Outcomes after surgery for children in Africa (ASOS-Paeds): a 14-day prospective observational cohort study

BACKGROUND

Safe anaesthesia and surgery are a public health imperative. There are few data describing outcomes for children undergoing anaesthesia and surgery in Africa. We aimed to get robust epidemiological data to describe patient care and outcomes for children undergoing anaesthesia and surgery in hospitals in Africa.

METHODS

This study was a 14-day, international, prospective, observational cohort study of children (aged <18 years) undergoing surgery in Africa. We recruited as many hospitals as possible across all levels of care (first, second, and third) providing surgical treatment. Each hospital recruited all eligible children for a 14-day period commencing on the date chosen by each participating hospital within the study recruitment period from Jan 15 to Dec 23, 2022. Data were collected prospectively for consecutive patients on paper case record forms. The primary outcome was in-hospital postoperative complications within 30 days of surgery and the secondary outcome was in-hospital mortality within 30 days after surgery. We also collected hospital-level data describing equipment, facilities, and protocols available. This study is registered with ClinicalTrials.gov, NCT05061407.

FINDINGS

We recruited 8625 children from 249 hospitals in 31 African countries. The mean age was 6·1 (SD 4·9) years, with 5675 (66·0%) of 8600 children being male. Most children (6110 [71·2%] of 8579 patients) were from category 1 of the American Society of Anesthesiologists Physical Status score undergoing elective surgery (5325 [61·9%] of 8604 patients). Postoperative complications occurred in 1532 (18·0%) of 8515 children, predominated by infections (971 [11·4%] of 8538 children). Deaths occurred in 199 (2·3%) of 8596 patients, 169 (84·9%) of 199 patients following emergency surgeries. Deaths following postoperative complications occurred in 166 (10·8%) of 1530 complications. Operating rooms were reported as safe for anaesthesia and surgery for neonates (121 [54·3%] of 223 hospitals), infants (147 [65·9%] of 223 hospitals), and children younger than 6 years (188 [84·3%] of 223 hospitals).

INTERPRETATION

Outcomes following anaesthesia and surgery for children in Africa are poor, with complication rates up to four-fold higher (18% vs 4·4-14%) and mortality rates 11-fold higher than high-income countries in a crude, unadjusted comparison (23·15 deaths vs 2·18 deaths per 1000 children). To improve surgical outcomes for children in Africa, we need health system strengthening, provision of safe environments for anaesthesia and surgery, and strategies to address the high rate of failure to rescue.

FUNDING

Jan Pretorius Research Fund of the South African Society of Anaesthesiologists and Association of Anesthesiologists of Uganda.

Toxicity Evaluation, Oxidative, and Immune Responses of Mercury on Nile Tilapia: Modulatory Role of Dietary Nannochloropsis oculata

The current study evaluated the potential ameliorative effect of a dietary immune modulator, Nannochloropsis oculata microalga, on the mercuric chloride (HgCl2)-induced toxicity of Nile tilapia. Nile tilapia (45-50 g) were fed a control diet or exposed to ¼ LC50 of HgCl2 (0.3 mg/L) and fed on a medicated feed supplemented with N. oculata (5% and 10% (50 or 100 g/kg dry feed)) for 21 days. Growth and somatic indices, Hg2+ bioaccumulation in muscles, and serum acetylcholinesterase (AChE) activity were investigated. Antioxidant and stress-related gene expression analyses were carried out in gills and intestines. Histopathological examinations of gills and intestines were performed to monitor the traits associated with Hg2+ toxicity or refer to detoxification. Hg2+ toxicity led to significant musculature bioaccumulation, inhibited AChE activity, downregulated genes related to antioxidants and stress, and elicited histopathological changes in the gills and intestine. Supplementation with N. oculata at 10% was able to upregulate the anti-oxidative-related genes while downregulated the stress apoptotic genes in gills and intestines compared to the unexposed group. In addition, minor to no histopathological traits were detected in the gills and intestines of the N. oculata-supplemented diets. Our data showed the benefit of dietary N. oculata in suppressing Hg2+ toxicity, which might support its efficacy as therapeutic/preventive agent to overcome environmental heavy metal pollution in aquatic habitats.

Diagnostic and therapeutic role of endoscopic ultrasound in liver diseases: A systematic review and meta-analysis

BACKGROUND

In hepatology, the clinical use of endoscopic ultrasound (EUS) has experienced a notable increase in recent times. These applications range from the diagnosis to the treatment of various liver diseases. Therefore, this systematic review summarizes the evidence for the diagnostic and therapeutic roles of EUS in liver diseases.

AIM

To examine and summarize the current available evidence of the possible roles of the EUS in making a suitable diagnosis in liver diseases as well as the therapeutic accuracy and efficacy.

METHODS

PubMed, Medline, Cochrane Library, Web of Science, and Google Scholar databases were extensively searched until October 2023. The methodological quality of the eligible articles was assessed using the Newcastle-Ottawa scale or Cochrane Risk of Bias tool. In addition, statistical analyses were performed using the Comprehensive Meta-Analysis software.

RESULTS

Overall, 45 articles on EUS were included (28 on diagnostic role and 17 on therapeutic role). Pooled analysis demonstrated that EUS diagnostic tests had an accuracy of 92.4% for focal liver lesions (FLL) and 96.6% for parenchymal liver diseases. EUS-guided liver biopsies with either fine needle aspiration or fine needle biopsy had low complication rates when sampling FLL and parenchymal liver diseases (3.1% and 8.7%, respectively). Analysis of data from four studies showed that EUS-guided liver abscess had high clinical (90.7%) and technical success (90.7%) without significant complications. Similarly, EUS-guided interventions for the treatment of gastric varices (GV) have high technical success (98%) and GV obliteration rate (84%) with few complications (15%) and rebleeding events (17%).

CONCLUSION

EUS in liver diseases is a promising technique with the potential to be considered a first-line therapeutic and diagnostic option in selected cases.

