EFFECT OF OILS, SURFACTANTS AND COSURFACTANTS ON PHASE BEHAVIOR AND PHYSICOCHEMICAL PROPERTIES OF SELF-NANOEMULSIFYING DRUG DELIVERY SYSTEM (SNEDDS) FOR IRBESARTAN AND OLMESARTAN

Objective: The main purpose of this study was to optimize the different conditions for the preparation of self-nanoemulsifying drug delivery system (SNEDDS) for both Irbesartan (IRB) and Olmesartan (OLM). Methods: Based on solubility study and emulsification efficiency, Preliminary investigations of various oils, surfactants and cosurfactants were carried out for selection of the proper SNEDDS ingredients. Pseudoternary phase diagrams were then plotted using series of concentrations to obtain optimum SNEDDS components that identify the efficient self-nanoemulsifying region. Sixteen unloaded SNEEDS formulae were prepared using Capryol 90, Cremophor RH 40 and Transcutol HP as oil, surfactant and cosurfactant respectively. The prepared SNEDDS were evaluated for self-nanoemulsification time, the effect of dilution (with different volumes at different pH values), optical clarity, viscosity, droplet size analysis as well as the polydispersity index (PDI). SNEDDS formulae were also evaluated for thermodynamic stability and zeta potential to confirm the stability of the prepared SNEDDS. Results: The results showed that the mean droplet size of all reconstituted SNEDDS was found to be in the nanometric range (<100 nm) and showed optimum PDI values. All formulae also showed rapid emulsification time, good optical clarity and found to be highly stable. Formulae with the smallest particle size, lowest emulsification time, best optical clarity and robust to dilution and pH change were selected to be loaded with IRB and OLM for further study. Conclusion: It was concluded that the prepared self-emulsified prototype was ready to incorporate many poorly soluble drugs in order to improve their solubility as well as bioavailability profile. Keywords: Irbesartan, Olmesartan, Self-nanoemulsifying drug delivery system (SNEDDS), Capryol 90, Cremophor RH 40 and Transcutol HP

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

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

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

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1⋅6 per cent at 24 h (high 1⋅1 per cent, middle 1⋅9 per cent, low 3⋅4 per cent; P < 0⋅001), increasing to 5⋅4 per cent by 30 days (high 4⋅5 per cent, middle 6⋅0 per cent, low 8⋅6 per cent; P < 0⋅001). Of the 578 patients who died, 404 (69⋅9 per cent) did so between 24 h and 30 days following surgery (high 74⋅2 per cent, middle 68⋅8 per cent, low 60⋅5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2⋅78, 95 per cent c.i. 1⋅84 to 4⋅20) and low-income (OR 2⋅97, 1⋅84 to 4⋅81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)

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

Development of an Improved Bonobo Optimizer and Its Application for Solar Cell Parameter Estimation

Recently, photovoltaic (PV) energy has been considered one of the most exciting new technologies in the energy sector. PV power plants receive considerable attention because of their wide applications. Consequently, it is important to study the parameters of the solar cell model to control and determine the characteristics of the PV systems. In this study, an improved bonobo optimizer (IBO) was proposed to improve the performance of the conventional bonobo optimizer (BO). Both the IBO and the BO were utilized to obtain the accurate values of the unknown parameters of different mathematical models of solar cells. The proposed IBO improved the performance of the conventional BO by enhancing the exploitation (local search) and exploration (global search) phases to find the best optimal solution, where the search space was reduced using Levy flights and the sine–cosine function. Levy flights enhance the explorative phase, whereas the sine–cosine function improves the exploitation phase. Both the proposed IBO and the conventional BO were applied on single, double, and triple diode models of solar cells. To check the effectiveness of the proposed algorithm, statistical analysis based on the results of 20 runs of the optimization program was performed. The results obtained by the proposed IBO were compared with other algorithms, and all results of the proposed algorithm showed their durability and exceeded other algorithms

Magnetized Saline Water Irrigation Enhances Soil Chemical and Physical Properties

