Determination of antioxidant activity of gum Arabic: an exudation from two different locations

Gum Arabic (GA) is the main product of acacia trees. As a raw and commercial samples, GA was extracted with methanol and analysed to measure the antioxidant activity using five methods: 2,2-diphenyl-1-picrylhydrazyl (DPPH), Folin-Ciocalteu indexes (FCI), which indicate total phenolic compounds (TPC), oxygen radical absorbance capacity (ORAC), ferric reducing antioxidant power (FRAP), and cupric reducing antioxidant capacity (CUPRAC). This study used antioxidant assays to detect TPC and selected appropriate and inexpensive methods to determine the antioxidant capacity of GA samples. The results reveal that the FCI, ORAC, and CUPRAC are correlated highly with FRAP. Person’s correlation coefficient (r) values are 0.98, 0.93, and 0.99, respectively, based on the sample size of(n=8). This means that the TPC of GA is highly correlated with their antioxidant activities that are measured by these three methods. Hence the FCI, ORAC, and the CUPRAC methods are more effective and simpler. They had similar predictive power to the FRAP of GA antioxidant activity. Consequently, GA is generally recognized as being slightly acidic which may have been obtained from appropriate methods of the antioxidant capacity detection. This acidity is due to the electronic transfer mechanism based on the selection of the working pH

Perceptions and Expectations of Medical Students towards the Quality of Educational Services offered at A Sudanese University: How Far is the Gap?

Background: Students are the primary customers of high education service, and are becoming more aware of their consumer rights and of gaps between their expectations of service delivery and the reality of services.Objective: of this study was to investigate medical students’ perceptions and expectations of educational services quality at X University in Sudan.Methods: One hundred ninety six registered medical students in the academic year 2013- 2014, were enrolled; sample was collected through convenience sample technique. The study was conducted by the use of Modified SERVQUAL questionnaire. SPSS version 20 was used for data analysis.Results: There was a negative mean score for quality gap in all dimensions of service quality. Students perceived tangibles as quality indicators of the service quality at university, and expect universities to have modern-looking equipment, so that staff can provide efficient service to them. There was a strong student concern about teaching staff promises regarding timetables and exam schedules to be fulfilled on time, which indicated the area of most concern amongst the respondents (gap score – 1.94). A clear communication problem regarding service delivery was inferred, as students perception towards solving their problems was very low (gap score -1.91).Conclusion: students’ perceptions of services delivered by X University falls below their expectations; that indicates student’s dissatisfaction. This large gap constitutes a great challenge to the administrators and educational policy makers, who are recommended to consider students feedback as a quality indicator in the quality assurance process.Keywords: medical student, quality education, Sudan

Gum arabic: an optimization of ultrasonic-assisted extraction of antioxidant activity

Gum Arabic (GA), also known as Acacia seyal gum (ASG), is a dried exudate from trees of Acacia senegal and Acacia seyal. It provides a rich source of non-viscous soluble fiber with significant health benefits and high antioxidant properties. Tonnes of raw GA are exported annually at a high cost with limited utilization in extraction form. Techniques for the extraction of the bioactive components of GA are available but the high extraction time and the capacity and quality of extraction hinders these procedures. Ultrasonic-assisted extraction is one of the most effective techniques for the recovery of antioxidant and phenolic compounds from ASG. A comparatively low extraction time has been reported for ultrasonication, but the influence of several extraction conditions such as temperature, time and ultrasonic power on the yield of extraction has not been thoroughly studied. This study investigates the optimal ultrasonic extraction conditions for maximum recovery of antioxidant and phenolic compounds from ASG using Response Surface Methodology (RSM) under the Central Composite Design (CCD). Three ultrasonic parameters, namely time in the range of (1-3 hours), power in the range of (1-3 level or 12 to 40 kHz) and temperature from (25-60 °C) were tested for their impact on antioxidant activity. The capacity of the extracts was determined by the scavenging activity of 1, 1-diphenyl-2-picrylhydrazyl (DPPH) radical, ferric reducing antioxidant power (FRAP) assay, and total phenolic compounds (TPC). The results indicated that ultrasonic time, power and temperature had a positive impact on antioxidant capacity and phenolic compounds. The optimum ultrasonic conditions were found to be a time of 3 hours, a power of 40 kHz, and a temperature of 42.50°C, under which, forty-eight bioactive compounds from the ASG extract were separated by Gas Chromatography coupled to Tandem Mass Spectrometry (GC-MS/MS)