The Protective Mechanism Against COVID-19, Antibody vs Cellular Immunity: An Extensive Review

The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has posed a significant threat to the world, causing a respiratory illness with a wide range of symptoms and affecting people of all sexes and age groups. Although the innate immune response to SARS-CoV-2 is not entirely understood, recent findings suggest that a high number of innate immune cells and inflammatory cytokines can help in fighting the virus. However, an excessive expression of cytokines can lead to a cytokine storm, resulting in a severe disease state with high morbidity and mortality. The coordinated actions of the innate and adaptive immune responses are responsible for eliminating virus-infected cells and inhibiting reinfection. The actual role of T-cell immunity and antibody responses is unclear, and further research is necessary to gain insights into the nature of immune protection. The SARS-CoV-2 S protein is considered a sensitive and useful protein that can be targeted by antibodies and T cells, providing significant biological targets for finding effective vaccines and treatments. Despite challenges in developing effective vaccines, the small number of reinfections suggests that a primary infection may offer some protection during subsequent exposure to the same virus. A deeper understanding of the vital role of B and T cells in COVID-19 may help in managing, controlling, and halting this new pandemic.

Post-Orthotopic Liver Transplant Cholangiopathy Assessment and Surveillance with Endoscopic Ultrasonography: The Way Forward

Post-orthotropic liver transplant (POLT) cholangiopathies are a group of biliary complications that develop after liver transplantation. These conditions can lead to significant morbidity and mortality if not detected and treated early. Traditionally, magnetic resonance cholangiopancreatography and computed tomography scan have been used to identify biliary complications after OLT. Hence, the current study aimed to evaluate the accuracy of endoscopic ultrasonography (EUS) in assessing and monitoring POLT cholangiopathies by performing a comprehensive review of the literature. Relevant articles published until February 2023 were searched from various databases including PubMed, Embase, and Cochrane Library. The search terms used were “endoscopic ultrasound,” “post-orthotopic liver transplantation,” “primary sclerosing cholangitis,” and “cholangiopathy.” Relevant articles were selected and included in this review. EUS has emerged as a state-of-the-art method for the assessment and surveillance of POLT cholangiopathies, with high success rates in diagnosing and treating biliary complications. In patients with primary sclerosing cholangitis, EUS can help in the early detection of primary tumors and biliary strictures and can be a guide in therapeutic interventions such as endoscopic retrograde cholangiopancreatography and biliary drainage. In conclusion, EUS has a superior diagnostic accuracy than other imaging modalities such as magnetic resonance cholangiopancreatography and computed tomography scan in detecting biliary complications after OLT.

The Use of Intraoperative Radiation Therapy (IORT) in Multimodality Management of Cancer Patients: a Single Institution Experience

BACKGROUND

Intraoperative radiation therapy (IORT) is a highly conformal type of radiation therapy given at time of surgery aiming for better tumor local control. It increases the tumor radiation dose without exceeding normal tissues tolerance doses.

PURPOSE

To assess the feasibility of IORT and short-term toxicities in patients with different cancer sites treated with multidisciplinary protocol including IORT.

PATIENTS AND METHODS

Medical records of cancer patients who received IORT as a part of their multidisciplinary treatment at King Faisal Specialized Hospital and Research center (KFSH&RC), Riyadh, Saudi Arabia, from January 2013 until December 2017 were retrospectively reviewed.

RESULTS

A total of 188 patients with 210 IORT applications were analyzed. Twenty-two patients had two applications at the same time. One hundred sixteen patients were males. Median age at time of diagnosis was 49.5 years (19-77). One hundred thirty-four patients had primary, while 54 cases had recurrent disease. Gastroesophageal cancer and soft tissue sarcoma were the most frequent diagnosis in 49 patients followed by colorectal cancer in 35 patients. Major surgeries with curative intent done in 183 patients (97.3%). Hyperthermic intraperitoneal chemotherapy (HIPEC) was performed in 118 (62.8%) patients. The 30-day postoperative mortality rate was 3.2%. Fifty-four (28.7%) patients develop grades III-IV complications according to Clavien-Dindo grading system.

CONCLUSION

The data presented discusses using of IORT treatment for different malignant tumors as a part of multimodality treatment. IORT seems safe and feasible; however, a longer follow-up period is needed for proper evaluation and to define the role of IORT in a tailored multimodality approach.

Enhanced Goat Milk MUFA Quality via Date Pit Supplementation: A Time-Based Pattern Recognition Analysis Utilizing Agricultural Waste Byproduct

Date pits are agricultural waste byproducts and are available in tons yearly. Milk MUFAs are lipids beneficial for health and sorted out for food product development. This work is aimed at researching the effect of supplementing dairy goats with date pit powder (DPP) as a source of fatty acids (FA), an alternative to enhancing the unsaturated FA in milk and analysed via chemometrics in a 3-month supplementation-based study. Saanen-Boer crossed dairy goats were divided into six groups comprising of control, 10 g and 20 g both for Ajwa DPP (high-quality dates) and Mariami DPP (agricultural waste byproduct), and another 30 g for Mariami DPP only. The supplementation exercise was done daily on each dairy goat. The DPP and milk samples were analysed for its FA profile applying GC-FID and followed by chemometric techniques, namely, PCA and PLS. Results indicated that the n-6/n-3 ratio was the highest for the unsupplemented group compared to the DPP-treated goats with lower n-6/n-3 ratios. The M30 group showcased the most promising health-related class of FAs viewed by 3D PCA and PLS model clustering patterns, in particular monounsaturated FA (MUFA) (C18:1n9c or oleic acid). These results suggest that Mariami DPP supplementation at higher doses and time to lactating Saanen-Boer cross goats can be a means to milk FA quantity and quality enhancement and that chemometrics via pattern recognition can be useful statistical tools when dealing with overwhelming data.

