Efficacy of mobile phone intervention to increase male partner antenatal care attendance for HIV testing in Moshi municipal, Tanzania: a randomized controlled trial

BACKGROUND

HIV partner counselling and testing in antenatal care (ANC) is a crucial strategy to raise the number of males who know their HIV status. However, in many settings like Tanzania, male involvement in antenatal care remains low, and there is a definite need for innovative strategies to increase male partner involvement. This study was designed to evaluate the efficacy of mobile phone intervention increase male partner ANC attendance for HIV testing in Moshi municipal, Tanzania.

METHODS

Between April and July 2022, we enrolled pregnant women presenting to a first ANC visit at Majengo and St. Joseph reproductive health facilities without their male partners. Eligible pregnant women were randomly assigned to invitation of their male partners either via phone calls, text messages from clinic staff and verbal invites from pregnant partners (intervention arm) or verbal invites only from the pregnant partners (control arm). Neither healthcare provider nor participant were blinded. The primary outcome was the proportion of male partners who attended ANC with their pregnant partners during a follow-up period of two consecutive visits. The secondary outcome measure was HIV testing among male partners following the invitation. Participants were analyzed as originally assigned (intention to treat).

RESULTS

A total of 350 pregnant women presenting to ANC for the first time were enrolled, with 175 women enrolled in each arm. The efficacy of male attendance with their pregnant women following the invitations was 83.4% (147/175) in the intervention arm and 46.3% (81/175) in the control arm. Overall, the results suggest a positive and statistically significant average treatment effect among men who received mobile phone intervention on ANC attendance. For the secondary outcome, the percent of male partners who accepted HIV counselling and testing was 99.3% (146/147) in the intervention arm and 93.8% (76/81) in the control arm. Married men were having higher odds of ANC attendance compared with single men (aOR:6.40(3.26-12.56), Males with multigravida women were having lower odds of ANC attendance compared with primigravida women (aOR:0.17(0.09-0.33).

CONCLUSION

The study demonstrates that supplementing verbal invitations with mobile phone calls and text messages from clinic staff can significantly increase male partner ANC attendance and HIV testing. This combined approach is recommended in improving ANC attendance and HIV testing of male partners who do not accompany their pregnant partners to antenatal clinics in the first visits.

TRIAL REGISTRATION

PACTR202209769991162.

Involvement of CircRNAs in regulating The "New Generation of Cancer Hallmarks": A Special Depiction on Hepatocellular Carcinoma

The concept of 'Hallmarks of Cancer' is an approach of reducing the enormous complexity of cancer to a set of guiding principles. As the underlying mechanism of cancer are portrayed, we find that we gain insight and additional aspects of the disease arise. The understanding of the tumor microenvironment (TME) brought a new dimension and led to the discovery of novel hallmarks such as senescent cells, non-mutational epigenetic reprogramming, polymorphic microbiomes and unlocked phenotypic plasticity. Circular RNAs (circRNAs) are single-stranded, covalently closed RNA molecules that are ubiquitous across all species. Recent studies on the circRNAs have highlighted their crucial function in regulating the formation of human malignancies through a range of biological processes. The primary goal of this review is to clarify the role of circRNAs in the most common form of liver cancer, hepatocellular carcinoma (HCC). This review also addressed the topic of how circRNAs affect HCC hallmarks, including the new generation hallmarks. Finally, the enormous applications that these rapidly expanding ncRNA molecules serve in the functional and molecular development of effective HCC diagnostic biomarkers and therapeutic targets.

Long-term cognitive dysfunction after the COVID-19 pandemic: a narrative review

Introduction

SARS-CoV-2, the virus responsible for the COVID-19 pandemic, has brought a conglomerate of novel chronic disabling conditions described as 'Long COVID/Post-COVID-19 Syndrome'. Recent evidence suggests that the multifaceted nature of this syndrome results in both pulmonary and extrapulmonary sequelae,chronic dyspnoea, persistent fatigue, and cognitive dysfunction being the most common, debilitating symptoms. Several mechanisms engender or exacerbate cognitive impairment, including central nervous system and extra-central nervous system causes, although the exact mechanism remains unclear. Both hospitalized and non-hospitalized patients may suffer varying degrees of cognitive impairment, ranging from fatigue and brain fog to prolonged deficits in memory and attention, detrimental to the quality-of-life years post-recovery. The aim of this review is to understand the underlying mechanisms, associations, and attempts for prevention with early intervention of long-term cognitive impairment post-COVID-19.

