Suboptimal correction of low anorectal anomalies: a possible cause for intractable constipation in children

Background Constipation is a common problem among patients following the repair of low anorectal anomalies. We present our experience in managing constipation in a group of these patients with reoperation to correct residual anterior anal misplacement.Patients and methods The study included pediatric patients presenting with significant constipation following the repair of low anorectal anomalies. Patients with evidence of residual anterior anal misplacement (either clinically, by means of MRI, or using electrical muscle stimulation) were offered a reoperation to bring their ani backward to an orthotropic position.Results Thirteen patients were included in the study between September 2009 and June 2015. Their ages ranged from 1.5 to 10 years. The primary anomaly was rectoperineal fistula in 10 (seven boys and three girls) and rectovestibular in three girls. Two types of reoperations were performed: a posterior anoplasty with posterior sphincterotomy (five cases), and a limited sagittal anorectoplasty (eight cases). Straining at defecation was relieved in all patients. Of the 13 patients, nine were relieved from their constipation (69%) and had regular bowel movements without medications. The remaining four (31%) showed partial improvement.Conclusion Among patients with low anorectal anomalies, suboptimal correction with residual anterior anal misplacement represents one correctable cause for persistence of constipation

Potential Of Sugarcane In Modern Energy Development In Southern Africa

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)For more than half of the Southern African population, human development is limited by a lack of access to electricity and modern energy for cooking. Modern bioenergy merits consideration as one means to address this situation in areas where sufficient arable land is available. While numerous studies have concluded that Africa has significant biomass potential, they do not indicate by how much it can effectively reduce the use of traditional biomass and provide more accessible energy, especially at a country level. Here, we evaluate the potential of sugarcane to replace traditional biomass and fossil fuel and enlarge the access to electricity in Southern Africa. By using its current molasses for ethanol production, Swaziland could increase electricity generation by 40% using bagasse and replace 60% of cooking fuel or 30% of liquid fossil fuel. Sugarcane expansion over 1% of the pasture land in Angola, Mozambique, and Zambia could replace greater than 70% of cooking fuel. Bioelectricity generation from modest sugarcane expansion could be increased by 10% in Malawi, Mozambique, and Zambia and by 20% in Angola. Our results support the potential of sugarcane as a modern energy alternative for Southern Africa.4Sao Paulo Research Foundation (FAPESP) [2012/00282-3, 2015/02270-0]Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

GAS CHROMATOGRAPHY-MASS SPECTROMETRY ANALYSIS AND ANTIOXIDANT ACTIVITY OF PUNICA GRANATUM L. PEELS AND ITS ROLE AS IMMUNOSTIMULANT AGAINST SCHISTOSOMA MANSONI INFECTION IN BIOMPHALARIA ALEXANDRINA

Objective: To evaluate the antioxidant activity and chemical composition of Punica granatum L. and test it as immunostimulants against Schistosoma mansoni infection to Biomphalaria alexandrina snails.Methods: Antioxidant activity was evaluated by measuring the free radical scavenging activity of the 90% defatted methanol extract (90% DM) of P. granatum peels and its sub-derived fractions was evaluated via 2,2'-diphenyl-1-picrylhydrazyl and its chemical constituents were identified via gas chromatography-mass spectrometry (GC-MS) analysis. B. alexandrina snails were exposed to pomegranate extracts (PEs) for 1 month before their challenging with S. mansoni miracidia. Infection rates, immunological and histological parameters were, then, evaluated in PE-exposed snails and compared to controls.Results: The antioxidants activities of PE, expressed as scavenging concentration at 50%, were in the following order; 90% DM (12.45) ˃n-butanol(15.59) ˃ethyl acetate (21.36) ˃water (49.16) µg/ml, compared to 7.50 µg/ml for ascorbic acid. The infection rates of PE-exposed snails were 20%,50%, 60%, 70%, and 80%, respectively, for 90% DM, n-butanol, ethyl acetate, water, and dichloromethane extracts compared to 95% in control snails. The number of amoebocytes showed a significant increase, clear differentiation, and size increment in exposed snails compared to controls. Moreover, hermaphrodite glands histology shows a full maturity in the formation of reproductive cells in PE-exposed snails. The GC-MS analysis of the 90% DM extract revealed the presence of 36 compounds representing 93.1% of the total composition. Piperidin-4-ol, 1,3-dimethyl-2,4,6-triphenyl (19.87%), and 6,11-dihydroxy-5,12 naphthacenequinone-1-carboxylic acid (7.80%) were the major components.Conclusion: The identified compounds in 90% DM extract of P. granatum may be responsible for the high antioxidant activity of the fruit and it may account for its immunostimulatory effect against S. mansoni infection in B. alexandrina.Keywords: Punica granatum L., Antioxidant activity, Biomphalaria alexandrina, Schistosoma mansoni, Infection rate, Gas chromatography-mass spectrometry

