Embryoid induction and plantlet regeneration from leaf segments of sugarcane (Saccharum officinarum L.)

     Sugarcane (Saccharum officinarum L.) is an economically important crop in Sudan for domestic consumption and export. It is the first and essential source for production of high purity sugar. Tissue culture techniques can be used for in vitro conservation of sugarcane (Taylor and Dukic, 1993) and mass propagation of elite cultivars of crop species. Moreover, it was used for production of pathogen-free planting material from infected mother plants. Variability induced in vitro can furnish a base for improvement of vegetatively propagated crops including sugarcane. Different tissue culture techniques were applied successfully to sugarcane propagation and plant regeneration through organogenesis of shoot meristem (Nadar and Heinz, 1977; Ho and Vasil, 1983a), cell suspension cultures (Ho and Vasil, 1983b, Aftab et al., 1996) and protoplast cultures ( Liu, 1994). Cell suspen - Sion cultures were also used for cytological, pathological (Peros and Lombard, 1992), biochemical and physiological investigations of sugarcane (Heinz et al., 1977).      This study was initiated, during 1998-2000, to investigate the effect of 2,4-D on induction of embryogenic callus from leaf explants of sugarcane and regeneration of somatic embryos on different concen-trations of Murashige and Skoog (1962) medium (MS)

Effect of cytokinins and auxins on micropropagation of shoot tip and nodal explants of two cultivars of sweet potato (Ipomoea batatas (L) Lam)

     In vitro propagation of two selected cultivars of sweet potato (Ipomoea batatas (L) Larn), Baladi White (BW) and Nigerian (N) were investigated using shoot tips and nodal explants during the period March, 1997 to July, 1998. Shoot regeneration from both cultivars was best on Murashige and Skoog (1962) medium without plant growth regulators. Morphogenetic response varied with the different types of explants and genotypes of sweet potato. Shoot morphogenesis from the sweet potato cv. BW was better than that from cv. N. Shoot tip explant was better for in vitro propagation of sweet potato cv. N. , while nodal cuttings were. better for cv. BW. The shoot regeneration rate induced on benzylaminopurine (BAP) was higher than that on kinetin. BAP in combination with naphthalene acetic acid (NAA) resulted in shoot and root morphogenesis from nodal explants of the sweet potato cv. N. The best shoot length was found on Murashige and Skoog medium (MS) supplemented with NAA at both 0.25 and 1.0 mg/l combined with 0.5 mg/l BAP

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

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

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

The First Multidisciplinary Heart Failure Clinic in Sudan: A Descriptive Report

Outcomes for patients with heart failure (HF) remain suboptimal worldwide, despite the national and International guidelines. A disease management program such as a multidisciplinary (MD) team HF clinic proved to be one of the effective strategies to improve patients' outcomes. In June 2018, the first MD-HF clinic was opened at Ahmed Gasim Cardiac Surgery and Renal Transplantation Center, Khartoum, Sudan. This focused report aims to share our experience and pave the way for such an approach for cardiac and other specialty services that may require MD-specialized clinics. We provide a detailed report of the MD team, structure, facilities, and plans of the HF clinic, which may be considered as a nucleus for an advanced HF program and heart transplant in Sudan