Quality of care in University Hospitals in Saudi Arabia: systematic review

Objectives: To identify the key issues, problems, barriers and challenges particularly in relation to the quality of care in university hospitals in the Kingdom of Saudi Arabia (KSA), and to provide recommendations for improvement. Methods: A systematic search was carried out using five electronic databases, for articles published between January 2004 and January 2015. We included studies conducted in university hospitals in KSA that focused on the quality of healthcare. Three independent reviewers verified that the studies met the inclusion criteria, assessed the quality of the studies and extracted their relevant characteristics. All studies were assessed using the Institute of Medicine indicators of quality of care. Results: Of the 1430 references identified in the initial search, eight studies were identified that met the inclusion criteria. The included studies clearly highlight a need to improve the quality of healthcare delivery, specifically in areas of patient safety, clinical effectiveness and patient-centredness, at university hospitals in KSA. Problems with quality of care could be due to failures of leadership, a requirement for better management and a need to establish a culture of safety alongside leadership reform in university hospitals. Lack of instructions given to patients and language communication were key factors impeding optimum delivery of patient-centred care. Decisionmakers in KSA university hospitals should consider programmes and assessment tools to reveal problems and issues related to language as a barrier to quality of care. Conclusions: This review exemplifies the need for further improvement in the quality of healthcare in university hospitals in KSA. Many of the problems identified in this review could be addressed by establishing an independent body in KSA, which could monitor healthcare services and push for improvements in efficiency and quality of care

An improved Agrobacterium mediated transformation in tomato using hygromycin as a selective agent

Bacterial wilt is a devastating disease of tomato crop throughout the world. This disease is very dangerous in hot and humid regions, where it spreads with the irrigation water to whole field within days, which resulted in severe decline in yield. Two varieties of tomato were used for developingbacterial wilt resistance. Riogrande responded more efficiently as compared to Roma. Regeneration frequency of 90.6% was achieved when leaf discs were used and 82.5% when hypocotyls were used as explant for tomato cv. Riogrande. While 65.4% regeneration was achieved from hypocotyls and 72.6% regeneration was obtained when leaf discs were used as explant for cv. Roma. Explants were cocultivated with Agrobacterium strain EHA101 containing a binary vector pTCL5, having hygromycin phosphotransferase (HPT) gene which confers resistance to hygromycin and -glucuronidase (GUS) gene in addition to Xa21 gene. Hygromycin (25 mg/l) was used as selectable marker while GUS is areporter gene. Acetosyringone (50 mM) enhanced transformation effeciency. Preselection period of 7 days was found to be indispensable for successful transformation of tomato crop. Transformation efficiency of 24% was observed for Riogrande and 8% for Roma. Molecular analysis of transgenic plants produced was carried out for hygromycin resistance gene. Transgenic plants contained the expected band of 670 bp. PCR analysis confirmed the foreign DNA in to the plant genome

Effect of explant plant source and acetosyringone concentration on transformation efficiency of wheat cultivars

Gene introduction into crop plants through genetic manipulation is a better alternative to conventional breeding for the improvement of stress tolerance. Agrobacterium-mediated transformation offers precise integration of genes into the genome with enhanced transgene stability. There are a number of factors which influence the rate of genetic transformation. The theme of this study is to exploit the explant source and acetosyringone concentration for the efficient development of Agrobacterium-mediated gene delivery system in wheat cultivars Inqilab 91 and Chakwal 97. Seedlings, mature embryos and calli used as explant sources for transformation in both the cultivars showed positive response. It was further observed that mature embryos produced maximum transformation efficiencies of 40.0 and 36.25% with 37.5 and 31.03% of regeneration frequencies of transgenic plants for Chakwal 97 and Inqilab 91, respectively. Seedlings produced 33.75 and 27.5% while calli produced 26.25 and 22.5% transformation efficiencies for both the cultivars. Acetosyringone concentration is also a limiting factor in transformation experiments especially in the case of cereals crop. Different concentrations of acetosyringone were used at the time of co-cultivation for optimization of the transformation protocol and maximum transformation efficiencies of 52.44 and 47.56% were obtained with 50 μM of acetosyringone from the cultivars Chakwal 97 and Inqilab 91, respectively.Key words: Wheat, agrobacterium, transformation, explant, acetosyringone

