Concurrent Acquisition of a Single Nucleotide Polymorphism in Diverse Influenza H5N1 Clade 2.2 Sub-clades

Highly pathogenic Influenza A H5N1 was first identified in Guangdong Province in 1996, followed by human cases in Hong Kong in 1997. The number of confirmed human cases now exceeds 300, and the associated Case Fatality Rate exceeds 60%. The genetic diversity of the serotype continues to increase. Four distinct clades or sub-clades have been linked to human cases. The gradual genetic changes identified in the sub-clades have been attributed to copy errors by viral encoded polymerases that lack an editing function, thereby resulting in antigenic drift. We report here the concurrent acquisition of the same polymorphism by multiple, genetically distinct, clade 2.2 sub-clades in Egypt, Russia, and Ghana. These changes are not easily explained by the current theory of “random mutation” through copy error, and are more easily explained by recombination with a common source. This conclusion is supported by additional polymorphisms shared by clade 2.2 isolates in Egypt and Germany

Aggregation of Single Nucleotide Polymorphisms in a Human H5N1 Clade 2.2 Hemagglutinin

The evolution of H5N1 has attracted significant interest 1-4 due to linkages with avian 5,6 and human infections 7,8. The basic tenets of influenza genetics 9 attribute genetic drift to replication errors caused by a polymerase complex that lacks a proof reading function. However, recent analysis 10 of swine influenza genes identifies regions copied with absolute fidelity for more than 25 years. In addition, polymorphism tracing of clade 2.2 H5N1 single nucleotide polymorphisms identify concurrent acquisition 11 of the same polymorphism onto multiple genetic backgrounds in widely dispersed geographical locations. Here we show the aggregation of regional clade 2.2 polymorphisms from Germany, Egypt, and sub-Sahara Africa onto a human Nigerian H5N1 hemagglutinin (HA), implicating recombination in the dispersal and aggregation of single nucleotide polymorphisms from closely related genomes

Aggregation of Single Nucleotide Polymorphisms in a Human H5N1 Clade 2.2 Hemagglutinin

The rapid evolution of the H5N1 serotype of avian influenza has been explained by a mechanism involving the selection of single nucleotide polymorphisms generated by copy errors. The recent emergence of H5N1 Clade 2.2 in fifty countries, offered a unique opportunity to view the acquisition of new polymorphism in these evolving genomes. We analyzed the H5N1 hemagglutinin gene from a fatal human case from Nigeria in 2007. The newly emerged polymorphisms were present in diverse H5N1 isolates from the previous year. The aggregation of these polymorphisms from clade 2.2 sub-clades was not supported by recent random mutations, and was most easily explained by recombination between closely related sequences

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

Taif’s Rose (Rosa damascena Mill var. trigentipetala) Wastes Are a Potential Candidate for Heavy Metals Remediation from Agricultural Soil

The current study examines the bioaccumulation potential of Taif rose shrubs by analyzing the shrubs’ wastes. f. At Al-Shafa Highland, four farms with plants of different ages were chosen to collect soil samples and vegetative waste (leaves and stems) for morphological and chemical analysis. The tallest stem and largest crown diameter (184.2 and 243.5 cm, respectively) were found in the oldest (20-year-old) shrubs, which also produced the highest biomass of pruning wastes of stems and leaves (3.9 and 1.3 t/ha, respectively). The 10-year-old shrubs gathered the highest concentration of Co and Pb (1.74 and 7.34 mg kg−1) in the stem and the highest Fe, Mn, and Ni (18.55, 18.60, and 9.05 mg kg−1) in the leaves, while the youngest plants (4 years) accumulated the highest Cr and Zn (0.83 and 13.44 mg kg−1) in their leaves. The highest contents of Cd, Cr, Cu, Fe, Mn, Pb, and Zn were found in the oldest Taif rose stem (34.94, 1.16, 36.29, 49.32, 51.22, 24.76, and 32.51 g ha−1), while the highest contents of Co and Ni were found in the stems of plants that were 10 and 12 years old (3.21 and 9.54 g ha−1, respectively). The Taif rose’s stem and leaves can absorb the majority of heavy metals that have been studied with BAF values greater than one. Significant relationships between various heavy metals in the soil and the same in the stems (Al, Co, and Pb) and leaves (Co, Fe, Mn, Ni, and Pb) of Taif roses have been observed. According to the current findings, the Taif rose is a promising viable and safe crop for heavy metals phytoremediation if it is grown in polluted soil because there is little to no risk of contamination in the use of its end products, high biomass of pruning wastes, and high efficiency of heavy metal removal