Methodology

A systematic search was conducted through multiple databases such as Medline, National Library of Medicine, Ovid, Scopus database to retrieve all the articles on the long-term sequalae of cognitive dysfunction after SARS-CoV-2 infection. The inclusion criteria included all articles pertinent to this specific topic and exclusion criteria subtracted studies pertaining to other aetiologies of cognitive dysfunction. This search was carefully screened for duplicates and the relevant information was extracted and analysed.

Results/discussion

To date, the exact pathogenesis, and underlying mechanisms behind cognitive dysfunction in COVID-19, remain unclear, hindering the development of adequate management strategies. However, the proposed mechanisms suggested by various studies include direct damage to the blood-brain barrier, systemic inflammation, prolonged hypoxia, and extended intensive care admissions. However, no clear-cut guidelines for management are apparent.

Conclusion

This review of the COVID-19 pandemic has elucidated a new global challenge which is affecting individuals' quality of life by inducing long-term impaired cognitive function. The authors have found that comprehensive evaluations and interventions are crucial to address the cognitive sequelae in all COVID-19 patients, especially in patients with pre-existing cognitive impairment. Nevertheless, the authors recommend further research for the development of relevant, timely neurocognitive assessments and treatment plans.

Understanding patient views and acceptability of predictive software in osteoporosis identification

INTRODUCTION

Research into patient and public views on predictive software and its use in healthcare is relatively new. This study aimed to understand older adults' acceptability of an opportunistic bone density assessment for osteoporosis diagnosis (IBEX BH), views on its integration into healthcare, and views on predictive software and AI in healthcare.

METHODS

Focus groups were conducted with participants aged over 50 years, based in South West England. Data were analysed using thematic analysis. Analysis was informed by the theoretical framework of acceptability.

RESULTS

Two focus groups were undertaken with a total of 14 participants. Overall, the participants were generally positive about the IBEX BH software, and predictive software's in general stating 'it sounds like a brilliant idea'. Although participants did not understand the intricacies of the software, they did not feel they needed to. Concerns about IBEX BH focussed more on the clinical indications of the software (e.g. more scans or medications), with participants expressing less trust in results if they indicated medication. Questions were also raised about how and who would receive the results of this software. Individual choice was evident in these discussions, however most indicated the preferences for spoken communication 'But I would expect that these results would be given by a human to another human.'

CONCLUSIONS

Focus group participants were generally accepting of the use of predictive software in healthcare.

IMPLICATIONS FOR PRACTICE

Thought and care needs to be taken when integrating predictive software into practice. Focusses on empowering patients, providing information on processes and results are key.

Progressive plasticity during colorectal cancer metastasis

Metastasis is the principal cause of cancer death, yet we lack an understanding of metastatic cell states, their relationship to primary tumor states, and the mechanisms by which they transition. In a cohort of biospecimen trios from same-patient normal colon, primary and metastatic colorectal cancer, we show that while primary tumors largely adopt LGR5 + intestinal stem-like states, metastases display progressive plasticity. Loss of intestinal cell states is accompanied by reprogramming into a highly conserved fetal progenitor state, followed by non-canonical differentiation into divergent squamous and neuroendocrine-like states, which is exacerbated by chemotherapy and associated with poor patient survival. Using matched patient-derived organoids, we demonstrate that metastatic cancer cells exhibit greater cell-autonomous multilineage differentiation potential in response to microenvironment cues than their intestinal lineage-restricted primary tumor counterparts. We identify PROX1 as a stabilizer of intestinal lineage in the fetal progenitor state, whose downregulation licenses non-canonical reprogramming.

Public health concerns about Tuberculosis caused by Russia/Ukraine conflict

According to WHO, Ukraine has the fourth-highest Tuberculosis (TB) incidence in the WHO European region while globally has the fifth-highest number of confirmed cases of extensively drug-resistant TB. Before the Russian invasion in Ukraine several interventions have been employed to mitigate the TB epidemic in the country. However, the ongoing war has demolished meticulous efforts and subsequently worsen the situation. WHO in collaboration with the Ukraine government and other organizations such as EU and UK are required to take up arms against the situation. In this work, implications brought up from the war, efforts, and recommendations to battling TB epidemic due to the war are highlighted.

