ASSESSMENT EFFECT OF ALOE VERA, AZADIRACHTA INDICA AND MORINGA OLEIFERA AQUEOUS EXTRACTS ON CARBON TETRACHLORIDE-INDUCED HEPATOTOXICITY IN RATS

Objective: This experiment aims to investigate the hepatotherapeutic effect of Aloe vera (AV), Azadirachta indica (N), and Moringa oleifera (MO).Methods: Eighty albino rats have been divided into ten groups. The first group was fed on a basal diet while the second group was administered paraffin (10 ml/kg body weight) through gavage for four days. The third to the tenth groups received (5 ml/kg body weight) CCl4: liquid paraffin (2:1) for three days followed by (10 ml/kg body weight) CCl4: liquid paraffin (2:1) for one day through gavage. Group three kept without any treatment, other groups then received (AV) (60 mg/kg body weight), (MO) (200 mg/kg body weight), (N) (200 mg/kg body weight), bi-extract of (AV+N), bi-extracts of (AV+MO), bi-extract of (MO+N), and tri-extracts of (AV+N+MO) respectively for 36 d. The liver and blood were studied for hepatotoxicity and antioxidant indices.Results: Biochemical and histopathological analysis revealed that CCl4 elevated plasma liver enzymes (aspartate transaminase, alanine aminotransferase, and gamma glutamyl transferase). Carbon tetrachloride also caused an elevation in erythrocyte content of glutathione with a concomitant increase in the plasma malondialdehyde content, along with marked atrophy of hepatocytes. However, these effects were ameliorated by the treatment of rats with the different extracts.Conclusion: Results showed that administration of the aquatic extracts of Aloe vera, Neem, and Moringa (separately/mixedly) played a therapeutic role against CCl4-induced liver damage by improving liver enzyme activities, antioxidant blood parameters, and a liver histopathological picture of intoxicated rats.Keywords: Aloe vera, Azadirachta indica, Moringa oleifera, CCl4 hepatotoxicity, Antioxidant, Rat hepatocyte

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Latex Hypersensitivity among Allergic Egyptian Children: Relation to Parental/Self Reports

Background. Latex allergy is one of the major health concerns and allergic reactions to latex may be serious and fatal. Purpose. In this study, we sought to determine the frequency of latex hypersensitivity in a group of allergic Egyptian infants and children and its relation to the history provided by the patients or caregivers. Methods. We consecutively enrolled 400 patients with physician diagnosed allergic diseases. The study measurements included clinical evaluation for the site and duration of allergy, history suggestive of latex allergy, family history of allergy, and skin prick testing (SPT) using a commercial latex extract. Results. The study revealed that 16/400 (4%) patients had positive SPT; 11 of them only had positive history of sensitivity to latex. Positive latex SPT was reported in 3.4% (11/326) of patients with bronchial asthma, 5.9% (7/118) of patients with skin allergy, and 4.5% (2/44) of patients with allergic rhinitis. SPT was positive in 7.4% (4/54) of patients with concomitant respiratory and skin allergy. Latex SPT was more specific than sensitive (97.69% and 77.77%, resp.) with a negative predictive value of 99.47%. Conclusion. Although underrecognized, latex is an important allergen in the pediatric age group with a sensitization frequency of 4% among allergic children. It was observed to be especially associated with multiple allergic diseases coexisting in the same patient. Pediatric allergologists should educate their patients on latex allergy and encourage the use of latex-free products

Hepato and neuro-protective influences of biopropolis on thioacetamide-induced acute hepatic encephalopathy in rats

Hepatic encephalopathy (HE) is a neuropsychiatric syndrome ultimately occurs as a complication of acute or chronic liver failure; accompanied by hyperammonemia. This study aimed to evaluate the potential of biopropolis as a hepato and neuroprotective agent using thioacetamide (TAA)-induced acute HE in rats as a model. Sixty Wistar rats were divided into five groups: Group 1 (normal control) received only saline and paraffin oil. Group 2 (hepatotoxic control) received TAA (300 mg/kg, once). Groups 3, 4 and 5 received TAA followed by vitamin E (100 mg/kg) and biopropolis (100 and 200 mg/kg), respectively, daily for 30 days. Evidences of hepatic encephalopathy were clearly detected in TAA-hepatotoxic group including significant elevation in the serum level of ammonia, liver functions, increased oxidative stress in liver and brain, apoptotic DNA fragmentation and overexpression of iNOS gene in brain tissue. The findings for groups administered biopropolis, highlighted its efficacy as a hepato and neuro-protectant through improving the liver functions, oxidative status and DNA fragmentation as well as suppressing the brain expression of iNOS gene. In conclusion, bioproplois, at a dose of 200 mg/kg/day protected against TAA-induced HE through its antioxidant and antiapoptotic influence; therefore, it can be used as a protective natural product.The accepted manuscript in pdf format is listed with the files at the bottom of this page. The presentation of the authors' names and (or) special characters in the title of the manuscript may differ slightly between what is listed on this page and what is listed in the pdf file of the accepted manuscript; that in the pdf file of the accepted manuscript is what was submitted by the author

