Coexistence of HBsAg/Anti-HBs and HBeAg/Anti-HBe in Sudanese Patients with Chronic Hepatitis B Virus Infection: A Cross-Sectional Study

Background: Seroconversion of hepatitis B surface antigen (HBsAg) to hepatitis B surface antibody (anti-HBs) is a recognized goal of HBV therapy. This dynamic transition responsible for the coexistence of HBsAg and anti-HBs is rarely detected in clinical cases. However, with vaccination and the use of various antiviral drugs, as well as the development of new medical technologies, recognizing the coexistence of HBsAg and anti-HBs has become more common. In addition, mutations in viral genomes, immune status, and human genetic factors may also contribute to such coexistence. The current study was designed to determine the prevalence of the coexistence of HBsAg and anti-HBs and HBeAg and anti-HBe in CHB patients in Sudan. Methods and Results: This was a descriptive cross-sectional study conducted in Khartoum state from November 2018 to January 2019. The study included 70 HBV-infected patients who were positive for HBsAg for more than six months. Blood samples were tested for HBsAg/Anti-HBs and HBeAg/Anti-HBe using Commercial ELISA Kits (Foresight, United Kingdom) and (PRECHEK, USA). Demographic data were collected using a structured questionnaire, and any antiviral agent and laboratory results were also recorded for each participant. The current study showed that one case (1.4%) was reactive for the coexistence of HBsAg/HBsAb and two cases (2.8%) for the coexistence of HBeAg/HBeAb. There was no statistical difference between the coexistence of HBsAg/HBsAb and HBeAg/HBeAb with age, gender, residence, and treatment status. Conclusion: Our study indicates that the frequencies of the coexistence of HBsAg/HBsAb and HBeAg/HBeAb among Sudanese patients with chronic HBV infection were low compared to previous studies in a different population

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

Intelligent Mechanisms of Macrophage Apoptosis Subversion by Mycobacterium

Macrophages are one of the first innate defense barriers and play an indispensable role in communication between innate and adaptive immune responses, leading to restricted Mycobacterium tuberculosis (Mtb) infection. The macrophages can undergo programmed cell death (apoptosis), which is a crucial step to limit the intracellular growth of bacilli by liberating them into extracellular milieu in the form of apoptotic bodies. These bodies can be taken up by the macrophages for the further degradation of bacilli or by the dendritic cells, thereby leading to the activation of T lymphocytes. However, Mtb has the ability to interplay with complex signaling networks to subvert macrophage apoptosis. Here, we describe the intelligent strategies of Mtb inhibition of macrophages apoptosis. This review provides a platform for the future study of unrevealed Mtb anti-apoptotic mechanisms and the design of therapeutic interventions

Biological Role of Zinc in Liver Cirrhosis: An Updated Review

Liver cirrhosis is a complication usually due to the consequence of persistent chronic liver disease. It is associated with different mechanisms, including hypoalbuminemia, impaired amino acid turnover, and micronutrient deficiencies. Consequently, cirrhotic patients can develop progressive complications like ascites, hepatic encephalopathy, and hepatocellular carcinoma. The liver is a vital organ that regulates the different metabolic pathways and transportation of trace elements. Zn is an indispensable micronutrient trace element involved in its crucial functions in cellular metabolic activity. Zn mediates its action by binding to a wide range of proteins; therefore, it imparts numerous biological effects, including cellular division, differentiation, and growth. It is also involved in critical processes for the biosynthesis of structural proteins and regulation of transcription factors and acts as a co-factor for the various enzymatic processes. As the liver is a significant regulator of Zn metabolism, its abnormalities lead to Zn deficiency, which has consequences on cellular, endocrine, immune, sensory, and skin dysfunctions. Conversely, Zn deficiency may modify the functions of hepatocytes and immune responses (acute phase protein production) in inflammatory liver diseases. This review has concisely stated the evolving indication of the critical role of Zn in biological processes and complications associated with liver cirrhosis pathogenesis due to Zn deficiency

Methicillin and Inducible Clindamycin-Resistant Staphylococcus aureus Isolated from Postoperative Wound Samples

The present study aimed to investigate the incidence of Methicillin-Resistant Staphylococcus aureus strains (MRSA) and inducible clindamycin resistant S. aureus (ICRSA) among postoperative wound infected patients. A total of 94 S. aureus strains were isolated by conventional laboratory methods from 135 swab samples collected from post-operative wound infected patients in Khartoum State hospitals. The isolated strains were screened for MRSA by using cefoxitin disc. ICRSA strains was detected by D-test and their susceptibility to antimicrobial agents was done by modified Kirby-Bauer’s disc diffusion method. Ninety-four S. aureus isolates were screened for MRSA strains, we found 42 (45%) of isolates were MRSA and 52 (55%) of strains were methicillin-sensitive S. aureus (MSSA) phenotype. The incidence of ICRSA, constitutive clindamycin resistant (CCRSA) and erythromycin resistant (ERSA) strains among S. aureus isolates were 15.9% (15/94), 9% (8/94) and 2.12% (2/94), respectively. ICRSA resistant strains were slightly more frequent among MRSA, when compared with MSSA strains (16.67% (7/42) vs. 15.38% (8/52)). In addition, 33% of ICRSA strains were found resistant to both co-trimoxazole and gentamicin, while, 23% of strains were resistant to vancomycin. This study concluded that MRSA strains was nearly accounted a half of clinical isolates, which need more attention by improving hospitals environment heath quality. ICRSA isolates were detected within both MRSA and MSSA strains and the D test must be implemented as routine susceptibility test to avoided clindamycin treatment failure

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population