Recent Advances in Understanding Peripheral and Gut Immune Cell-Mediated Salt-Sensitive Hypertension and Nephropathy

Hypertension is the primary modifiable risk factor for cardiovascular, renal, and cerebrovascular diseases and is considered the main contributing factor to morbidity and mortality worldwide. Approximately 50% of hypertensive and 25% of normotensive people exhibit salt sensitivity of blood pressure, which is an independent risk factor for cardiovascular disease. Human and animal studies demonstrate that the immune system plays an important role in the etiology and pathogenesis of salt sensitivity of blood pressure, kidney damage, and vascular diseases. Antigen-presenting and adaptive immune cells are implicated in salt-sensitive hypertension and salt-induced renal and vascular injury. Elevated sodium activates antigen-presenting cells to release proinflammatory cytokines including IL (interleukin) 6, tumor necrosis factor-α, IL-1β, and accumulate isolevuglandin-protein adducts. In turn, these activate T cells release prohypertensive cytokines including IL-17A. Moreover, high-salt intake is associated with gut dysbiosis, leading to inflammation, oxidative stress, and blood pressure elevation but the mechanistic contribution to salt-sensitivity of blood pressure is not clearly understood. Here, we discuss recent advances in research investigating the cause, potential biomarkers, and therapeutic targets for salt-sensitive hypertension as they pertain to the gut microbiome, immunity, and inflammation.

Dynamical behaviours and stability analysis of a generalized fractional model with a real case study

Introduction

Mathematical modelling is a rapidly expanding field that offers new and interesting opportunities for both mathematicians and biologists. Concerning COVID-19, this powerful tool may help humans to prevent the spread of this disease, which has affected the livelihood of all people badly.

Objectives

The main objective of this research is to explore an efficient mathematical model for the investigation of COVID-19 dynamics in a generalized fractional framework.

Methods

The new model in this paper is formulated in the Caputo sense, employs a nonlinear time-varying transmission rate, and consists of ten population classes including susceptible, infected, diagnosed, ailing, recognized, infected real, threatened, diagnosed recovered, healed, and extinct people. The existence of a unique solution is explored for the new model, and the associated dynamical behaviours are discussed in terms of equilibrium points, invariant region, local and global stability, and basic reproduction number. To implement the proposed model numerically, an efficient approximation scheme is employed by the combination of Laplace transform and a successive substitution approach; besides, the corresponding convergence analysis is also investigated.

Results

Numerical simulations are reported for various fractional orders, and simulation results are compared with a real case of COVID-19 pandemic in Italy. By using these comparisons between the simulated and measured data, we find the best value of the fractional order with minimum absolute and relative errors. Also, the impact of different parameters on the spread of viral infection is analyzed and studied.

Conclusion

According to the comparative results with real data, we justify the use of fractional concepts in the mathematical modelling, for the new non-integer formalism simulates the reality more precisely than the classical framework.

222 Robotic Surgery: Public Perceptions and Current Misconceptions

Aim

While surgeons and robotic companies are key stakeholders involved in the adoption of Robotic Surgery (RS), the public's role is often overlooked. However, given that patients hold ultimate power over their healthcare decisions, public acceptance of RS is crucial. This study aims to identify public understanding, opinions and misconceptions on RS and present solutions to facilitate its wider integration.

Method

An online questionnaire distributed via social media platforms between February and May 2021 identified the views of UK adults on RS. The data was evaluated using thematic analysis, descriptive statistics, and statistical analysis. Statistical differences in age, gender, education level, and presence in the medical field were also sought.

Results

263 responses were obtained, with 216 (82.1%) analysed. Demographic differences provided significantly different results. Participants were relatively uninformed about RS, with a median knowledge score of 4.00(2.00–6.00) on a 10-point likert scale. Fears surrounding increased risk, reduced precision and technological failure were identified, alongside misconceptions on what RS entails, including it being autonomous. However, providing factual information in the survey about RS statistically increased participant comfort (p=<0.0001). Most (61.8%) participants believed robot manufacturers were responsible for malfunctions, but doctors were held accountable more by older, less educated, and non-medical participants.

Conclusions

This study highlights the role of negative and inaccurate public perceptions surrounding RS in impeding its widespread adoption. Greater emphasis must be placed on patient education in RS to mitigate misconceptions and ensure greater diffusion of its benefits

219 The Opportunities and Challenges of Robotic Surgery: A Surgeon and Robotic Company Perspective

Introduction

As an increasing number of specialties have begun to adopt robotic surgery (RS), its prevalence within the NHS is continually rising. This study aims to establish stakeholders’ opinions on the opportunities and challenges of the widespread adoption of RS.