Recent advances in the diagnosis and management of typhoid fever in Africa: A review

Typhoid fever, a classical disease of enteric origin caused by Salmonella species of bacteria, is among the most important diseases threatening public health in Africa. The African continent is a marker for both low resources within the healthcare system and poor disease control policy formulations in managing endemic infectious diseases. Since the colonial era, the Widal serological test has been used to confirm typhoid fever in Africa, however recent studies recommend blood culture, and when blood culture cannot be obtained, clinical findings, laboratory Widal test confirmation, and ruling out other febrile illnesses as confirmatory pathway to diagnose typhoid fever in Africa. Managing typhoid fever relies on antimicrobials. In 1980s chloramphenicol was the medication of choice. Years later, amoxicillin and co-trimoxazole were adopted. However, the instantaneous rise of resistant strains of Salmonella enterica confers an important challenge to treat the burdensome enteric fever. The current treatment algorithm of typhoid fever in Africa relies significantly on the use of fluoroquinolones, macrolides, and cephalosporins. Developed nations have successfully addressed and controlled typhoid fever via improvement in accessing safe water and food, better sanitary and hygienic behaviours, and vaccines development. Nevertheless, there is significant evidence to infer improvement in the diagnosis management of typhoid fever over the last few decades, and efforts are underway to control the disease spread in Africa. This review aims to provide an overview of the latest developments in typhoid fever diagnosis and management in Africa and provide key recommendations for a coordinated approach to mitigate typhoid in the continent.

[Role of optical coherence tomography in unilateral amblyopia]

PURPOSE

To compare the macular and papillary parameters on optical coherence tomography (OCT) between the amblyopic eye and the healthy eye in subjects with unilateral strabismic or anisometropic amblyopia.

PATIENTS AND METHODS

This is a cross-sectional and comparative study carried out over two years, from April 1, 2019, to March 31, 2021. We included patients aged over 5years, followed for unilateral amblyopia, free of any neurological and/or ocular pathology. The evaluation of the macular and papillary parameters in the amblyopic and healthy eyes was performed with Swept-Source Optical Coherence Tomography (OCT-SS). The parameters were compared according to age group and type of amblyopia.

RESULTS

We collected 50 patients, 29 children, and 21 adults, with a mean age of 19.8years. Amblyopia was secondary to anisometropia in 40 patients and strabismus in 10 patients. Analysis of macular tomographic parameters found no significant difference between amblyopic eyes and healthy eyes for mean macular thickness (P=0.86), central macular thickness (P=0.86), or mean macular volume (P=0.54). The mean retinal peripapillary fiber thickness (RNFL) was 107.48μm in the amblyopic eye and 103.8μm in the healthy eye, with a statistically significant difference (P<0.001). This significant thickening of the RNFL in amblyopic eyes was present in adults (P<0.001), children (P<0.001), anisometropic (P<0.001), and strabismic amblyopia (P=0.024). Analysis of the other optic nerve head parameters revealed no significant difference between amblyopic eyes and healthy eyes in terms of optic disc surface area (P=0.89), neuro-retinal annulus surface area (P=0.47), vertical (P=0.98) or horizontal (P=0.74) cup to disc ratio.

CONCLUSION

Amblyopia is accompanied by thickening of the peripapillary retinal fibers without macular repercussions. However, larger prospective studies are needed to confirm these results.

Monkeypox virus: A zoonosis of concern

An outbreak of Monkeypox detected in nonendemic regions outside Africa has received much attention around the globe. In this letter, we highlight epidemiology, pathogenesis, diagnosis, and recommendations to mitigate the spread of monkeypox.

An Adaptive and Spectrally Efficient Multi-Channel Medium Access Control Protocol for Dynamic Ad Hoc Networks

Medium access control (MAC) protocols in ad hoc networks have evolved from single-channel independent transmission mechanisms to multi-channel concurrent mechanisms to efficiently manage the demands placed on modern networks. The primary aim of this study is to compare the performance of popular multi-channel MAC (MMAC) protocols under saturated network traffic conditions and propose improvements to the protocols under these conditions. A novel, dynamically adaptive MMAC protocol was devised to take advantage of the performance capabilities of the evaluated protocols in changing wireless ad hoc network conditions. A simulation of the familiar MAC protocols was developed based on a validated simulation of the IEEE 802.11 standard. Further, the behaviors and performances of these protocols are compared against the proposed MMAC protocols with a varying number of ad hoc stations and concurrent wireless channels in terms of throughput, Jain's fairness index, and channel access delay. The results show that the proposed MMAC protocol, labeled E-SA-MMAC, outperforms the existing protocols in throughput by up to 11.9% under a constrained number of channels and in channel access delays by up to 18.3%. It can be asserted from these observations that the proposed approach provides performance benefits against its peers under saturated traffic conditions and other factors, such as the number of available wireless channels, and is suitable for dynamic ad hoc network deployments.

