Effect of dexamethasone on reducing pain and gastrointestinal symptoms associated with cesarean section: a systematic review and meta-analysis

Background: Dexamethasone has analgesic and antiemetic actions that have been documented in the literature. Therefore, we performed a systematic review and meta-analysis to investigate its overall effectiveness in reducing a variety of negative outcomes after cesarean section. Objectives: To investigate the efficacy and safety of dexamethasone for reducing pain associated with cesarean section, nausea, vomiting, pruritus, postoperative need for analgesia, postoperative antiemetic requests and headache. Methods: We searched PubMed, Cochrane CENTRAL, SCOPUS, and Web of Science for relevant clinical trials. We then performed a systematic review and meta-analysis, including only randomized, placebo-controlled clinical trials. Our main population target was women undergoing elective cesarean delivery. The intervention under consideration was dexamethasone administered both by intravenous (IV) or subcutaneous (SC) over a variety of doses. The comparator was a placebo. Our main outcomes included: (1) perceptions as indicated by pain scores, (2) occurrence of nausea and (3) occurrence of vomiting. Secondary outcomes included: (4) occurrence of pruritus, (5) need for postoperative analgesia, (6) need for postoperative antiemetic drugs and (7) occurrence of headache. We assessed the quality of included studies using the risk of bias tool described in Cochrane\u27s handbook for systematic reviews of interventions. Results: We found that dexamethasone seemed to significantly reduce scores for pain at rest (p<0.001), as well as occurrence of nausea (p<0.001) and vomiting (p<0.001). The drug also showed significant reduction of negative symptoms in other secondary outcomes, including need for postoperative analgesia (p<0.001) and postoperative antiemetic drugs (p<0.001). However, the drug showed no significant effect in reducing headache and pruritus or in improving pain at movement scores. Conclusion: Dexamethasone appears to decrease perception of pain at rest and protects against nausea and vomiting. However, it does not seem effective against headaches or pruritus

Isolation and identification of a prodigiosin-like pigment producer Vibrio sp. isolate from a sea snail Thais sp

Marine bacteria associated with Mediterranean Sea snails have not been explored intensively. The aim of the study was to explore marine pigmented bacteria associated with the sea snail Thais sp. commonly found in Alexandria seashores where a red-pigmented bacterium was isolated and identified as Vibrio sp. based on phenotypic traits and 16S rRNA gene sequence analysis. Based on ultraviolet-visible (UV-vis) spectral and liquid chromatography-mass spectrometry (LC-MS) analysis, the red pigment was identified as a prodigiosin-like pigment. To our knowledge, this is the first report on the isolation of a Vibrio strain from a gastropod able to synthesize prodigiosin. Maximum production (7 mg/L) was achieved after two days in MZM cultures containing 0.5% mannitol and 2.5% soybean meal, pH 7 and statically incubated at 30 °C, using Plackett-Burman factorial design. RT-qPCR revealed that pks-1 and nrps responsible for the biosynthesis of prodigiosin and other bioactive compounds were up-regulated by the addition of sublethal concentrations of imipenem, DMSO, and the heavy metals copper oxide and chromium VI oxide. Through this work it can be concluded that marine invertebrates should be further explored for bacteria producing bioactive compounds whose synthesis can be enhanced or blocked depending on the carbon and nitrogen sources adopted in the fermentation medium. Moreover, the mRNA expression of the genes responsible for prodigiosin-like pigment production can be up-regulated through adopting sub-lethal concentrations of stress inducing compounds as well as co-cultivatio

The Role of Medical Image Modalities and AI in the Early Detection, Diagnosis and Grading of Retinal Diseases: A Survey.