Method

Participants were recruited through social media platforms such as LinkedIn or via university affiliations and current RS research. Semi-structured interviews of eight surgeons and five company representatives were conducted online. Transcripts were analysed to formulate themes surrounding the opportunities and challenges of RS.

Results

This study identified six common themes amongst shareholders: Perspective, Ethics, Impact of Robotics, Training, Adoption and Finances. The success rates and quality of results offered by RS make it a recognised future surgical staple amongst interviewees. However, the technology remains a contentious subject amongst surgeons, with many doubting whether the benefits outweigh the costs associated with implementation. Such reservations are further exacerbated by the absence of a formal training pathway. National guidelines are necessary to embed RS within the NHS infrastructure, allowing greater standardisation for patients and surgeons. The importance of patient education to address misconceptions was emphasised. Despite current high costs, robotic technology is forecasted to become cheaper with greater use and increased market competition. Interviewees stressed that responsibility for errors lies with the surgeon, but with the manufacturer for instrument malfunctions.

Conclusions

This study highlights stakeholders’ views on the opportunities and challenges of RS. The identified themes should form the basis of the proposed recommendations to facilitate a more widespread adoption of RS.

Prevalence of intestinal nematodes infection in school children of urban areas of district Lower Dir, Pakistan

Abstract Intestinal parasitism is the main cause of disease all over the world and described as a significant community health problem. The current study intended to find out the occurrence and identification of hazard factors linked with IPIs among 4-12 years aged shool-age children residing in Lower Dir district, Pakistan during 2019 - 2020. A cross-sectional school-based study was conducted using a pre-arranged pre-tested survey. Anthropometric data and stool collection were done to obtain the findings. The direct wet mount preparation in saline/iodine/methods was used for stool examination. Data were investigated using the GraphPad Prism 5. A total of 400 children studied (mean age of 8.6±3.6 years) the total incidence rate for the intestinal parasitic disease was established to be 71.75%. Of the 400 children studied, the overall prevalence rate for intestinal parasitic infections was found to 71.75% Ascaris lumbricoides (33.1%), Trichuris trichiura (1.04%), E. vermicularis (1.39%), Hookworm (19.86%) were identified in children living in the study area. We concluded that there is a mass scale campaigns were required to generate alertness about health and sanitation in children and the need for the development of effective poverty control programs because deworming (killing of worm with drugs) alone is not adequate to control parasitic infections.

Death caused by covid-19 in top ten countries in Asia affected by covid-19 pandemic with special reference to Pakistan

The COVID-19 is a contagious viral disease, was first emerged in Wuhan, China in December 2019 and became the whole world on alert. The mortality rate in top most countries in Asia with special reference to Pakistan has been focused. Since February 26 to September 2020 the total confirmed cases and mortality rate was measured through Wikipedia and the notable journals. Iran is the only country having highest number of deaths (5.73%) followed by Indonesia (3.77%) while Saudi Arabia shows the lowest number of deaths as 1.39%. In Pakistan the first case was confirmed in 26th February, 2020. The nCov-19 has closely related to severe acute respiratory syndrome (SARS) hence SARS COV-2 was named. This virus is responsible for more than 33.9 million deaths in over all the world as of 20th September, 2020. The number of new cases is increasing time to time. Sindh province of Pakistan has reported the highest number of cases till September, 20, 2020 as compared to other parts of the country and has the highest number of death followed by Khyber Pakhtunkhwa. Because of the person to person contact the disease is spreading rapidly. The individuals who has already infected with other diseases like cancer or diabetic etc. are vulnerable. The nCOV-19 is the most contagious due to its mode of transmission. There is still no vaccine is available for the treatment of disease caused by nCoV-2019. It is therefore the only option to control this pandemic is to adopt effective preventive measures.

1289 Gender Representation in The Authorship of Surgical Journals

Introduction

Despite the increase in female doctors graduating from medical schools internationally, gender disparity in surgery remains. This disparity is also evident in academic surgery. This study aims to quantify the extent of gender disparity in the authorship of articles in major surgical journals.

Method

The Top 10 Surgical Journals were identified using SCImago Journal Rank indicator. Authorship details for papers published in 2019 were collected. Authors were assigned as female, male or unknown using Gender API software (Gender API, Germany). For each journal, the percentage of first author, last author, corresponding author and all authors split by gender was interrogated. Gender differences by publication type were also identified.

Results

9 of the 10 journals had full names publicly available. Overall, 2414 manuscripts were interrogated which included 16,277 number of authors. Respectively, females and males accounted for 29.8% [22.9-34.9%] (N = 655) and 62.4% [56.3-70.2%] (N = 1419) of first authors, 20.6% [11.8-27.1%] (N = 453) and 74.2% [65.6-84.1%] (N = 1706) of last authors, 23.9% [14.9-29.6%] (N = 510) and 69.9% [60.5-79.3%] (N = 2341) of corresponding authors and in total 27% [19.4-31.6%] (N = 4298) and 65.5% [58.6-73.4%] (N = 9982) of all authors. The wide range in these results could be a result of various factors.

Conclusions

This study has identified a gender imbalance in authorship positions, with the greatest difference observed in the most senior author position. Whether this is reflective of the current disparity observed in senior academic surgery positions or due to gender discrimination is unclear.

1075 Paediatric Injuries Pre And During COVID-19 Requiring an Operative Intervention: The District General Hospital Experience

Aim

To assess the effect of lockdown and the following summer period on paediatric trauma patients who required an operative intervention in a district general hospital.

Method

A single centre retrospective audit was performed on all paediatric patients <16 years requiring an operative intervention. Two study periods were assessed – pre-COVID (22/03/2019- 30/09/2019) and during the COVID-19 pandemic and subsequent summer period (26/03/2020 – 26/09/2020). Data were collected on patient demographics, type of injury sustained, and intervention performed.

Results

During the COVID-19 pandemic 119 operations were performed, compared to 238 operations performed before the pandemic. Distal radius fractures were the most common injury both during and before the pandemic. However, during the pandemic there was a higher incidence of both hand injuries and lower limb lacerations. The most common type of operation both before and during the pandemic was manipulation under anaesthetic, but there was an increased incidence of washouts performed during the pandemic.

Conclusions

Despite extensive restructuring of services due to COVID-19, 119 operations were performed during the pandemic. However, this is 119 fewer operations than the same period of the previous year. The reduced rate of operations could be a consequence of increased parental supervision, and less outdoor activity during the pandemic period, but further research is necessary.

Food handlers: an important reservoir of protozoans and helminth parasites of public health importance

Food handlers plays a primary role in the transmission of pathogenically important protozoans and helminth parasites. This study was aimed to evaluate the prevalence of intestinal pathogenic protozoans and helminth parasites among food handlers in and around University of Malakand, Lower Dir, Pakistan. Stool samples were collected from 642 food handlers (all of male) in a cross-sectional study from January to November, 2017. Wet Mount Techniques and concentration methods by using salt and formol-ether solutions. Three hundred and eighty four cases (59.8%) were found infected with one more parasites. Most of the individuals were found infected with helminth (47.6%) as compared to intestinal protozoans (0.93%). Seventy two cases (11.2%) of the cases presented mixed infection with both intestinal protozoan and helminth parasites. The order of prevalence for intestinal helminth was Ancylostoma duodenale (n = 258, 40.1%), followed by Taeniasa ginata (n=96, 14.9%) Ascaris lumbricoides (n = 54, 8.40%) and Trichuris trichura (n=30, 4.60%). For intestinal protozoa, Entamoeba histolytica/dispar (n = 36, 5.64%) was the only protozoan detected. Mono-parasitism was higher than poly-parasitism. Family size income and education level were the factors significantly (P<0.05) associated in the parasites prevalence. Current research showed that IPIs are primarily the foodborne pathogens still an important public health problem in Pakistan. Effective control programs on parasitic diseases transfer and their associated factors are recommended.

Gender representation in editorial boards of international general surgery journals

Background

Despite women constituting over half of new doctors, gender disparity remains an issue. Surgery has shown particularly slow progress towards gender parity. This study aimed to quantify gender representation within editorial boards of the highest ranking international general surgery journals.

Methods

Surgical journals were collated using two indices: SCImago Journal Rank (SJR) and Journal Impact Factor (JIF). Non-general surgery journals were excluded. Journals were contacted, requesting gender editorial team demographics. Editorial board data were collected via journal websites on 28 November 2019.

Results

The top 25 general surgery journals according to SJR and JIF ranking methods were determined, identifying 28 unique journals. Editorial board data were publicly available for 27 of these 28 surgical journals, and were examined. Women accounted for 20.2 per cent (568 of 2816) of total editorial board positions. Women constituted 11 per cent (4 of 36) of editor-in-chief positions, 32 per cent (29 of 92) of deputy editors, and 19.1 per cent (369 of 1935) of general editorial board positions.

