New Approach for Using of Mentha longifolia L. and Citrus reticulata L. Essential Oils as Wood-Biofungicides: GC-MS,SEM, and MNDO Quantum Chemical Studies

Background: Fungi growing on wood cause deterioration of stored food materials or discoloration of the wood itself, and the search for new and safe bioagents is recently needed. Methods: Essential oils (EOs) from aerial parts from Mentha longifolia L. and Citrus reticulata L., analyzed by gas chromatography-mass spectrometry (GC-MS), were tested for their antifungal activity by the vapor method against four common fungi, Aspergillus flavus, A. niger, A. fumigatus, and Fusarium culmorum, and confirmed by SEM examination as the oils applied on wood samples. Results: The most abundant compounds identified in the EO from M. longifolia were menthone and eucalyptol; in C. reticulata EO, they were β-caryophyllene, β-caryophyllene oxide, and β-elemene. EOs from M. longifolia and C. reticulata, at 500 and 250 µL/mL, showed potent antifungal activity against A. flavus and A. fumigatus, with 100% fungal mycelial inhibition growth (FMIG). C. reticulata and M. longifolia EOs, at 125 µL/mL, observed FMIG values of 98% and 95%, respectively, against A. fumigatus. M. longifolia EO, at 500 and 250 µL/mL, showed potent activity against A. niger, with 100% FMIG. F. culmorum completely inhibited (100% FMIG) EOs from M. longifolia and C. reticulata applied at 500 µL/mL. Pinus roxburghii Sarg. Wood, treated with M. longifolia at 125 µL/mL, showed inhibition zone values of 7.33 and 21.33 mm against A. flavus and A. niger, respectively. Conclusions: Both oils possessed good wood-biofungicide activity with the vapor method, as clearly shown by the SEM examination. These activities suggest their possible use as natural wood preservatives.     

Prevalence and impact of comorbidities on disease prognosis among patients with COVID-19 in Bangladesh: A nationwide study amid the second wave

BackgroundSocio-demographics and comorbidities are involved in determining the severity and fatality in patients with COVID-19 suggested by studies in various countries, but study in Bangladesh is insufficient.AimsWe designed the study to evaluate the association of sociodemographic and comorbidities with the prognosis of adverse health outcomes in patients with COVID-19 in Bangladesh.MethodsA multivariate retrospective cohort study was conducted on data from 966 RT-PCR positive patients from eight divisions during December 13, 2020, to February 13, 2021. Variables included sociodemographic, comorbidities, symptoms, Charlson comorbidity index (CCI) and access to health facilities. Major outcome was fatality. Secondary outcomes included hospitalization, duration of hospital stay, requirement of mechanical ventilation and severity.ResultsMale (65.8%, 636 of 966) was predominant and mean age was 39.8 ± 12.6 years. Fever (79%), dry cough (55%), and loss of test/smell (51%) were frequent and 74% patients had >3 symptoms. Fatality was recorded in 10.5% patients. Comorbidities were found in 44% patients. Hypertension (21.5%) diabetes (14.6%), and cardiovascular diseases (11.3%) were most prevalent. Age >60 years (OR: 4.83, 95% CI: 2.45–6.49), and CCI >3 (OR: 5.48, 95% CI: 3.95–7.24) were predictors of hospitalizations. CCI >4 (aOR: 3.41, 95% CI: 2.57–6.09) was predictor of severity. Age >60 years (aOR: 3.77, 95% CI: 1.07–6.34), >3 symptoms (aOR: 2.14, 95% CI: 0.97–4.91) and CCI >3 vs. CCI <3 (aOR: 5.23, 95% CI: 3.77–8.09) were independently associated with fatality.ConclusionsIncreased age, >3 symptoms, increasing comorbidities, higher CCI were associated with increased hospitalization, severity and fatality in patients with COVID-19.     

