Evaluation of absorbent materials for use as ad hoc dry decontaminants during mass casualty incidents as part of the UK’s Initial Operational Response (IOR)

Copyright: © 2017 Kassouf et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.The UK's Initial Operational Response (IOR) is a revised process for the medical management of mass casualties potentially contaminated with hazardous materials. A critical element of the IOR is the introduction of immediate, on-scene disrobing and decontamination of casualties to limit the adverse health effects of exposure. Ad hoc cleansing of the skin with dry absorbent materials has previously been identified as a potential means of facilitating emergency decontamination. The purpose of this study was to evaluate the in vitro oil and water absorbency of a range of materials commonly found in the domestic and clinical environments and to determine the effectiveness of a small, but representative selection of such materials in skin decontamination, using an established ex vivo model. Five contaminants were used in the study: methyl salicylate, parathion, diethyl malonate, phorate and potassium cyanide. In vitro measurements of water and oil absorbency did not correlate with ex vivo measurements of skin decontamination. When measured ex vivo, dry decontamination was consistently more effective than a standard wet decontamination method ("rinse-wipe-rinse") for removing liquid contaminants. However, dry decontamination was ineffective against particulate contamination. Collectively, these data confirm that absorbent materials such as wound dressings and tissue paper provide an effective, generic capability for emergency removal of liquid contaminants from the skin surface, but that wet decontamination should be used for non-liquid contaminants.Peer reviewedFinal Published versio

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 < 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

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Parvovirus B19‐induced hemophagocytic lymphohistiocytosis: Case report and review of the literature

HLH is a catastrophic and likely underdiagnosed pathology with multiple triggers including infection. PVB19 can cause persistent marrow infection leading to HLH despite negative acute serologic markers making timely diagnosis difficult. Increased awareness of PVB19-HLH is warranted given its potentially lethal nature and the careful interpretation required with serologic markers

Amphidinolides F and C2: An Odyssey in Total Synthesis

International audienceAmphidinolides F, C, C2, and C3 are marine natural products isolated from dinoflagellates amphidinium species. They share the same macrolactone core, the difference between them residing at the side chain level. A predominant feature of these amphidinolides is the presence of two trans-THF rings inside the macrolactone core, titanium mediated C-glycosylation being applicable to build these motives. Thus, the original strategy for their total synthesis was based on the assembly of three main fragments corresponding to C 1-C 9 , C 10-C 19 , and C 20-C 29 or C 20-C 34 disconnections. Whereas synthesis of all fragments was successful, the C-glycosylation reaction between C 19 and C 20 turned out to be an issue. Therefore, a second route was designed. The new disconnection between C 17 and C 18 was based on a sulfone addition and a desulfonylation sequence. Our convergent strategy allowed the total synthesis of amphidinolide F and enabled a new unifying route towards the synthesis of amphidinolides C, C2, and C3 using a late-stage divergent approach. Although unsatisfying yields at some critical steps, our work culminated into the first total synthesis of amphidinolide C2

Evaluation of antioxidant capacity and physicochemical properties of Sudanese baobab (Adansonia digitata) seed-oil

The oil quality parameters of the seed oil of Baobab (Adansonia digitata) were evaluated using standard methods of analysis. The Iodine value, Peroxide value, Saponification value were 86 g/100g, 4.08 mEq/Kg, 188 mg/g, respectively, for seed oil. The oil content of the kernel was higher 23% compared to the hulls that contain 5.4% oil. The kernel oil contains substantial quantities of calcium, potassium, and magnesium, which were found to be 4116, 2339 and 1629 mg/Kg, respectively. The fatty acid profile showed that oleic and linoleic were the major unsaturated fatty acids, whereas palmitic was the major saturated acid. The oil also, showed considerable amount of total phenolic content (TPC) and worthy antioxidant activity. Baobab oil has great nutritional and industrial potentials. It is therefore recommended that more and advanced research should be undertaken for this abundant source of natural nutritious oil

Safety, target engagement, and biomarker effects of bosutinib in dementia with Lewy bodies