Ukraine's triple emergency: Food crisis amid conflicts and COVID-19 pandemic

Globally, both Russia and Ukraine play a key role in food production. Both countries are known for their meticulous positions in producing and exporting wheat, maize, sunflower seed oil, and cotton seed oil. Although the conflict between Russia and Ukraine has been going on for more than 5 years, the recent invasion of Russia in Ukraine has endangered food security in Ukraine during the COVID‐19 pandemic. As COVID‐19 cripples the healthcare infrastructure of Ukraine, food insecurity challenges the civilian population to migration. As the conflict intensitifes, damages to properties, loss of lives, rise of infectious diseases, incremental rise in energy prices, and fuel consumption are some of the possible consequences. This commentary aims to highlight the different ways in which access to food has been endangered, the implications that food crisis has on the world, and thus provide key recommendations on what needs to be addressed to mitigate the rising risks of the food crisis in the world.

The impact of COVID-19 on patients with neurological disorders and their access to healthcare in Africa: A review of the literature

INTRODUCTION

The coronavirus disease 2019 (COVID-19) pandemic has hampered the progress of neurological healthcare services for patients across Africa. Before the pandemic, access to these services was already limited due to elevated treatment costs among uninsured individuals, shortage of medicines, equipment, and qualified personnel, immense distance between residing areas and neurological facilities, and a limited understanding of neurological diseases and their presentation by both the health workers and the African population.

METHODOLOGY

The databases PubMed, Google Scholar, Science Direct, and the National Library of Medicine were searched for literature. All articles on neurological disorders in Africa were considered.

AIM

This review article explores the challenges of providing the best services for patients suffering from neurological disorders in Africa amid the COVID-19 pandemic and provides evidence-based recommendations.

RESULTS

As Africa's governments made more resources available to support patients affected by COVID-19, neurological care received less priority and the capacity and competency to treat patients with neurological disorders thus suffered substantially. Both short-term and long-term strategies are needed to improve the quality of neurological services after the pandemic in the region.

CONCLUSION

To strengthen Africa's neurological services capability during and after the COVID-19 pandemic, African governments must ensure appropriate healthcare resource allocation, perform neurology management training, and increase health security measures in medication supply. Long-term strategies include incorporating responsible finance and resource procurement and advancement of tele-neurology. International collaboration is essential to promote the sustainable improvement of neurological services in Africa.

A review on acute, severe hepatitis of unknown origin in children: A call for concern

Hepatitis is defined as the inflammatory reaction of the liver parenchyma. It is either acute, which resolves within six months or may be chronic. An outbreak of severe, acute hepatitis of unknown origin in children was reported in nearly all World Health Organisation (WHO) regions except in the Africa. As per the recent update on the 26th of May, approximately 650 cases have met the WHO's probable criteria. While some are yet to be confirmed, the WHO warns that the figure may be underestimating the real situation. The observed clinical presentation includes outstanding immoderate levels of transaminases, vomiting from the previous presentation, pale/mild stools, and jaundice. So far, the viruses which can cause viral hepatitides, like Hepatitis A, B, C, D, and E, have not been detected in any of the identified cases. Some literature reported human enteric adenovirus type 41F in the majority of cases aged sixteen or younger, with few cases of co-infection with SARS-CoV-2. Currently, only several hypotheses have discussed the causality of the outbreak. However, no consensus has been reached. During this outbreak, it is important to adhere to both hand and body hygiene, general infection and control prevention strategies, and lastly, case presentation matching the criteria of case definition set by the WHO. Said identified cases should be reported to concerned health authorities on an urgent basis and must be kept under proper surveillance.

•

Hepatitis is defined as the inflammatory reaction of the liver parenchyma. It is either acute, which resolves within six months or may be chronic.

•

An outbreak of severe, acute hepatitis of unknown origin in children was reported in nearly all World Health Organisation (WHO) regions except in the Africa.

•

Although extensive research has not been conducted on the rapidly-progressing AHUO in children, current literature has reported human enteric adenovirus type-41F in most cases aged sixteen or younger.

•

Potential confounding coronavirus infection is one of several theories currently being considered in acute non-hepatitis A–E viral hepatitis origin.

•

During this outbreak, it is important to adhere to both hand and body hygiene, general infection and control prevention strategies, and lastly, case presentation matching the criteria of case definition set by the WHO.

Is Alzheimer's disease an infectious neurological disease? A review of the literature

INTRODUCTION

Alzheimer's disease (AD) is a leading cause of dementia around the globe. Its pathogenesis is characterized primarily by the extracellular deposition of amyloid β peptides and intracellular neurofibrillary tangles. Despite the significant investments in neurological research, the exact molecular mechanism of AD pathogenesis is still not fully elucidated. Several studies converge on a hypothesis that pathogenic microbes might play a role in AD progression. Although this hypothesis has been considered relatively weak for decades, it has recently received considerable attention due to increasing evidence on the association between microorganisms and AD. There is a lack of experimental and scientific arguments conveying that these microorganisms engender cognitive and neuropathological deficits and modifications specific to AD, challenging the theory that it could be an infectious neurological disease. This review focuses on recent advances in the infection hypothesis and provides an overview of new findings portraying the significance of pathogenic microbes in AD and the challenges confronting the validity of the hypothesis.

METHODOLOGY

Data were collected from medical journals published on PubMed, Ovid MEDLINE, ScienceDirect, and Embase bibliographical databases with a predefined search strategy. All articles considering neurological disorders, especially AD associated with infectious diseases, were included.

RESULTS

This work focused on providing an overview of new findings around the relationship between microorganisms and AD, challenges facing the validity of the theory, and recommendations on how the scientific community can best develop alternative approaches to address the pathophysiology of AD.

CONCLUSION

While many studies reinforce the suspicion of an infectious etiology of AD, it is important to note that it is yet not validated how microorganisms' presence in the brain can develop AD due to the limited available evidence. Certainly, ground-breaking work is mandatory in this field of research, and these reports so far warrant a thorough investigation into how a chronic infection may remain silent while progressing its neuroinflammation. Amid this uncertainty arises the hope that many researchers will take on this challenge and join this endeavor to benefit AD patients worldwide.

Russia-Ukraine conflict and COVID-19: a double burden for Ukraine's healthcare system and a concern for global citizens

The conflict between Ukraine and Russia significantly influences the healthcare sector. The ongoing COVID-19 pandemic and the armed conflict have badly devastated the established healthcare system. Only 36.08% of the Ukrainian population has received the COVID-19 vaccination, with the majority receiving two doses, and currently, Ukraine records the highest mortality rate in the world. In addition to the conflict injuries, increased susceptible deaths to COVID-19 can be found due to inadequate vaccination rates for the disease. To save their lives and for their well-being, many individuals have been relocating to the underground metro stations, other cities, nearby towns and countries. In these settings, social distancing, hand sanitation and wearing masks are not prioritised. In the current circumstances, the broken healthcare system needs to be rebuilt, and the Non-Governmental Organizations (NGOs), doctors and all the front-line workers should extend their humanitarian support to the Ukrainian population. Conclusion: It is an arduous task for healthcare organisations to supply vaccines and medicines in this ‘armed conflict’ between Russia and Ukraine. This can only happen when both parties extend their support to rebuild the shattered healthcare infrastructure.

Correlated Electrical Conductivities to Chemical Configurations of Nitrogenated Nanocrystalline Diamond Films

Diamond is one of the fascinating films appropriate for optoelectronic applications due to its wide bandgap (5.45 eV), high thermal conductivity (3320 W m−1·K−1), and strong chemical stability. In this report, we synthesized a type of diamond film called nanocrystalline diamond (NCD) by employing a physical vapor deposition method. The synthesis process was performed in different ratios of nitrogen and hydrogen mixed gas atmospheres to form nitrogen-doped (n-type) NCD films. A high-resolution scanning electron microscope confirmed the nature of the deposited films to contain diamond nanograins embedded into the amorphous carbon matrix. Sensitive spectroscopic investigations, including X-ray photoemission (XPS) and near-edge X-ray absorption fine structure (NEXAFS), were performed using a synchrotron beam. XPS spectra indicated that the nitrogen content in the film increased with the inflow ratio of nitrogen and hydrogen gas (IN/H). NEXAFS spectra revealed that the σ*C–C peak weakened, accompanied by a π*C=N peak strengthened with nitrogen doping. This structural modification after nitrogen doping was found to generate unpaired electrons with the formation of C–N and C=N bonding in grain boundaries (GBs). The measured electrical conductivity increased with nitrogen content, which confirms the suggestion of structural investigations that nitrogen-doping generated free electrons at the GBs of the NCD films.

335 Early Initiation of Biochemical Venous Thromboembolism Prophylaxis Following Traumatic Spleen Injury Is Safe and Effectively Reduce VTE Events

Aim

This study examines the safety and timing initiating VTE prophylaxis post traumatic splenic injuries (TSI).

Method

Patients with TSI were identified from prospectively maintained Trauma Audit and Research Network (TARN) database from 2015–2020 in a single tertiary trauma centre. Clinical and radio-logical information were collected retrospectively. TSI were graded using American Association for the Surgery of Trauma (AAST) splenic injury scale. Chemical venous thromboprophylaxis initiation were categorised as not given, &lt;48h and &gt;48h following the injury.

