Can Chronic Nitric Oxide Inhibition Improve Liver and Renal Dysfunction in Bile Duct Ligated Rats?

The aims of the present work were to study the effects of chronic NO inhibition on liver cirrhosis and to analyze its relationship with liver and kidney damage markers. Two inhibitors of NO synthesis (inducible NO synthase (iNOS) inhibitor, aminoguanidine (AG), and nonselective NOS inhibitor, L-nitroarginine methyl ester (L-NAME)) were administered for 6 weeks to bile duct ligated (BDL) rats 3 days after surgery. The present study showed that BDL was associated with liver injury and renal impairment. BDL increased liver NO content and myeloperoxidase (MPO) activity. This was corroborated by increased oxidative stress, TNF-α, TGF-1β, and MMP-13 genes overexpression. Although both drugs reduced NO synthesis and TNF-α gene overexpression, only AG improved renal dysfunction and liver damage and reduced liver oxidative stress. However, L-NAME exacerbated liver and renal dysfunction. Both drugs failed to modulate TGF-1β and MMP-13 genes overexpression. In conclusion, inhibition of NO production by constitutive nitric oxide synthase (cNOS) plays a crucial role in liver injury and renal dysfunction while inhibition of iNOS by AG has beneficial effect. TNF-α is not the main cytokine responsible for liver injury in BDL model. Nitric oxide inhibition did not stop the progression of cholestatic liver damage

Overview on Hepatitis B vaccination

Background: Hepatitis B virus (HBV) infection is increasing globally, posing a serious public health problem. Hepatitis B virus (HBV) infection and mortality are among the leading causes of death worldwide. Concerns for public health are amplified by the fact that about a third of the world's population is afflicted with HBV. HBV infection may result in cirrhosis, hepatocellular cancer, or both (HCC).Immunization is the most cost-effective strategy available worldwide for controlling and preventing hepatitis B in terms of benefit-cost ratio. Objective: This review article discusses the most critical components of the HBV vaccine and the most efficient strategies for increasing HBV vaccinatio

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

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

GPR scan assessment

Mekaad Radwan monument is situated in the neighborhood of Bab Zuweila in the historical Cairo, Egypt. It was constructed at the middle XVII century (1635 AD). The building has a rectangle shape plan (13 × 6 m) with the longitudinal sides approximately WNW-ESE. It comprises three storages namely; the ground floor; the opened floor (RADWAN Bench) and the living floor with a total elevation of 15 m above the street level. The building suffers from severe deterioration phenomena with patterns of damage which have occurred over time. These deterioration and damages could be attributed to foundation problems, subsoil water and also to the earthquake that affected the entire Greater Cairo area in October 1992. Ground Penetrating Radar (GPR) scan was accomplished against the walls of the opened floor (RADWAN Bench) to evaluate the hazard impact on the walls textures and integrity. The results showed an anomalous feature through the southern wall of RADWAN Bench. A mathematical model has been simulated to confirm the obtained anomaly and the model response exhibited a good matching with the outlined anomaly

Aminoguanidine potentiates the hepatoprotective effect of Silymarin in CCL4 treated rats

This study examined the possible hepatoprotective effect of aminoguanidine in comparison with silymarin and investigated the possible beneficial effects of the combination of aminoguanidine and silymarin on CCL4-induced liver fibrosis. Male Wister albino rats were randomly divided into five groups (10 rats/group). Group I included control rats injected only with liquid paraffin and saline; group II represents CCL4 control (injected with CCL4 3 times a week for 6 weeks in a dose of 25μl/100gm.b.w i.p, diluted 1:6 with liquid paraffin); group III treated with aminoguanidine (100 mg/kg); group IV was given silymarin (100 mg/kg); group V was given aminoguanidine (100 mg/kg) and silymarin (100 mg/kg). Fibrosis was depicted histologically and biochemically.CCL4 increased serum liver enzymes (ALT, AST, and ALP), lactate dehydrogenase (LDH), level of nitric oxide (NO), tumor necrosis factor alpha (TNFα) and liver malondialdehyde content (MDA), collagen fiber percent and decreased liver reduced glutathione (GSH) content as endogenous antioxidant. Histopathological changes induced by CCL4 include regenerative nodules, deteriorated parenchyma; the lobules were infiltrated with fat and structurally altered. Aminoguanidine, silymarin and their combination reduced these changes and attenuated the pathological effects of CCL4 induced liver injury. The combination of both drugs was better than each drug alone. It is concluded that aminoguanidine has protective effect against CCL4 induced hepatoxicity via its iNOS inhibition and antioxidant effects. In addition, the combination of AG with silymarin has more potent hepatoprotective effect than each drug alone

Evaluation of the role of MSCT airway mapping in guiding trans-bronchial lung biopsy in cases of inaccessible lung lesions

Objective: This work aimed for using multislice computed tomography (MSCT) to map the bronchial tree and assess the exact site, direction, airway findings and bronchial measurements to guide trans-bronchial lung biopsy from an inaccessible lung lesion. Patients and methods: This study was carried on 26 patients. It was conducted in the Radiology Department, in collaboration with Chest Department, in the period from January 2015 to April 2016. All patients were subjected to Virtual Bronchographic (VB) examination and Trans-Bronchial lung biopsy (in selected cases guided by the VB results). Results: In this study, MSCT-VB maps guided the fiber-optic bronchoscopy in 30 bronchial lesions in 26 patients to the proper sampling site for different lung lesions with success rate 100% and CT maps were done, reaching 3rd to 7th order bronchial generation with mean distance from central bronchi was 21.3 mm and mean target bronchial diameter was 1.9 mm. Right sided lesions encountered in 57.7% and left sided lesions in 42.3% with the most common segmental affection was the right upper lobe in 36.7% of bronchial lesions and the apico-posterior subsegment of left upper lobe in 23.3% of lesions, then planning according to the site of the lesion in relation to the bronchial tree in the VB was done. Histopathological assessment was done with 61.5% neoplastic lesions and 38.5% inflammatory lesions. Conclusion: Multiplanar reconstruction images together with virtual bronchographic images were accurate in the detection of lesion’s site, depiction of degree of narrowing, and distal visualization of airways. This CT map should be used to guide bronchoscopy or to direct trans-bronchial needle biopsy to guarantee positive histopathological results