Curcumin loaded liposome formulation: Enhanced efficacy on performance, flesh quality, immune response with defense against Streptococcus agalactiae in Nile tilapia (Orechromis niloticus)

Application of novel trend comprising antioxidant phytogenics is aiming to minimize the stress related factors and associated diseases in intensive fish culturing. Today, the concept of exploiting and protecting natural antioxidants represents a paradigm shift for the aqua feed industry. Therefore, our principal goal targeting liposome as a novel nanocarrier for curcumin is directed to attain superior performance, fillet antioxidant stability and bacterial resistance in Nile tilapia. A total of 500 Nile tilapia fingerlings (average body weight, 10.27 ± 0.10 g) assigned into five experimental groups in 25 glass aquaria of 120 L capacity at the density 20 fish/aquaria. The experimental groups were supplemented with varying doses of liposomal curcumin-NPs, LipoCur-NPs (0, 5, 15, 25 and 35 mg/kg diet) were reared for 12 weeks and later Streptococcus agalactiae (S. agalactiae) challenged model was performed. Inclusion of LipoCur-NPs (25 and 35 mg/kg diet) had the most prominent impact on Nile tilapia growth rate and feed conversion ratio. The immune boosting outcomes post supplementing 35 mg/kg diet of LipoCur-NPs were evidenced by higher myeloperoxidase, lysozyme and total immunoglobulin levels. Even after 4 weeks frozen storage, LipoCur-NPs at the dose of 35 mg/kg diet prominently increased (P < 0.05) the fillet scavenging capability for free radicals (1,1-diphenyl-2-picrylhydrazyl and 2,2'-Azino-bis (3-ethylbenzothiazoline-6-sulfonic acid) with an inverse reduction in lipid peroxidation biomarker (malondialdehyde). Notably, upregulation of GSH-Px, CAT, and SOD genes in fillet of 35 mg/kg LipoCur-NPs fed fish coordinated with higher T-AOC and lower oxidative markers (ROS and H₂O₂). Post S. agalactiae challenge, higher supplementation levels of LipoCur-NPs (35 mg/kg diet) greatly attenuated the expression of its vital virulence genes (cfb, fbsA and cpsA) with higher expression of Igm, CXC-chemokine and MHC genes. Concordantly, downregulation of inflammatory markers (IL-1β, TNF-α and IL-8) and upregulation of anti-inflammatory ones (IL-10 and TGF-β) were remarkably documented. Based on these findings, the innovative curcumin loaded liposome was considered a novel multitargeting alternative not only playing an imperative role in Nile tilapia growth promotion and fillet stability upon storage, but also protecting efficiently against S. agalactiae.

Grass carp IL-20 binds to IL-20R2 but induces STAT3 phosphorylation via IL-20R1

IL-20 is a pleiotropic cytokine that belongs to the IL-10 family and has a variety of biological functions in tissue homeostasis and regulation of host immune defenses. It signals through a heterodimeric receptor composed of a subunit with a long intracellular domain (R1 type receptor) and a subunit with a short intracellular domain (R2 type receptor). In this study, the R1 type receptor (CiIL-20R1/CRFB8) and the R2 type receptor (CiIL-20R2/CRFB16) were identified in grass carp Ctenopharyngodon idella. Expression analysis revealed that IL-20R2 was highly expressed in the gills and skin in healthy fish. Infection with Flavobacterium columnare resulted in the downregulation of both receptors in the gill at 48 and 72 h, whilst infection with grass carp reovirus induced their expression in the head kidney and spleen at 72 h. In the primary head kidney leucocytes, the expression levels of IL-20R1 and IL-20R2 were decreased after stimulation with 250 ng/mL IL-1β but not affected by IFN-γ. Co-immunoprecipitation analysis showed that CiIL-20R2/CRFB16 but not CiIL-20R1/CRFB8 bound to CiIL-20L. Furthermore, it was shown that CiIL-20R1/CRFB8 was responsible for activating the phosphorylation of STAT3, whilst CiIL-20R2/CRFB16 was not involved. Structural modeling analysis showed that key residues involved in the interaction between IL-20 and receptors were highly conserved between grass carp and humans, suggesting that the signal transduction and functions of IL-20/IL-20R axis are evolutionarily conserved.

Exploring the Interactive Effects of Thymol and Thymoquinone: Moving towards an Enhanced Performance, Gross Margin, Immunity and Aeromonas sobria Resistance of Nile Tilapia (Oreochromis niloticus)

Plant-derived bioactive compounds with promising nutritional and therapeutic attributes (phytogenics) are among the top priorities in the aquaculture sector. Therefore, the impact of thymol (Thy) and/or thymoquinone (ThQ) on the growth, immune response antioxidant capacity, and Aeromonas sobria (A. sobria) resistance of Nile tilapia was investigated. Four fish groups were fed a control diet and three basal diets supplemented with 200 mg/kg diet of Thy or ThQ and a blend of both Thy and ThQ at a level of 200 mg/kg diet each. At the end of the feeding trial (12 weeks), the tilapias were challenged intraperitoneally with virulent A. sobria (2.5 × 108 CFU/mL) harboring aerolysin (aero) and hemolysin (hly) genes. The results revealed that tilapias fed diets fortified with a combination of Thy and ThQ displayed significantly enhanced growth rate and feed conversion ratio. Notably, the expression of the genes encoding digestive enzymes (pepsinogen, chymotrypsinogen, α-amylase and lipase) and muscle and intestinal antioxidant enzymes (glutathione peroxidase, catalase and superoxide dismutase) was significantly upregulated in Thy/ThQ-fed fish. An excessive inflammatory response was subsided more prominently in the group administrated Thy/ThQ as supported by the downregulation of il-β, il-6 and il-8 genes and in contrast, the upregulation of the anti-inflammatory il-10 gene. Remarkably, dietary inclusion of Thy/ThQ augmented the expression of autophagy-related genes, whilst it downregulated that of mtor gene improving the autophagy process. Furthermore, Thy/ThQ protective effect against A. sobria was evidenced via downregulating the expression of its aero and hly virulence genes with higher fish survival rates. Overall, the current study encouraged the inclusion of Thy/ThQ in fish diets to boost their growth rates, promote digestive and antioxidant genes expression, improve their immune responses and provide defense against A. sorbia infections with great economic benefits.

Percutaneous transhepatic cholangiography vs endoscopic ultrasound-guided biliary drainage: A systematic review

BACKGROUND

Percutaneous transhepatic cholangiography is a diagnostic and therapeutic procedure that involves inserting a needle into the biliary tree, followed by the immediate insertion of a catheter. Endoscopic ultrasound-guided biliary drainage (EUS-BD) is a novel technique that allows BD by echoendoscopy and fluoroscopy using a stent from the biliary tree to the gastrointestinal tract.

