Medical prospects of cryptosporidiosis in vivo control using biofabricated nanoparticles loaded with Cinnamomum camphora extracts by Ulva fasciata

Background and Aim: Global efforts are continuing to develop preparations against cryptosporidiosis. This study aimed to investigate the efficacy of biosynthesized Ulva fasciata loading Cinnamomum camphora oil extract on new zinc oxide nanoparticles (ZnONPs shorten to ZnNPs) and silver nanoparticles (AgNPs) as alternative treatments for Cryptosporidium parvum experimental infection in rats. Materials and Methods: Oil extract was characterized by gas chromatography-mass spectrometry, loaded by U. fasciata on ionic-based ZnO and NPs, and then characterized by transmission electron microscopy, scanning electron microscopy, and X-ray diffraction. Biosafety and toxicity were investigated by skin tests. A total of 105 C. parvum oocysts/rat were used (n = 81, 2–3 W, 80–120 g, 9 male rats/group). Oocysts shedding was counted for 21 d. Doses of each preparation in addition to reference drug were administered daily for 7 d, starting on post-infection (PI) day (3). Nitazoxanide (100 mg) was used as the reference drug. After 3 weeks, the rats were sacrificed for postmortem examination and histopathological examination. Two blood samples/rat/group were collected on the 21st day. Ethylenediaminetetraacetic acid blood samples were also used for analysis of biochemistry, hematology, immunology, micronucleus prevalence, and chromosomal abnormalities. Results: C. camphora leaves yielded 28.5 ± 0.3 g/kg oil and 20 phycocompounds were identified. Spherical and rod-shaped particles were detected at 10.47–30.98 nm and 18.83–38.39 nm, respectively. ZnNPs showed the earliest anti-cryptosporidiosis effect during 7–17 d PI. Other hematological, biochemical, immunological, histological, and genotoxicity parameters were significantly fruitful; hence, normalized pathological changes induced by infestation were observed in the NPs treatments groups against the infestation-free and Nitazoxanide treated group. Conclusion: C. camphora, U. fasciata, ZnNPs, and AgNPs have refluxed the pathological effects of infection as well as positively improved host physiological condition by its anticryptosporidial immunostimulant regenerative effects with sufficient ecofriendly properties to be proposed as an alternative to traditional drugs, especially in individuals with medical reactions against chemical commercial drugs

Consanguinity and reproductive health among Arabs

Consanguineous marriages have been practiced since the early existence of modern humans. Until now consanguinity is widely practiced in several global communities with variable rates depending on religion, culture, and geography. Arab populations have a long tradition of consanguinity due to socio-cultural factors. Many Arab countries display some of the highest rates of consanguineous marriages in the world, and specifically first cousin marriages which may reach 25-30% of all marriages. In some countries like Qatar, Yemen, and UAE, consanguinity rates are increasing in the current generation. Research among Arabs and worldwide has indicated that consanguinity could have an effect on some reproductive health parameters such as postnatal mortality and rates of congenital malformations. The association of consanguinity with other reproductive health parameters, such as fertility and fetal wastage, is controversial. The main impact of consanguinity, however, is an increase in the rate of homozygotes for autosomal recessive genetic disorders. Worldwide, known dominant disorders are more numerous than known recessive disorders. However, data on genetic disorders in Arab populations as extracted from the Catalogue of Transmission Genetics in Arabs (CTGA) database indicate a relative abundance of recessive disorders in the region that is clearly associated with the practice of consanguinity

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

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Validity of Cooking in Microwave and Gamma-irradiation on Highly Virulent Aeromonas hydrophila Isolates in Basa Fish Fillet