Multi CENTER Experience of Interrupted Versus Continuous Parachuting Suturing Technique of Hepatico-jejunostomy Posterior Layer Anastomosis

Background: In Biliary enteric anastomosis procedures, hepatico-jejunostomies are a crucial step. Depending on the situation, the hepatico-jejunostomy operation procedure varies depending on the surgical school, and can be continuous or interrupted. Patients and Methods: A prospective comparative randomized study included 100 Patients  complaining of Malignant pancreatic tumour (65%), iatrogenic bile duct injury (20%), multiple common bile duct stones (10%) and liver transplantation of cirrhotic patients (5%) underwent hepatico-jejunostomy anastomosis to review a multi-center experience of hepatico-jejunostomy anastomosis in Theodor Bilharz Research Institute and Faculty of Medicine of Cairo University with regard to the types of anastomosis performed, early and late complications, and long-term patency and outcomes. Results: According to the type of suturing technique, hepatico-jejunostomy anastomosis patients are sub grouped into posterior interrupted sutures group A and posterior parachuting sutures group B. A significant direct correlation of leakage in group A  with obstructive jaundice (r = 0.327 and p value = 0.02), CBD diameter (r = 0.408 and p value = 0.001), and Duct wall thickness (r = 0.408 and p value = 0.001) While there were inverse correlations with pre-operative stent (r = -0.375 and p value = 0.01)

Autophagy in antitumor activity of aloin for breast cancer cells compared with doxorubicin

252-264Breast cancer is the most commonly diagnosed cancer and is one of the leading causes of cancer mortality in women worldwide. Natural product compounds have attracted significant attention for their potent effects against human cancers. Aloin, a natural phytochemical anthraquinone glycoside extracted from Aloe sp., has been previously reported for its antitumor activity. Autophagy is a highly conserved process that mediates the degradation of dysfunctional cellular components, such as senescent proteins and organelles. In the present study, we verified the involvement of autophagy in tolerance to aloin, especially in breast cancer cells with negative estrogen receptors, and as an alternative pathway to promote cell death in cells expressing mutant p53 status, which often limits the efficacy and accounts for resistance to chemotherapy. We studied the effect of aloin on 2 types of breast cancer cell lines, estrogen receptor-positive (T47D) and triple negative (MDA-MB231), and compared to an anthraquinone analog, doxorubicin (Dox) as a reference compound. Aloin inhibited the cell growth of both T47D and MDA-MB231 cancer cells, in a time- and dose-dependent manner with a more pronounced effect in the 72 h exposure regimen, and in the ERα+ breast cell line. The autophagic activity of aloin was emphasized by the formation of autophagosomes and autolysophagosomes, as early and late autophagic compartments, respectively, as well as the accumulation of acidic vesicular organelles in the tumor cells. Also, upregulation in the protein expression of some marker genes of autophagy such as beclin 1 and LC3BII/LC3I, and conversely down-regulation in pmTOR and p62 was recorded. The results suggest that autophagy can be regarded as one of the mechanistic modes of aloin cytotoxicity in breast cancer cells that evade apoptosis through genetic mutations in p53

EHS clinical guidelines on the management of the abdominal wall in the context of the open or burst abdomen.

To provide guidelines for all surgical specialists who deal with the open abdomen (OA) or the burst abdomen (BA) in adult patients both on the methods used to close the musculofascial layers of the abdominal wall, and regarding possible materials to be used