Delayed surgical debridement in pediatric open fractures: a systematic review and meta-analysis.

Purpose: Open fractures are considered orthopedic emergencies that are traditionally treated with surgical debridement within 6 h of injury to prevent infection. However, this proclaimed “6-h rule” is arbitrary and not based on rigorous scientific evidence. The aim of our study was to systematically review the literature that compares late (>6 h from the time of injury) to early (<6 h from the time of injury) surgical debridement of pediatric open fractures. Methods: We searched several databases from 1946 to 2013 for any observational or experimental studies that evaluated late and early surgical debridement of pediatric open fractures. We performed a meta-analysis using a random effects model to pool odds ratios for a comparison of infection rates between children undergoing late versus early surgical debridement. We also investigated the infection rates in upper- and lower-limb pediatric open fractures. Descriptive, quantitative, and qualitative data were extracted. Results: Of the 12 articles identified, three studies (retrospective cohort studies) were eligible for the meta-analysis, encompassing a total of 714 open fractures. The pooled odds ratio (OR = 0.79) for infection between late and early surgical debridement was in favor of late surgical debridement but was not statistically significant (95 % CI 0.32, 1.99; p = 0.38, I 2 = 0 %). No significant difference in infection rate was detected between pediatric open fractures in the upper and lower limbs according to the time threshold in the included studies (OR = 0.72, 95 % CI 0.29, 1.82; p = 0.40, I 2 = 0 %). Conclusions: The cumulative evidence does not, at present, indicate an association between late surgical debridement and higher infection rates in pediatric open fractures. However, initial expedient surgical debridement of open fractures in children should always remain the rule. Thus, multi-center randomized controlled trials or prospective cohort studies will be able to answer this question with more certainty and a higher level of evidence

Bacteriological and chemical properties of soil amended with fermented poultry bird feather

Huge amount of poultry wastes are generated annually in developing nations, of which end up in our environment. Feather as a poultry waste have caused environmental concerns in many of these countries. In this research work, poultry feather was used to study its effects on bacteriological and chemical properties in agricultural soil. The feathers collected were grinded, sterilized and fermented before mixing it with soil. Total heterotrophic counts of colonies were enumerated from the soil samples. Isolates were characterized based on morphological and series of biochemical tests. Soil chemical analysis for pH, carbon, nitrogen, phosphorus, calcium, potassium was also carried out. The heterotrophic bacteria count of the treated soil had the highest count in the range of 1.54 x106 to 2.02 x106 (CFU/g) as against the control soil with 1.24 x106 (CFU/g). The bacteria identified from these samples were Bacillus sp., Proteus sp., Staphylococcus sp. and Actinomyces sp. Actinomyces sp. was isolated only after three weeks of treatment with the feather while all other bacteria were also present in the control soil but at elevated levels based on heterotrophic bacteria count in the treated soil. The soil chemical analysis of the treated soil had high amount of mineral (Organic carbon 1.10 %, nitrogen 0.09%, phosphorus 0.53±0.02 mg/kg, magnesium 0.45±0.01 mg/kg as against the control (Organic carbon 0.26%, nitrogen 0.05%, phosphorus 0.30±0.10 mg/kg, magnesium 0.45±0.01 mg/kg) and their pH is almost near neutrality, 7.12 and 7.08 respectively. The result suggested that soil treated with poultry feather increased the plate count of Bacillus sp, Proteus sp, Staphylococcus sp and Actinomyces sp. Poultry feather which is a waste by-product can provide essential nutrients for the survival of soil microorganisms, plant growth and therefore can be exploited as biofertilizer.Keywords: Bacillus sp., biofertilizer, fermentation, keratin, poultry wast

Probing the nucleotide-binding activity of a redox sensor: two-component regulatory control in chloroplasts

Two-component signal transduction systems mediate adaptation to environmental changes in bacteria, plants, fungi, and protists. Each two-component system consists of a sensor histidine kinase and a response regu- lator. Chloroplast sensor kinase (CSK) is a modified sensor histidine kinase found in chloroplasts—photosynthetic organelles of plants and algae. CSK regulates the tran- scription of chloroplast genes in response to changes in photosynthetic electron transport. In this study, the full- length and truncated forms of Arabidopsis CSK proteins were overexpressed and purified in order to characterise their kinase and redox sensing activities. Our results show that CSK contains a modified kinase catalytic domain that binds ATP with high affinity and forms a quinone adduct that may confer redox sensing activity

Occupational Hazards and HBV infection among health care workers in Public Teaching Hospitals in Khartoum State, Sudan: A multiple Discriminant Analysis

Background: Infection with HBV leads to a wide spectrum of liver injury. It ranges from acute self-limited infection and fulminant hepatitis to chronic hepatitis.Objectives: To examine the prevalence of sero-epidemiologic markers of hepatitis B virus and to identify the risk factors of exposure to HBV among health care workers in Public Teaching Hospitals in Khartoum State, Sudan; in 2004.Methods: The study was a cross sectional, facility-based study. It was conducted on stratified two stage cluster sampling of 843 subjects. The study adopted multivariate statistical approach, using Multiple Discriminant Analysis (MDA) and some non-parametric tests.Results: Infection rate measured by Anti-HB core, carrier rate measured by HBs Ag, and a profile of high infectivity rate measured by HBe Ag was found to be high; while immunity rate measured by Anti-HBs was found to be low. Needle stick injury, contaminated sharp instruments injury andexposure to blood are the most significant occupational variables related to infection rate of HBV. Contaminated sharp instruments injury and exposure to blood, are the most significant occupational variables related to carrier rate. Date of needle stick injury, incidence and date of contaminated sharp instruments injury, incidence and date of exposure to blood have significant relation to immunity rate against HBV infection.Conclusion: The prevalence rate of HBV markers among HCWs in Public Teaching Hospitals in Khartoum State, Sudan, differs according to occupational hazard factors. With the exception of the HBeAg, seroprevalence of all HBV markers was found to be significantly correlated with occupational hazards (P&lt;0.05).Key words: HBV markers, HCWs

