Molecular study of Helicobacter pylori virulence genes CagA, Hpa and BabA2 in Egyptian patients

Objective: The objective of this study was to detect virulence genes of Helicobacter pylori (H.pylori) cagA, babA2 and hpa in gastric biopsies from patients with different stages of gastritis by polymerase chain reaction to correlate the presence of genes with the severity of the diseases.Method: A total of 80 non repetitive gastric biopsies from antrum of the stomach were obtained from the patients and subjected to study for histological examination, unease activity, culture for H.pylori, and polymerase chain reaction studies of virulence genes cagA, babA2 and hpa.Results: The most frequent detected gene by PCR was hpa (66.7%) and followed by cagA and babA2 (61.6%) for each. There was significant association between the three genes (P=0.0001). The study of the association between the virulence gene of H.pylori and different clinical symptoms revealed significant association of dyspepsia with cagA(P=0.001) babA2 and hpa (P=0.0001), regurgitation with cagA and babA2( P=0.002),vomiting with cagA and babA2 (P=0.01, P=0.002, respectively) and nausea with cagA and babA2 (P=0.0001, P=0.03, respectively). The virulence genes were detected in gastric ulcer. The degree of inflammation in histopathological examination was also statistically significant associated with the presence of virulences genes cagA (P=0.01), babA2 (p=0.0001) and hpa (P=0.0001)The present study highlights the presence of virulence genes in H.pylori associated with gastric ulcer. The genes cagA, babA2 and hpa are prevalent among the strains affecting the patients. Moreover, these genes are associated with marked clinical and pathological severity. The genes are significantly associated with each other. Further studies are recommended to validate these findings.Keywords: Gastritis, Genotypes, H.pylori, cagA, babA2, hpa, PC

Evaluation of the antioxidant and antimicrobial activities of the spent coffee extracts and their applications as natural food preservatives of chicken fillets

The present study aimed at evaluating the phytochemical composition, antioxidant, and antimicrobial potentials of spent coffee extracts (SCE) to use these extracts as natural preservatives of food. The effectiveness of SCE in postponing the oxidation and extending the shelf life of chicken fillets through delaying the microbial growth were investigated. Spent coffee was collected and extracted using water and ethanol. The extracts were analyzed for their bioactive components using Gas chromatography-mass spectrometry (GC/MS) and antioxidant properties using different spectrophotometric assays. The detected bioactive components were mainly fatty acids (80 %), flavonoids, terpenoids and caffeine (5.4 %). Spent coffee ethanolic extract was richer in its active components than the aqueous one. Additionally, the in vitro antibacterial efficacy of the extracts against several food-borne bacterial strains revealed that spent coffee ethanolic extract was effective against all the tested bacteria with inhibitory percentages ranging from 34.62 to 66.69 %, whereas the aqueous extract expressed an inhibitory effect only against Salmonella typhimurium (35.82 %). To assess the practical utility of SCE as food preservatives, chicken fillets were treated with SCE at two levels (0.1 % and 0.2 %) and butylated hydroxytoluene (BHT, 0.02 %) was used as a synthetic preservative. The antioxidant and microbiological attributes of the SCE treated chicken fillets were investigated at 3 d intervals for 15 d. The results showed that inclusion of SCE enhanced the chicken fillets antioxidant properties and microbiological characteristics. Furthermore, the chicken fillets treatments succeeded in stopping the rise of the total bacterial count, with no Salmonella sp. or fungal contamination, and additionally, the overall total coliform was less than 102 cfu/ g; indicating their safety for human consumption. In conclusion, this study proved that spent coffee-treated chicken fillets exhibited extended shelf life through delaying the microbial spoilage and maintaining the antioxidant quality

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background: Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods: The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results: A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion: Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05-1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4-7 days or ≥ 8 days of 1.25 (1.04-1.48), p = 0.015 and 1.31 (1.11-1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries