Enzymatic Preparation of Low-Phenylalanine Formula Derived from Skim Milk Hydrolysate for Phenyl ketonuric Patients

Background: Phenylketonuria (PKU) is one of the most common inborn errors of amino acids metabolism. WHO guidelines introduced in 1979 and revised 1988 for breast-feeding infants with PKU included a formula containing low amounts of phenylalanine as a part of dietary prescription. Mental retardation can be prevented if PKU is diagnosed in the 1st three weeks of life and diet therapy started straightaway throughout life and especially in the hyper phenylalaninemic mothers before conception and during pregnancy. Aim of the Work: The aim of the present study was to synthesize a lowphenylalanine formula suitable to be taken by PKU children, adolescents and the hyperphenylalaninemic mothers. Materials and Method: This formula should be of high biological value, taken safely by those patients and to be of low cost. The formula was prepared from skim milk hydrolysate using two proteolytic enzymes. The first was the immobilized purified papain enzyme and the second was the modified protease XXIII prepared from Aspergillus oryzae. The skim milk hydrolysate was adsorbed on barium sulphate or activated carbon for removing phenylalanine. They were applied separately for the purpose of debittering and nutritional value comparison. Results: This skim milk hydrolysate had been supplemented with the amino acids tryptophan, tyrosine, methionine and valine. Beside the comprehensive amino acids analysis (Especially for the free amino acids), this formula was then analyzed for protein, fat, lactose and ash contents as well as microbiological and biological testing on mice. Hyperphenylalaninemia was induced in BALB/c mice model then changes in blood phenylalanine level and weight were scored during the periods of mutagenesis as well as the treatment period compared with the control group. Conclusion: The amino acids analysis showed that phenylalanine was 0.71gm/100 gram protein in the skim milk hydrolysate compared to 3.26gm amino acid/100 gram protein in the skim milk. The level of free phenylalanine decreased from 6.34% (In the skim milk) to 0% after adsorption to barium sulphate and compared to 3.41% after adsorption to activated carbon. The formula adsorbed on barium sulphate, although it is more preserving to the nutritional composition; yet, it is less effective in the debittering effect than that adsorbed on activated carbon. This formula, in addition to being of high nutrional value, it is not expensive since it is obtained from skim milk hydrolysate. From the present study, it could be concluded that: The synthesized low-phenylalanine formula was effective in supplying most of the needed dietary intakes for conditions of hyperphenylalaninemia. The use of the immobilized purified Papain and modified protease XXIII from Aspergillus oryzae in enzymatic hydrolysis of skim milk has been proved to be effective in hydrolysis and emulsification. Keywords: Phenylketonuria, skim milk. Egypt. J. Hum. Genet Vol. 9 (1) 2008: pp. 51-7

CHANGES IN SOME BIOPHYSICAL AND BIOCHEMICAL PARAMETERS IN BLOOD AND URINE OF WORKERS CHRONICALLY EXPOSED TO BENZENE

Objective: Benzene may occur naturally as a component of petroleum, or may be manufactured synthetically. It is found in the environment as a contaminant from both human activities and natural processes, posing serious bio-hazards from chronic exposure.Methods: A total of 330 individual were enrolled to study possible health hazards of benzene contamination; 265 males occupationally chronically exposed to low levels of benzene in their daily activity were compared to 65 healthy individuals of the same socio-economic standard. Benzene workers were divided between 45 workers in printing shops, 70 subjects dealing with benzene containing paints (painters), 75 subjects working in professions related to automotive work (autoworkers) and 75 car drivers.Results: benzene itself was not detected in blood or urine of all participants, but the levels of its metabolites; phenol and t,t-muconic acid, were higher in the blood and urine samples in the group of benzene-exposed workers. The results also indicate that individuals in this group are under oxidative stress. However, neither the determined liver function nor the kidney function tests showed significant deviation from controls. However, the results of the biophysical hematological parameters, including the degree of hemolysis, blood viscosity, RBCs aggregation and form factor were significantly deviated from normal.Conclusion: The deviation of the determined biochemical and biophysical parameters from normal may predispose such workers to a variety of health problems. Early correction of the oxidative stress and the hematological parameters and improvement of working conditions are necessary to prevent their progress to more serious health conditions, especially in children and young adolescents working under similar conditions.Running Title : Chronic exposure to benzene in work plac

Improved Gastrointestinal Symptoms and Quality of Life after Conversion from Mycophenolate Mofetil to Enteric-Coated Mycophenolate Sodium in Renal Transplant Patients Receiving Tacrolimus

It is reported that a conversion from mycophenolate mofetil (MMF) to enteric-coated mycophenolate sodium (EC-MPS) relieves gastrointestinal (GI) symptom burden and improves health-related quality of life (HRQoL). However, it is unclear whether renal transplant recipients using tacrolimus receive the same benefit from the conversion. In this prospective, multi-center, open-label trial, patients were categorized into two groups by their GI symptom screening. Equimolar EC-MPS (n=175) was prescribed for patients with GI burdens; those with no complaints remained on MMF (n=83). Gastrointestinal Symptom Rating Scale (GSRS) and Gastrointestinal Quality of Life Index (GIQLI) were evaluated at baseline and after one month. Patients and physicians completed Overall Treatment Effect (OTE) at one month. EC-MPS-converted patients had worse GSRS and GIQLI scores at baseline than MMF-continued patients (all P<0.001). Significant improvements in GSRS and GIQLI scores were observed for EC-MPS-converted patients at one month, but MMF-continued patients showed worsened GSRS scores (all P<0.05). OTE scale indicated that EC-MPS patients improved in overall GI symptoms and HRQoL more than MMF patients did (P<0.001). In tacrolimus-treated renal transplant recipients with GI burdens, a conversion from MMF to EC-MPS improves GI-related symptoms and HRQoL