Results

In total 102 patient were included out of 136 patients identified with TSI. 34 patients were excluded for lack of electronic data, palliative decision, or fatal condition on arrival. 12 patients out of 102 required operative management (OM) and 90 patients NOM. VTE prophylaxis was not given for 31 (30.4%). Medical reasons for this include severe brain injury and early discharge before 48 hours. VTE prophylaxis was initiated for 37 (36.3%) patients within 48 hours, and for 34 patients (33.3%) after 48 hours of admission. Seven patients developed thromboembolic events, majority of which (6/7) received VTE prophylaxis after 48 hours. Importantly, none of the patients who received VTE prophylaxis had rebleeding.

Conclusions

This study showed that early initiation of chemical VTE prophylaxis (&lt;48h) is safe, resulted in lower incidence of DVTs/PEs without increasing the risk of bleeding. Results from this study supports recommendation from other studies 1 to initiate chemical VTE prophylaxis after TSI as early as 24h post injury with no other contra-indications.

5 Cervical Spine Pedicle Screw Accuracy in Open Fluoroscopic, Navigated and Template Guided Systems- a Systematic Review

Aim

Pedicle screws provide excellent fixation for a wide range of indications; their adoption in the cervical spine has been slower than in the thoracic and lumbar spine, largely due to the smaller pedicle sizes and proximity to neurovascular structures in the neck. Recent years have seen the development of technology to improve accuracy and thereby safety in cervical pedicle screw placement over traditional fluoroscopic techniques, including intraoperative 3D navigation, computer assisted systems and physical templates with screw guides. We have performed a systematic review into the accuracy rates of the various systems.

Method

PubMed and Cochrane Library databases were searched; keywords "pedicle screw cervical spine" were searched; 9 valid papers involving 1427 screws were found.

Results

Accuracy rates were 80.6% for fluoroscopy, 91.4% for navigation methods, and 96.7% for templates.

Conclusions

Superior results for templates are complemented by reduced radiation exposure to patient and surgeon; however, the technology requires prolonged pre-operative planning to create the bespoke template, and the development of an infrastructure to allow for their rapid production and delivery is needed before they become more widely available.

Two broad methods of navigation currently exist: intraoperative CT scanning providing real-time 3D navigation and preoperative CT registration in relation to a fixed reference with intraoperative computer assistance. At present, these methods are more commonly used, due to their proven improved accuracy rates over fluoroscopy, availability in emergencies and alongside minimally invasive techniques.

Despite their novelty and limitations, templates provide promising accuracy scores, although practical considerations may inhibit their proliferation.

Saccharomyces cerevisiae OS303 expression of an alkaline protease from a newly isolated Bacillus subtilis D9

The aim of this study was to produce high yield of a local bacterial alkaline protease in the yeast system because the scientific involvement of microorganisms in enzyme production is still not given enough attention in Saudi Arabia. Soil samples were collected from the rhizosphere of some desert plants in Saudi Arabia. Ninety-three alkaline protease producing bacterial isolates were recovered on skimmed-milk agar at pH 9.4 and 45°C for 48 hr. Isolate D9 obtained from the rhizosphere of Heliotropium digynum at Dhahran City was the most potent isolate in respect to enzyme productivity (184.6 U/ml). The full gene of alkaline protease was amplified and showed the expected size (1300 bp). Restriction enzymes analysis also verified the integrity of the PCR product. The sequence of the protease gene revealed an open reading frame of 1329 nt correspond to the full length of the protease gene of isolate D9 encoding a 443 aa protein. After ligation of the amplified gene by the TA cloning method, digestion with appropriate restriction enzymes confirmed the integrity of the cloned gene. The insert was prepared by two PCRs that were conducted with a pair of primers specifically designed for this purpose. The digested and purified cloning vector pRS426/GAL1p-207-Glu-MS was ligated with the insert then transformed into various strains of Saccharomyces cerevisiae via the electroporation method. Maximum protease expression was done by recombinant OS303 in galactose containing media (145.5 U/ml) with an approximately 2-fold increase when compared with the wild OS303 strain., this may be due to ability to activate gal operon.

963 Management of Acute Gallstone-Related Complications at Great Western Hospital (GWH): Re-Audit

Aim

Gallstone related disease accounts for a third of the admissions to the Surgical Department. In June 2019, a clinical audit was undertaken at Great Western Hospital assessing the number of patients who underwent cholecystectomy, following initial diagnosis, in accordance to current guidelines. The results demonstrated a very low number of patients had cholecystectomy, within the targeted time frame, which led to the implementation of a dedicated operative “hot gallbladder” list weekly. In June 2020, we re-audit the service to evaluate the impact of the change implemented.