Biocontrol of Fusarium wilt disease in pepper plant by plant growth promoting Penicillium expansum and Trichoderma harzianum

Plant growth promoting fungi (PGPF) were employed in the present study to biocontrol Fusarium wilt disease in pepper plants. Two of the five fungal isolates were chosen based on biochemical characteristics such as their production of hydrocyanic acid, siderophores, and IAA, phosphate solubilization, and in vitro antifungal activities. The most potent fungal isolates were identified as Penicillium expansum (P. expansum) and Trichoderma harzianum (T. harzianum). Using GC-MS, it was found that PGPF extracts contain compounds with antifungal activity, antioxidants, and plant growth stimulators. The combined effect of T. harzianum and P. expansum increased the protection against fusarial wilt by (76.74%), followed by T. harzianum by (50%), then P. expansum by (17.64%). Significant improvement because of using the mixture (T. harzianum and P. expansum) showed an increase in shoot length (59.4%), root length (129%), and number of leaves (52.6%). Chlorophyll A and B levels in infected plants were consistently raised by 28.71% and 67.58%, respectively; as a result of application the mixture (T. harzianum and P. expansum). Also, there was an increase in soluble proteins and carbohydrates in infected plants treated with (T. harzianum) by 25.42% and 31.78% over untreated infected plants, respectively. It could be recommended that the use of targeted PGPF strains, especially a mixture of T. harzianum and P. expansum could be commercially used as therapeutic nutrients against Fusarium wilt of pepper plants

Diagnostic performance and predictive value of rheumatoid factor, anti-cyclic-citrullinated peptide antibodies and HLA-DRB1 locus genes in rheumatoid arthritis

<p>Abstract</p> <p>Background</p> <p>We evaluated the significance of the genes, defined as <it>DRB1*04 </it>or <it>DRB1*01</it>, in rheumatoid arthritis (RA) patients. We focused on the role of genetic and serologic markers to predict disease activity and destructive process of joints.</p> <p>Methods</p> <p>Sixty patients with RA were examined. Radiographic changes were evaluated by (Larsen score) and disease activity was measured by disease activity score 28 (DAS28). The markers analyzed were: erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), anti-cyclic citrullinated peptides (anti-CCP2) and HLA-<it>DRB1 </it>alleles typed by PCR.</p> <p>Results</p> <p>In this study, anti-CCP antibodies, CRP, RF and AKA were detected in 83.3%, 56.7%, 71.7% and 52% of patients respectively. HLA-<it>DRB1</it>*01 was found in 45% of patients and 35% of them had one or two HLA-<it>DRB1*04 </it>alleles. According to <it>DRB1*04 </it>subtypes, (<it>DRB1* 0405</it>) was present in of 80% them. For prediction of grade of activity, the independent predictors were anti-CCP (OR 19.6), and <it>DRB1*04 </it>positive allele (OR 5.1). The combination of <it>DRB1*04 </it>+ anti-CCP antibodies gave increase in the specificity and positive predictive value to 92% and 90 respectively. As regards to the prediction of radiological joint damage, the independent predictors were HLA-<it>DRB1*04</it>, HLA-<it>DRB1*01</it>, RF, and CRP > 18 (OR 5.5, 4.5, 2.5, 2.0 respectively).</p> <p>Conclusion</p> <p>Our findings suggest that anti-CCP2 is superior to RF for the detection of RA and provided predictive information on joint destruction and disease activity. The presence of RA associated antibodies (ACCP or RF) and/or the SE genes are indicative for a poorer radiological outcome and higher grade of activity.</p

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

The relationship between lipid profile after fat loading and coronary artery disease severity assessed by SYNTAX score

BACKGROUND: Dyslipidemia is an established risk factor for coronary artery disease (CAD). Despite this, only half of CAD patients present with fasting dyslipidemia. Some reports have linked postprandial lipemia to atherosclerosis. We aimed to test the relationship between postprandial lipid profile (after fat loading) and CAD severity assessed by the SYNTAX score.METHODS: We included 53 patients with documented CADs. We checked both fasting and postprandial (2 hours) lipograms after fat loading with 17 g/body surface area (m2). Then we assessed CAD severity via coronary angiography using the SYNTAX score. Our study is registered in clinicaltrials.gov (NCT03175393).RESULTS: *53 patients with age 57.92 ± 7.82 were recuirted. 36 (68% ) of them were male .We observed a significant increase in postprandial triglycerides (TGs); TGs (154.30 ±73.23 vs. 128.07 ± 69.40 mg/dl; P < 0.001), very-low-density lipoproteins (VLDL) (30.85 ± 14.65 vs. 25.60 ± 13.93 mg/dl; P < 0.001) as well as a significant decrease in the postprandial level of total cholesterol (162.37 ± 45.86 vs. 168.26 ± 45.96 mg/dl; P = 0.03) in comparison to their fasting level.We found that the SYNTAX score had a significant positive moderate correlation with 2-hour postprandial TGs (r = 0.55; P < 0.001) and 2-hour postprandial VLDL (r = 0.50; P < 0.001). Based on the current study, predictors of high Syntax score were older age OR: 1.23( 1.11-3.47); P< 0.001, post-prandial triglyceride OR: 2.34 (1.89-5.66); P< 0.001 and post-prandial VLDL OR: 1.76( 1.50-3.49); P< 0.001CONCLUSION: Postprandial lipograms, especially TGs, are significantly and positively related to CAD severity