The purpose of the study was to verify the existence and pathogenicity of Aeromonas hydrophila (A. hydrophila) in fish by validating the bactericidal effects of microwave and Gamma radiation on infected fish fillets. A total of 100 frozen Basa fish fillet samples were collected randomly from different markets in Zagazig, Sharkia Governorate, Egypt, and subjected to microbiological examination. The results revealed a 14% prevalence rate of A. hydrophila in fish fillets, which were tested for the presence of seven virulence genes: aerA, act, ast, alt, hyl, ahhR, and ahh1. All isolates exhibited traits related to virulence. The most predominated gene was ast (64.2%), followed by aerA, act, hyl, and ahhR (57.14% for each). Then, an experimental protocol for several treatments showed that Gamma radiation at a dose of 1 kGy decreased the count of A. hydrophila in fish fillets by 4.4 log10 CFU/g whereas doses of 2 and 3 kGy eradicated the pathogen. The same positive effect was recorded towards the microwave after cooking for 1, 2, and 3 minutes. Therefore, using microwave cooking and Gamma-irradiation alone and in combination with other decontamination methods may be more efficient in lowering the pathogen counts in fish meat.

Studying the influence of formulation and process variables on Vancomycin-loaded polymeric nanoparticles as potential carrier for enhanced ophthalmic delivery

Ocular topically applied Vancomycin (VCM) suffers poor bioavailability due to its high molecular weight and hydrophilicity. In the Present investigation, VCM-loaded polymeric nanoparticles (PNPs) were developed aiming to enhance its ocular bioavailability through prolonging its release pattern and ophthalmic residence. PNPs were prepared utilizing double emulsion (W/O/O), solvent evaporation technique. 2 3X4 1 full factorial design was applied to evaluate individual and combined influences of polymer type, Eudragit® RS100, sonication time, and Span® 80 concentration on PNPs particle size, encapsulation efficiency, and zeta potential. Further, the optimized formulae were incorporated in 1% Carbopol® - based gel. In-vivo evaluation of the optimized formulae was performed via Draize test followed by microbiological susceptibility testing on albino rabbits. Results revealed successful formulation of VCM- loaded PNPs was achieved with particle sizes reaching 155 nm and up to 88% encapsulation. Draize test confirmed the optimized formulae as non-irritating and safe for ophthalmic administration. Microbiological susceptibility testing confirmed prolonged residence, higher Cmax. with more than two folds increment in the AUC(0.25- 24) of VCM-PNPs over control groups. Thus, VCMloaded PNPs represent promising carriers with superior achievements for enhanced Vancomycin ophthalmic delivery over the traditional use of commercially available VCM parenteral powder after constitution into a solution by the ophthalmologists

Nanoparticles as tool for enhanced ophthalmic delivery of vancomycin: a multidistrict-based microbiological study, solid lipid nanoparticles formulation and evaluation

Context: A microbiological multidistrict-based survey from different Egyptian governorates was conducted to determine the most prevalent causative agents of ocular infections in the Egyptian population. Antibiotic sensitivity testing was then performed to identify the most potent antimicrobial agent. Vancomycin (VCM) proved the highest activity against gram-positive Staphylococcus bacteria, which are the most commonly isolated causative agents of ocular infection. However, topically applied VCM suffers from poor ocular bioavailability because of its high molecular weight and hydrophilicity. Objective: the aim of the present study was to develop VCM-loaded solid lipid nanoparticles (SLNs) using water-in-oil-in-water (W/O/W) double emulsion, solvent evaporation technique to enhance ocular penetration and prolong ophthalmic residence of VCM. Method: Two consecutive full factorial designs (24 followed by 32 ) were adopted to study the effect of different formulation and process parameters on SLN formulation. The lipid type and structure, polyvinyl alcohol (PVA) molecular weight and concentration, sonication time, as well as lipid:drug ratio were studied as independent variables. The formulated SLN formulae were evaluated for encapsulation efficiency, particle size, and zeta potential as dependent variables. Results: The statistically-optimized SLN formula (1:1 ratio of glyceryltripalmitate:vancomycin with 1% low molecular weight PVA and 1 min sonication time) had average particle size of 277.25 nm, zeta potential of -20.45, and 19.99% drug encapsulation. Scanning and transmission electron micrographs showed well-defined, spherical, homogenously distributed particles. Conclusion: The present study suggests that VCM incorporation into SLNs is successfully achievable; however, further studies with different nanoencapsulation materials and techniques would be valuable for improving VCM encapsulation