Conclusion

The findings demonstrate gender disparity within editorial boards of the most prominent general surgery journals.

Evaluation of vegetables grown in dry mountainous regions for soil transmitted helminths contamination

Infection caused by geo-helminth parasites are called geohelminthiasis are one of the global health problems. Vegetables eaten raw is the principal source of transmission of geo-helminth parasites. Pakistani people believe that eating raw vegetables are a significant source to get important vitamins and minerals. Based on the high incidence of pathogenic parasites and cultivating different vegetable types in the study areas, we conducted this study to evaluate the geo-helminth contamination of raw vegetables in northwest Khyber Pakhtunkhwa, Pakistan. This is a descriptive study comprised, 1942 samples of 25 various types of vegetables. The samples were examined in physiological saline solution using sedimentation and centrifugation methods. The findings were analyzed by Graph-Pad version 5. P value less than 0.05 (95% CI) was considered significant. Results showed that 16.5% (n=322) of all vegetables were contaminated with one or more type of geo-helminth parasites. Garlic was the highest (35%) and cauliflower the lowest (4%) contaminated samples respectively. Ascaris lumbricoides was the most common geo-helminth found followed by hook worm species while Trichuris trichura was the least in all the vegetable samples. Leafy vegetables were highly contaminated 25.3% than vegetables with root parts 21.2% and fruity 9.09%. More than half of the contaminated vegetables were contaminated with single species of geo-helminth (P<0.05) while less than half with multiple types of geo-helminth contamination. Ninety two vegetables samples were contaminated with 2 species of parasites (P<0.05) and 45 with 3 (P>0.05) species of geo-helminth parasites. Education level of vendors and means of display were not significantly associated while types of vegetable used were significantly associated with the prevalence of parasites. The findings of this study provide evidence that consumption of raw vegetable has a high risk of acquiring geo-helminth infections. The authors believe that preventing the human to enter to the vegetable farmland for defecation, avoiding the irrigation of agricultural fields via night soil, and educating the people on proper washing and cooking of vegetables may be useful in reducing parasitic infections.

Biochemical studies on protein, phenolic contents and antioxidant activities of Sida cordifolia extracts

The study aimed to characterize the antioxidant properties regarding the Sida cordifolia with special reference to its detailed biochemical analysis. The study revealed that chlorophyll A (0.9 ± 0.3 mg/g), total chlorophyll content (3.0 ± 0.7 mg/g), total carotenoid content (0.3 ± 0.1 mg/g), total soluble proteins (7.5 ± 0.1 mg/g), and total phenolic contents (5.6 ± 1.3 mg/g) were found highest in flower tissue of S. cordifolia. However, peroxidase (POD) contents (118 ± 31 units/g), superoxide dismutase (SOD)  activity (64 ± 1.5 units/g) were maximum in the leaf tissues, while catalase (CAT)  contents (133 ± 25 units/g), ascorbate peroxidase (APX)  contents (145 ± 44 units/g) were also found more in the flowers of S. cordifolia rather than other parts. Our results conclude that leaves, stem, flower of S. cordifolia could be exploited in pharmacology due to presence of different antioxidants reflected in flower and leaf extract make them potent and profound therapeutic agents.                     KEY WORDS: Alkaloids, Flavonoids, Phenolics, Antioxidant, Sida cordifolia   Bull. Chem. Soc. Ethiop. 2020, 34(2), 427-434 DOI: https://dx.doi.org/10.4314/bcse.v34i2.18

Simplified risk stratification criteria for identification of patients with MRSA bacteremia at low risk of infective endocarditis: implications for avoiding routine transesophageal echocardiography in MRSA bacteremia

The aim of this study was to identify patients with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia with low risk of infective endocarditis (IE) who might not require routine trans-esophageal echocardiography (TEE). We retrospectively evaluated 398 patients presenting with MRSA bacteremia for the presence of the following clinical criteria: intravenous drug abuse (IVDA), long-term catheter, prolonged bacteremia, intra-cardiac device, prosthetic valve, hemodialysis dependency, vertebral/nonvertebral osteomyelitis, cardio-structural abnormality. IE was diagnosed using the modified Duke criteria. Of 398 patients with MRSA bacteremia, 26.4 % of cases were community-acquired, 56.3 % were health-care-associated, and 17.3 % were hospital-acquired. Of the group, 44 patients had definite IE, 119 had possible IE, and 235 had a rejected diagnosis. Out of 398 patients, 231 were evaluated with transthoracic echocardiography (TTE) or TEE. All 44 patients with definite IE fulfilled at least one criterion (sensitivity 100 %). Finally, a receiver operator characteristic (ROC) curve was obtained to evaluate the total risk score of our proposed criteria as a predictor of the presence of IE, and this was compared to the ROC curve of a previously proposed criteria. The area under the ROC curve for our criteria was 0.710, while the area under the ROC curve for the criteria previously proposed was 0.537 (p < 0.001). The p-value for comparing those 2 areas was less than 0.001, indicating statistical significance. Patients with MRSA bacteremia without any of our proposed clinical criteria have very low risk of developing IE and may not require routine TEE.

