Audit of postoperative nausea and vomiting in paediatric day case surgery

OBJECTIVE: To assess the incidence of PONV, delay in discharge or unplanned admissions in paediatric surgical cases done at the Surgical Day Care Unit at Aga Khan University between January and July 2009. METHODS: All paediatric ASA 1-2 cases, from 6 months to 18 years of age undergoing day case surgeries at the Surgical day care unit were included in this retrospective audit. Data was collected on a designed form filled with information from preoperative, intraoperative and postoperative recovery forms. Any relevant data was also noted from nurses notes in recovery room and step down unit. Episodes of vomiting, delay in discharge, or unplanned admission due to PONV were documented. Data was analyzed on SPSS 14. RESULTS: Out of 163 patients only one patient (0.6%) had an episode of vomiting in the recovery room and two patients (1.2 %) had vomiting in the step down unit. There was no delay in discharge or unplanned admission due to PONV in paediatric day cases during the period of our audit. CONCLUSION: The incidence of postoperative vomiting in paediatric day cases at our day care unit does not justify polymodal prophylaxis as a protocol for PONV

The Global Alliance for Infections in Surgery: Defining a Model for Antimicrobial Stewardship-Results From an International Cross-Sectional Survey

BACKGROUND: Antimicrobial Stewardship Programs (ASPs) have been promoted to optimize antimicrobial usage and patient outcomes, and to reduce the emergence of antimicrobial-resistant organisms. However, the best strategies for an ASP are not definitively established and are likely to vary based on local culture, policy, and routine clinical practice, and probably limited resources in middle-income countries. The aim of this study is to evaluate structures and resources of antimicrobial stewardship teams (ASTs) in surgical departments from different regions of the world. METHODS: A cross-sectional web-based survey was conducted in 2016 on 173 physicians who participated in the AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections) project and on 658 international experts in the fields of ASPs, infection control, and infections in surgery. RESULTS: The response rate was 19.4%. One hundred fifty-six (98.7%) participants stated their hospital had a multidisciplinary AST. The median number of physicians working inside the team was five [interquartile range 4-6]. An infectious disease specialist, a microbiologist and an infection control specialist were, respectively, present in 80.1, 76.3, and 67.9% of the ASTs. A surgeon was a component in 59.0% of cases and was significantly more likely to be present in university hospitals (89.5%, p \u3c 0.05) compared to community teaching (83.3%) and community hospitals (66.7%). Protocols for pre-operative prophylaxis and for antimicrobial treatment of surgical infections were respectively implemented in 96.2 and 82.3% of the hospitals. The majority of the surgical departments implemented both persuasive and restrictive interventions (72.8%). The most common types of interventions in surgical departments were dissemination of educational materials (62.5%), expert approval (61.0%), audit and feedback (55.1%), educational outreach (53.7%), and compulsory order forms (51.5%). CONCLUSION: The survey showed a heterogeneous organization of ASPs worldwide, demonstrating the necessity of a multidisciplinary and collaborative approach in the battle against antimicrobial resistance in surgical infections, and the importance of educational efforts towards this goal

Variability in lipid profile in patients with acute myocardial infarction from two tertiary care hospitals in Pakistan

Objective: To investigate changes in total cholesterol, high density lipoprotein (HDL)-cholesterol, low density lipoprotein (LDL)-cholesterol and triglycerides in serum of Pakistani patients with AMI due to age, gender, body mass index (BMI), diabetes, hypertension, and smoking, and also find out the prevalence of hypercholesterolemia, hypertriglyceridemia, low HDL-cholesterol and isolated low-HDL cholesterol in them.Patients and Methods: Serum samples from 451 consecutive AMI patients (250 from National Institute of Cardiovascular Diseases, Karachi and 201 from Armed Forces Institute of Cardiology, Rawalpindi) were analyzed for total cholesterol, HDL-cholesterol and triglycerides using kit methods. LDL-cholesterol was determined using the Friedewald formula.Results: Mean serum concentrations of total cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides in AMI patients were found to be 181 +/- 50 mg/dl, 35.7 +/- 11.3 mg/dl, 110 +/- 47 mg/dl and 177 +/- 127 mg/dl, respectively. Mean levels of total cholesterol and HDL-cholesterol were not significantly affected by age, gender, BMI, diabetes mellitus, hypertension and smoking. Mean LDL-cholesterol concentration, however, was found to be significantly increased in diabetes mellitus (p=0.047), while age, gender, BMI, hypertension and smoking had no significant effect on the levels of this lipoprotein. Mean levels of triglycerides were significantly decreased in older patients (\u3e50 years) compared to younger (\u3c50 \u3eyears) ones (p=0.019). Gender, BMI, diabetes mellitus, hypertension and smoking, however, had no effect on triglyceride levels The frequencies of hypercholesterolemia, hypertriglyceridemia, low HDL-cholesterol and isolated low-HDL-cholesterol were found to be 30.6%, 30.1%, 48.6% and 34.1%, respectively.Conclusion: High prevalence of hypertriglyceridemia and low HDL-cholesterol (which constitute a component of metabolic syndrome) in Pakistani AMI patients is suggestive that these two lipid abnormalities could be playing a major role in the development of atherosclerosis in Pakistani population