Comparison between combined regional nasal block and general anesthesia versus general anesthesia with dexmedetomidine during endoscopic sinus surgery

ABSTRACTBackground Research findings are inconsistent regarding the efficiency of regional nasal blocks over hypotensive techniques. The current study aimed to compare regional nasal block to dexmedetomidine (DEX) for surgical field optimization.Methods A total of 70 patients (ASA I or II) aged 18 to 65 years were divided into two groups (35 patients each). The DEX group received 1 µg/kg of DEX in 10 minutes after induction of anesthesia, followed by 0.7 µg/kg/hour during maintenance of anesthesia. The other group [Sphenopalatine ganglion block (SPGB) group] was subjected to regional nasal block by SPGB immediately after induction of general anesthesia. This was done via a transoral approach using 2 ml of a mixture of lidocaine (2%) and bupivacaine (0.5%) for each side.Results Surgical conditions were satisfactory in all patients of both groups, but significantly better with bilateral SPGB. In addition, the block group had also improved extubation characteristics and postoperative analgesia. Patients who received bilateral SPGB complained significantly of dental numbness.Conclusions Both DEX and regional nasal block provided excellent functional endoscopic sinus surgery (FESS) with a high score of surgeons’ satisfaction. The SPGB can provide better surgical field optimization with less blood loss, less intraoperative analgesic consumption, and early extubation with minor complications, and better immediate postoperative pain profile. So, SPGB can be used efficiently and safely in combination with general anesthesia in patients undergoing FESS

Fungal infection profile in critically ill COVID-19 patients: a prospective study at a large teaching hospital in a middle-income country

Abstract Background Critically ill COVID-19 patients are highly susceptible to opportunistic fungal infection due to many factors, including virus-induced immune dysregulation, host-related comorbidities, overuse and misuse of antibiotics or corticosteroids, immune modulator drugs, and the emergencies caused by the pandemic. This study aimed to assess the incidence, identify the potential risk factors, and examine the impact of fungal coinfection on the outcomes of COVID-19 patients admitted to the intensive care unit (ICU). Methods A prospective cohort study including 253 critically ill COVID-19 patients aged 18 years or older admitted to the isolation ICU of Zagazig University Hospitals over a 4-month period from May 2021 to August 2021 was conducted. The detection of a fungal infection was carried out. Results Eighty-three (83) patients (32.8%) were diagnosed with a fungal coinfection. Candida was the most frequently isolated fungus in 61 (24.1%) of 253 critically ill COVID-19 patients, followed by molds, which included Aspergillus 11 (4.3%) and mucormycosis in five patients (1.97%), and six patients (2.4%) diagnosed with other rare fungi. Poor diabetic control, prolonged or high-dose steroids, and multiple comorbidities were all possible risk factors for fungal coinfection [OR (95% CI) = 10.21 (3.43–30.39), 14.1 (5.67–35.10), 14.57 (5.83–33.78), and 4.57 (1.83–14.88), respectively]. Conclusion Fungal coinfection is a common complication of critically ill COVID-19 patients admitted to the ICU. Candidiasis, aspergillosis, and mucormycosis are the most common COVID-19-associated fungal infections and have a great impact on mortality rates

Nano Propolis, Zinc Oxide Nanoparticles, and Their Composites: A Novel Green Synthesis with Synergistic Antioxidant and Anticancer Properties

Nanoparticles of zinc oxide (ZnO NPs), propolis, and the ZnO–propolis composite (ZnO-P NCs) have been synthesized using a biomimetic approach. Zeta potential analysis and Fourier-transform infrared spectroscopy (FT-IR) proved the formation and stability of nanomaterials. Findings using X-ray diffraction (XRD), scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDX), EDX-imaging, and transmission electron microscopy (TEM) demonstrated that the particle size of ZnO-P NCs was 9.70 nm. The antioxidant (DPPH radical scavenging) activity of synthesized nanomaterials was investigated. IC50 values of zinc oxide, propolis, and ZnO-P NCs nanoparticles were 2.75, 1.7, and 1.45 mg mL−1, respectively. In addition, their selectivity and anticancer activity for cancer cell lines (Hela and MCF-7) and human normal (W138) cell lines were investigated. ZnO-P NCs were highly effective against the cell line for breast cancer with an IC50 value of 18 µg/mL, indicating its anticancer-promising potent cytotoxicity in breast cancer treatment, and 23 µg/mL against cervical cancer. In addition, the higher observed safety, antioxidant, and anticancer activities for synthesized ZnO-P NCs confirmed the synergistic effect of this combination. It was obtained that the specific mechanisms underlying the synergy effect between zinc oxide nanoparticles and nanopropolis in their composite formulation varied depending on the preparation method, ratio, and concentration of the components