Efficacy of i-Port Advance system on patients satisfaction and glycemic control among patients with type 1 diabetes in Saudi Arabia

Background and aimsTo determine the efficacy of i-Port Advance system on patients satisfaction and glycemic control among patients with type 1 diabetes (T1D).MethodsThis prospective study was performed among 73 patients with T1D (13–29 years) at Prince Sultan Military Medical City, Riyadh, Saudi Arabia. Demographic data were collected at baseline and clinical characteristics were collected at baseline and 12 weeks. Patients’ responses to Morisky Medication Adherence Scale (MMAS-8) and Insulin Delivery Satisfaction Survey (IDSS) were recorded at baseline and 12 weeks after initiating the i-Port Advance system.ResultsAt 12 weeks, significant improvement was evident in the IDSS subscales, which comprises the IDSS effective (p = 0.048), burdensome (p = 0.032), and IDSS inconvenient (p = 0.001), with the total baseline IDSS score being 2.6 ± 0.42, and at 12 weeks being 3.7 ± 0.72 (p = 0.037). The MMAS total score at baseline was 4.6 ± 1.2, and at 12 weeks, it increased to 6.4 (p = 0.028). HbA1c level was 8.4% at baseline and decreased to 7.9% (p = 0.001) at 12 weeks. The total daily dose of insulin at baseline registered 0.9 ± 0.13, which declined to 0.8 ± 0.12 (p = 0.048) at 12 weeks. Fasting blood sugar value was 197 ± 23.4 at baseline, which dropped to 182 ± 24.5 at 12 weeks (p = 0.01); and the postprandial glucose at baseline was 195 ± 21.4 and declined to 177 ± 19.2 at 12 weeks (p = 0.01). The hypoglycemic episodes revealed a noteworthy reduction after the i-Port Advance system usage.ConclusionUse of i-Port Advance system was found to raise the patients’ satisfaction levels and lower both the hypoglycemic episodes as well as the HbA1c levels.     

Use of a modified introducer sheath with a side-hole to improve access to left ventricular veins with proximal origin.

AIMS: Despite technical advances in tools used to facilitate implantation of cardiac resynchronization therapy (CRT) devices, there are many hurdles related mainly to the variation in the anatomy of the coronary veins. One such difficulty is the presence of a very proximal origin of the lateral or postero-lateral cardiac vein. METHODS AND RESULTS: We describe an alteration of existing left ventricular (LV) lead delivery sheath with the creation of a side-hole 35-50 mm from its tip. This modification is made to provide access to proximal cardiac vein ostia, while maintaining adequate support for the delivery system. The modified introducer sheath was used in the implantation of six CRT systems (four defibrillators and two pacemakers) in patients who had a proximal origin of the lateral or postero-lateral cardiac vein, all of which were successful and without complications. CONCLUSION: In those patients with unusual proximal origin of target LV veins, modifications of the introducer sheath with the creation of a side-hole facilitate the successful implantation of the LV pacing lead. Until this modified sheath is tested, this technique is considered experimental and may carry unknown risks.     

Predictors of long-term survival after pancreaticoduodenectomy for peri-ampullary adenocarcinoma: A retrospective study of 5-year survivors

Background: Pancreaticoduodenectomy(PD) is the standard curative treatment for periampullary tumors. The aim of this study is to report the incidence and predictors of long-term survival( ≥ 5 years) after PD. Methods: This study included patients who underwent PD for pathologically proven periampullary adenocarcinomas. Patients were divided into 2 groups: group(I) patients who survived less than 5 years and group(II) patients who survived ≥ 5 years. Results: There were 47(20.6%) long-term survivors( ≥ 5 years) among 228 patients underwent PD for periampullary adenocarcinoma. Patients with ampullary adenocarcinoma represented 31(66.0%) of the long-term survivors. Primary analysis showed that favourable factors for long-term survival include age 60 years old, serum CEA 5 ng/mL, serum CA 19-9 37 U/mL, non-cirrhotic liver, tumor size 2 cm, site of primary tumor, postoperative pancreatic fistula, R0 resection, postoperative chemotherapy, and no recurrence. Multivariate analysis demonstrated that CA 19-9 37 U/mL [OR(95% CI) = 1.712(1.24 8–2.34 8), P = 0.001], smaller tumor size [OR(95% CI) = 1.335(1.032–1.726), P = 0.028] and R0 resection [OR(95% CI) = 3.098(2.095–4.582), P 0.001] were independent factors for survival ≥ 5 years. The prognosis was best for ampullary adenocarcinoma, for which the median survival was 54 months and 5-year survival rate was 39.0%, and the poorest was pancreatic head adenocarcinoma, for which the median survival was 27 months and 5-year survival rate was 7%. Conclusions: The majority of long-term survivors after PD for periampullary adenocarcinoma are patients with ampullary tumor. CA 19-9 37 U/mL, smaller tumor size, and R0 resection were found to be independent factors for long-term survival ≥ 5 years.     

Minimal invasive para-rectus approach for limited open reduction and percutaneous fixation of displaced acetabular fractures

Introduction

Minimal invasive fixation has been reported as an alternative option for treatment of acetabular fractures to avoid blood loss and complications of extensive approaches. Closed reduction and percutaneous lag screw fixation can be done in minimally displaced acetabular fractures. Open reduction is indicated, if there is wide displacement. In this study, we report the use of a mini-open anterior approach to manipulate and reduce anteriorly displaced transverse acetabular fractures combined with percutaneous lag screw fixation.

Methods

This report included eight patients. All had anterior displaced simple transverse acetabular fractures. An oblique mini-incision was made above and medial to the mid-inguinal point, and lateral to the lateral border of rectus abdominis muscle. The external abdominal oblique aponeurosis was incised along its fibres. The arched fibres of internal abdominal oblique were displaced medially above the inguinal ligament to expose and incise the fascia transversalis. Care was taken to avoid injury of ilioinguinal nerve, inferior epigastric vessels, and spermatic cord. The external iliac vessels were palpated and protected laterally. A blunt long bone impactor was introduced through this small incision to manipulate and reduce the fracture under fluoroscopic control. Fluoroscopic guided percutaneous lag screw fixation was done in all patients.

Results

The average time to operation was 4 days. Average blood loss was 110 mL. Operative time averaged 95 min. Maximum fracture displacement averaged 10 mm preoperatively and 1.3 mm postoperatively. According to Matta score, anatomical reduction of the fracture was achieved in five patients and imperfect in three. Follow up averaged 27 months. Wound healing occurred without complications and fracture union was achieved without secondary displacement in all patients. Average time to fracture healing was 14 weeks. According to the modified Merle d’Aubigné score, functional outcome was good to excellent in all patients.

Discussion and conclusion

Limited open reduction can solve the problem of fracture reduction, which is the main concern in minimal invasive fixation of acetabular fractures. It may help the inclusion of displaced acetabular fractures for percutaneous lag screw fixation. This mini-para-rectus approach has the advantages of minimal soft tissue dissection with the possible anatomical reduction of simple transverse displaced acetabular fractures.     

Isokinetic training – its radiographic and inflammatory effects on chronic low back pain: A randomized controlled trial

Background:Isokinetic training (IKT) and core stabilization training (CST) are commonly used for balance training in musculoskeletal conditions. The knowledge about the effective implementation of these training protocols on radiological and biochemical effects in university football players with chronic low back pain (LBP) is lacking.Objective:To find and compare the effects of isokinetic training and CST on radiological and biochemical effects in university football players with chronic LBP.Design:Randomized, double-blinded controlled study.Setting:University hospital.Participants:60 LBP participants were randomized into isokinetic group (IKT; n = 20), core stabilization group (CST; n = 20) and the control group (n = 20) and received respective exercises for 4 weeks.Outcome measures:Radiological (muscle cross sectional area & muscle thickness) and biochemical (C-reactive protein, tumor necrosis factor -α, interleukin [IL]-2, IL-4, IL-6) values were measured at baseline and after 4 weeks (immediate effect).Results:The reports of the IKT, CST and control group were compared between the groups. Four weeks following training IKT group shows more significant changes in muscle cross sectional area (Psoas Major, Quadratus Lumborum, Multifidus and Erector Spinae muscles) and muscle thickness (Multifidus) than CST and control groups (p < 0.001). Biochemical measures such as C-reactive protein, tumor necrosis factor -α, IL-2, IL-4 and IL-6 also show significant improvement in IKT group than the other 2 groups (P < .001).Conclusion:Training through Isokinetic is an effective treatment program than conventional exercise programs in the aspect of radiological and biochemical analysis in university football players with chronic LBP, which may also help to prevent further injury. The present study can be used to improve the physical therapist''s knowledge and clinical decision skills on LBP in football players.     

