Study of urinary leukotriene E4 in atopic dermatitis: relation to disease severity

Background: Atopic dermatitis (AD) is a chronic relapsing inflammatory skin disease prevalent in patients with a personal or family history of atopy. Cysteinyl leukotrienes (LTs) are inflammatory mediators which play a role in the pathogenesis of atopic diseases. Urinary leukotriene E4 (LTE4) has been used as an index of the whole body cysteinyl LTs production. Objective: This study was meant to evaluate the importance of LTs in atopic dermatitis (AD) and to study the correlation of urinary LTE4 with disease severity and some commonly altered parameters in AD. Methods: The study included 30 children and adolescents diagnosed to have atopic dermatitis. Ten age and sex matched healthy children and adolescents were enrolled for comparison. They were subjected to clinical evaluation and measurement of urinary LTE4, absolute eosinophilic count, serum IgE and IL-4 and IL-5 in peripheral blood mononuclear cell culture (PBMC) supernatant. The patients were categorized into mild (n=5), moderate (n=16) and severe (n=9) AD subgroups. Results: The study revealed a significant increase in absolute eosinophilic count, urinary LTE4, serum IgE and IL-4 and IL-5 in PBMC culture supernatant in the patients as compared to controls. Moreover, urinary LTE4 levels were significantly increased in moderate and severe cases of AD as compared to the control group, whereas mild cases had levels that were comparable to the controls. Urinary LTE4 levels were higher in severe (p < 0.01) and moderate cases (p < 0.05) when compared to mild cases. Significant positive correlations could be elicited between urinary LTE4 and PBMC IL-4, disease severity scale, absolute eosinophilic count and serum total IgE. However, urinary LTE4 could not be correlated statistically with PBMC IL-5. Conclusion: Elevation in urinary LTE4 excretion in AD patients was demonstrated reflecting increased production of cysteinyl LTs. Urinary LTE4 was correlated to clinical and laboratory markers of severity suggesting that it could be an easy, non invasive and objective prognostic test in AD. Trials of 5-lipoxygenase inhibitors and LT receptor antagonists as additional lines of therapy in AD could thus be suggested.Keywords: atopic dermatitis, urinary LTE4, IgE, IL-4, IL-5, eosinophilic countEgypt J Pediatr Allergy Immunol 2003; 1(2): 134-

Sagitol C, a new cytotoxic pyridoacridine alkaloid from the sponge Oceanapia sp.

AbstractA new pyridoacridine alkaloid named sagitol C (2) together with two known compounds; kuanoniamine C (1) and sagitol (3) were isolated from the EtOAc fraction of the Indonesian sponge Oceanapia sp. Their chemical structures were established on the basis of physical and spectroscopic methods 1D and 2D NMR, in addition to mass spectrometry and comparison with literature data. Sagitol C was found to exhibit cytotoxic activity when tested against different cancer cell lines

Outbreak of H3N2 influenza at a US military base in Djibouti during the H1N1 pandemic of 2009.

PMC3855413BACKGROUND: Influenza pandemics have significant operational impact on deployed military personnel working in areas throughout the world. The US Department of Defense global influenza-like illness (ILI) surveillance network serves an important role in establishing baseline trends and can be leveraged to respond to outbreaks of respiratory illness. OBJECTIVE: We identified and characterized an operationally unique outbreak of H3N2 influenza at Camp Lemonnier, Djibouti occurring simultaneously with the H1N1 pandemic of 2009 [A(H1N1)pdm09]. METHODS: Enhanced surveillance for ILI was conducted at Camp Lemonnier in response to local reports of a possible outbreak during the A(H1N1)pdm09 pandemic. Samples were collected from consenting patients presenting with ILI (utilizing a modified case definition) and who completed a case report form. Samples were cultured and analyzed using standard real-time reverse transcriptase PCR (rt-RT-PCR) methodology and sequenced genetic material was phylogenetically compared to other published strains. RESULTS: rt-RT-PCR and DNA sequencing revealed that 25 (78%) of the 32 clinical samples collected were seasonal H3N2 and only 2 (6%) were A(H1N1)pdm09 influenza. The highest incidence of H3N2 occurred during the month of May and 80% of these were active duty military personnel. Phylogenetic analysis revealed that sequenced H3N2 strains were genetically similar to 2009 strains from the United States of America, Australia, and South east Asia. CONCLUSIONS: This outbreak highlights challenges in the investigation of influenza among deployed military populations and corroborates the public health importance of maintaining surveillance systems for ILI that can be enhanced locally when needed.JH Libraries Open Access Fun