Relationship between poultry biosecurity assessments and Escherichia coli prevalence in poultry farms

A crucial first step in preventing the introduction and spread of harmful microorganisms in poultry farms is biosecurity. The objectives of this investigation were to assess biosecurity measures and the prevalence of different E. coli species in commercial chicken farms in Sharkia province, Egypt. Sensitivity of E. coli strains was identified, and their susceptibility to antibiotics and disinfection was evaluated as well. Four farms provided 21 samples each, for a total of 84 samples. Three samples of each were collected for water, feed, litter, cloaca, wall, hand, and foot boots. All the studied farms obtained a "poor biosecurity" grade, meaning that their overall biosecurity score, which is comprised of 40% external and 36.54% internal biosecurity, was less than 50%. Escherichia coli species were found in 79.76% of the samples. It was isolated from water, feed, litter, cloaca, walls, hands, and foot boots with percentages of 91.6; 83.3; 91.6; 100; 58.3; 58.3 and 75%, respectively. Biosecurity level had significant negative correlations with the isolated E. coil species. Escherichia coli O119 was the most common serotype in litter and the cloaca, while E. coli O1 was the most prevalent serotype in walls and hands. Additionally, serotypes for E. coli O26, O159, O128 and O78 were included. According to the patterns of antibiotic sensitivity, amikacin, nitrofurantoin, gentamycin, and levofloxacin showed intermediate sensitivity, whereas E. coli O119 bacteria were highly sensitive to ciprofloxacin. In the absence and presence of organic matter, Virocid, Cid 2000 and finally Virkon S were the most efficient against E. coli O119. According to this study, there were differences in the investigated farms' biosecurity levels in relation to the occurrence of Escherichia coli. To reduce the introduction and persistence of E. coli in poultry farms, several biosecurity practices and management, including stringent cleaning and disinfection measures should be applied

Relationship between poultry biosecurity assessments and Escherichia coli prevalence in poultry farms

A crucial first step in preventing the introduction and spread of harmful microorganisms in poultry farms is biosecurity. The objectives of this investigation were to assess biosecurity measures and the prevalence of different E. coli species in commercial chicken farms in Sharkia province, Egypt. Sensitivity of E. coli strains was identified, and their susceptibility to antibiotics and disinfection was evaluated as well. Four farms provided 21 samples each, for a total of 84 samples. Three samples of each were collected for water, feed, litter, cloaca, wall, hand, and foot boots. All the studied farms obtained a "poor biosecurity" grade, meaning that their overall biosecurity score, which is comprised of 40% external and 36.54% internal biosecurity, was less than 50%. Escherichia coli species were found in 79.76% of the samples. It was isolated from water, feed, litter, cloaca, walls, hands, and foot boots with percentages of 91.6; 83.3; 91.6; 100; 58.3; 58.3 and 75%, respectively. Biosecurity level had significant negative correlations with the isolated E. coil species. Escherichia coli O119 was the most common serotype in litter and the cloaca, while E. coli O1 was the most prevalent serotype in walls and hands. Additionally, serotypes for E. coli O26, O159, O128 and O78 were included. According to the patterns of antibiotic sensitivity, amikacin, nitrofurantoin, gentamycin, and levofloxacin showed intermediate sensitivity, whereas E. coli O119 bacteria were highly sensitive to ciprofloxacin. In the absence and presence of organic matter, Virocid, Cid 2000 and finally Virkon S were the most efficient against E. coli O119. According to this study, there were differences in the investigated farms' biosecurity levels in relation to the occurrence of Escherichia coli. To reduce the introduction and persistence of E. coli in poultry farms, several biosecurity practices and management, including stringent cleaning and disinfection measures should be applied