortality. Multivariate regression was performed to identify predictors of recurrent stroke and mortality. Results: A total of 129 patients from 118 studies were included (median age 56 [IQR:44-64], 62% females). Right (28%) and left (26%) hemispheric stroke syndromes accounted for the majority of clinical presentation, and multivessel ischemic infarcts (>2 territories) were observed in 66%. Conventional vascular risk factors were infrequent (1%-21%), while deep vein thrombosis and systemic embolism occurred in 59% and 38% of patients, respectively, either preceding or coinciding with stroke onset. Malignancy and autoimmune diseases were identified in 72% and 22%, respectively. Anticoagulation was initiated in 66% and 21% underwent valvular treatment. Over a median follow-up of 1.3 months, stroke recurrence and death occurred in 48% and 50%, respectively. Malignancy significantly increased mortality risk (OR 16.8, P<0.001), while autoimmune-related NBTE (OR 0.2, P=0.029), and anticoagulation with UFH/LMWH (OR 0.3, P=0.011) and VKA (OR 0.09, P=0.002) reduced mortality. Recurrent stroke was more likely in patients with malignancy (OR 16.8, P=0.001) and those receiving DOACs (OR 6.2, P=0.057) Conclusion: NBTE should be considered in stroke patients lacking conventional risk factors, particularly with underlying malignancy or autoimmune disease. Malignancy and DOAC use may increase the risk of recurrent strokes in this patient population.
In healthcare organisations such as the NHS, transparency is a crucial facet of effective leadership, with characteristics such as open communication, consistent information sharing and trusting relationships promoting a shared sense of purpose among staff and subsequently positively influencing patient outcomes. However, many nurses display cynicism towards their employing organisations and leaders, characterised by negative attitudes, scepticism and distrust. This article details a systematic review and meta-analysis that examined the association between leadership transparency and workplace cynicism among nurses, focusing on predictors, mechanisms and outcomes. Nineteen studies involving a total of 8,360 nurses met the inclusion criteria. A significant negative association was found between leadership transparency and workplace cynicism among nurses. Leadership transparency was linked to greater trust, reduced emotional exhaustion and enhanced team alignment. Overall, leadership transparency has a key role in reducing workplace cynicism among nurses by fostering trust, ethical communication and psychological safety.
Non-islet cell tumor hypoglycemia (NICTH) is a rare paraneoplastic syndrome in which a tumor secretes high molecular weight IGF-II, causing hypoglycemia. It is most frequently associated with solitary fibrous tumors (SFTs). SFTs are rare mesenchymal neoplasms that most commonly arise in the thoracic cavity but may occur at various extrapleural sites. When SFTs are complicated by hypoglycemia due to IGF-2 secretion, the condition is termed Doege–Potter syndrome. A 50-year-old man presented with recurrent episodes of daytime fatigue, hunger, and sugar cravings, in addition to nocturnal hypoglycemia requiring awakening every two hours to eat, often accompanied by profuse sweating. Home glucose monitoring confirmed hypoglycemia during symptomatic episodes. He had no significant past medical, surgical, or family history, and no history of substance abuse or chronic medication use. Concurrently, he reported persistent cough and exertional dyspnea, for which he was evaluated in the pulmonology clinic. Initial laboratory investigations were unremarkable. A supervised 72-hour fasting test confirmed hypoglycemia. IGF-1 levels were also measured, but IGF-2 test was unavailable locally. Biochemical results are summarized in Table 1, demonstrating hypoinsulinemic hypoglycemia. Chest computed tomography, performed for respiratory complaints, revealed a well-circumscribed pulmonary mass (image1). Histopathological examination confirmed a solitary fibrous tumor. Taken together, the biochemical results and pathology established a diagnosis of NICTH. Following the diagnosis of NICTH, the patient was stabilized with prednisolone 20 mg twice daily for one week, which improved his hypoglycemia. He then underwent surgical excision of the pulmonary solitary fibrous tumor. Postoperatively, hypoglycemic episodes resolved completely. At follow-up, the patient remained asymptomatic. This case highlights the importance of considering Doege–Potter syndrome in otherwise healthy individuals with unexplained fasting or nocturnal hypoglycemia, as early diagnosis and definitive surgical management can be curative. The authors declare no conflict of interest regarding this case report. No external funding was received for this work.Figure 1:Chest CT showing a large pulmonary solitary fibrous tumorContrast-enhanced CT of the chest demonstrating a well-circumscribed, heterogenous mass in the right hemithorax measuring approximately 12.7 × 12.0 cm Table 1:Relevant Biochemical FindingsLaboratory evaluation demonstrating hypoglycemia with suppressed insulin and C-peptide levels, negative sulfonylurea screen, low-normal IGF-1, and absence of insulin autoantibodies.