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

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

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Evaluation of antibacterial activity of different Moringa oleifera leaf extract on Streptococcus mutans: An in-vitro antimicrobial study

Dental caries, which has a complex etiology brought on by several facultative anaerobes, is a well-known serious oral health issue in the majority of developing countries. The primary pathogen linked to this illness is Streptococcus mutans. S. mutans species that are resistant to numerous commercial antibiotics have been found in dental caries patients. Multi-drug resistance (MDR) is a natural occurrence that poses a significant global hazard to human health. While there are several therapeutic options for treating or preventing dental decay, the worldwide burden of MDR-related diseases is continually growing. In order to evaluate the effectiveness of different Moringa oleifera leaf extract as a solvent to control S. mutans infection the current study was created. S. mutans was isolated and identified, then used the disc diffusion method to assess the isolates' susceptibility to antibiotics as well as different extracts. The results of a one-way ANOVA exposed significant (P< 0.001) differences between the various extract solutions and S. mutans. The highest level of efficacy among the three extract was ethanol extract on another hands the cold distal water extract was the lowest efficacy against S. mutans. M. oleifera solution with ethanol extract is more effective than the other extract types

Utilizing experimental design and desirability function in optimizing RP-HPLC method for simultaneous determination of some skeletal muscle relaxants and analgesics

Abstract An experimental design and response surface methodologies using Plackett–Burman and Box-Behnken designs were applied for selecting and optimizing the most appropriate parameters which significantly affect the separation and quantitative estimation of five skeletal muscle relaxants and four analgesic drugs (baclofen, methocarbamol, dantrolene sodium, orphenadrine citrate, cyclobenzaprine hydrochloride, ketoprofen, etoricoxib, ibuprofen, and mefenamic acid) with a relatively short duration of analysis in a single run. For the separation of the nine drugs, an INERTSIL ODS-V3-5 µm C18 column (250 × 4.6 mm I.D.) was used with the optimum mobile phase conditions (45.15 mM ammonium acetate buffer pH 5.56 adjusted with acetic acid, acetonitrile, and methanol in a ratio of 30.5:29.5:40, v/v/v with a flow rate of 1.5 mL/min) and UV-detection at 220 nm. The optimized method was successfully subjected to the validation steps as described in ICH guidelines for linearity, precision, accuracy, robustness, and sensitivity. The optimized and validated method was effectively applied to determine the content of the studied drugs in their pharmaceutical preparations and to expand its applicability to the counterfeit estimation of etoricoxib in different brands of tablet dosage forms

Identification of predominant pathogenic bacteria isolated from respiratory manifested small ruminants in western north Egypt with regard to their susceptibility to antibiotics

Respiratory illnesses continue to be a persistent issue threatens small ruminants as sheep and goat flocks which constitute an important section of the livestock economy in Egypt. The current study have conducted survey among a total of 432 acquiring respiratory manifested sheep (n≈ 380) and goat (n≈ 85) flocks scattered in Western North regions in Egypt during September 2020 to June 2021. Bacterial screening was proceeding through classical cultivation and biochemical identification as well as screening of their antibiogram.  The bacterial isolation revealed that the most prevalent pathogen was Klebsiella pneumoniae from 123 cases (27.15%), followed by Mannheimia haemolytica 108 (23.84%), Escherichia coli 75(16.5%); Staphylococcus spp. 36 (7.9%) and Streptococcus spp. 14(3.1%). The sensitivity to various antimicrobial agents was tested and demonstrated multi-drug resistant. In conclusion, the study supported the concept of the multi-bacterial etiology of the respiratory infections among sheep and goat flocks. There were high incidences of multidrug resistance behavior of the bacterial isolates which may constitute a public health importance