IN VITRO PROPAGATION OF PLECTRANTHUS BARBATUS ANDREWS AS IMPORTANT MEDICINAL PLANT

Plectranthus barbatus Andrew (Coleus forskolii) is one of the important species of the genus Plectranthus (Coleus) belonging to family Lamiaceae, with a many of traditional medicinal uses in India. C. forskolii is only known source of forskolin; a compound with a many uses in pharmaceutical industries. C. forskolii was lack in Egyptian flora. Moreover, there were no previously studies on this plant in Egypt. Therefore, the present study used tool of biotechnology to conserve the stocks of this plant by micropropagation. C. forskolii seedlings came from its native Thailand at June 2013 and were put in the greenhouse in Desert Research Center for creating an efficient micropropagation protocol. The study was carried out on the effect of growth regulators (cytokinins and auxins) on different micropropagation stages of the explants. In multiplication stage, initiated shoots were cultured on MS medium supplemented with various concentrations (0.5, 1.0, 1.5 and 2.0 mg/L) of cytokinins (6-benzylaminopurine (BA), Kinetin ( KIN) and Thidiazuron (TDZ). The mean number of axillary shoots per explant of C. forskolii reached the highest value 6.19 ±0.573 on MS medium containing 2.0mg/L TDZ. Where, the highest value of mean length was 6.44± 0.310 cm on MS medium containing 1.0 mg/L KIN. The mean number of roots / explant of C. forskolii reached the highest value and the mean length were 30.00 ± 0.577 and 11.8±0.860 cm respectively, on 1/2 MS medium containing 0.5mg/L indole-3-butyric acid(IBA). While, the highest value of shoot length was 11.8±0.860 cm on 1/2 MS medium containing  2.0mg/L naphthalene acetic acid (NAA). A percentage of 83% of rooted plantlets were successfully acclimatized after four weeks and grown normally in the greenhouse in sterile soil mixture of garden soil,  vermiculate and sand (2:1:1/v/v/v). The protocol could be cost effective and useful in germplasm conservation and delivery of tissue cultured Coleus plants

Effect of Cognitive Rehabilitation on Improving Cognitive Function and Activities of Daily Living among Elderly Patients With Stroke at Assiut University Hospital

Cognitive impairment is a frequent consequence of stroke. The study aimed to measure the effect of cognitive rehabilitation of elderly patients with stroke on their cognitive function and activities of daily living. Quasi experimental research design were used in this study. This study was conducted at neuropsychiatric, physical medicine and rehabilitation departments at Assiut University hospital, their number were 70 elderly stroke patients aged 60 years and above, (study group, 35, control group, 35) . Six tools were utilized ,tool 1: Socio- demographic characteristics and questions about stroke tool II: Mini-Mental State Examination tool III: Digit Span tool IV: Logical memory tool V: Geriatric Depression Scale. Tool VI:  Barthel Index scale. The rehabilitation program: consist of five practical session about spatial memory, attention and concentration, visual attention, fish face task and N400 task and three theoretical session about health education for diabetes mellitus, hypertension and prevention of recurrent stroke. The main result of the present study revealed that a significant statistical difference was existed between both studied groups in relation to Min Mental State Examination  (P-value = 0.000*). Conclusion: Application of training program about cognitive impairment  of stroke elderly patients have significant therapeutic effect on cognitive function, and on activities of daily living. Recommendation: Routine use of screening assessment of cognitive impairment in every stroke patient for early detection, and Health education to the elderly patients and caregivers about the possible ways of prevention of recurrent stroke and ways for controlling of diabetes and hypertension Keywords: Cognitive rehabilitation, Elderly, Stroke patient