AIM

To compare the technical aspects and outcomes of percutaneous transhepatic BD (PTBD) and EUS-BD.

METHODS

Different databases, including PubMed, Embase, clinicaltrials.gov, the Cochrane library, Scopus, and Google Scholar, were searched according to the guidelines for Preferred Reporting Items for Systematic reviews and Meta-Analyses to obtain studies comparing PTBD and EUS-BD.

RESULTS

Among the six studies that fulfilled the inclusion criteria, PTBD patients underwent significantly more reinterventions (4.9 vs 1.3), experienced more postprocedural pain (4.1 vs 1.9), and experienced more late adverse events (53.8% vs 6.6%) than EUS-BD patients. There was a significant reduction in the total bilirubin levels in both the groups (16.4-3.3 μmol/L and 17.2-3.8 μmol/L for EUS-BD and PTBD, respectively; P = 0.002) at the 7-d follow-up. There were no significant differences observed in the complication rates between PTBD and EUS-BD (3.3 vs 3.8). PTBD was associated with a higher adverse event rate than EUS-BD in all the procedures, including reinterventions (80.4% vs 15.7%, respectively) and a higher index procedure (39.2% vs 18.2%, respectively).

CONCLUSION

The findings of this systematic review revealed that EUS-BD is linked with a higher rate of effective BD and a more manageable procedure-related adverse event profile than PTBD. These findings highlight the evidence for successful EUS-BD implementation.

Antihyperlipidemic effect of Punica granatum mesocarp extract (PGME) in rats

Hyperlipidemia is an umbrella term that refers to any disorder of elevated level of lipids circulating in the blood; and is considered the most significant risk factor contributing to the prevalence of cardiovascular, hepatic, and other diseases. The present study was designed to evaluate the possible antihyperlipidemic potential Punica granatum mesocarp extract (PGME) in albino rats using high-fat diet model of hyperlipidemia. Forty-two albino rats were utilized in this experiment arranged randomly in seven groups, six rats each, of different treatments. Hyperlipidemia model was induced by incorporating coconut oil (1.5% w/w) and cholesterol (1.5 % w/w) in diet supplied to rats, for 6 weeks (+ve control); test group rats received PGME at escalating doses of 100 or 200 mg/kg, orally, daily for 6 weeks with keeping on high-fat diet; standard group rats received Rosuvastatin at dose of 2 mg/kg, orally, daily for 6 weeks along with high-fat diet; further 2 groups of rats received only PGME at the same dose levels with keeping on normal diet; while rats of -ve control group received only the vehicles of the used agents. Blood samples were picked out at the end of the experimental course for different assays. Clinicochemical analyses revealed that PGME exhibited dose-dependent protection against hyperlipidemia indicated by improved biomarkers, including, lipid profile parameters, namely cholesterol, triacylglycerols and lipoproteins; enzymatic hepatic parameters, namely, AST, ALT, and GGT; and non-enzymatic parameters, namely, total protein, albumin, globulins, total bilirubin, conjugated bilirubin, unconjugated bilirubin. The mechanism of the obtained lipid profile improvement of PGME may be based on the phytochemical principals Tannins, Phenolics and Flavonoids, indicated by preliminary detection tests. Data of the present study may suggest PGME as a good natural source for promising antihyperlipidemic remedies.  

Study of resveratrol against bone loss by using in-silico and in-vitro methods

By applying the in-silico method, resveratrol was docked on those proteins which are responsible for bone loss. The Molecular docking data between the resveratrol and Receptor activator of nuclear factor-kappa-Β ligand [RANKL] receptors proved that resveratrol binds tightly to the receptors, showed the highest binding affinities of -6.9, -7.6, -7.1, -6.9, -6.7, and -7.1 kcal/mol. According to in-vitro data, Resveratrol reduced the osteoclasts after treating Marrow-Derived Macrophages [BMM] with Macrophage colony-stimulating factor [MCSF] 20ng / ml and RANKL 50ng / ml, with different concentrations of resveratrol (2.5, 10 μg / ml) For 7 days, the cells were treated with MCSF (20 ng / ml) and RANKL (40 ng / ml) together with concentrated trimethyl ether and resveratrol (2.5, 10 μg / ml) within 12 hours. Which, not affect cell survival. After fixing osteoclast cells with formaldehyde fixative on glass coverslip followed by incubation with 0.1% Triton X-100 in PBS for 5 min and after that stain with rhodamine phalloidin staining for actin and Hoechst for nuclei. Fluorescence microscopy was performed to see the distribution of filaments actin [F.actin]. Finally, resveratrol reduced the actin ring formation. Resveratrol is the best bioactive compound for drug preparation against bone loss.

Functional characterization of an interleukin 20 like homologue in grass carp Ctenopharyngodon idella

IL-20 is a pleiotropic cytokine that belongs to the IL-10 family and plays an important biological role in tissue homeostasis and regulation of host immune defenses. IL-20 homologues have recently been discovered in fish, but their functions have not been studied. In this study, an IL-20 like (IL-20L) cytokine was cloned in grass carp (Ctenopharyngodon idella) and its bioactivities were investigated. Expression analysis showed that the CiIL-20L gene was constitutively expressed in tissues with the highest expression detected in the head kidney. It was upregulated in the head kidney after infection with Flavobactrium columnare (F. cloumnare) and grass carp reovirus II (GCRV II). The recombinant CiIL-20L produced in E. coli cells was shown to be effective in inducing the expression of Th cytokine genes (IFN-γ, IL-4/13A, IL-4/13B and IL-10), macrophage marker genes (arginase 2, IRF4, KLF4 and SOCS3) and inflammatory genes (IL-1β, IL-6, IL-8 and TNFα) in the head kidney leukocytes when stimulated at 12 h. Long term culture (6 days) of head kidney macrophages in the presence of CiIL-20L leads to high expression of IRF4, TGFβ1 and arginase 2. Our data suggest that IL-20 may play regulatory roles in promoting Th responses, macrophage differentiation and inflammation.

