Lawsonia inermis seeds cotyledon and coat extracts as a potential antimicrobial agent

Background: The plant Lawsonia inermis, which is a member of the Lythraceae family, has long been used to cure a number of diseases. Previous studies have demonstrated the antibacterial capabilities of the plant's components. However, neither the efficiency of these extracts on bacterial strains that are antibiotic-resistant nor a systematic analysis of the extracts from the various seed components have been conducted. Methods: The coat part was separated from the cotyledon. Each part was pulverized and extracted with ethanol, acetone, and hexane. The inhibitory effects of the resulting extracts were tested on three pathogenic bacterial strains and a fungus. The effect of the extracts on antibiotic-resistant bacteria was also evaluated.Results: When tested against pathogenic bacteria (Bacillus subtilis, Staphylococcus aureus, Klebsiella pneumonia, and Candida albicans), L. inermis seed parts (cotyledon and coat) showed varying levels of antibacterial and antifungal activity. In which the ethanolic extract outperformed the acetonic extract in effectiveness. The minimal inhibitory concentration (MIC) for each pathogenic microorganism was established. Utilizing the extract yield, total antibacterial activity (TAA) was calculated. Lawsonia inermis seed components inhibited antibiotic-resistant strains of S. aureus and P. aeruginosa, with strong antibacterial activity seen in aqueous extracts of their cotyledons and coats.Conclusion: We summarize that Lawsonia inermis seed extracts, which have historically been used as secure antimicrobials for human healthcare and cosmetics have the potential to replace current antimicrobial agents that are no longer effective. Moreover, may be a promising source for the isolation of potent drugs for the treatment of bacterial diseases.Keywords: Lawsonia inermis; Henna; Extract; Seeds; Bacterial Infection; Antibiotics Resistance   

Dark energy problem: from phantom theory to modified Gauss-Bonnet gravity

The solution of dark energy problem in the models without scalars is presented. It is shown that late-time accelerating cosmology may be generated by the ideal fluid with some implicit equation of state. The universe evolution within modified Gauss-Bonnet gravity is considered. It is demonstrated that such gravitational approach may predict the (quintessential, cosmological constant or transient phantom) acceleration of the late-time universe with natural transiton from deceleration to acceleration (or from non-phantom to phantom era in the last case).Comment: LaTeX 8 pages, prepared for the Proceedings of QFEXT'05, minor correctons, references adde

Interacting holographic dark energy model and generalized second law of thermodynamics in non-flat universe

In the present paper we consider the interacting holographic model of dark energy to investigate the validity of the generalized second laws of thermodynamics in non-flat (closed) universe enclosed by the event horizon measured from the sphere of the horizon named $L$. We show that for $L$ as the system's IR cut-off the generalized second law is respected for the special range of the deceleration parameter.Comment: 11 pages, no figure

Screening of cosmological constant for De Sitter Universe in non-local gravity, phantom-divide crossing and finite-time future singularities

We investigate de Sitter solutions in non-local gravity as well as in non-local gravity with Lagrange constraint multiplier. We examine a condition to avoid a ghost and discuss a screening scenario for a cosmological constant in de Sitter solutions. Furthermore, we explicitly demonstrate that three types of the finite-time future singularities can occur in non-local gravity and explore their properties. In addition, we evaluate the effective equation of state for the universe and show that the late-time accelerating universe may be effectively the quintessence, cosmological constant or phantom-like phases. In particular, it is found that there is a case in which a crossing of the phantom divide from the non-phantom (quintessence) phase to the phantom one can be realized when a finite-time future singularity occurs. Moreover, it is demonstrated that the addition of an $R^2$ term can cure the finite-time future singularities in non-local gravity. It is also suggested that in the framework of non-local gravity, adding an $R^2$ term leads to possible unification of the early-time inflation with the late-time cosmic acceleration.Comment: 42 pages, no figure, version accepted for publication in General Relativity and Gravitatio

Finite-time future singularities in modified Gauss-Bonnet and F(R,G)\mathcal{F}(R,G) gravity and singularity avoidance

We study all four types of finite-time future singularities emerging in late-time accelerating (effective quintessence/phantom) era from $\mathcal{F}(R,G)$-gravity, where $R$ and $G$ are the Ricci scalar and the Gauss-Bonnet invariant, respectively. As an explicit example of $\mathcal{F}(R,G)$-gravity, we also investigate modified Gauss-Bonnet gravity, so-called $F(G)$-gravity. In particular, we reconstruct the $F(G)$-gravity and $\mathcal{F}(R,G)$-gravity models where accelerating cosmologies realizing the finite-time future singularities emerge. Furthermore, we discuss a possible way to cure the finite-time future singularities in $F(G)$-gravity and $\mathcal{F}(R,G)$-gravity by taking into account higher-order curvature corrections. The example of non-singular realistic modified Gauss-Bonnet gravity is presented. It turns out that adding such non-singular modified gravity to singular Dark Energy makes the combined theory to be non-singular one as well.Comment: 35 pages, no figure, published version, references adde

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

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 &lt; 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

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10&nbsp;years; 78.2% included were male with a median age of 37&nbsp;years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020