Improved photovoltaic performance of monocrystalline silicon solar cell through luminescent down-converting Gd2O2S:Tb3+ phosphor

This work reports on efforts to enhance the photovoltaic performance of standard p‐type monocrystalline silicon solar cell (mono‐Si) through the application of ultraviolet spectral down‐converting phosphors. Terbium‐doped gadolinium oxysulfide phosphor and undoped‐gadolinium oxysulfide precursor powders were prepared by a controlled hydrothermal decomposition of a urea homogeneous precipitation method. The resulting rare‐earth element hydroxycarbonate precursor powders were then converted to the oxysulfide by annealing at 900°C in a sulfur atmosphere. The as‐prepared phosphors were encapsulated in ethylene vinyl acetate co‐polymer resin and applied on the textured surface of solar cell using rotary screen printing. Comparative results from X‐ray powder diffraction, field emission scanning electron microscopy, scanning transmission electron microscopy, and photoluminescence spectroscopy studies on the microstructure and luminescent properties of the materials are reported. We also compared the optical reflectance and external quantum efficiency response of the cells with and without a luminescent phosphor layer. The results obtained on the terbium‐doped gadolinium oxysulfide phosphor show clearly that the down‐conversion effect induced by the terbium dopant play a crucial role in enhancing the photovoltaic cells' performance. Under an empirical one‐sun illumination, the modified cells showed an optimum enhancement of 3.6% (from 16.43% to 17.02%) in conversion efficiency relative to bare cells. In the concentration range of 1 to 2.5 mg/mL, EVA/Gd2O2S (blank) composites also improve electrical efficiency, but not as much as EVA/Gd2O2S:Tb3+ composites

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Mapping geographical inequalities in oral rehydration therapy coverage in low-income and middle-income countries, 2000-17

Background Oral rehydration solution (ORS) is a form of oral rehydration therapy (ORT) for diarrhoea that has the potential to drastically reduce child mortality; yet, according to UNICEF estimates, less than half of children younger than 5 years with diarrhoea in low-income and middle-income countries (LMICs) received ORS in 2016. A variety of recommended home fluids (RHF) exist as alternative forms of ORT; however, it is unclear whether RHF prevent child mortality. Previous studies have shown considerable variation between countries in ORS and RHF use, but subnational variation is unknown. This study aims to produce high-resolution geospatial estimates of relative and absolute coverage of ORS, RHF, and ORT (use of either ORS or RHF) in LMICs. Methods We used a Bayesian geostatistical model including 15 spatial covariates and data from 385 household surveys across 94 LMICs to estimate annual proportions of children younger than 5 years of age with diarrhoea who received ORS or RHF (or both) on continuous continent-wide surfaces in 2000-17, and aggregated results to policy-relevant administrative units. Additionally, we analysed geographical inequality in coverage across administrative units and estimated the number of diarrhoeal deaths averted by increased coverage over the study period. Uncertainty in the mean coverage estimates was calculated by taking 250 draws from the posterior joint distribution of the model and creating uncertainty intervals (UIs) with the 2 center dot 5th and 97 center dot 5th percentiles of those 250 draws. Findings While ORS use among children with diarrhoea increased in some countries from 2000 to 2017, coverage remained below 50% in the majority (62 center dot 6%; 12 417 of 19 823) of second administrative-level units and an estimated 6 519 000 children (95% UI 5 254 000-7 733 000) with diarrhoea were not treated with any form of ORT in 2017. Increases in ORS use corresponded with declines in RHF in many locations, resulting in relatively constant overall ORT coverage from 2000 to 2017. Although ORS was uniformly distributed subnationally in some countries, within-country geographical inequalities persisted in others; 11 countries had at least a 50% difference in one of their units compared with the country mean. Increases in ORS use over time were correlated with declines in RHF use and in diarrhoeal mortality in many locations, and an estimated 52 230 diarrhoeal deaths (36 910-68 860) were averted by scaling up of ORS coverage between 2000 and 2017. Finally, we identified key subnational areas in Colombia, Nigeria, and Sudan as examples of where diarrhoeal mortality remains higher than average, while ORS coverage remains lower than average. Interpretation To our knowledge, this study is the first to produce and map subnational estimates of ORS, RHF, and ORT coverage and attributable child diarrhoeal deaths across LMICs from 2000 to 2017, allowing for tracking progress over time. Our novel results, combined with detailed subnational estimates of diarrhoeal morbidity and mortality, can support subnational needs assessments aimed at furthering policy makers' understanding of within-country disparities. Over 50 years after the discovery that led to this simple, cheap, and life-saving therapy, large gains in reducing mortality could still be made by reducing geographical inequalities in ORS coverage. Copyright (c) 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe