Hepatoprotective Effects of Moringa Oleifera Seeds Against Ethanol Induced Liver Damage In Wistar Rats

Hepatocytes are reportedly susceptible to the injurious effects of oxidants when exposed to toxic substances such as Ethanol . The widespread claims of the medicinal efficacy of various parts of Moringa oleifera plant have been well documented in literature. Oil was extracted from seeds and acetone extract was prepared from defatted seeds and evaluate antioxidant properties. The in vitro antioxidant of oil and acetone extract of Moringa oleifera (M. oleifera) seeds were assayed by DPPH scavenging activity and reducing power. The in vivo hepatoprotective effects evaluated in male Wistar rats against ethanol induced liver damage in preventive and curative models. The M. oleifera oil and acetone extract (300 mg/kg body weight (bw), and silymarin (100 mg/kg bw) were administered orally in both the studies. Liver injury was induced by 40% ethanol administration (3.76 gm/kg bw, orally) for 30 days. Both moringa oil and acetone extract showed a good amount of phenols and flavonoids and appeared antioxidant activity in reducing power and DPPH scavenging activity assay, while the oil of moringa was the more effective one compared with acetone extract. The level of plasma aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP) , total bilirubin , albumin, total protein and plasma antioxidant state (MDA content and catalase activity) were determined to assay hepatotoxicity. Ethanol administration caused severe hepatic damage in rats as evidenced by elevated plasma AST, ALT, ALP , total bilirubin, albumin, , total protein , MDA content and catalase activity levels. The oil , acetone extract of M. oleifera and silymarin administration prevented the toxic effect of ethanol on the above plasma parameters in preventive model. The present study concludes that oil and acetone extract of M. oleifera seeds have significant antioxidant and hepatoprotective activity against ethanol induced hepatotoxicity. Key words: Moringa oil , Moringa acetone extract, ethanol, antioxidant, liver,

Chest Tube Removal: Efficacy of Cold Application and Breathing Exercise on Pain and Anxiety Level

Context: Post-cardiothoracic surgical chest tube removal (CTR) is considered a painful technique and one of the most painful patients' experiences in the intensive care unit. Painkillers are the most prevalent method to relieve the pain, but the patient may not respond well and achieved complete relaxation. Regardless of scientific advances, no efficient action is possessed to decrease pain and anxiety because of it. Aim: This study aimed to investigate the efficacy of cold application and breathing exercises on pain and anxiety levels following chest tube removal.Methods: A quasi-experimental design (one group pre/post-test) was utilized to achieve the aim. This study was conducted in the Intensive Care Unit at the Cardio-Thoracic Academy Affiliated to Ain Shams University Hospital, Cairo. A Purposive sample included 60 patients undergoing cardiothoracic surgical procedures and having at least two chest tubes in place. Data were collected using three tools; a structured interviewing questionnaire, pain intensity assessment visual numeric scale, short-form McGill pain assessment questionnaire, modified comfort scale, and breathing exercise checklist. Results: This study revealed that patients suffer from severe pain before CTR without cold application and breathing exercise (61.7%), or with the application of them (66.7%), the pain level improved during removal as 80% of patients display no pain when using the cold application and breathing exercise that increased to 95% after 10-15 minute of removal compared to 8.3% when cold application and breathing exercise not used. Otherwise, the anxiety level decreased during CTR as 58.3% had mild anxiety level with cold application and breathing exercises compared to 38.3% had a very severe anxiety level. Mild anxiety level increased to 91.7% after 10-15 minutes of CTR compared to 16.7 % when CTR without application. Conclusion: Cold application and breathing exercises are useful for reducing patients' pain and anxiety levels associated with chest tube removal after cardiothoracic surgery. Encouraging critical care nurses to use cold application and breathing exercises as a non- pharmacological pain relief technique during chest tube removal was highly recommended

Evaluation of the Biocompatibility of a Recent Bioceramic Root Canal Sealer (BioRoot™ RCS): In-vivo Study

BACKGROUND: Recently, new calcium silicate bioceramic sealers were introduced to the market. The selection of root canal sealers should not only be based on the different physical parameters but also on local biocompatibility and tissue tolerance. AIM: This study aimed to evaluate and compare the in-vivo biocompatibility of a BioRoot RCS in parallel to MTA Fillapex and AH Plus sealers. METHODS: Polyethylene tubes containing the freshly mixed test materials were implanted in the subcutaneous tissue of 32 Wistar rats. Empty tubes served as negative controls. After 7, 14, 30, and 60 days, the animals were sacrificed, and the implants with surrounding tissues were processed for routine histological analysis. Histological sections were analyzed under light microscopy. The tissue response was determined by the inflammatory cell infiltration intensity and the fibrous capsule thickness. RESULTS: Results revealed a statistically significant decrease of the inflammation intensity by time within each group for all tested sealers and control. A well-defined thin capsule was observed for all tested sealers at 60 days. CONCLUSION: BioRoot RCS exhibited rapid recovery of inflammation similar to controls. Thus, within the limitations of this study, it can be considered a biocompatible sealer with acceptable tissue tolerance

