RT-PCR ANALYSIS OF GENES EXPRESSION TO EVALUATE THE BIOMEDICAL IMPORTANCE OF MEDICAL-HERBAL EXTRACTS IN DIABETES TREATMENT

Fenugreek is an annual crop belonging to the legume family grown in most parts of the world. It is known to possess a number of medicinal properties, but a little phytochemical research has been carried out on the seeds of species; Trigonella hamosa Leguminosae. Previously we reported that Trigonella seeds extract are shown to have hypoglycemic effects on experimental diabetic rats. The aim of the current study is to understand the molecular mechanism of antidiabetic actions of Trigonella. Therefore, we examined the expressions levels of genes involved in glucose metabolism in liver of diabetic rats. Upon this basis, streptozotocin (STZ)-diabetic rats are used to assess hepatic glucokinase (GCK), insulin like growth factor-1 (IGF- 1), and glucose transporters (GLUT-2) genes expressions after Trigonella administration by oral intragastric intubation for two months, using RT-PCR assay. The current findings demonstrated that Trigonella reduced significantly glucose level in diabetic rats, while significantly increases insulin serum level. GCK expression levels in hepatic tissue of diabetic-rats are found to be suppressed, while Trigonella treatment induces an increase in hepatic GCK activity. Diabetes due to STZ has a little effect on IGF-1 gene expression, while Trigonella administration elevates mRNA expression significantly. On the other hand, Trigonella reduce and normalize the elevation of GLUT-2 gene expression, which increased due to STZ treatment. These results indicated that Trigonella are powerful antidiabetic agent, induce hypoglycemia by up-regulation of CGK and IGF-1 genes expression and induce an insulin mimetic activity

RT-PCR ANALYSIS OF GENES EXPRESSION TO EVALUATE THE BIOMEDICAL IMPORTANCE OF MEDICAL-HERBAL EXTRACTS IN DIABETES TREATMENT

Fenugreek is an annual crop belonging to the legume family grown in most parts of the world. It is known to possess a number of medicinal properties, but a little phytochemical research has been carried out on the seeds of species; Trigonella hamosa Leguminosae. Previously we reported that Trigonella seeds extract are shown to have hypoglycemic effects on experimental diabetic rats. The aim of the current study is to understand the molecular mechanism of antidiabetic actions of Trigonella. Therefore, we examined the expressions levels of genes involved in glucose metabolism in liver of diabetic rats. Upon this basis, streptozotocin (STZ)-diabetic rats are used to assess hepatic glucokinase (GCK), insulin like growth factor-1 (IGF- 1), and glucose transporters (GLUT-2) genes expressions after Trigonella administration by oral intragastric intubation for two months, using RT-PCR assay. The current findings demonstrated that Trigonella reduced significantly glucose level in diabetic rats, while significantly increases insulin serum level. GCK expression levels in hepatic tissue of diabetic-rats are found to be suppressed, while Trigonella treatment induces an increase in hepatic GCK activity. Diabetes due to STZ has a little effect on IGF-1 gene expression, while Trigonella administration elevates mRNA expression significantly. On the other hand, Trigonella reduce and normalize the elevation of GLUT-2 gene expression, which increased due to STZ treatment. These results indicated that Trigonella are powerful antidiabetic agent, induce hypoglycemia by up-regulation of CGK and IGF-1 genes expression and induce an insulin mimetic activity

The Bouveret Syndrome: An Unusual Cause of Hematemesis

Gallstones are usually silent. Less commonly, patients with cholelithiasis develop symptoms and/or complications; biliary fistula occurs in 3% to 5% of the cases. When a large stone is passed and occludes the duodenum, gastric outlet obstruction (the Bouveret syndrome) may result. In reported cases, the stones are usually larger than 2.5 cm. The usual presenting symptoms are those of bowel obstruction: abdominal pain, nausea, and vomiting. Less commonly, the patients experience melena and, rarely, hematemesis. We describe a patient who had the largest stone reported to cause hematemesis rather than bowel obstruction and to be diagnosed endoscopically. The 5 X 4 X 3 cm stone was extracted surgically. Endoscopic diagnosis and extraction of stones up to 3 cm in size has been reported, avoiding the need for surgery