Method

A retrospective observational analysis of patients admitted to the Hospital in June 2020 with gallstone related disease. Data was collected using the Surgical on-call lists, these were analysed and patients selected according to the reason for admission, only gallstone related issues were considered in this analysis. Finally, via Medway, the time from admission to surgery was assessed.

Results

Despite the disruption in service provision due to COVID-19, the implementation of the “hot gallbladder” list led to a 10.7% increase in timely cholecystectomies, bringing the overall compliance to 14%. There was also a significant reduction in biliary relate re-admissions, from 58% to 37%. Despite 47.3% of patients were still awaiting surgery, the waiting list was reduced by 5.2% in only 1 year.

Conclusions

This study demonstrated that the implementation of the “hot gallbladder” list has improved the compliance with the current guidelines. The change has brought us in line with the national average of 15%, as estimated by RCSEng, therefore demonstrating the efficacy of the weekly list.

1-trifluoromethoxyphenyl-3-(1-propionylpiperidin-4-yl) urea (TPPU), a soluble epoxide hydrolase inhibitor, lowers L-NAME-induced hypertension through suppression of angiotensin-converting enzyme in rats

OBJECTIVE

This study evaluated the efficacy of the soluble epoxide hydrolase (sEH) inhibitor, TPPU on chronic NG-Nitro L-arginine methyl ester (L-NAME)-induced hypertension in rats and its effects on plasma Angiotensin II (Ang II), cardiac Angiotensin-converting enzyme (ACE) and Angiotensin II receptor type 1 (AT1R) expressions.

MATERIALS AND METHODS

Forty Sprague Dawley rats were divided into 5 groups. Two groups served as control and received orally either vehicle or TPPU (3 mg/kg) for five weeks. The other three groups were given L-NAME (50 mg/kg/day) in drinking water for five weeks. Two weeks after the L-NAME treatment, animals received orally either saline or TPPU (3 mg/kg/day) or lisinopril (10 mg/kg/day) daily for 3 weeks. Blood pressure (BP) was measured weekly. At the end of the experiment, plasma Ang II, cardiac ACE and AT1R protein and gene expressions were determined.

RESULTS

L-NAME caused a significant increase in BP of the animals. TPPU and lisinopril resulted in normalization of L-NAME-induced hypertension. They also caused a significant reduction in Ang II and ACE protein and gene expressions compared to L-NAME and vehicle-treated animals.

CONCLUSIONS

This study demonstrates that TPPU effectively lowers L-NAME-induced hypertension in rats. The mechanism of its antihypertensive effect is likely mediated by the suppression of ACE gene and protein expression, leading to a lower Ang II level.

Cholinergic nerve regulation of heart regeneration

Background

Cardiac nerves regulate many important physiological functions of the heart such as heart rate and contractility. The emerging role of cardiac nerves during tissue homeostasis and regeneration is beginning to be appreciated. We discovered that neonatal mice are capable of regenerating their hearts following injury within a brief period after birth by proliferation of the pre-existing cardiomyocytes. Furthermore, we have demonstrated that cholinergic nerves play an important role in guiding the neonatal heart regenerative response. However, the adult mammalian heart, including the human heart, is incapable of regeneration following injury. Thus, there is great excitement about understanding the evolutionarily conserved mechanisms of endogenous cardiac regeneration, so that we can explore potential avenues to reawaken this process in adult humans.

Purpose

Our overarching goal is to define the mechanisms by which cholinergic nerves regulate heart regeneration following ischemic injury by using the neonatal mouse heart regeneration model. These studies will uncover novel pathways by which cholinergic signaling promotes cardiomyocyte proliferation and heart regeneration, which holds significant therapeutic potential for treatment of adult heart disease.

Methods

In this project, we employed genetically engineered mouse models of the critical receptors for cholinergic signaling in the heart to define the mechanisms of cholinergic nerve regulation of heart regeneration. First, we generated a cardiomyocyte-specific deletion of the muscarinic receptor (M2), the most predominant muscarinic receptor subtype present in the heart. In addition, we utilized the α7 nicotinic receptor (Chrna7) knockout mice to study the role of Chrna7 in endogenous immune cells, which is the main mediator of the cholinergic anti-inflammatory pathway. These mouse models will address how cholinergic nerves regulate heart regeneration via the M2 muscarinic receptor signaling and the inflammatory response following injury.