Due to rapid population growth and pressure on water resources, it is necessary to use economic and non-traditional techniques for irrigation. One of these techniques is the use of salt water after treatment with a magnetic force. A simulation experiment was conducted with soil columns using three quantities of saline water: 0, 3, and 6 g L&minus;1 (S0, S3, and S6). Magnetic forces of 0, 1000, 2000, 3000, 4000, 5000, 6000, and 7000 gauss were used to study the effects of magnetic forces on leachate and soil physicochemical properties at different depths. The results at all soil depths showed that the pH decreased with increasing salinity from S0 to S3 and S6 by an average of 8.44, 8.28, and 8.27%, respectively. Soil EC decreased significantly with depth by 10&ndash;35%. The maximum SAR, SSP, and CROSS values (16.3, 51.1, and 17.6, respectively) were reported when no magnetic force was used, while the lowest values (13.9, 49.9, and 15.3) were recorded when using 3000 gauss under S6 within the soil profile. Magnetizing the water halved the EC of the leachate under S0, while it decreased the EC by 12.4% under S3. Increasing the magnetic force enhanced the leachate SAR, SSP, and CROSS values by 4.9&ndash;20.4% on average under S3 and S6. Magnetic forces augmented the hydraulic conductivity at the same salinity level and with increasing salinity, resulting in an increment of 50% at S3 and S6 compared with S0. After nine hours, the maximum cumulative infiltration rate was under 1000 and 4000 gauss. Our results demonstrated the important effects of magnetically treated irrigation water and could therefore support its application in agriculture under conditions of low water resources and quality

Silicon application mitigated the adverse effects of salt stress and deficit irrigation on drip-irrigated greenhouse tomato

Tomato (Solanum lycopersicum L.) is an important vegetable crop around the world, and water scarcity and soil salinization are two major unfavorable factors limiting the fruit yield and quality of greenhouse tomato in arid and semi-arid regions. The application of exogenous silicon has been reported to enhance tomato yield under salt or drought stress, but its effect under combined salt-drought stress remains unclear. A two-season (autumn 2021 and spring 2022) experiment was conducted with three irrigation levels (I1, 90%−100% θf, where θf is the field capacity; I2, 70%−80% θf; I3, 50%−60% θf), two soil salinity levels (S0, 0.1%, g/g; S1, 0.4%, g/g) and two silicon application rates (T0, 0 mM; T1, 2.4 mM) to explore their combined effects on leaf silicon content, photosynthetic parameters, fruit yield, nutrient yield, crop water productivity (WP), nitrogen uptake and utilization, nutrient water productivity (NWP) and economic benefit of drip-irrigated greenhouse tomato. The results showed that deficit irrigation and salt stress exerted significant inhibiting effects on leaf silicon content, photosynthetic parameters, tomato yield, and water-nitrogen productivity, but the inhibition was alleviated by silicon application, which increased leaf silicon content by 67.0%, net photosynthetic rate (Pn) by 25.3%, fruit yield by 12.3%, WP by 11.9%, nutrient yield by 10.0% (titratable acids) - 27.4% (soluble sugars) and NWP by 9.2% (titratable acids) - 26.1% (soluble sugars) on average. The average fruit yield over the two growing seasons was 66.01, 54.29 and 44.31 t ha−1 under I1, I2 and I3, and the silicon application increased average leaf silicon content by 71.9%, 65.2% and 63.0%, Pn by 11.1%, 12.9% and 7.6%, and fruit yield by 12.8%, 16.2%, and 8.1% at the three irrigation levels, respectively. Plant nitrogen uptake (NU) and nitrogen partial factor productivity (NPFP) increased but nitrogen use efficiency (NUE) tended to decrease with the increasing irrigation level, while silicon application improved NUE by 3.9% and 2.2% and NPFP by 13.8% and 11.7% in the two growing seasons, respectively. Silicon application significantly increased net profit by 24.3% and 17.7% in autumn 2021 and spring 2022, respectively. According to the principal component analysis, I1T1S0 ranked first in both growing seasons. The correlation matrix showed that fruit yield was positively correlated with leaf silicon content, Pn, stomatal conductance, WP, NU, NUE, NPFP, nutrient yield and net profit, while it had negative correlation with NWP. In conclusion, exogenous silicon application can improve the fruit yield and nutrient yield of drip-irrigated greenhouse tomato by enhancing leaf silicon content and photosynthetic capability under drought-stressed and salt-affected conditions

Efficiently activated carbons from corn cob for methylene blue adsorption

International audienc