The effects of unilateral varicose ovarian vein on antioxidant capacity and oocyte quality in rat ovary

Several researchers have reported the relationship between infertility in male and varicocele for so many years but the implication of varicocele in female patients is remains elusive. Here, we aim to examine the effects of unilateral varicose ovarian vein on antioxidant capacity and oocyte quality of rat ovary after the experimental creation of varicocele in female rats. Materials and Methods: In this study, thirty adult female albino rats were divided into three equal groups: Group 1 as the control group has 10 rats, Group 2 as the sham group has 10 rats and they underwent a sham operation and finally Group 3 has the varicocele group has 10 rats. Antioxidant assays for superoxide dismutase, glutathione peroxidase and catalase were performed using specific assay kits and gene expression for Bax, Bmp-15, Hsp-27 and Gdf-9 was done via real time PCR. Results: The adverse effects of the experimentally induced varicocele were reported and recorded on the left ovary compared to the right sided ovary (no varicocele induction) in the varicocele group. Real time PCR data shows that the expression of Gdf-9, Hsp-27 and Bmp-15 genes were all significantly reduced at p≤ 0.05. Conclusion: The results of this study show that reduced gene expression of Bmp-15, Gdf-9 and Hsp-27, increased gene expression of bax and an imbalance between pro-oxidant/ antioxidant ratio are few of the several mechanisms by which varicocele may lead to infertility in female

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Global, regional, and national sepsis incidence and mortality, 1990–2021: a systematic analysis

BACKGROUND: The global burden of sepsis, a life-threatening dysregulated host response to infection leading to organ dysfunction, remains challenging to quantify. We aimed to comprehensively estimate the global, regional, and national burden of sepsis, including the impact of the COVID-19 pandemic and underlying causes of sepsis-related deaths with co-occurring infectious syndromes. METHODS: We used multiple cause-of-death, hospital, minimally invasive tissue sampling, and linked death certificate and hospital record data representing 149 million deaths, covering 4290 location-years with mortality estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 to capture explicit and implicit sepsis cases and deaths. We estimated age-location-sex-specific fractions of sepsis-related deaths from 195 underlying causes of death and 22 infectious syndromes from 1990 to 2021 using binomial logistic regression models, and estimated sepsis-related deaths using GBD cause-specific mortality estimates. Using 250 million hospital admissions and 7·82 million deaths from hospital data, representing 1310 location-years, we modelled case fatality rates by use of binomial logistic regression, applied to sepsis death estimates to estimate sepsis incidence by age, location, and year. FINDINGS: In 2021, we estimated 166 million (95% uncertainty interval 135-201) sepsis cases and 21·4 million (20·3-22·5) all-cause sepsis-related deaths globally, representing 31·5% of total global deaths. Sepsis-related deaths decreased between 1990 and 2019, followed by a surge in 2020 and 2021. As of 2021, individuals aged 15 years and older experienced increases across incidence (230%) and mortality (26·3%) since 1990. Those aged 70 years and older had the highest sepsis-related mortality in 2021 (9·28 million [8·74-9·86] deaths). Sepsis-related deaths from infectious underlying causes decreased from 11·8 million (11·1-12·5) in 1990 to 8·34 million (7·72-9·01) in 2019, then increased by 86·4% to 15·5 million (14·7-16·4) in 2021. Sepsis-related mortality due to non-infectious underlying causes of death increased from 4·69 million (4·35-5·05) in 1990 to 5·81 million (5·40-6·25) in 2021; the leading non-infectious underlying causes of death with sepsis were stroke, chronic obstructive pulmonary disease, and cirrhosis. In 2021, bloodstream infections inclusive of HIV and malaria (3·08 million [2·83-3·35]) and lower respiratory infections inclusive of COVID-19 (11·33 million [1·20-1·47]) were the most prominent infectious syndromes complicating sepsis-related deaths from non-infectious underlying causes, representing a consistent trend since 1990. INTERPRETATION: The global burden of sepsis increased in 2020 and 2021, reversing progress from 1990. Sepsis incidence and mortality increased in people aged 15 years and older, especially those aged 70 years and older, and as a complication of non-infectious underlying causes of death such as stroke, primarily through bloodstream infections and lower respiratory infections. The global burden of sepsis is substantial, and sepsis is increasingly a complication of non-infectious causes of death. FUNDING: Gates Foundation, Wellcome Trust, and Department of Health and Social Care using UK aid funding managed by the Fleming Fund