Salt tolerance variation in some common trees

The reduction in seed germination and seedling growth varies with plant species, salinity level and ionic composition of the salts present in soil solutions. Seed germination of Leucaena leucocephala and Prosopis juliflora were affected in soil extract of all halophytic communities. Significant (p < 0.05) reduction in seed germination of Thespesia populnea was found in soil extract of Cressa-Suaeda-Atriplex and Suaeda-Heliotropium-Tamarix community. The root growth of P. juliflora was significantly reduced in soil extract of Haloxylon-Suaeda-Atriplex community. Significant inhibition in shoot growth of L. leucocephala and P. juliflora were found in soil extract of Haloxylon-Suaeda-Atriplex community. L. leucocephala and T. populnea showed low tolerance in soil extract of Cressa-Suaeda-Atriplex community. P. juliflora demonstrated low tolerance in soil extract of Haloxylon-Suaeda-Atriplex community. The soil collected from different community showed variation for soil conductivity and cations. The highest sodium (11,500 µg/g) was observed in Suaeda-Heliotropium-Tamarix community. Salsola-Fagonia- Zygophyllum community exhibited the lowest concentration of sodium and potassium, 500 and 75 µg/g, respectively. It was found that sodium was directly proportional to the conductivity of the soil extract

Analysis of Near-infrared (NIR) spectroscopy for chlorophyll prediction in oil palm leaves

Oil palm nutrient content is investigated with using chlorophyll as a representative factor correlated with NIR spectroscopy spectral absorbance. NIR spectroscopy method of sampling have been tested to overcome time consuming, complex chemical analysis procedure and invasive sampling method in order to identify chlorophyll content in an oil palm tree. Spectral absorbance data from range 900 nm to 1700 nm and chlorophyll data, then tested through five pre-processing methods which is Savitzky-Golay Smoothing (SGS), Multiplicative Scatter Correction (MSC), Single Normal Variation (SNV), First Derivative (1D) and also Second Derivative (2D) using Partial Least Square (PLS) regression prediction model to evaluate the correlation between both data. The overall results show, SGS has the best performance for preprocessing method with the results, the coefficient of determination (R2) values of 0.9998 and root mean square error (RMSE) values of 0.0639. In summary, correlation of NIR spectral absorbance data and chlorophyll can be achieved using a PLS regression model with SGS pre-processing technique. Thus, we can conclude that NIR spectroscopy method can be used to identify chlorophyll content in oil palm with using time saving, simple sampling and non-invasive method

Dizajn, razvoj i vrednovanje novih nanoemulzija za transdermalnu primjenu celekoksiba

The aim of the present study was to investigate the potential of nanoemulsion formulations for transdermal delivery of celecoxib (CXB). The in vitro skin permeation profile of optimized formulations was compared with CXB gel and nanoemulsion gel. Significant increase in the steady state flux (Jss), permeability coefficient (Kp) and enhancement ratio (Er) was observed in nanoemulsion formulations T1 and T2 (p < 0.05). The highest value of these permeability parameters was obtained in formulation T2, which consisted of 2% m/m of CXB, 10% m/m of oil phase (Sefsol 218 and Triacetin), 50% m/m of surfactant mixture (Tween-80 and Transcutol-P) and 40% m/m of water. The anti-inflammatory effects of formulation T2 showed a significant increase (p < 0.05) in inhibition after 24 h compared to CXB gel and nanoemulsion gel on carrageenean-induced paw edema in rats. These results suggested that nanoemulsions are potential vehicles for improved transdermal delivery of CXB.U radu su opisana ispitivanja nanoemulzija za transdermalnu primjenu celekoksiba (CXB). Profil permeacije kroz kožu ispitivan je in vitro i uspoređivan sa CXB gelom i nanoemulzijskim gelom. U formulacijama T1 i T2 postignuto je značajno povećanje ustaljenog fluksa (Jss), koeficijenta permeabilnosti (Kp) i povećanje omjera (Er) (p < 0.05). Najveće vrijednosti parametara permeabilnosti dobivene su u formulaciji T2 koja je sadržala 2% m/m CXB, 10% m/m uljne faze (Sefsol 218 i Triacetin), 50% m/m površinski-aktivnih tvari (Tween-80 i Transcutol-P) i 40% m/m vode. Protuupalno djelovanje formulacije T2 na edem šape štakora uzrokovan karageninom značajno je povećano (p < 0.05) poslije 24 h u usporedbi sa CXB gelom i nanoemulzijskim gelom. Rezultati ukazuju na poboljšanu isporuku celekoksiba putem nanoemulzija

