Antibacterial and antifungal activities of the extract and fractions of aerial parts of Heliotropium bacciferum

Background: H. bacciferum belonging to the family Boraginaceae is an important medicinal plant. The current research was carried out to investigate the medicinal properties of this plant.Methodology: The crude (methanol fraction) and n-hexane, ethyl acetate, butanol and aqueous fractions were subjected to antibacterial and antifungal activities by using standard methodology available in literature. Bacterial strains of Salmonella typhi, Escherichia coli, Pseudomonas Aeroginosa, Staphylococcus aureus, Erwinia carotovora, Klebsiella Pneumoniae, Bacillus subtilis and Bacillus atrophaeus were used for antibacterial activity.Results: All the fractions were active against different bacterial strains but n-hexane and ethyl acetate showed (Zone of inhibition ranged from 18-30 mm) highest activity. The fungal strains, Trichoderma longibrachiantum, Aspergillus flavus, Aspergillus niger, Fusarium solani and Candida albican were used for antifungal activity. Excellent inhibitory effect was observed against all fungal strains. The minimum inhibitory concentration (MIC) against various fungal strains was determined. The minimum inhibitory concentrations (MICs) of the investigated plant fractions ranged from 0.5- 2.00 mg/ml.Conclusion: The plant showed significant antibacterial and antifungal activities. All tested plant extracts exhibit activities against different fungal strains. The result against various microorganisms shows the therapeutic potential of the plant H. bacciferumKeywords: H. bacciferum, Medicinal Plant, crude fractions, Antimicrobial activities

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Smart nanocrystals of artemether: fabrication, characterization, and comparative in vitro and in vivo antimalarial evaluation

Syed Muhammad Hassan Shah,1 Farhat Ullah,2 Shahzeb Khan,2,3 Syed Muhammad Mukarram Shah,4 Marcel de Matas,5 Zahid Hussain,6 Muhammad Usman Minhas,7 Naser M AbdEl-Salam,8 Khaled Hafez Assi,3 Mohammad Isreb3 1Department of Pharmacy, Sarhad University of Science &amp; Information Technology, Peshawar, 2Department of Pharmacy, University of Malakand, Chakdara, Pakistan; 3Institute of Life Sciences Research, School of Pharmacy, University of Bradford, West Yorkshire, 4Department of Pharmacy, University of Swabi, KPK, Pakistan; 5SEDA Pharmaceutical Development Services, The BioHub at Alderley Park, Cheshire, UK; 6Faculty of Pharmacy, Department of Pharmaceutics, Universiti Teknologi MARA, Selangor, Malaysia; 7Faculty of Pharmacy &amp; Alternative Medicine, The Islamia University of Bahawalpur Pakistan, Bahawalpur, Pakistan; 8Riyadh Community College, King Saud University, Riyadh, Saudi Arabia Abstract: Artemether (ARTM) is a very effective antimalarial drug with poor solubility and consequently low bioavailability. Smart nanocrystals of ARTM with particle size of 161&plusmn;1.5&nbsp;nm and polydispersity index of 0.172&plusmn;0.01 were produced in &lt;1&nbsp;hour using a wet milling technology, Dena&reg; DM-100. The crystallinity of the processed ARTM was confirmed using differential scanning calorimetry and powder X-ray diffraction. The saturation solubility of the ARTM nanocrystals was substantially increased to 900&nbsp;&micro;g/mL compared to the raw ARTM in water (145.0&plusmn;2.3&nbsp;&micro;g/mL) and stabilizer solution (300.0&plusmn;2.0&nbsp;&micro;g/mL). The physical stability studies conducted for 90&nbsp;days demonstrated that nanocrystals stored at 2&deg;C&ndash;8&deg;C and 25&deg;C were very stable compared to the samples stored at 40&deg;C. The nanocrystals were also shown to be stable when processed at acidic pH (2.0). The solubility and dissolution rate of ARTM nanocrystals were significantly increased (P&lt;0.05) compared to those of its bulk powder form. The results of in vitro studies showed significant antimalarial effect (P&lt;0.05) against Plasmodium falciparum and Plasmodium vivax. The IC50 (median lethal oral dose) value of ARTM nanocrystals was 28- and 54-fold lower than the IC50 value of unprocessed drug and 13- and 21-fold lower than the IC50 value of the marketed tablets, respectively. In addition, ARTM nanocrystals at the same dose (2&nbsp;mg/kg) showed significantly (P&lt;0.05) higher reduction in percent parasitemia (89%) against P. vivax compared to the unprocessed (27%), marketed tablets (45%), and microsuspension (60%). The acute toxicity study demonstrated that the LD50 value of ARTM nanocrystals is between 1,500&nbsp;mg/kg and 2,000&nbsp;mg/kg when given orally. This study demonstrated that the wet milling technology (Dena&reg; DM-100) can produce smart nanocrystals of ARTM with enhanced antimalarial activities. Keywords: artemether, milling, smart nanocrystals, nanosuspension, in vitro dissolution, antimalarial activit