Toward more specific and transparent research and development costs: The case of seasonal influenza vaccines

Background

The ability to calculate the development costs for specific medicines and vaccines is important to inform investments in innovation. Unfortunately, the literature is predominated by non-reproducible studies only measuring aggregate level drug research and development (R&D) costs. We describe methodology that improves the transparency and reproducibility of primary indication expected R&D expenditures.

Methods

We used publically accessible clinical trial data to investigate the fate of all seasonal influenza vaccine candidates that entered clinical development post year 2000. We calculated development times and probabilities of success for these candidates through the various phases of clinical development. Clinical trial cost data obtained from university based clinical researchers were used to estimate the costs of each phase of development. The cost of preclinical development was estimated using published literature.

Results

A vaccine candidate entering pre-clinical development in 2011 would be expected to achieve licensure in 2022; all costs are reported in 2022 Canadian dollars (CAD). After applying a 9% cost of capital, the capitalized total R&D expenditure amounts to $474.88 million CAD.

Conclusion

Clinical development costs for vaccines and drugs can be estimated with increased specificity and transparency using public sources of data. The robustness of these estimates will only increase over time due to public disclosure incentives first introduced in the late 1990s. However, preclinical development costs remain difficult to estimate from public data.     

Brain networks disconnection in early multiple sclerosis cognitive deficits: An anatomofunctional study

Severe cognitive impairment involving multiple cognitive domains can occur early during the course of multiple sclerosis (MS). We investigated resting state functional connectivity changes in large‐scale brain networks and related structural damage underlying cognitive dysfunction in patients with early MS. Patients with relapsing MS (3–5 years disease duration) were prospectively assigned to two groups based on a standardized neuropsychological evaluation: (1) cognitively impaired group (CI group, n = 15), with abnormal performances in at least 3 tests; (2) cognitively preserved group (CP group, n = 20) with normal performances in all tests. Patients and age‐matched healthy controls underwent a multimodal 3T magnetic resonance imaging (MRI) including anatomical T1 and T2 images, diffusion imaging and resting state functional MRI. Structural MRI analysis revealed that CI patients had a higher white matter lesion load compared to CP and a more severe atrophy in gray matter regions highly connected to networks involved in cognition. Functional connectivity measured by integration was increased in CP patients versus controls in attentional networks (ATT), while integration was decreased in CI patients compared to CP both in the default mode network (DMN) and ATT. An anatomofunctional study within the DMN revealed that functional connectivity was mostly altered between the medial prefrontal cortex (MPFC) and the posterior cingulate cortex (PCC) in CI patients compared to CP and controls. In a multilinear regression model, functional correlation between MPFC and PCC was best predicted by PCC atrophy. Disconnection in the DMN and ATT networks may deprive the brain of compensatory mechanisms required to face widespread structural damage. Hum Brain Mapp 35:4706–4717, 2014. © 2014 Wiley Periodicals, Inc .     

Minilaparoscopic appendectomy using a new spiral needle

Background

Acute appendicitis is the most frequent abdominal disease and requires urgent surgery. At the present time, laparoscopic appendectomy is a well-accepted emergency procedure at most centers. In this study, we used a new spiral needle to facilitate the procedure, making it easy, minimally invasive, and cost effective.

Methods

The study included 70 patients of both sexes with acute appendicitis that was treated by laparoscopic appendectomy using a new spiral needle. These cases were treated at the General Surgery Department, Zagazig University, Egypt, from May 2012 to August 2013. In the procedure we used only two ports (a 10-mm port directly below the umbilicus for the camera and a 5-mm port at the left iliac fossa at the midclavicular line). The new spiral needle was used to hold the appendix during the procedure and was inserted into the right iliac fossa depending on the site of the appendix.

Results

The mean age of the patients was 27.3 years, mean operative time was 40 min, and mean hospital stay was 1.3 days. Ten patients (14 %) had minimal bleeding at the site of needle passage into the mesoappendix. Wound infection at the site of umbilical port occurred in four patients (5.7 %) postoperatively.

Conclusion

Laparoscopic appendectomy using our new spiral needle is easy, minimally invasive, and cost effective.