Effect of Moringa oleifera (Lam.) pods as feed additive on egg antioxidants, chemical composition and performance of commercial layers

The present study was designed to investigate the influence of Moringa oleifera (Lam.) pod meal (MPM) on production, immunity, and functional food index of chicken eggs. Two hundred HyLine W36 layer birds aged 50 weeks, 1469 ± 46.63 g, were assigned to four treatments in a completely randomized design, with five replicates and ten birds each. Diets A, B, C, and D were formulated with the same caloric and protein levels, but with differing MPM dose levels of 0, 5, 10, and 15g MPM/kg finisher diet, respectively. Data for production performance, quality, and chemical composition of eggs were analysed by one-way ANOVA, and means were compared with Duncan’s multiple range test. As a result of this study, feed conversion ratio (FCR) and egg mass (EM) were significantly decreased and recorded lowest in Group B, which was offered 5 g/kg above the basal diet. Bioactives such as β-carotene, quercetin, and selenium levels were increased (540, 121, &amp; 72.21μg/100g of yolk, respectively), whereas cholesterol levels in egg yolk and serum were decreased significantly, that is, 201.87 mg/100g and 8.47 mg/dl, respectively. Serum biochemical indicators, including serum glutamic-pyruvic transaminase (SGPT), glucose, creatinine and cholesterol levels, were lowered significantly. Proximate analysis of egg yolk showed that moisture and ether extract were decreased, whereas crude protein (CP), ash and minerals, sodium (Na), potassium (K), calcium (Ca), magnesium (Mg), and phosphorus (P) contents were increased. The outcomes of this study showed that MPM supplementation affects EM, serum biochemistry and bioactive compounds of the egg yolk positively. Keywords: Antibody titers, β-carotene, cholesterol, egg quality, quercetin, seleniu

P08.36 Radioresistance of glioblastoma stem-like cells is associated with DNA replication stress, which is a promising therapeutic target

Introduction: The inevitability of tumour recurrence in glioblastoma (GBM) patients despite multi-modality treatment consisting of surgery, radiotherapy and chemotherapy, is reflected by a median survival of only 14 months. Tumour recurrence is thought to be driven by a small population of glioblastoma stem-like cells (GSCs) that are resistant to conventional therapies. DNA damage response (DDR) pathways have been shown to be up-regulated in GSCs and implicated in radioresistance and treatment failure. However the precise cause of enhanced DDR signalling in GSCs and the extent to which these signalling networks contribute to therapy resistance remains elusive. The objectives of this study were to investigate the underlying cause of DDR upregulation and treatment resistance in GSCs with a view to identifying novel and promising therapeutic targets. Materials and Methods: A panel of primary patient derived GBM cell lines cultured under conditions to enrich for or deplete the tumour stem cell population (GSC vs bulk respectively) were utilised in order to investigate enhanced GSC DDR under basal conditions and in response to ionising radiation. Confirmatory studies were also performed in cells sorted for the putative GSC marker CD133. The effects of a panel of small molecule DDR inhibitor agents on cell survival in GSC and bulk cells were quantified. Results: GSCs exhibited higher levels of total and activated DDR targets ATR, CHK1, ATM and PARP1 under basal conditions and were radioresistant compared to paired bulk populations. This was not due to increased levels of reactive oxygen species (ROS). Instead, we show that RPA is significantly higher in replicating GSCs and confirm by DNA fibre assays that GSCs and CD133+ cells have increased numbers of stalled replication forks, fewer new origins and slower DNA replication compared to bulk or CD133- populations, demonstrating for the first time that replication stress (RS) is a hallmark of GSCs. We identify increased expression of long neural genes as a likely mechanism for RS and DNA double strand breaks (DSBs) in GSCs and show that their radioresistance is reversed by dual inhibition of key RS and DDR proteins ATR and PARP. Conclusions: This study demonstrates the novel finding that replication stress is a hallmark of GSCs and resonates with recently published studies in neural progenitor cells showing that RS preferentially induces DNA DSB in long neural genes. Taken together, we implicate RS as a driver of enhanced DDR in GSCs and identify novel therapeutics with potential to improve clinical outcomes by overcoming the radioresistance of GB