ACE Gene Polymorphism in Coronary Artery Disease in West Bank, Palestine

Heart disease is the most hazardous chronic disease that leads to death worldwide. Hypertension is one of the most risk factors that leads to CVD. This study has been conducted to examine the relationship between a genetic polymorphism in the angiotensin gene and coronary heart disease, and the correlation of this polymorphism with environmental and nutritional risk factors. A case-control study has been conducted involving 100 CAD patients and 100 healthy individuals as a control group. DNA was isolated from patient\u27s peripheral blood, and angiotensin-converting enzyme (ACE) I/D gene polymorphism was assayed by polymerase chain reaction (PCR). The results showed that the ACE I/D polymorphism distribution was as follows: Genotype frequencies of DD, II, and DI among cases were 0.42, 0.21, 0.37; respectively. There was a significant association between the studied environmental and nutritional factors and the incidence of CAD I/D especially BMI (≥ 25), cigarette smoking, and family history. The general health level of society can be improved by modifying lifestyle like eating DASH diet (dietary approach to stop hypertension), increasing physical activity and avoiding smoking and processed food. The study emphasizes the possibility of early detection of heart disease risk by using the ACE gene polymorphism test

Desalination Pretreatment Technologies: Current Status and Future Developments

Pretreatment of raw feed water is an essential step for proper functioning of a reverse osmosis (RO) desalination plant as it minimizes the risk of membrane fouling. Conventional pretreatment methods have drawbacks, such as the potential of biofouling, chemical consumption, and carryover. Non-conventional membrane-based pretreatment technologies have emerged as promising alternatives. The present review focuses on recent advances in MF, UF, and NF membrane pretreatment techniques that have been shown to be effective in preventing fouling as well as having low energy consumption. This review also highlights the advantages and disadvantages of polymeric and ceramic membranes. Hybrid technologies, which combine the benefits of conventional and non-conventional methods or different membranes, are also discussed as a potential solution for effective pretreatment. The literature that has been analyzed reveals the challenges associated with RO pretreatment, including the high cost of conventional pretreatment systems, the difficulty of controlling biofouling, and the production of large volumes of wastewater. To address these challenges, sustainable hybrid strategies for ceramic membrane-based systems in RO pretreatment are proposed. These strategies include a thorough assessment of the source water, removal of a wide range of impurities, and a combination of methods such as adsorption and carbon dioxide with a low amount of antiscalants. Furthermore, the suggestion of incorporating renewable energy sources such as solar or wind power can help reduce the environmental impact of the system. A pilot study is also recommended to overcome the difficulties in scaling ceramic systems from laboratory to industrial scale. The review also emphasizes the importance of conducting an effective assessment to suggest a treatment for the brine if needed before being discharged to the environment. By following this framework, sustainable, energy-efficient, and effective solutions can be recommended for pretreatment in desalination systems, which can have significant implications for water scarcity and environmental sustainability

N-PASS Versus mPAT in Assessment and Management of Neonatal Pain at Neonatal ICUs in Palestine

Background: Neonates frequently experience pain as a result of diagnostic or therapeutic interventions or as a result of a disease process. Neonates cannot verbalize their pain experience and depend on others to recognize, assess and manage their pain. Neonates may suffer immediate or long-term consequences of unrelieved pain. Accurate assessment of pain is essential to provide adequate management. Observational scales, which include physiological and behavioral responses to pain, are available to aid consistent pain management. Pain assessment is considered as the fifth vital sign. Objectives: Aims of the present study were (1) to compare two commonly cited neonatal pain assessment tools, Neonatal Pain, Agitation and Sedation Scale (N-PASS) and modified Pain Assessment Tool (mPAT), with regard to their psychometric qualities, (2) to explore intuitive clinicians' ratings by relating them to the tools' items and (3) to ensure that neonates receive adequate pain control. Methods: Two coders applied both pain assessment tools to 850 neonates while undergoing a painful or a stressful procedure. Each neonate was assessed before, during and after the procedure. The evaluation before and after the procedure was done using NPASS, while pain score during the procedure was assessed by mPAT. Analyses of variances and regression analyses were used to investigate whether tools could discriminate between the procedures and whether tools' items were predictors of pain severity. Results: Internal consistency, reliability and validity were high for both assessment tools. N-PASS tool discriminated between painful and stressful situations better than mPAT. There was no relation between the age of neonate and the pain score. Moreover, P-value was statistically significant between mPAT score and post procedural assessment score as well as between pre and post procedural assessment scores. Conclusion: Both assessment tools performed equally well regarding physiologic parameters. However, N-PASS makes it possible to assess pain during sedation. It was noticed that gaps exist between practitioner knowledge and attitude regarding neonatal pain.</jats:p

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit