Antioxidant activity of different extracts of red pitaya (Hylocereus polyrhizus) seed

Antioxidant activity of three different extracts (ethanolic, chloroformic, and hexanic) of red flesh pitaya (Hylocereus polyrhizus) seed using free radical scavenging assay, linoleic acid model system, and ferric thiocyanate (FTC) method was determined. Ethanolic extract inhibit 74.76% of free radicals at 1000 μg/mL, while chloroformic extract gave the highest inhibition using linoleic acid model system (98.90% at 100 μg/mL) and FTC (96.34%) method. Total phenolic and ascorbic acid contents of the seed were 13.56 ± 2.04 and 0.36 ± 0.01 mg/g, respectively, while catechin was the major flavonoid detected. In conclusion, the study showed that both polar and non-polar compounds contribute to the antioxidative activity measured

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Antioxidant activities from pulp, peel and seed of white [Hylocereus undatus (HAW.) Britton & Rose] and red flesh pitaya [Hylocereus polyrhizus (F.A.C. Weber) Britton & Rose]

Consumption of fruits and vegetables is important in maintaining good health as being proven by many studies. Their functional qualities as natural antioxidant, antimicrobial and anticancer were the common interest among researchers. Best known for its betacyanin pigments, pitaya fruit gained a lot of attention recently in investigating its functional properties. Hence, this study was conducted to determine the bioactive compounds (total phenolic, betacyanin, ascorbic acid, flavonoids and tocopherols) and antioxidant activity [2,2-diphenyl-1-picrylhydrazyl (DPPH) free radical scavenging,conjugated diene and ferric thiocyanate (FTC)] of pulp, peel and seed of white (Hylocereus undatus) and red flesh pitaya (H. polyrhizus). Evaluations of antioxidant activity were carried out against the samples that were extracted using ethanol, chloroform and hexane. The chemical profiling of the selected extracts were then determined using gas chromatography-mass spectrometry (GC-MS). Seed of white and red flesh pitaya gave significantly (p<0.05) higher amount of total phenolic compounds but the least in betacyanin and ascorbic acid content in comparison to the pulp and peel. All flavonoids (catechin, epicatechin, myricetin and quercetin) tested were present in peel and seed of both types of pitaya fruits except for kaempferol while only catechin was detected in both pulps. Antioxidant activity of ethanol extract from red flesh pitaya pulp was significantly (p<0.05) higher than that of white flesh as determined by all the three different methods of antioxidant determination. The ethanol, chloroform and hexane extracts of peel and seed gave the same trend between the white and red flesh pitaya. Hexane extracts of peel gave the highest free radical scavenging activity as compared to that of ethanol and chloroform. However, there is no significant difference among all the extracts as determined by conjugated diene and FTC assay methods. On the other hand, ethanol extracts of the red flesh pitaya seed exhibited the highest antioxidant activity in comparison to other extracts and the seed of white flesh pitaya. Based on their high antioxidant activities, hexane extracts of both white and red flesh pitaya peel and ethanol extract of red flesh pitaya seed were selected to undergo fractionation and GC-MS analysis. Various compounds such as tocopherols, squalene and phytosterols were revealed from the fractionated hexane extracts of both types of pitaya peel and ethanol extract of red seed. In conclusion, numerous antioxidants are present in all parts of white and red flesh pitaya. Their utilization and further study can be carried out especially on the peel and seed judging from their ability to act as antioxidant

Antimicrobial release from a lipid bilayer titanium implant coating is triggered by Staphylococcus aureus alpha-haemolysin

Infections represent a significant challenge in joint replacements, often leading to the need for high-risk revision surgeries. There is an unmet need for novel technologies that are triggered by pathogens to prevent long-term joint replacement infections. The use of supported lipid bilayers (SLBs) with encapsulated antimicrobial agents, which are responsive to bacterial virulence factors, offers an exciting approach to achieving this goal. In this study, Ti was functionalised using octadecylphosphonic acid (ODPA) to form an SLB with an encapsulated antibiotic (novobiocin), effective against methicillin-resistant Staphylococcus aureus. Using the solvent-assisted method, the SLB with encapsulated novobiocin was developed on the surface of ODPA-modified Ti quartz crystal microbalance (QCM) sensors. QCM monitoring and fluorescence microscopy supported the successful formation of a planar SLB with encapsulated novobiocin. Incorporation of novobiocin in the SLB resulted in significantly reduced attachment and viability of S. aureus NCTC 7791, with no significant reduction in human bone marrow stromal cell viability. Additionally, in the presence of varying concentrations of α-haemolysin, a virulence factor from S. aureus, the SLB demonstrated a dose-dependent release pattern. The findings indicate the possibility of creating a biocompatible implant coating that releases an antimicrobial in the presence of a bacterial virulence factor, in a dose-dependent manner

Strategies for introducing titania onto mesostructured silica nanoparticles targeting enhanced photocatalytic activity of visible-light-responsive Ti-MSN catalysts