Traditional dilated ophthalmoscopy can reveal diseases, such as age-related macular degeneration (AMD), diabetic retinopathy (DR), diabetic macular edema (DME), retinal tear, epiretinal membrane, macular hole, retinal detachment, retinitis pigmentosa, retinal vein occlusion (RVO), and retinal artery occlusion (RAO). Among these diseases, AMD and DR are the major causes of progressive vision loss, while the latter is recognized as a world-wide epidemic. Advances in retinal imaging have improved the diagnosis and management of DR and AMD. In this review article, we focus on the variable imaging modalities for accurate diagnosis, early detection, and staging of both AMD and DR. In addition, the role of artificial intelligence (AI) in providing automated detection, diagnosis, and staging of these diseases will be surveyed. Furthermore, current works are summarized and discussed. Finally, projected future trends are outlined. The work done on this survey indicates the effective role of AI in the early detection, diagnosis, and staging of DR and/or AMD. In the future, more AI solutions will be presented that hold promise for clinical applications

Matrix-assisted laser desorption-ionization-time-of-flight mass spectrometry as a reliable proteomic method for characterization of Escherichia coli and Salmonella isolates

Aim: Identification of pathogenic clinical bacterial isolates is mainly dependent on phenotypic and genotypic characteristics of the microorganisms. These conventional methods are costive, time-consuming, and need special skills and training. An alternative, mass spectral (proteomics) analysis method for identification of clinical bacterial isolates has been recognized as a rapid, reliable, and economical method for identification. This study was aimed to evaluate and compare the performance, sensitivity and reliability of traditional bacteriology, phenotypic methods and matrix-assisted laser desorption-ionization-time-of-flight mass spectrometry (MALDI-TOF MS) in the identification of clinical Escherichia coli and Salmonella isolates recovered from chickens. Materials and Methods: A total of 110 samples (cloacal, liver, spleen, and/or gall bladder) were collected from apparently healthy and diseased chickens showing clinical signs as white chalky diarrhea, pasty vent, and decrease egg production as well as freshly dead chickens which showing postmortem lesions as enlarged liver with congestion and enlarged gall bladder from different poultry farms. Results: Depending on colonial characteristics and morphological characteristics, E. coli and Salmonella isolates were recovered and detected in only 42 and 35 samples, respectively. Biochemical identification using API 20E identification system revealed that the suspected E. coli isolates were 33 out of 42 of colonial and morphological identified E. coli isolates where Salmonella isolates were represented by 26 out of 35 of colonial and morphological identified Salmonella isolates. Serological identification of isolates revealed that the most predominant E. coli serotypes were O1 and O78 while the most predominant Salmonella serotype of Salmonella was Salmonella Pullorum. All E. coli and Salmonella isolates were examined using MALDI-TOF MS. In agreement with traditional identification, MADI-TOF MS identified all clinical bacterial samples with valid scores as E. coli and Salmonella isolates except two E. coli isolates recovered from apparently healthy and diseased birds, respectively, with recovery rate of 93.9% and 2 Salmonella isolates recovered from apparently healthy and dead birds, respectively, with recovery rate of 92.3%. Conclusion: Our study demonstrated that Bruker MALDI-TOF MS Biotyper is a reliable rapid and economic tool for the identification of Gram-negative bacteria especially E. coli and Salmonella which could be used as an alternative diagnostic tool for routine identification and differentiation of clinical isolates in the bacteriological laboratory. MALDI-TOF MS need more validation and verification and more study on the performance of direct colony and extraction methods to detect the most sensitive one and also need using more samples to detect sensitivity, reliability, and performance of this type of bacterial identification

Prevalence and Clinical Significance of SEN-virus and TT- virus Infection in Chronic HCV Patients

Background: SEN virus (SENV) and Torque teno virus (TTV) are blood born viruses. Their effect on the development and progress of liver diseases is still unclear. The aim of this study was to determine the prevalence and effect of SENV and TTV among chronic hepatitis C (CHC) patients. Patients and Methods: two hundred patients with CHC were the subjects of this work. A single blood sample was collected from each patient. Thorough clinical examination and relevant laboratory and radiological investigations were done. SENV and TTV were tested for by polymerase chain reaction (PCR). Results: SENV was identified in 3 and TTV was found in 21 (10.5%) of patients. No statistically significant difference was detected as regards clinical status, laboratory findings or radiological examination between SENV or TTV positive and negative patients. Conclusion: SENV and TTV exist among CHC patients. They had insignificant implications on the course or progression of liver diseases. &nbsp; &nbsp