Active Fractions of Methanol Crude Obtained from Acacia seyal gum: Antioxidant Capacity using FTIR Analysis

The present study is on Acacia seyal gum (ASG), which is an exudate from Talha tree. It provides a rich source of polyphenolics compounds that are used traditionally in folk medicine. The study aims to determine the antioxidant capacity (AC) and functional groups of ASG and Prebio-T-commercial (PTC) samples. The methanol crude extracts of both ASG and PTC have fractioned into chloroform (CHF), hexane (HF), acetone (AF) and methanol (MF) using solvent-solvent portion. Both ferric reducing antioxidant power (FRAP), and cupric reducing antioxidant capacity (CUPRAC) assays for each fraction examined. Crude methanol extracts (CME) and its active compositions also analysed carefully using Fourier Transform Infrared Spectroscopy (FTIR) technique. The findings presented a wide variety of functional groups provided by the FTIR spectra (eights bands approximately. Regarding cupric reducing antioxidant capacity (CUPRAC), the methanol crude extracts values are 888.6±4.57 mg TE/100g extract, for PTC as compared to 474.3± 2.23 mg TE/100g of extract for ASG. However, both methanol and acetone fractions revealed significantly (p ≤ 0.05) high FRAP values ranged between 599.8±7.5 and 741.8±5.8 mg TE/100g fraction; for PTC and ASG, respectively. While CUPRAC showed insignificant (p ≥ 0.05) same values 356.1±2.62 mg TE/100g of fraction; for MF of both PTC and ASG respectively. Therefore, in this study, methanolic fractions (MFs) are found to be more effective than acetone fractions (AFs), except for CHF and HF. Finally, the antioxidant activity of the active fraction has provided some evidence regarding its functional groups which may have used in traditional medicine

Active fractions of methanol crude obtained from acacia seyal gum and their anti-proliferative effects against human breast cancer cell lines

Background: This study is on Acacia seyal gum, which is an exudate from Talha (Acacia seyal) tree. It provides a rich source of prebiotic that is used traditionally in folk medicine. Aims: The anti-proliferative effect (APE) of Acacia seyal gum (ASG) and Prebio-T-commercial (PTC) samples on human breast cancer (MCF-7) cell lines and their antioxidant activities (AA) were investigated. Methods: The methanol crude extracts of both Acacia seyal gum and Prebio-T-commercial were fractioned into acetone and methanol, respectively. The antiproliferative effect on human breast cancer cell lines for each fraction was examined using sulphorhodamine assay (SRB assay). Methanol crude extracts and their active compositions were analysed carefully using gas chromatography-mass spectrometry technique. Results: The most anti-proliferative effect was detected in the sample collected from Prebio-T-commercial (IC50=8.97µg/mL) as compared to Acacia seyal gum (IC50=9.56µg/mL). Regarding total phenolic content (TPC), the methanol crude extracts values are 694±2.58mg, GAE/100g for Prebio-T-commercial as compared to 155.78±2.58, GAE/100g for Acacia seyal gum. However, both acetone and methanol fractions of Acacia seyal gum and Prebio-T-commercial were found to be highly anti-proliferative to human breast cancer. For bioactive compounds determinations, the methanol crude extract from Acacia seyal gum is mainly dominated by Isovitamin C (42.37%), Crypton (5.86%), and Hydroquinone (4.86%) as major components. Conclusion: Finally, the antioxidant and anti-proliferative properties of the active fraction have shown some evidence regarding its use in traditional medicine as well as the prevention of cancer cell growth. This suggests the potential use of their bioactive compounds as natural anticancer agents

Tissue Glucocorticoid Metabolism in Adrenal Insufficiency:A Prospective Study of Dual-release Hydrocortisone Therapy