Acridine Orange and Flow Cytometry: Which Is Better to Measure the Effect of Varicocele on Sperm DNA Integrity?

We evaluated the effect of varicocelectomy on semen parameters and levels of sperm DNA damage in infertile men. A total of 75 infertile men with varicocele and 40 fertile men (controls) were included in this study. Semen analysis and sperm DNA damage expressed as the DNA fragmentation index using acridine orange staining and chromatin condensation test by flow cytometry were assessed before and 6 months after varicocelectomy. The patients were also followed up for 1 year for pregnancy outcome. Semen parameters were significantly lower in varicocele patients compared to controls (P<0.05). Mean percentages of sperm DNA fragmentation and sperm DNA chromatin condensation in patients were significantly higher than those in controls (P<0.05). After varicocelectomy, sperm DNA fragmentation improved significantly, whereas sperm chromatin condensation was not significantly changed. In 15 out of 75 varicocele patients, clinical pregnancy was diagnosed; those with positive pregnancy outcome had significant improvement in sperm count, progressive sperm motility, and sperm DNA fragmentation, but there was no significant difference in sperm DNA condensation compared to negative pregnancy outcome patients. We concluded from this study that acridine orange stain is more reliable method than flow cytometry in the evaluation of sperm DNA integrity after varicocelectomy

Developing a regional network for the assessment of evapotranspiration

Determining evapotranspiration (ET) is essential for water accounting and for the management of irrigated agriculture from farm to region. We describe here a collaborative initiative aimed at establishing a prototype ET network in six countries of North Africa and the Near East (NENA region). The network utilizes a low-cost and open-source system, termed the CORDOVA-ET, consisting of a base station and sensing nodes to collect the weather data needed to determine the reference and actual ET (ETo and ETa). Here, we describe the network-deployment processes, system architecture, data-collection methodology, quality-control procedures, and some of the ET results obtained so far during a four-year period, starting in 2018. The network has been developed as an iterative and collaborative process, where training and capacity building have been the main drivers. The feedback and experiences gathered from the users have helped improve the different versions of the prototypes and enhance their assembly, deployment, reliability, and ease of operation. At the same time, the involvement in the construction, maintenance, and data analysis has also provided valuable insight into calculating ET from energy-balance methods. The network operated during six cropping seasons and the results were mixed, while data integrity (hourly and daily) varied from 95 to 23% depending on the country and season. Validation of the ET estimates was performed using the ECMWF ERA5 dataset as an independent reference. The energy-balance algorithm implemented in the system to determine the ETa was validated using the OpenCropLib Python library. While the results of the data validation demonstrated the reliability and accuracy of the CORDOVA-ET system, network operations required significant support and special motivation on the part of the users. It is concluded that collaboration among users, together with the support services and participation of different stakeholders interested in agricultural water management, would be essential elements to ensure the sustainability of the ET network

Study on the short-term effects of increased alcohol and cigarette consumption in healthy young men's seminal quality

Many studies have reported a negative impact of lifestyle factors on testicular function, spermatozoa parameters and pituitary-gonadal axis. However, conclusions are difficult to draw, since studies in the general population are rare. In this study we intended to address the early and late short-term impact of acute lifestyle alterations on young men's reproductive function. Thirty-six healthy male students, who attended the Portuguese academic festivities, provided semen samples and answered questionnaires at three time-points. The consumption of alcohol and cigarette increased more than 8 and 2 times, respectively, during the academic festivities and resulted in deleterious effects on semen quality: one week after the festivities, a decrease on semen volume, spermatozoa motility and normal morphology was observed, in parallel with an increase on immotile spermatozoa, head and midpiece defects and spermatozoa oxidative stress. Additionally, three months after the academic festivities, besides the detrimental effect on volume, motility and morphology, a negative impact on spermatozoa concentration was observed, along with a decrease on epididymal, seminal vesicles and prostate function. This study contributed to understanding the pathophysiology underlying semen quality degradation induced by acute lifestyle alterations, suggesting that high alcohol and cigarette consumption are associated with decreased semen quality in healthy young men.publishe