A Comprehensive Review of Transaminitis and Irritable Bowel Syndrome

We observed in the literature that irritable bowel syndrome (IBS) may be linked to irregular parameters of the metabolic system (MS) and liver function. For that reason, we conducted this systematic review to comprehensively analyze the association of transaminitis (elevated alanine transaminase (ALT)) with IBS. This review was designed by following methods described in the Cochrane Handbook for Systematic Reviews of Interventions. Published peer-reviewed journal articles were included. Data were extracted based on study design, age, gender, author, date of publication or availability online, publication type, participants, gender (M/F), and types of IBS. Our electronic multiple databases yielded a total of 519 preliminary studies; we then removed duplicate studies and left with 326 studies. After reviewing the full text of these articles, a total of 83 studies were eliminated and lastly, three studies were selected for this systematic review for quantitative and qualitative analysis. All the enrolled subjects in included studies were diagnosed with IBS by the Rome II and III criteria and among these sub-jects, 50.4% had IBS-D, 13.8% had IBS-C, 30.3% had IBS-M, and 3.5% had IBS-U. The prevalence of elevated ALT with other liver enzymes (γ-GT levels and aspartate aminotransferase (AST)) in patients with irritable bowel syndrome whether their body mass index (BMI) was high or not (16.9% vs. 7.7%; p=0.015) and γ-GT (24.1% vs. 11.5%; p=0.037), Lee et al., 2016. The IBS-D subtype was seen more commonly in patients whose alcohol intake was significantly high however their study data showed no significant change in elevation of ALT. The upper limits normal values for serum liver enzymes were de-fined as 41 international per liter in males and 31 international units per liter in females for ALT. No significant relationships were observed between IBS status and elevated γ-GT (OR, 1.647; 95% CI, 0.784-3.461). The review study proposes a potential relation between elevated ALT levels, MS, and IBS, and this review might be the first review in IBS patients to observe the association of elevated ALT in the IBS population. Although further additional trials with a large sample size will be required to confirm these results. Furthermore, for assessing the efficacy of the manipulation of gut microbiota ran-domized controlled trials in a large population of IBS patients are needed to establish a causal-resultant relationship between IBS, MS, and liver damage.

The first life skills intervention to enhance well-being amongst university students in the Arab world: 'Khotwa' pilot study

Although Life Skills programs showed to improve the psychological and physical wellbeing of individuals, little attention has been paid, worldwide and in the Arab countries in specific to implementing life skills intervention for university students. In this study, we tested the effectiveness of a life skills based health promotion intervention KHOTWA (STEP) in enhancing the wellbeing of university students in Lebanon, a country that faces economic and political instability. This is a quasi-experimental study, with pre and post-test, intervention-control design. Each group was formed of 78 participants studying in a private university in Lebanon. Mixed design was used to address the process and outcomes objectives of the intervention. The program was carried online due to COVID-19 pandemic. Significant differences were observed between the intervention and the control groups for life skills, dietary habits and mental health scores at the 3-month follow-up. For the intervention group, a significant increase was observed in the mean score of each of the following Life Skills subscales: self-care (p = 0.001), work and study (p = 0.013), career and education planning (p = 0.011) and looking forward/goal settings (p < 0.001). Students also achieved a healthier eating habit compared to those in the control group by decreasing their consumption of processed food. There was no significant effect in terms of body mass index (p = 0.827). Also, there was a significant change in the mental health status (p = 0.012) only in the intervention group as its mean score decreased after 3 months of the intervention implementation. This intervention enhances the mental health and promotes healthy habits leading consequently to a better quality of life and more productivity amongst university students. Therefore, such interventions should be replicated in other similar context to improve university students’ well-being.

Induction of secondary metabolites on nanoparticles stress in callus culture of Artemisia annua L

Nanoparticles are known bio elicitors in plant biotechnology. Different concentrations of ZnO, CuO and CoO nanoparticles were used for the enhanced accumulation of secondary metabolites and antioxidant activities in the callus derived from root, shoot and leaf of Artemisia annua L. Biomass of callus was somehow affected on high concentrations of Nps. Phenolic content was observed maximum (60µg) in shoot callus at 0.1mg/l of CuONps. Total antioxidant activity was observed maximum (33µg) in root callus at 0.1mg/l of ZnOnps. Total reducing power maximum (33µg) was observed in root callus at concentration of 0.05 mg/l of CoONps. Maximum radical scavenging activity was observed in shoot callus at 0.05mg/l of ZnONps. Rutin gallic acid and caffic acid were also determined in most of the samples by HPLC. The study concludes that different Nps have positive effect on the induction of secondary metabolites in A.annua plant.

Meta-Analysis and Systematic Review of Primary Renal Tubular Acidosis in Patients With Autoimmune Hepatitis and Alcoholic Hepatitis

Renal and hepatic functions are often mingled through both the existence of associated primary organ diseases and hemodynamic co-relationship. The primary objective of this study was to sum up the relationship between autoimmune hepatitis (AIH) on renal tubular acidosis (RTA) and the stages of the disease. A systematic review was performed for 24 trials. A total of 3687 patients were included. The incidence of RTA occurring and short-term mortality reduction was seen in two groups; for an overall effect: Z = 2.85 (P = 0.004) a total 95% CI of 0.53 [0.34, 0.82]. Only one patient with alcoholic liver cirrhosis was found to have an incomplete type of RTA. Test for overall effect: Z = 2.28 (P = 0.02) 95% CI of 2.83 [1.16, 6.95]. A reduction in fatal infections with dual therapy of corticosteroid plus N-acetylcysteine (NAC) test for overall effect: Z = 3.07 (P = 0.002) with 95% CI of 0.45 [0.27, 0.75]. Autoimmune diseases are the most frequent underlying cause of secondary RTA in adults. The primary renal disease must be actively excluded in all patients with hepatic failure by aggressive clinical and laboratory evaluations.