DEVELOPMENT OF SOME TOLERANT YEAST (SACCHAROMYCES CEREVISIAE) STRAINS TO HEAT AND SALT STRESSES

All living organisms are subjected to changing in conservational conditions, to which they must adapt to. Stress is defined as a threat refers to the physiological balance of systems critical to survival organisms. Five yeast strains (Saccharomyces cerevisiae) were subjected to different adverse environmental situations, such as thermal, osmotic and oxidative (salt) stresses. The objective of this work was to detect the most tolerant yeast strains under salt or heat stresses.  Five yeast strains were exposed in a first experiment to heat stress at 20°C or 40°C beside to the control at 30°C to detect the more tolerant strain. The same yeast strains were subjected in a second experiment to two different concentrations of salt stress (NaCl); 0.5 or 1.0 M, separately, for two days (at 30°C as normal temperature for growth), other strains were exposed to 0.5 M concentration of NaCl for 24 hours, then 1 M for another 24 hours. For the heat stress results, strain S4 was more tolerant at 40oCwith insignificant difference compared to the control (30oC), while it showed significant difference at 20°C. Strain S5 also was more tolerant at 20oC with insignificant difference compared to the control. For salt treatment, the only insignificant value was for strain S3at 0.5M NaCl compared with the control

RT-PCR FOR ANTIOXIDANT GENES FROM EGYPTIAN GRAY MANGROVE Avicennia marina UNDER SALT STRESS TO NABQ PROTECTED AREA

RT-PCR was conducted for four genes implicated for salt tolerance, oxidative and osmotic stresses in Egyptian gray mangroves within Nabq protected area in South Sinai Governorate. The results showed over-expression of the mRNA of ferritin (amFer1) gene as very high expression, followed by increase in  mRNA of superoxide dismutase (amSOD1) and ubiquitin conjugation2 (amUBC2).  At the same time gene expression of catalase (amCAT1) decreased

THE siRNA EFFICACY OF SOLUBLE ACID INVERTASE DOWN-REGULATION IN SUGARCANE (SACCHARUM SPP.)

Sugarcane (Saccharum sp. hybrids) is a C4 grass used as a major source of sucrose. Invertase enzymes hydrolyse sucrose into hexose sugars reducing the production markedly. Soluble acid invertase role is always a case of discussion for having a major or minor role in the breakdown process in sink tissues. Bio-deterioration is another serious problem accomplishes the sucrose production, the delay between harvest and milling of sugarcane cause enormous depreciation in cane tonnage as well as sugar recovery. Beside another many factors, it was improved that both neutral and acid invertase present in cane stalk and both have tendency to increase after harvest. In the present study, sugarcane cultivar G.99/103, Saccharum  officinarium, was used to establish Inplanta transformation experiment for down-regulation of soluble acid invertase gene using siRNA application. The transgenic plants were examined chemically and genetically to estimate the percentage of silencing and its impact on the sucrose content. The enzyme activity showed reduction compared to control in most transgenic plants and consequently the decrease in expression level of soluble acid invertase increase the Brix value significantly in some of the transgenic plants

GENETIC DIVERSITY ASSESSMENT OF IN VITRO IRRADIATED TOMATO (LYCOPERSICON ESCULENTUM MILL.) USING SCOT MARKERS

Tomato (Lycopersicon esculentum Mill.) is considered the major and important globally vegetable crops especially in Egypt. Tissue culture techniques have facilitated the induction of mutant which helps in crop improvement. The mutation induction in vegetative crops through tissue culture may be the optimal method to improve these crops. Tomato explants of Idkawy Egyptian cultivar were cultured in vitro on MS medium supplemented with 0.2 mg/L BAP. The resulted plantlets were irradiated with different gamma radiation doses (50, 100, 150, 200 or 250 Gy) and the survival and mean of shoot length decreased as gamma radiation doses increased. The survival percentages of irradiated plantlets were ranged from 78.75% with 50 Gy dose to 18.75% with 250 Gy dose, while the shoot length values were decreased by a rate of 2.71 cm for dose 50 Gy and 1.2 cm for 250 Gy dose. The ten SCoT primers amplified a total of 114 amplicons with a range from 4 with SCoT-4 primer to 18 amplicons with SCoT-5  primer with an average of 11.4 amplicons per primer, The radiation specific markers were ranged from one fragment with SCoT-1 and SCoT-2 primers, SCoT- 5 two fragments with primer to five fragments with SCoT-3 and SCoT-33 primers

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

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

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