Titanium-mesostructured silica nanoparticles (Ti-MSN) catalysts which are excellent photocatalytic materials for the environment were prepared by supporting mesostructured silica nanoparticles (MSNs) with titanium species synthesized by three different approaches: microwave and in situ and ex situ electrochemical methods, denoted as Ti-MSN-M, Ti-MSN-I, and Ti-MSN-E, respectively. The physicochemical properties of the catalysts were investigated via XRD, 29Si NMR, N2 adsorption-desorption, FTIR, ESR, and UV-DRS analyses. Characterization results revealed that the introduction of mesoporous titania nanoparticles (MTNs) prepared by the microwave method onto MSNs (Ti-MSN-M) did not significantly affect the silica framework. However, the silica network in the Ti-MSN-I and Ti-MSN-E was rather disrupted, particularly for the former catalyst, due to the desilication accompanied by isomorphous substitution of Ti in the MSN framework to form Si[sbnd]O[sbnd]Ti bonds. Ti was also found to be exchanged with the terminal hydroxyl groups of all catalysts to form the Si[sbnd]O[sbnd]Ti bonds. The addition of Ti species onto MSNs also increased the number of oxygen vacancies (Vo) and metal defect sites. Photocatalytic testing on the decolorization of Congo red (CR) resulted in the following order: Ti-MSN-I (94%) > Ti-MSN-M (90%) > Ti-MSN-E (34%). The Vo and metal defect sites were responsible in lowering the band gap of catalysts and decreasing the electron–hole recombination, while the great numbers of Si[sbnd]O[sbnd]Ti bonds as well as large surface area and pore volume increased the active sites and offered a good surface contact with light to enhance the activity of catalysts. A kinetic study demonstrated that the photodegradation followed the pseudo-first-order Langmuir-Hinshelwood model. Ti-MSN-I and Ti-MSN-M maintained their activities for up to five runs without serious catalyst deactivation, indicating their potential for the degradation of dye in wastewater. Mineralization measurements of CR by TOC and BOD5 analyses after 3 h of contact time were 85.7% and 87.6% using Ti-MSN-M, while 83.7% and 80.3% using Ti-MSN-I, respectively. Optimization by response surface methodology showed that the catalyst dosage, pH, and TiO2 loading were the significant factors in the decolorization of CR. This study demonstrated that these two green technologies; electrochemical and MW have a great potential to be used in synthesis of various advanced materials for greener and more sustainable processes

Surgical site infection after gastrointestinal surgery in children : an international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.Peer reviewe

Frequency and management of maternal infection in health facilities in 52 countries (GLOSS): a 1-week inception cohort study

Background Maternal infections are an important cause of maternal mortality and severe maternal morbidity. We report the main findings of the WHO Global Maternal Sepsis Study, which aimed to assess the frequency of maternal infections in health facilities, according to maternal characteristics and outcomes, and coverage of core practices for early identification and management. Methods We did a facility-based, prospective, 1-week inception cohort study in 713 health facilities providing obstetric, midwifery, or abortion care, or where women could be admitted because of complications of pregnancy, childbirth, post-partum, or post-abortion, in 52 low-income and middle-income countries (LMICs) and high-income countries (HICs). We obtained data from hospital records for all pregnant or recently pregnant women hospitalised with suspected or confirmed infection. We calculated ratios of infection and infection-related severe maternal outcomes (ie, death or near-miss) per 1000 livebirths and the proportion of intrahospital fatalities across country income groups, as well as the distribution of demographic, obstetric, clinical characteristics and outcomes, and coverage of a set of core practices for identification and management across infection severity groups. Findings Between Nov 28, 2017, and Dec 4, 2017, of 2965 women assessed for eligibility, 2850 pregnant or recently pregnant women with suspected or confirmed infection were included. 70·4 (95% CI 67·7–73·1) hospitalised women per 1000 livebirths had a maternal infection, and 10·9 (9·8–12·0) women per 1000 livebirths presented with infection-related (underlying or contributing cause) severe maternal outcomes. Highest ratios were observed in LMICs and the lowest in HICs. The proportion of intrahospital fatalities was 6·8% among women with severe maternal outcomes, with the highest proportion in low-income countries. Infection-related maternal deaths represented more than half of the intrahospital deaths. Around two-thirds (63·9%, n=1821) of the women had a complete set of vital signs recorded, or received antimicrobials the day of suspicion or diagnosis of the infection (70·2%, n=1875), without marked differences across severity groups. Interpretation The frequency of maternal infections requiring management in health facilities is high. Our results suggest that contribution of direct (obstetric) and indirect (non-obstetric) infections to overall maternal deaths is greater than previously thought. Improvement of early identification is urgently needed, as well as prompt management of women with infections in health facilities by implementing effective evidence-based practices

Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low- and middle-income countries

Background: This study assessed the potential cost-effectiveness of high (80–100%) vs low (21–35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa. Methods: Decision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars ($). Results: High FiO2 may be cost-effective (cheaper and effective). In Nigeria, the average cost for high FiO2 was$216 compared with $222 for low FiO2 leading to a −$6 (95% confidence interval [CI]: −$13 to −$1) difference in costs. In India, the average cost for high FiO2 was $184 compared with$195 for low FiO2 leading to a −$11 (95$15 to −$6) difference in costs. In South Africa, the average cost for high FiO2 was$1164 compared with $1257 for low FiO2 leading to a −$93 (95% CI: −$132 to −$65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a −1.05 (95% CI: −1.14 to −0.90) percentage point reduction in SSIs. Conclusion: High FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this