Background: Patients with adrenal insufficiency (AI) require life-long glucocorticoid (GC) replacement therapy. Within tissues, cortisol (F) availability is under the control of the isozymes of 11β-hydroxysteroid dehydrogenase (11β-HSD). We hypothesize that corticosteroid metabolism is altered in patients with AI because of the nonphysiological pattern of current immediate release hydrocortisone (IR-HC) replacement therapy. The use of a once-daily dual-release hydrocortisone (DR-HC) preparation, (Plenadren®), offers a more physiological cortisol profile and may alter corticosteroid metabolism in vivo.Study Design and Methods: Prospective crossover study assessing the impact of 12 weeks of DR-HC on systemic GC metabolism (urinary steroid metabolome profiling), cortisol activation in the liver (cortisone acetate challenge test), and subcutaneous adipose tissue (microdialysis, biopsy for gene expression analysis) in 51 patients with AI (primary and secondary) in comparison to IR-HC treatment and age- and BMI-matched controls.Results: Patients with AI receiving IR-HC had a higher median 24-hour urinary excretion of cortisol compared with healthy controls (72.1 µg/24 hours [IQR 43.6-124.2] vs 51.9 µg/24 hours [35.5-72.3], P = .02), with lower global activity of 11β-HSD2 and higher 5-alpha reductase activity. Following the switch from IR-HC to DR-HC therapy, there was a significant reduction in urinary cortisol and total GC metabolite excretion, which was most significant in the evening. There was an increase in 11β-HSD2 activity. Hepatic 11β-HSD1 activity was not significantly altered after switching to DR-HC, but there was a significant reduction in the expression and activity of 11β-HSD1 in subcutaneous adipose tissue.Conclusion: Using comprehensive in vivo techniques, we have demonstrated abnormalities in corticosteroid metabolism in patients with primary and secondary AI receiving IR-HC. This dysregulation of pre-receptor glucocorticoid metabolism results in enhanced glucocorticoid activation in adipose tissue, which was ameliorated by treatment with DR-HC

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 years; 78.2% included were male with a median age of 37 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

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

Adolescent transport and unintentional injuries: a systematic analysis using the Global Burden of Disease Study 2019

Background: Globally, transport and unintentional injuries persist as leading preventable causes of mortality and morbidity for adolescents. We sought to report comprehensive trends in injury-related mortality and morbidity for adolescents aged 10–24 years during the past three decades. Methods: Using the Global Burden of Disease, Injuries, and Risk Factors 2019 Study, we analysed mortality and disability-adjusted life-years (DALYs) attributed to transport and unintentional injuries for adolescents in 204 countries. Burden is reported in absolute numbers and age-standardised rates per 100 000 population by sex, age group (10–14, 15–19, and 20–24 years), and sociodemographic index (SDI) with 95% uncertainty intervals (UIs). We report percentage changes in deaths and DALYs between 1990 and 2019. Findings: In 2019, 369 061 deaths (of which 214 337 [58%] were transport related) and 31·1 million DALYs (of which 16·2 million [52%] were transport related) among adolescents aged 10–24 years were caused by transport and unintentional injuries combined. If compared with other causes, transport and unintentional injuries combined accounted for 25% of deaths and 14% of DALYs in 2019, and showed little improvement from 1990 when such injuries accounted for 26% of adolescent deaths and 17% of adolescent DALYs. Throughout adolescence, transport and unintentional injury fatality rates increased by age group. The unintentional injury burden was higher among males than females for all injury types, except for injuries related to fire, heat, and hot substances, or to adverse effects of medical treatment. From 1990 to 2019, global mortality rates declined by 34·4% (from 17·5 to 11·5 per 100 000) for transport injuries, and by 47·7% (from 15·9 to 8·3 per 100 000) for unintentional injuries. However, in low-SDI nations the absolute number of deaths increased (by 80·5% to 42 774 for transport injuries and by 39·4% to 31 961 for unintentional injuries). In the high-SDI quintile in 2010–19, the rate per 100 000 of transport injury DALYs was reduced by 16·7%, from 838 in 2010 to 699 in 2019. This was a substantially slower pace of reduction compared with the 48·5% reduction between 1990 and 2010, from 1626 per 100 000 in 1990 to 838 per 100 000 in 2010. Between 2010 and 2019, the rate of unintentional injury DALYs per 100 000 also remained largely unchanged in high-SDI countries (555 in 2010 vs 554 in 2019; 0·2% reduction). The number and rate of adolescent deaths and DALYs owing to environmental heat and cold exposure increased for the high-SDI quintile during 2010–19. Interpretation: As other causes of mortality are addressed, inadequate progress in reducing transport and unintentional injury mortality as a proportion of adolescent deaths becomes apparent. The relative shift in the burden of injury from high-SDI countries to low and low–middle-SDI countries necessitates focused action, including global donor, government, and industry investment in injury prevention. The persisting burden of DALYs related to transport and unintentional injuries indicates a need to prioritise innovative measures for the primary prevention of adolescent injury. Funding: Bill & Melinda Gates Foundation

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