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

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

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 &lt; 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

Heavy Metal Content in Chicken Meat Products: A Health Risk Assessment Study

There is an increasing demand for chicken meat products due to their high nutritive value, specific aroma and flavor, and cheap price compared to red meat. However, there is a clear lack of information on the residual content of toxic metals such as lead (Pb), cadmium (Cd), mercury (Hg), and trace elements such as zinc (Zn), and copper (Cu) in such products. Therefore, this study was undertaken to estimate the residual contents of Pb, Cd, Hg, Zn, and Cu in five chicken meat products including chicken burger, chicken fillet, chicken luncheon, chicken nuggets, and chicken panne. Moreover, estimated daily intakes (EDI), and the potential health risks of heavy metals due to consumption of such meat products were calculated for Egyptian adults and children. The achieved results indicated no detection of Hg in any sample. However, the other measured elements were detected in all examined chicken meat product samples at variable concentrations. The chicken burger had the highest metal concentrations. Several samples had higher Pb and Cd levels than the set maximum permissible limits. However, the calculated EDI, hazard ratio, and hazard index revealed no potential risks associated with the consumption of such chicken meat products among Egyptian adults and children

Using Optimized Three-Band Spectral Indices and a Machine Learning Model to Assess Squash Characteristics under Moisture and Potassium Deficiency Stress

Moisture and potassium deficiency are two of the main limiting variables for squash crop performance in many water-stressed places worldwide. If major output decreases are to be avoided, it is critical to detect signs of crop stress as early as possible in the growth cycle. Proximal remote sensing can be a reliable technique for offering a rapid and precise instrument and localized management tool. This study tested the ability of proximal hyperspectral remotely sensed data to predict squash traits in two successive seasons (spring and fall) with varying moisture and potassium rates. Spectral data were collected from drip-irrigated squash that had been treated to varied rates of irrigation and potassium fertilization over both investigated seasons. To forecast potassium-use efficiency (KUE), chlorophyll meter (Chlm), water-use efficiency (WUE), and seed yield (SY) of squash, different commonly used and newly-introduced spectral index values for three bands (3D-SRIs), as well as a Decision Tree (DT) model, were evaluated. The results revealed that the newly constructed three-band SRIs based on the wavelengths of the visible (VIS), near-infrared (NIR), and red-edge regions were sensitive enough to measure the four tested parameters of squash in this study. For instance, NDI558,646,708 presented the highest R2 of 0.75 for KUE, NDI744,746,738 presented the highest R2 of 0.65 for Chlm, and NDI670,628,392 presented the highest R2 of 0.64 for SY of squash. The results further demonstrated that the principal component analysis (PCA) demonstrated the ability to distinguish moisture stress from potassium deficiency stress at the flowering stage onwards. Combining 3D-SRIs, DT-based bands (DT-b), and the aggregate of all spectral characteristics (ASF) with DT models would be an effective strategy for estimating four observed parameters with appropriate accuracy. For example, the model’s approximately 30 spectral characteristics were extremely important for predicting KUE. Its outputs with R2 were, for the training and validation datasets, 0.967 (RMSE = 0.175) and 0.818 (RMSE = 0.284), respectively. For measuring Chlm, the DT-DT-b-20 model demonstrated the best. In the training and validation datasets, the R2 value was 0.993 (RMSE = 0.522) and 0.692 (RMSE = 2.321), respectively. The overall outcomes showed that proximal-reflectance-sensing-based 3D-SRIs and DT models based on 3D-SRIs, DT-b, and ASF could be used to evaluate the four tested parameters of squash under different levels of irrigation regimes and potassium fertilizer