Comparison of transgenic plant production for bacterial blight resistance in Pakistani local rice (Oryza sativa L.) cultivars

The study was carried out to improve bacterial leaf blight resistance in three rice cultivars (Basmati - 370, DR - 82 and IR - 6) by Agrobacterium mediated transformation system. Three week-old scutellum derived calli were infected with Agrobacterium strain EHA101, containing binary vector pTCL5 which has Xa 21 gene. Different levels of acetosyringone were tested to enhance transformation efficiency. Acetosyringone at 300 ìM showed 56.6% GUS expression with 100 and 200 ìM acetosyringone showing 13.3 and 30.0% GUS expression, respectively. Maximum transformation efficiency was obtained using DR - 82 with calli exposed to 300 ìM acetosyringone for 2 min. Direct hygromycin selection with 48 h ofco-cultivation was superior to pre-selection in all three cultivars. Transient GUS expression was 51.4% while stable GUS expression in calli was 18.8%. PCR analysis confirmed the presence of the Xa 21 gene in transformed regenerated plants. Stable varietal transformation efficiency was DR - 82 > Basmati-370 > IR - 6. Resistance of transgenic plants against Xanthomonas oryzae pathovar oryzae was evaluated with various strains/isolates at the seedling stage. All PCR positive transgenic plants of DR - 82 and Basmati - 370 were resistant with lesion areas less than 5% of the inoculated leaf area. The tested transgenic plants were resistant to all the indigenous and exotic strains tested due to the broad spectrum protection provided by the Xa 21 gene

ACTIVITY OF ADENOSINE DEAMINASE AND ITS ISOENZYMES IN SERUM OF PREGNANT BUFFALOES

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Enhanced regeneration in explants of tomato (Lycopersicon esculentum L.) with the treatment of coconut water

A standardized protocol was developed to enhance the in vitro regeneration efficiency of five varieties of tomato from hypocotyls and leaf disc with the involvement of coconut water. Different concentrations of IAA and kinetin were used alone and in combination with 12% of coconut water.Significant differences for regeneration, time taken to regenerate and number of leaf primordial were observed for different treatments, type of explant, use of coconut water and also among varieties. Higher regeneration was obtained in Avinash followed by Roma and Rio Grande. Maximum regeneration 95.75% was obtained with 0.5 mgL-1 of IAA, 1.5 mgL-1 Kinetin along with 12% coconut water in Avinash and hypocotyl was proved to be better for regeneration than leaf discs. The inclusionof coconut water in the media significantly reduced the number of days taken for callus induction leading to regeneration, as compared to media without coconut water. Significant increase in number of shoot primordial was observed in hypocotyls as well as in leaf disc derived calli with the addition of coconut water. Plants obtained were transferred to the glass house in small pots of compost and higher frequency of survival was observed from plantlets obtained with the addition of coconut water

Comparative phytotoxicity of aqueous extracts of centaurea maculosa and melilotus officinalis on germinability and growth of wheat

Weed incursion in cultivated fields is a serious biological problem, which causes considerable yield losses of economically important field crops through allelopathy and competitive interactions. Spotted knapweed (Centaurea maculosa) and yellow melilot (Melilotus officinalis) are among the most prevalent weeds in cultivated fields of Pakistan, particularly in wheat fields. Like many other weeds, they may pose allelopathic and competitive challenges to field crops. The objective of this study was to evaluate allelopathic potentials of the two weeds on germination and seedling growth of wheat under laboratory conditions. Amounts of 15, 20, 25 and 30% concentrated leaf aqueous extracts of C. maculosa and M. officinalis were prepared and tested for their effects on germination percentage, radicle and coleoptile lengths of wheat. Germination, radicle and coleoptile lengths of test crop declined significantly at higher concentration (25-30%) of the extracts of two weeds. However, concentration of M. officinalis up to 20% had either no effect or stimulatory effects on the studied growth characteristics of wheat. Highest germination inhibition and decreased seedling growth were caused by leaf extracts of C. maculosa at 30% extract concentration. Growth inhibition was generally dependent on the extract concentration. The study indicated that both plant exhibited allelopathic activity and growth inhibitory effects on wheat at higher concentration; however, extracts of C. maculosa were more phytoinhibitory than M. officinalis. The weeds could serve as potent allelopathic plants for management of other weeds

Perioperative Teaching and Feedback: How are we doing in Canadian OTL-HNS programs?