FAVIPIRAVIR AND DEXAMETHASONE IN MANAGEMENT OF SARS-COV2 INFECTION

Background. The clinical presentation of Coronavirus disease 19 (COVID-19) varies from mild symptoms to severe illness including multiorgan dysfunction. Favipiravir is an antiviral agent which has been previously used for treatment of influenza and was recently approved for treatment of mild to moderate COVID-19 in India. Objective. The Objective of this study was to assess the role of Favipiravir and Dexamethasone in patients with COVID-19. Methods. A total of 17 patients were included in this observational study. The included patients were RT-PCR for SARS-Cov-2 positive with increased inflammatory markers. All patients received Antiviral therapy, Anticoagulation (Enoxaparin 0.4mg subcutaneous twice daily), Steroids (Dexamethasone 8mg daily for 5days and 4mg daily for 5 days). Viral clearance (time to RT-PCR negative), time to defervescence after antiviral therapy, time to become independent of Oxygen support was studied. Results. Fever, myalgias, dry cough and dyspnea were the commonest presentation of COVID-19. All of our patients had lymphopenia. In our study 11 (64.7%) patients had bilateral ground glass opacities on CT chest while 6 had consolidation in addition to ground glass opacities. In two patients, who required non-invasive ventilation, Favipiravir was stopped and these patients received Remdesivir for a total of 5 days. In patients who received Favipiravir only, the Median time to RT-PCR negative, defervescence and oxygen independence was 8,3 and 6 days respectively. Conclusion. Our observational study demonstrated improvement in the majority of patients with COVID-19 with use of Favipiravir. Additional studies are needed to compare the efficiency of Favipiravir with Remdesivir.

Antioxidant and antimicrobial properties of Indo-Malayan stingless bee (Heterotrigona itama) honey from different seasons and distribution of flowers

The quality of honey produced by stingless bees can be affected by a variety of factors. Different seasons may have an influence on stingless bee behaviour while different flower sources may affect the properties of stingless bee honey. Thus, this study aimed to determine the antioxidant and antimicrobial properties of stingless bee honey from different multifloral sources collected during dry and rainy seasons. Honey was collected from hives placed in two different areas with multifloral (area A and B). The difference between these areas was area A only planted with two types of flowers (with stevia) and area B with more than two flowers. Pollen in the honey samples was identified to confirm the seasonal variations. The antioxidative potential of the honey samples was determined using total phenolic content (TPC), DPPH and FRAP assays and total carotenoid content (TCC). Antimicrobial properties were analysed using well diffusion method (mm) against the foodborne pathogens Escherichia coli, Staphylococcus aureus, Listeria monocytogenes and Salmonella enterica serovar Typhimurium. The results revealed that honey harvested during the dry season showed higher antioxidant properties compared to those harvested in the rainy season. The highest antioxidant activities were measured in honey samples taken from area B. Nevertheless, honey harvested in both seasons showed antimicrobial properties against all tested food pathogens, with the dry season samples showing the highest inhibition. Surprisingly, only honey from area A present showed no antimicrobial effect against E. coli. This study showed that the antioxidant and antimicrobial properties of multifloral stingless bee honey are strongly affected by seasonal differences and the distribution of the flowering plant

Y-Shaped Vesica Fellea Duplex Gallbladder Causing Acute Biliary Pancreatitis

Gallbladder duplication refers to the splitting of "gallbladder primordium" during the early embryonic development in the fifth or early sixth week. Although it is a very rare congenital abnormality and most of the patients will be asymptomatic, yet the symptomatic cases present with abdominal complaints like nausea vomiting, abdominal pain leads to cholecystitis, cholangitis, biliary colic, or pancreatitis. Herein, we present a case report of duplication of the gallbladder, which was difficult to diagnose on radiology. We report a case of a 35-year-old female who was admitted with acute gallstone pancreatitis. The diagnosis was made by magnetic resonance cholangiopancreatography (MRCP) and blood tests. She underwent an inpatient endoscopic retrograde cholangiopancreatography (ERCP) which cleared the bile duct and confirmed the diagnosis of the duplex gallbladder. The patient was then discharged home and an outpatient cholecystectomy is being planned.The duplex gallbladder may possibly be associated with other anomalies of the bile duct system. Biliary pancreatitis has been associated with such abnormality. Accurate diagnosis is crucial to achieving due to the possibility that gallbladder can be missed in imaging testing. Cholecystectomy required extreme care because these anomalies can lead to critical injuries of the bile duct and vascular system.

Inhibition of L-NAME-induced hypertension by combined treatment with apocynin and catalase: the role of Nox 4 expression

Reactive oxygen species (ROS) such as superoxide (O2-) generated by NAD(P)H oxidases have emerged as important molecules in blood pressure regulation. This study investigated the effect of apocynin and catalase on blood pressure and renal haemodynamic and excretory function in an L-NAME induced hypertension model. Forty Male Wistar-Kyoto (WKY) rats (n=8 per group) were treated with either: vehicle (WKY-C); L-NAME (WKY-L, 15 mg/kg/day in drinking fluid); WKY-L given apocynin to block NAD(P)H oxidase (WKY-LApo, 73 mg/kg/day in drinking water.); WKY-L given catalase to enhance ROS scavenging (WKY-LCat, 10000 U/kg/day i.p.); and WKY-L receiving apocynin plus catalase (WKY-LApoCat) daily for 14 days. L-NAME elevated systolic blood pressure (SBP), 116+/-1 to 181±4 mmHg, reduced creatinine clearance, 1.69+/-0.26 to 0.97+/-0.05 ml/min/kg and fractional sodium excretion, 0.84+/-0.09 to 0.55+/-0.09 % at day 14. Concomitantly, plasma malondialdehyde (MDA) increased six fold, while plasma total superoxide dismutase (T-SOD), plasma nitric oxide (NO) and plasma total antioxidant capacity (T-AOC) were decreased by 60-70 % and Nox 4 mRNA expression was increased 2-fold. Treatment with apocynin and catalase attenuated the increase in SBP and improved renal function, enhanced antioxidative stress capacity and reduced the magnitude of Nox4 mRNAs expression in the L-NAME treated rats. This study demonstrated that apocynin and catalase offset the development of L-NAME induced hypertension, renal dysfunction and reduced oxidative stress status, possibly contributed by a reduction in Nox4 expression during NOS inhibition. These findings would suggest that antioxidant compounds such as apocynin and catalase have potential in treating cardiovascular diseases.