Results

Our results demonstrate that inhibition of two different cholinergic receptors (muscarinic and nicotinic) results in a reduction in cardiomyocyte proliferation and inhibition of the neonatal cardiac regenerative response following injury. More importantly, we demonstrate that cholinergic signaling mediates the cardiac regenerative response mainly through suppression of pro-inflammatory cytokines via the cholinergic anti-inflammatory pathway.

Conclusions

Cholinergic nerve signaling plays an important role in mounting a robust cardiac regenerative response following injury. These results have significant therapeutic potential, which will forge new paradigms with respect to the role of cardiac nerves during mammalian cardiac regeneration and reveal potential mechanisms regarding the benefits of nerve stimulation following cardiac injury in humans.

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): American Heart Association, Wisconsin Partnership Program

Low-loss waveguides on Y-cut thin film lithium niobate: towards acousto-optic applications

We investigate the dependence of photonic waveguide propagation loss on the thickness of the buried oxide layer in Y-cut lithium niobate on insulator substrate to identify trade-offs between optical losses and electromechanical coupling of surface acoustic wave (SAW) devices for acousto-optic applications. Simulations show that a thicker oxide layer reduces the waveguide loss but lowers the electromechanical coupling coefficient of the SAW device. Optical racetrack resonators with different lengths were fabricated by argon plasma etching to experimentally extract waveguide losses. By increasing the oxide layer thickness from 1 µm to 2 µm, we were able to reduce propagation loss of 2 µm (1 µm) wide waveguide from 1.85 dB/cm (3 dB/cm) to as low as 0.37 dB/cm (0.77 dB/cm). Resonators with a quality factor greater than 1 million were demonstrated as well. An oxide thickness of approximately 1.5 µm is sufficient to significantly reduce propagation loss, due to leakage into the substrate and simultaneously attain good electromechanical coupling in acoustic devices. This work not only provides insights on the design and realization of low-loss photonic waveguides in lithium niobate, but also, most importantly, offers experimental evidence of how the oxide thickness directly impacts losses and guides its selection for the synthesis of high-performance acousto-optic devices in Y-cut lithium niobate on insulator.

Novel on chip rotation detection based on the acousto-optic effect in surface acoustic wave gyroscopes

An Acousto-Optic Gyroscope (AOG) consisting of a photonic integrated device embedded into two inherently matched piezoelectric surface acoustic wave (SAW) resonators sharing the same acoustic cavity is presented. This constitutes the first demonstration of a micromachined strain-based optomechanical gyroscope that uses the effective index of the optical waveguide due to the acousto-optic effect rather than conventional displacement sensing. The theoretical analysis comparing various photonic phase sensing techniques is presented and verified experimentally for the cases based on a Mach-Zehnder interferometer, as well as a racetrack resonator. This first prototype integrates acoustic and photonic components on the same lithium niobate on insulator (LNOI) substrate and constitutes the first proof of concept demonstration of the AOG. This approach enables the development of a new class of micromachined gyroscopes that combines the advantages of both conventional microscale vibrating gyroscopes and optical gyroscopes.

Uterine exteriorization versus intraperitoneal repair: effect on intraoperative nausea and vomiting during repeat cesarean delivery - A randomized clinical trial

OBJECTIVE

The current study aims to compare the rate of intraoperative nausea and vomiting after repeat cesarean delivery (CD) under two different approaches: by intraperitoneal incision repair or by uterus exteriorization for incision reapair.

MATERIALS AND METHODS

We conducted a single-blinded randomized clinical trial (NCT03009994) at a tertiary University Hospital between the 1st of September 2016 and the 31st of December 2017. The study included pregnant women at term of gestation (>37 weeks) scheduled for repeat CD under spinal anesthesia. Women were assigned to either uterine exteriorization for incision repair (Group I) or intraperitoneal incision repair (Group II). The primary assessed was the rate of nausea and vomiting during CD.

RESULTS

The study included 1028 women in the final analysis. The rate of intraoperative nausea and vomiting was significantly lower in the intraperitoneal repair group compared to the exteriorization group (24% versus 38.7%, p= 0.001). Likewise, occurrence of uterine atony and the need for additional uterotonics were significantly lower in the intraperitoneal repair group (p= 0.001 and 0.02 respectively). Postoperatively, the rate of nausea and vomiting (12.6 % versus 21 %; P=0.001), and the time to the first recognized bowel movement (12.3 hours versus 14.1 hours; P=0.003) were significantly lower in the intraperitoneal repair group compared to the exteriorization group.

CONCLUSIONS

Intraperitoneal repair of the uterine incision during repeat CD is beneficial compared to exteriorization. Improvements in the rate of intra- and postoperative nausea, vomiting, uterine atony and time to the first recognized bowel movement were observed in patients operated with this technique.