Bacterial Diseases Affecting the Cultured Sepia Officinalis Leading to Increase Mortality Rates in The Laboratory

The early growth, mortality rates and bacterial infections of the cultured Sepia Officinalis were experimentally studied in the laboratory. Two hundred eighty-five sepia larvae were hatched and placed in a 100-liter capacity rectangular glass aquarium (filled with seawater) in the laboratory. The Sepia individuals (285 individuals) were divided into two groups the first fed on a mixture of amphipods, rotifers and artemia and the second group fed only on amphipods to follow their growth and mortality. The second group was observed to grow faster with length 6.76 ± 0.06mm and weight 0.11 ± 0.01gm than the first one. The survival rate was 100% by the end of the first week and decreased gradually by the end of the second week. The recorded mortality rate reached 49% by the day 15th, where they infected with bacterial disease of Vibrio alginolyticus. The clinical signs of the diseased S. Officinalis were lethargic condition, food fasting and multiple skin ulcers with white-gray discoloration were observed and appeared on the body. The main postmortem lesions were congestion of the internal organ, beside the presence of ascetic fluid. The mortality among the diseased Sepia was increased by age; however, it may cause death of most individuals by increasing time more than two weeks. The findings of antibiotic sensitivity test cleared that the isolated V. alginolyticus was sensitive to amoxiclav (amoxicillin-clavulanate), streptomycin, ciprofloxacin and chloramphenicol. Controversially, it was resistant to oxytetracycline, tobramycin, gentamycin and enrofloxacin

Bacterial Diseases Affecting the Cultured Sepia Officinalis Leading to Increase Mortality Rates in The Laboratory

The early growth, mortality rates and bacterial infections of the cultured Sepia Officinalis were experimentally studied in the laboratory. Two hundred eighty five sepia larvae were hatched and placed in a 100 liter capacity rectangular glass aquarium (filled with seawater) in the laboratory. The Sepia individuals (285 individuals) were divided into two groups the first fed on a mixture of amphipods, rotifers and artemia and the second group fed only on amphipods to follow their growth and mortality. The second group was observed to grow faster with length 6.76 ± 0.06mm and weight 0.11 ± 0.01gm than the first one. The survival rate was 100% by the end of the first week and decreased gradually by the end of thesecond week. The recorded mortality rate reached 49% by the day 15th, where they infected with bacterial disease of Vibrio alginolyticus. The clinical signs of the diseased S. Officinalis were lethargic condition, food fasting and multiple skin ulcers with white-gray discoloration were observed and appeared on the body. The main post mortem lesions were congestion of the internal organ, beside the presence of ascetic fluid. The mortality among the diseased Sepia was increased by age; however it may causes death of most individuals by increasing time more than two weeks. The findings of antibiotic sensitivity test cleared that the isolated V. alginolyticus was sensitive to amoxiclav (amoxicillin-clavulanate), streptomycin, ciprofloxacin and chlormphinicol. Controversially, it was resistant to oxytetracycline, tobramycin, gentamycine and enrofloxacin.Keywords: Sepia Officinalis - growth rate - mortality rate - bacterial infection

Trends in HIV/AIDS morbidity and mortality in Eastern 3 Mediterranean countries, 1990–2015: findings from the Global 4 Burden of Disease 2015 study