Oligomeric states in sodium ion-dependent regulation of cyanobacterial histidine kinase-2

Two-component signal transduction systems (TCSs) consist of sensor histidine kinases and response regulators. TCSs mediate adaptation to environmental changes in bacteria, plants, fungi and protists. Histidine kinase 2 (Hik2) is a sensor histidine kinase found in all known cyanobacteria and as chloroplast sensor kinase in eukaryotic algae and plants. Sodium ions have been shown to inhibit the autophosphorylation activity of Hik2 with precedes phosphoryl transfer to response regulators, but the mechanism of inhibition has not been determined. We report on the mechanism of Hik2 activation and inactivation probed by chemical cross-linking and size exclusion chromatography together with direct visualisation of the kinase using negative-stain transmission electron microscopy of single particles. We show that the functional form of Hik2 is a higher-order oligomer such as a hexamer or octamer. Increased NaCl concentration converts the active hexamer into an inactive tetramer. The action of NaCl appears to be confined to the Hik2 kinase domain

A Hyaluronic Acid Functionalized Self-Nano-Emulsifying Drug Delivery System (SNEDDS) for Enhancement in Ciprofloxacin Targeted Delivery against Intracellular Infection

Ciprofloxacin (CIP), a potent anti-bacterial agent of the fluroquinolone family, shows poor solubility and permeability, thus leading to the development of intracellular pathogens induced multi-drug resistance and biofilms formation. To synergistically improve the biopharmaceutical parameters of CIP, a hyaluronic acid (FDA approved biocompatible polymer) functionalized self-nano emulsifying drug delivery system (HA-CIP-SNEDDS) was designed in the present study. SNEDDS formulations were tested via solubility, droplet size, zeta potential, a polydispersity index, thermodynamic stability, surface morphology, solid-state characterization, drug loading/release, cellular uptake, and biocompatibility. The final (HA-CIP-SNEDDS) formulation exhibited a mean droplet size of 50 nm with the 0.3 poly dispersity index and negative zeta potential (-11.4 mV). HA-based SNEDDS containing CIP showed an improved ability to permeate goat intestinal mucus. After 4 h, CIP-SNEDDS showed a 2-fold and HA-CIP-SNEDDS showed a 4-fold permeation enhancement as compared to the free CIP. Moreover, 80% drug release of HA-CIP-SNEDDS was demonstrated to be superior and sustained for 72 h in comparison to free CIP. However, anti-biofilm activity of HA-CIP-SNEDDS against Salmonella typhi was higher than CIP-SNEDDS and free CIP. HA-CIP-SNEDDS exhibited increased biocompatibility and improved oral pharmacokinetics as compared to free CIP. Taken together, HA-CIP-SNEDDS formulation seems to be a promising agent against Salmonella typhi with a strong targeting potential

Focused antenatal care acceptance in northeastern region of Nigeria: clients' perspective.

Antenatal care is the medical care of the woman during pregnancy to ensure healthy outcomes for both mother and the baby. World Health Organization (WHO) recommended adoption of a new model of ANC known as Focused Ante-Natal Care (FANC), with four clinic visits during pregnancy for all the women in low risk category. Pregnant women who are at low risk of complication form about 75% of all pregnant women Objectives: The objective of the study was to determine acceptance of Focused Antenatal Care among antenatal clinic attendees in health institutions in northeastern Nigeria. Materials And Method: Focused group discussion was used as a qualitative method of data collection in 6 different health facilities. Results: Majority of the clients preferred the FANC to the old method of ANC. Some clients had already started cutting the number of ANC visits in their own way by late presentation during pregnancy. Such practices may contribute negatively to early detection and prevention of diseases during pregnancies. Conclusion: It is therefore highly recommended to fast track governments efforts towards commencement of FANC as recommended by the WHO in all the health facilities in the region in particular and the whole Nigerian nation in general

Moving from development to implementation of digital innovations within the NHS: myHealthE, a remote monitoring system for tracking patient outcomes in child and adolescent mental health services

OBJECTIVE: This paper aims to report our experience of developing, implementing, and evaluating myHealthE (MHE), a digital innovation for Child and Adolescents Mental Health Services (CAMHS), which automates the remote collection and reporting of Patient-Reported Outcome Measures (PROMs) into National Health Services (NHS) electronic healthcare records. METHODS: We describe the logistical and governance issues encountered in developing the MHE interface with patient-identifiable information, and the steps taken to overcome these development barriers. We describe the application's architecture and hosting environment to enable its operability within the NHS, as well as the capabilities needed within the technical team to bridge the gap between academic development and NHS operational teams. RESULTS: We present evidence on the feasibility and acceptability of this system within clinical services and the process of iterative development, highlighting additional functions that were incorporated to increase system utility. CONCLUSION: This article provides a framework with which to plan, develop, and implement automated PROM collection from remote devices back to NHS infrastructure. The challenges and solutions described in this paper will be pertinent to other digital health innovation researchers aspiring to deploy interoperable systems within NHS clinical systems