Palmar psoriasis or missed BCC?-A case report

Case report

A 76-year-old Caucasian woman with a history of previous BCCs excised from the head and legs was referred from the dermatology team with a biopsy proven superficial BCC to the left palm. The patient had presented to the dermatology team with the same lesion 7 years prior to the definitive diagnosis. The lesion was described as 27 × 15 mm scaly, poorly-defined, plaque-like lesion to the central palm. There was no ulceration or visible telangiectasia. At the time, an initial diagnosis of psoriasis was given and she received several courses of topical treatments to no avail. Eventually, a biopsy was taken which revealed a multifocal superficial BCC. After unsuccessful attempts at treating with topical Imiquimod, the lesion was surgically excised and resurfaced with a full thickness skin graft.

Discussion

The current understanding that BCCs derive from cells of the hair follicle cannot explain their appearance on the palm. Alternative hypotheses have been proposed as to their actual origin which would account for this rare occurrence. Ultimately, histology can determine the nature of the lesion. We urge clinicians encountering atypical, non-healing lesions to glabrous skin to keep in mind a diagnosis of skin cancer as a delayed diagnosis can lead to increased morbidity.

Prevalence of hepatitis B virus infection among pregnant women in Jos, Nigeria

Objectives:

The study sought to determine the prevalence and risk factors associated with Hepatitis B surface antigenemia (HBsAg) positivity among pregnant women in Jos, Nigeria.

Methodology:

This was a cross-sectional study carried out among the pregnant population in five healthcare facilities in Jos, between November 1, 2017 and April 30, 2018. Informed consent was obtained, and data on sociodemographic and risk factors for hepatitis B virus (HBV) infection were collected. Hepatitis B viral infection was assessed using the in vitro HBsAg diagnostic rapid kit (Acon Laboratories, USA). Descriptive statistics, Chi-square test, and logistic regression were performed to identify predictors of HBV infection in the study population. All statistical analyses were carried out on STATA version 15.

Results:

Of the 3,238 women enrolled, 7.4% (241/3238) (95% confidence interval [CI] = 6.6% to 8.4%) were HBsAg positive. The absence of HBV vaccination (adjusted odds ratio [AOR] = 2.49; 95% CI = 1.49–4.09; P < 0.001), co-infection with HIV (AOR = 1.90; 95% CI = 1.18–3.08; P = 0.009), and higher parity (AOR = 1.37; 95% CI = 1.04–1.79; P = 0.024) were independently associated with HBV infection in pregnancy.

Conclusions:

The prevalence of HBV infection among pregnant women was high, especially among those without prior vaccination for HBV, those with HIV co-infection and higher parity.

Self-Treatment with Antibiotics: Knowledge level, Prevalence and Indications for Practicing Among University Students in Jordan

BACKGROUND

Self-treatment with antibiotics involves obtaining medicines without a prescription, sharing medicines with members of one's social circle, or using leftover medicines stored at home.

OBJECTIVE

Assess the prevalence, knowledge level, reasons for practicing self-treatment of antibiotic among undergraduate university students.

METHODS

The study was conducted cross-sectional on a sample of 201 students. A pre-validated questionnaire called "self-treatment with antibiotics", containing 27 close-ended questions, was administered to each subject. Data were analyzed using SPSS version 16 and the results were expressed as counts and percentages.

RESULTS AND DISCUSSION

Knowledge about self-treatment with antibiotics was good in general, and health-related students had a better level of knowledge about self-treatment with antibiotics than non-health-related students. The majority of the participants had not used self-treatment with antibiotics. Gender, age, and the last time antibiotic taken affected self-treatment with antibiotics. The most common indication for self-treatment with antibiotics was flu, cold, and tonsillitis. The most common reason for practicing self-treatment with antibiotics was being considered as a convenient and rapid solution. Internet was the main source for university students regarding knowledge about antibiotic use and resistance.

CONCLUSION

Self-treatment with antibiotics is affected by several social and demographic variables, and the role of media, public policies, university curricula as well as physicians and pharmacists should be enforced and activated to eliminate inappropriate uses of antibiotics and to correct misconceptions that encourage self-treatment with antibiotics.

The first two months epidimiological study of COVID-19, related public health preparedness, and response to the ongoing epidemic in Pakistan

As an underdeveloped country, the coronavirus disease 2019 (COVID-19) epidemic has posed a major risk to the health and economy of Pakistan. The SIR (susceptible-infected-recovered) model of epidemiologic analysis predicts that there should have been more cases since late March 2020 in Pakistan. We therefore sought to investigate COVID-19's prevalence and epidemiologic trends in Pakistan. Research for COVID-19 is still in its early stages, so data were collected from official websites and research journals, then analyzed for the disease's prevalence, epidemiology, mortality and recoveries. The results indicated that a rapid increase had indeed occurred in the number of COVID-19 infections in Pakistan, with the first case reported on 25 February, 2020. From 25 February 25 to April, 2020, COVID-19 infected 11,155 people in Pakistan, with 237 deaths (2.12%) and 2527 recoveries (19.96%). We found a statistically significant positive correlation between the prevalence of COVID-19 and the mortality ratio (r = 0.983, r 2 = 0.966; p ≤ 0.05). We concluded that proper management must be undertaken to improve the quarantine system, and the World Health Organization guidelines must be closely followed to cope with COVID-19. There is no vaccine for COVID-19, so antiviral drugs (interferon alfa, ribavirin) may be useful to prevent COVID-19; however, severe control measures implemented in China have significantly mitigated the spread of COVID-19. Suspected and confirmed cases must be treated in separate rooms. Staying home and social distancing are the safe way to proceed.

An investigative study of antitumor properties of a novel thiazolo[4,5-d]pyrimidine small molecule revealing superior antitumor activity with CDK1 selectivity and potent pro-apoptotic properties

New thiazolo[4,5-d]pyrimidine analogues were synthesized and biologically assessed in-vitro for their antineoplastic activity. The growth inhibitory effects of these compounds were assessed through the National Cancer Institute-United States of America (NCI-USA) anticancer screening program. Compound5(7-Chloro-3-(2,4-dimethoxyphenyl)-5-methylthiazolo[4,5-d]pyrimidine-2(3H)-thione) was found to have a potent and broad-spectrum cytotoxic action against NCI panel with GI₅₀ (50% growth inhibition concentration) mean graph midpoint (MG-MID) = 2.88 µM. MTT assay was used to determine IC₅₀ values of the most potent agent against HCT-116 colorectal carcinoma and WI-38 human lung fibroblast cell lines; 5.33 µM ± 0.69 and 21.69 µM ± 1.04, respectively. Flow cytometric analysis revealed that compound5triggered apoptosis and G2/M cell cycle arrest. The ability of compound5to inhibit CDK1 (Cyclin-Dependent Kinase 1)/Cyclin B complex was evaluated, and its IC₅₀ value was 97 nM ± 2.33. Moreover, according to the gene expression analysis, compound5up-regulated p53, BAX, cytochrome c, caspases-3,-8 and-9 besides down-regulated Bcl-2. In conclusion, compound5exerted a potent pro-apoptotic activity through the activation of the intrinsic apoptotic pathway and arrested the cell cycle at the G2/M phase.

Fetomaternal Outcome of Pregnancy in Women with Tetralogy of Fallot

This prospective study was done to determine fetomaternal outcomes of pregnancy in women with Tetralogy of Fallot (TOF) and carried out in two centres especially in the care of patients with adult congenital heart disease (CHD) from January 2005 to December 2009. Clinical, haemodynamic and obstetric data were reviewed for pregnant women with TOF. Ten (10) pregnant women were identified in the age range 18 to 47 years. Most of the patients were in the age group of 18 to 27 years, 34 to 36 weeks gestational age (in week) and primi gravida (60%). Right-sided aortic arch (20%) and major anomalies of pulmonary collaterals (30%) were common anomalies anatomical association. Normal vaginal delivery was the mode of delivery (70%) in the majority of the patients. Spontaneous abortions were occurred in 3(30%) patients. Primary maternal cardiac events complicating pregnancies were congestive heart failure (20%), arrhythmias and cardiovascular events (10%). Premature labor (40%) was the most common obstetric complication. Premature birth (40%), fetal demise (20%), neonatal death (10%) and cardiac anomaly at birth (10%) were the offspring complications in the study. Women with TOF can go through pregnancy with a low risk to themselves with frequent treatable complications, but there is a high incidence of miscarriage, premature births and low birth weight. An incidence of congenital anomaly in the fetus is higher than that found in the normal population.

Histone H3K27M Mutation Overrides Histological Grading in Pediatric Gliomas

Pediatric high-grade gliomas (HGG) are rare aggressive tumors that present a prognostic and therapeutic challenge. Diffuse midline glioma, H3K27M-mutant is a new entity introduced to HGG in the latest WHO classification. In this study we evaluated the presence of H3K27M mutation in 105 tumor samples histologically classified into low-grade gliomas (LGG) (n = 45), and HGG (n = 60). Samples were screened for the mutation in histone H3.3 and H3.1 variants to examine its prevalence, prognostic impact, and assess its potential clinical value in limited resource settings. H3K27M mutation was detected in 28 of 105 (26.7%) samples, and its distribution was significantly associated with midline locations (p-value < 0.0001) and HGG (p-value = 0.003). Overall and event- free survival (OS and EFS, respectively) of patients with mutant tumors did not differ significantly, neither according to histologic grade (OS p-value = 0.736, EFS p-value = 0.75) nor across anatomical sites (OS p-value = 0.068, EFS p-value = 0.153). Detection of H3K27M mutation in pediatric gliomas provides more precise risk stratification compared to traditional histopathological techniques. Hence, mutation detection should be pursued in all pediatric gliomas. Meanwhile, focusing on midline LGG can be an alternative in lower-middle-income countries to maximally optimize patients' treatment options.

Survival of antibiotic resistant Escherichia coli in vacuumpacked keropok lekor: Food safety alert among SME keropok lekor producers

The microbiological quality of thirty ready-to-eat (RTE) keropok lekor (a sausage shape Malaysian fish product) was evaluated in comparison to microbiological guidelines for ready to eat foods. The two E. coli isolates were subjected to DNA sequencing, identified and tested for their resistance towards fifteen different antibiotics. The survival and growth of the isolated E. coli strains inoculated in keropok lekor at atmospheric air and vacuum packaging were also evaluated. Results revealed that four samples (13.33%) contained Enterobacteriaceae counts that exceeded the recommended allowable counts of 4.0 log₁₀ CFU/g. Unsatisfactory level of coliforms (< 1.7 log₁₀ CFU/g) was also observed in ten of the samples; two of which contained E. coli (2.1 ± 0.17 and 3.7 ± 0.02 log₁₀ CFU/g), suggesting of poor hygiene and sanitation practices. While the 'Possible E10' E. coli strain was observably resistant towards Nalidixic acid (30µg) alone, B10 E. coli isolate was worryingly resistant towards Ampicillin (10µg), Ceftazidime (30µg), Ciprofloxacin (5µg), Ceftriaxone (30µg), Nalidixic acid (30µg) and Tetracycline (30µg). This study also revealed that the growth and survival of the 'Possible E10' and B10 E. coli strains were not significantly affected by vacuum packaging when stored at both 4°C and 28°C. Therefore, intervention programmes to alert and educate smallmedium enterprisers (SMEs) of keropok lekor producers on food safety as well as potential health risks that can be associated due to inappropriate handling procedures of such product, merits consideration.

Esculent coating of spider silk enhanced the preservation and shelf life of apricot

Abstract According to the Food and Agriculture Organization (FAO), roughly one-third of the total food produced is lost globally. The major cause of this wastage is the perishability of fruits and vegetables. Therefore, researchers have endeavored to develop an effective preservation technique. Our study explored the potential application of spider silk as an odourless and edible preservative coating for fruits. The spider silk was collected from spiders reared in the laboratory, following by degumming and dissolution to formulate the silk solution. For this study, apricots were selected as the model fruit. The apricots were dip coated with the formulated silk solution and allowed to dry. In order to enhance the beta sheet content of the silk coating, the fruits were exposed to water annealing for varying intervals of time under vacuum condition. The effect of silk coating and water annealing time period on preservation of fruits was then evaluated morphologically and gravimetrically. The results showed that the fruits, which were used as control, exhibited a greater degree of water loss and suffered from fungal attack. In contrast, the silk coated fruits showed less water loss and were protected from fungal attack. Therefore, the study provides compelling evidence regarding the application of spider silk as a preservative coating.