Background: Discrepancies between resident and faculty perceptions regarding optimal teaching and feedback during surgery are well known but these differences have not yet been described in Otolaryngology - Head and Neck Surgery (OTL-HNS). The objectives were thus to compare faculty and resident perceptions of perioperative teaching and feedback in OTL-HNS residency programs across Canada with the aim of highlighting potential areas for improvement. Methods: An anonymous electronic questionnaire was distributed to residents and teaching faculty in OTL-HNS across Canada with additional paper copies distributed at four institutions. Surveys consisted of ratings on a 5-point Likert scale and open-ended questions. Responses among groups were analysed with the Wilcoxon-Mann Whitney test, while thematic analysis was used for the open-ended questions. Results: A total of 143 teaching faculty and residents responded with statistically significant differences on 11 out of 25 variables. Namely, faculty reported higher rates of pre and intra-operative teaching compared to resident reports. Faculty also felt they gave adequate feedback on residents\u27 strengths and technical skills contrary to what the residents thought. Both groups did agree however that pre-operative discussion is not consistently done, nor is feedback consistently given or sought. Conclusion: Faculty and residents in OTL-HNS residency programs disagree on the frequency and optimal timing of peri-operative teaching and feedback. This difference in perception emphasizes the need for a more structured approach to feedback delivery including explicitly stating when feedback is being given, and the overall need for better communication between residents and staff

Outputs and Growth of Primary Care Databases in the United Kingdom: Bibliometric Analysis.

BACKGROUND: Electronic health database (EHD) data is increasingly used by researchers. The major United Kingdom EHDs are the 'Clinical Practice Research Datalink' (CPRD), 'The Health Improvement Network' (THIN) and 'QResearch'. Over time, outputs from these databases have increased, but have not been evaluated. OBJECTIVE: This study compares research outputs from CPRD, THIN and QResearch assessing growth and publication outputs over a 10-year period (2004-2013). CPRD was also reviewed separately over 20 years as a case study. METHODS:  Publications from CPRD and QResearch were extracted using the Science Citation Index (SCI) of the Thomson Scientific Institute for Scientific Information (Web of Science). THIN data was obtained from University College London and validated in Web of Science. All databases were analysed for growth in publications, the speciality areas and the journals in which their data have been published. RESULTS: These databases collectively produced 1,296 publications over a ten-year period, with CPRD representing 63.6% (n=825 papers), THIN 30.4% (n=394) and QResearch 5.9% (n=77). Pharmacoepidemiology and General Medicine were the most common specialities featured. Over the 9-year period (2004-2013), publications for THIN and QResearch have slowly increased over time, whereas CPRD publications have increased substantially in last 4 years with almost 75% of CPRD publications published in the past 9 years. CONCLUSION: These databases are enhancing scientific research and are growing yearly, however display variability in their growth. They could become more powerful research tools if the National Health Service and general practitioners can provide accurate and comprehensive data for inclusion in these databases

Aryl Hydrocarbon Receptor Ligands Inhibit IGF-II and Adipokine Stimulated Breast Cancer Cell Proliferation

Obesity increases human cancer risk and the risk for cancer recurrence. Adipocytes secrete paracrine factors termed adipokines that stimulate signaling in cancer cells that induce proliferation. The aryl hydrocarbon receptor (AHR) is a ligand-activated transcription factor that plays roles in tumorigenesis, is regulated by exogenous lipophilic chemicals, and has been explored as a therapeutic target for cancer therapy. Whether exogenous AHR ligands modulate adipokine stimulated breast cancer cell proliferation has not been investigated. We provide evidence that adipocytes secrete insulin-like growth factor 2 (IGF-2) at levels that stimulate the proliferation of human estrogen receptor (ER) positive breast cancer cells. Using highly specific AHR ligands and AHR short interfering RNA (AHR-siRNA), we show that specific ligand-activated AHR inhibits adipocyte secretome and IGF-2-stimulated breast cancer cell proliferation. We also report that a highly specific AHR agonist significantly ( \u3c 0.05) inhibits the expression of E2F1, CCND1 (known as Cyclin D1), MYB, SRC, JAK2, and JUND in breast cancer cells. Collectively, these data suggest that drugs that target the AHR may be useful for treating cancer in human obesity