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

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

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 &lt; 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

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Gamma rays-assisted bacterial synthesis of bimetallic silver-selenium nanoparticles: powerful antimicrobial, antibiofilm, antioxidant, and photocatalytic activities

Abstract Background Bimetallic nanoparticles (BNPs) has drawn a lot of attention especially during the last couple of decades. A bimetallic nanoparticle stands for a combination of two different metals that exhibit several new and improved physicochemical properties. Therefore, the green synthesis and design of bimetallic nanoparticles is a field worth exploring. Methods In this study, we present a green synthesis of silver nanoparticles (Ag NPs), selenium (Se) NPs, and bimetallic Ag-Se NPs using Gamma irradiation and utilizing a bacterial filtrate of Bacillus paramycoides. Different Techniques such as UV-Vis., XRD, DLS, SEM, EDX, and HR-TEM, were employed for identifying the synthesized NPs. The antimicrobial and antibiofilm activities of both the Ag/Se monometallic and bimetallic Ag-Se NPs were evaluated against some standard microbial strains including, Aspergillus brasiliensis ATCC16404, Candida albicans ATCC10231, Alternaria alternate EUM108, Fusarium oxysporum EUM37, Escherichia coli ATCC11229, Bacillus cereus ATCC15442, Klebsiella pneumoniae ATCC13883, Bacillus subtilis ATCC15442, and Pseudomonas aeruginosa ATCC6538 as a model tested pathogenic microbes. The individual free radical scavenging potentials of the synthesized Ag NPs, Se NPs, and bimetallic Ag-Se NPs were determined using the DPPH radical scavenging assay. The degradation of methylene blue (MB) dye in the presence of the synthesized Ag NPs, Se NPs, and bimetallic Ag-Se NPs was used to assess their photocatalytic behavior. Results According to the UV-Vis. spectrophotometer, the dose of 20.0 kGy that results in Ag NPs with the highest O.D. = 3.19 at 390 nm is the most effective dose. In a similar vein, the optimal dose for the synthesis of Se NPs was 15.0 kGy dose with O.D. = 1.74 at 460 nm. With a high O.D. of 2.79 at 395 nm, the most potent dose for the formation of bimetallic Ag-Se NPs is 15.0 kGy. The recorded MIC-values for Ag-Se NPs were 62.5 µg mL− 1, and the data clearly demonstrated that C. albicans was the organism that was most susceptible to the three types of NPs. The MIC value was 125 µg mL− 1 for both Ag NPs and Se NPs. In antibiofilm assay, 5 µg mL− 1 Ag-Se NPs inhibited C. albicans with a percentage of 90.88%, E. coli with a percentage of 90.70%, and S. aureus with a percentage of 90.62%. The synthesized NPs can be arranged as follows in decreasing order of antioxidant capacity as an antioxidant result: Ag-Se NPs > Se NPs > Ag NPs. The MB dye degradation in the presence of the synthesized Ag NPs, Se NPs, and bimetallic Ag-Se NPs was confirmed by the decrease in the measured absorbance (at 664 nm) after 20 min of exposure to sunlight. Conclusion Our study provides insight towards the synthesis of bimetallic NPs through green methodologies, to develop synergistic combinatorial antimicrobials with possible applications in the treatment of infectious diseases caused by clinically and industrial relevant drug-resistant strains

An Eco-Friendly Synthetic Approach for Copper Nanoclusters and Their Potential in Lead Ions Sensing and Biological Applications

A new preparation route for high-luminescent blue-emission pepsin copper nanoclusters (Pep-CuNCs) is introduced in this work. The synthesized nanoclusters are based on a pepsin molecule, which is a stomach enzyme that works to digest proteins that exist in undigested food. Here, we have developed an eco-friendly technique through microwave-assisted fast synthesis. The resulting copper nanoclusters (CuNCs) exhibit significant selectivity towards Pb(II) ions. The pepsin molecule was utilized as a stabilizer and reducing agent in the production procedure of Pep-CuNCs. The characteristics of the resulting Pep-CuNCs were studied in terms of size, surface modification, and composition using various sophisticated techniques. The CuNCs responded to Pb(II) ions through the fluorescence quenching mechanism of the CuNCs&rsquo; fluorescence. Thus, great selectivity of Pep-CuNCs towards Pb(II) ions was observed, allowing sensitive determination of this metal ion at lab-scale and in the environment. The CuNCs have detection limits for Pb(II) in very tenuous concentration at a nanomalar scale (11.54 nM). The resulting Pep-CuNCs were utilized significantly to detect Pb(II) ions in environmental samples. Additionally, the activity of Pep-CuNCs on different human tumor cell lines was investigated. The data for the observed behavior indicate that the Pep-CuNCs displayed their activity against cancer cells in a dose dependent manner against most utilized cancer cell lines