Objectives We used the results of the Global Burden of Disease 2015 study to estimate trends of HIV/AIDS burden in Eastern Mediterranean Region (EMR) countries between 1990 and 2015. Methods Tailored estimation methods were used to produce final estimates of mortality. Years of life lost (YLLs) were calculated by multiplying the mortality rate by population by age-specific life expectancy. Years lived with disability (YLDs) were computed as the prevalence of a sequela multiplied by its disability weight. Results In 2015, the rate of HIV/AIDS deaths in the EMR was 1.8 (1.4–2.5) per 100,000 population, a 43% increase from 1990 (0.3; 0.2–0.8). Consequently, the rate of YLLs due to HIV/AIDS increased from 15.3 (7.6–36.2) per 100,000 in 1990 to 81.9 (65.3–114.4) in 2015. The rate of YLDs increased from 1.3 (0.6–3.1) in 1990 to 4.4 (2.7–6.6) in 2015. Conclusions HIV/AIDS morbidity and mortality increased in the EMR since 1990. To reverse this trend and achieve epidemic control, EMR countries should strengthen HIV surveillance,and scale up HIV antiretroviral therapy and comprehensive prevention services

Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

BACKGROUND: Measurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy development, and programme decision making. Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we drew from two widely used summary measures to monitor such changes in population health: disability-adjusted life-years (DALYs) and healthy life expectancy (HALE). We used these measures to track trends and benchmark progress compared with expected trends on the basis of the Socio-demographic Index (SDI). METHODS: We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2016. We calculated DALYs by summing years of life lost and years of life lived with disability for each location, age group, sex, and year. We estimated HALE using age-specific death rates and years of life lived with disability per capita. We explored how DALYs and HALE differed from expected trends when compared with the SDI: the geometric mean of income per person, educational attainment in the population older than age 15 years, and total fertility rate. FINDINGS: The highest globally observed HALE at birth for both women and men was in Singapore, at 75·2 years (95% uncertainty interval 71·9-78·6) for females and 72·0 years (68·8-75·1) for males. The lowest for females was in the Central African Republic (45·6 years [42·0-49·5]) and for males was in Lesotho (41·5 years [39·0-44·0]). From 1990 to 2016, global HALE increased by an average of 6·24 years (5·97-6·48) for both sexes combined. Global HALE increased by 6·04 years (5·74-6·27) for males and 6·49 years (6·08-6·77) for females, whereas HALE at age 65 years increased by 1·78 years (1·61-1·93) for males and 1·96 years (1·69-2·13) for females. Total global DALYs remained largely unchanged from 1990 to 2016 (-2·3% [-5·9 to 0·9]), with decreases in communicable, maternal, neonatal, and nutritional (CMNN) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). The exemplars, calculated as the five lowest ratios of observed to expected age-standardised DALY rates in 2016, were Nicaragua, Costa Rica, the Maldives, Peru, and Israel. The leading three causes of DALYs globally were ischaemic heart disease, cerebrovascular disease, and lower respiratory infections, comprising 16·1% of all DALYs. Total DALYs and age-standardised DALY rates due to most CMNN causes decreased from 1990 to 2016. Conversely, the total DALY burden rose for most NCDs; however, age-standardised DALY rates due to NCDs declined globally. INTERPRETATION: At a global level, DALYs and HALE continue to show improvements. At the same time, we observe that many populations are facing growing functional health loss. Rising SDI was associated with increases in cumulative years of life lived with disability and decreases in CMNN DALYs offset by increased NCD DALYs. Relative compression of morbidity highlights the importance of continued health interventions, which has changed in most locations in pace with the gross domestic product per person, education, and family planning. The analysis of DALYs and HALE and their relationship to SDI represents a robust framework with which to benchmark location-specific health performance. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform health policies, health system improvement initiatives, targeted prevention efforts, and development assistance for health, including financial and research investments for all countries, regardless of their level of sociodemographic development. The presence of countries that substantially outperform others suggests the need for increased scrutiny for proven examples of best practices, which can help to extend gains, whereas the presence of underperforming countries suggests the need for devotion of extra attention to health systems that need more robust support. FUNDING: Bill & Melinda Gates Foundation