Clostridium difficile infection in liver transplant recipients: a retrospective study of rates, risk factors and outcomes

Clostridium difficile infection (CDI) occurs in 3-7% of liver transplant recipients (LTR). However, few data exist on the recent epidemiology, predictors and outcomes of CDI in LTR. A cohort study was performed including LTR from 2000 to 2010 at a tertiary care hospital in Detroit. CDI was defined as diarrhea with a stool C. difficile positive test. Data analyzed included demographics, comorbidities, length of stay (LOS), severity of CDI, rates of recurrence (<12 weeks), relapse (<4 weeks) and overall mortality. Predictors of CDI were calculated using Cox proportional hazard model; 970 LTR were followed for years. Overall prevalence of CDI was 18.9%. Incidence of CDI within 1 year of transplant was 12.4%. Severe CDI occurred in 29.1%. CDI recurrence and relapse rates were 16.9% and 9.7%, respectively. Independent predictors of CDI were year of transplant (hazard ratio [HR] 1.137, 95% confidence interval [CI] 1.06-1.22; p < 0.001), white race (105/162 whites, HR 1.47, 95% CI 1.03-2.1; p = 0.035), Model for End-Stage Liver Disease score (HR 1.03, 95% CI 1.01-1.045, p = 0.003) and LOS (HR 1.01, 95% CI 1.005-1.02, p < 0.001). Significant mortality was observed among LTR with CDI compared to those without CDI (p = 0.003). We concluded that CDI is common among LTR and is associated with higher mortality.

Development of the ITER magnetic diagnostic set and specification

ITER magnetic diagnostics are now in their detailed design and R&D phase. They have passed their conceptual design reviews and a working diagnostic specification has been prepared aimed at the ITER project requirements. This paper highlights specific design progress, in particular, for the in-vessel coils, steady state sensors, saddle loops and divertor sensors. Key changes in the measurement specifications, and a working concept of software and electronics are also outlined.

Active screening at entry for tuberculosis among new immigrants: a systematic review and meta-analysis

Although there is no evidence that imported tuberculosis increases the incidence of the disease in host countries, the rise in migration worldwide raises concerns regarding the adequacy of surveillance and control of immigrant-associated tuberculosis in low incidence countries. Assessing the performance of screening of immigrants for tuberculosis is key to rationalizing control policies for the detection and management of immigrant-associated tuberculosis. We performed a systematic review and meta-analysis to determine the yield of active screening for tuberculosis among new immigrants at the point of entry. The yield for pulmonary tuberculosis was 3.5 cases per 1,000 screened (95% CI 2.9-4.1; I(2) = 94%); for refugees, asylum seekers and regular immigrants the estimates were 11.9 (95% CI 6.7-17.2; I(2) = 92%), 2.8 (95% CI 2.0-3.7; I(2) = 96%) and 2.7 (95% CI 2.0-3.4; I(2) = 81%), respectively. The yield estimates for immigrants from Europe, Africa and Asia were 2.4 (95% CI 1.3-3.4; I(2) = 51.5%), 6.5 (95% CI 3.2-10.0; I(2) = 62%) and 11.2 (95% CI 6.2-16.1; I(2) = 95%), respectively. These results provide useful data to inform the development of coherent policies and rational screening services for the detection of immigrant-associated tuberculosis.

A new acylated flavone glycoside from the fruits of Stocksia brauhica

Phytochemical investigations of the fruits of Stocksia brauhica (Sapindaceae) resulted in the isolation of a new acylated flavone glycoside. Its structure of the new compound brauhenefloroside D (1) was established as 3-O-[(alpha-L-rhamnopyranosyl)oxy]-7-O-[(acetyl)-beta-D-glucopyranosyl (1 --> 4)]-[6-O-(4-hydroxy-E-cinnamoyl)-beta-D-glucopyranosyl-(1 --> 2)-alpha-L-rhamnopyranosyl)-oxy]-kaempferol. The structure elucidation of the new compound was based primarily on 1D and 2D NMR analysis, including COSY, HMBC and HMQC correlations.