Abstract Introduction Bosutinib, a dual Abelson/Src inhibitor, was investigated in individuals with dementia with Lewy bodies (DLB). Methods A single site, randomized, double‐blind, placebo‐controlled study of the effects of oral bosutinib, 100 mg once daily for 12 weeks on primary safety and pharmacokinetics and secondary biomarker outcomes. Results Twenty‐six participants were randomized and included male and female (12:1) in the bosutinib arm and all male (13) in the placebo arm. The average age was 72.9 ± 8.1 (year ± standard deviation). There were no serious adverse events and no dropouts. Bosutinib was measured in the cerebrospinal fluid (CSF) and inhibited Abelson. Bosutinib reduced CSF alpha‐synuclein and dopamine catabolism. Discussion Bosutinib is safe and well tolerated and penetrates the blood–brain barrier to inhibit Abelson and reduce CSF alpha‐synuclein and dopamine catabolism, suggesting that bosutinib (100 mg) may be at or near the lowest effective dose in DLB. These results will guide adequately powered studies to determine the efficacy of a dose range of bosutinib and longer treatment in DLB. Highlights Bosutinib is a dual Abl/Src inhibitor that penetrates the blood brain barrier Bosutinib is safe and tolerated in individuals with dementia with Lewy bodies Bosutinib engages its target via inhibition of Abl and Src Bosutinib reduces CSF alpha‐synuclein and attenuates breakdown of dopamine Bosutinib improves activities of daily living in dementia with Lewy bodie

Alteration of Autophagy and Glial Activity in Nilotinib-Treated Huntington’s Disease Patients

Nilotinib is a tyrosine kinase inhibitor that is safe and tolerated in neurodegeneration, it achieves CSF concentration that is adequate to inhibit discoidin domain receptor (DDR)-1. Nilotinib significantly affects dopamine metabolites, including Homovanillic acid (HVA), resulting in an increase in brain dopamine. HD is a hereditary disease caused by mutations in the Huntingtin’s (HTT) gene and characterized by neurodegeneration and motor and behavioral symptoms that are associated with activation of dopamine receptors. We explored the effects of a low dose of nilotinib (150 mg) on behavioral changes and motor symptoms in manifest HD patients and examined the effects of nilotinib on several brain mechanisms, including dopamine transmission and gene expression via cerebrospinal fluid (CSF) miRNA sequencing. Nilotinib, 150 mg, did not result in any behavioral changes, although it significantly attenuated HVA levels, suggesting reduction of dopamine catabolism. There was no significant change in HTT, phosphorylated neuro-filament and inflammatory markers in the CSF and plasma via immunoassays. Whole miRNA genome sequencing of the CSF revealed significant longitudinal changes in miRNAs that control specific genes associated with autophagy, inflammation, microglial activity and basal ganglia neurotransmitters, including dopamine and serotonin

Depression and Its Associated Factors among Diabetes Mellitus Patients Attending the primary health care centers in United Arab Emirates: A Cross-Sectional Study

Diabetes mellitus (DM) and depression are major global public health problems. Depression negatively affects the course of DM through hormonal, neuronal, or immune system changes that directly affect the body's ability to produce or use insulin. The coexistence of depression with DM also results in poor glycemic control by causing poor self-care behaviors such as lack of physical activity. The coexistence of depression with DM also results in poor glycemic control. The study aimed to assessing depression and Its associated Factors among diabetes mellitus patients attending the primary health care centers in United Arab Emirates. This study was conducted on 463 diabetic patients attended the primary health care centers during 8th may to 26th may, 2021. Nine primary health care centers were selected according to the accessibility. The Patient Health Questionnaire-9 (PHQ-9) was selected of the actual 9 criteria upon which the diagnosis of DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) depressive disorders is based. Our study showed that there was non-significant difference in depression Levels between non-smokers and smokers, there was non-significant difference in depression Levels and education levels, there was significant difference in depression Levels and marital status, non-significant difference in depression Levels and nationality, non-significant difference in depression Levels and type of diabetes. Conclusion based on this study the prevalence of depression among female diabetes mellitus was high. From this study we concluded that depression levels: non-depressed, mild depression, moderate depression, moderately and severe depression are high in married participants comparing with single, divorced and widow participant