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Pre-scaling up of improved Dursi variety was carried out in Chora district of Buno Bedele zone Southwestern Ethiopia with the objectives to popularize improved Dursi tef variety, to create wider demand towards improved Dursi tef variety and strength stakeholders’ linkage in the study area. The variety was scaled up on ten farmers’ fields those predominantly selected in collaboration with respective three kebeles’ Development Agents based on farmers’ willingness to provide the required land size. The land size of 25 m x 25 m was used where all the recommended agronomic practice like seed rate, fertilizer rate and weed control method were used for the accomplishment of the activity. Training was provided to Dursi growers, development agents and woreda agricultural experts to facilitate further production and dissemination of the variety. Data like number of participants on the training and yield data were recorded and analyzed using simple descriptive statistics. The result revealed that, about 124 (104 male and 20 female) participants were participated on the training. The mean grain yield of 1790 kg ha-1 was obtained which is greater than yield obtained during demonstration trial. Therefore, Dursi variety was recommended for further dissemination across numerous tef producers in the study area and similar agro ecologies.

Background: Epilepsy is a complex neurological disorder affecting millions worldwide and is the most common major neurological complication during pregnancy. Carbamazepine, a widely used antiepileptic drug, has been associated with oxidative damage. Vitamin C, a powerful antioxidant has shown potential in controlling seizures and improving fertility. This study aimed to evaluate the protective effects of vitamin C against carbamazepine and pentylenegtetrazole-induced seizures on pre-implantation loss in pregnant Wistar rats.Methods: We randomly assigned Thirty pregnant rats into six groups of five animals each. Group received distilled water (2 ml/kg), Group 2 was administered pentylenetetrazol (PTZ) at a dose of 60 mg/kg, Group 3 received vitamin C (100mg/kg) along with PTZ (60 mg/kg), Group 4 was given carbamazepine (20 mg/kg), Group 5 received both carbamazepine (20 mg/kg) and PZT (60 mg/kg), and Group 6 was pretreated with vitamin C, carbamazepine and PZT at doses of 100 mg/kg, 20 mg/kg and 60mg/kg, respectively. Treatments were administered via gavage once daily for 11 consecutive days, while PTZ was administered intraperitoneally ones. Oxidative stress parameters were assessed in the pituitary, ovary and uterine tissues alongside hematological parameters and sex hormones concentrations. We also evaluated preimplantation loss. Results: The results demonstrated that vitamin C effectively mitigated the adverse effects of oxidative stress, hormonal disruptions, preimplantation loss, and hematological changes induced by seizure and carbamazepine.Conclusion: The study concludes that antioxidant properties of vitamin C at gestation contribute to its protective effects against seizures and carbamazepine-induced alterations in reproductive parameters. The findings may have implications for human exposure to antiepileptics during pregnancy.

The experiment was conducted in 2022 main rainy cropping season in Chora and Gechi districts of Buno Bedele zone with the objectives to evaluate the yield performance and economic profitability of food barley varieties, to identify farmers’ varietal selection criteria and to improve the targeted farmers` knowledge and skills towards improved selected food barley production and management practices. Based on barley production potential and road accessibility, five kebeles were selected where two improved barley varieties (Adoshe and HB 1307) were demonstrated and evaluated alongside the local variety (Torja) replicated on 14 demonstration sites. The 100 m2 plot size was used for each variety where all the recommended agronomic practices were followed. Data like grain yield, farmers’ varietal selection criteria’s, number of training and field day participants, cost incurred and profit obtained were collected where descriptive statistics, one way ANOVA, matrix raking and partial budget were used to analyze the collected data. Both list-wise deletion and single imputation methods were used in order to fix non-equal treatment as missed data among the fourteen demonstration sites. Accordingly, the descriptive result of list-wise deletion revealed that, the mean grain yield of 37.14, 39.79and 19.49 qt ha-1 were obtained from Adoshe, HB1307 and local varieties respectively whereas the mean grain yield of 34.04, 39.79 and 19.69 qt ha-1 were obtained from Adoshe, HB1307 and local varieties respectively. The list-wise deletion and imputation method analysis of variance among the yield of demonstrated barley varieties shows that there is statistically significant yield difference at (P

BackgroundAfrican animal trypanosomiasis hinders sustainable livestock productivity in sub-Saharan Africa. About 17 million infected cattle are treated with trypanocides annually but most of the drugs are associated with drawbacks, necessitating the search for a promising chemotherapeutic agent.ObjectivesIn this study, the effects of β-sitosterol on Trypanosoma congolense infection were investigated along with its effect on the trans-sialidase gene expressions.ResultsOral treatment with β-sitosterol at 15 and 30 mg/kg body weight (BW) for 14 days significantly (p 0.05) in the group treated with 15 mg/kg BW β-sitosterol. Similarly, a non-significant negative (p > 0.05) correlation between the biomolecule and the TconTS3 and TconTS4 gene variants was observed in the β-sitosterol-treated groups while positive correlations were observed in the infected untreated control group.ConclusionThe observed effect of β-sitosterol on T. congolense infection could make the compound a possible template for the design of novel trypanocides.

BackgroundMetaproteomics is a subfield in meta-omics that is used to characterize the proteome of a microbial community. Despite its importance and the plethora of publications in different research area, scientists struggle to fully comprehend its functional impact on the study of microbiomes. In this study, bibliometric analyses are used to evaluate the current state of metaproteomic research globally as well as evaluate the specific contribution of Africa to this burgeoning research area. In this study, we use bibliometric analyses to evaluate the current state of metaproteomic research globally, identify research frontiers and hotspots, and further predict future trends in metaproteomics. The specific contribution of Africa to this research area was evaluated.MethodsRelevant documents from 2004 to 2022 were extracted from the Scopus database. The documents were subjected to bibliometric analyses and visualization using VOS viewer and Biblioshiny package in R. Factors such as the trends in publication, country and institutional cooperation networks, leading scientific journals, author’s productivity, and keywords analyses were conducted. The African publications were ranked using Field-Weighted Citation Impact (FWCI) scores.ResultsA total of 1,138 documents were included and the number of publications increased drastically from 2004 to 2022 with more publications (170) reported in 2021. In terms of publishers, Frontiers in Microbiology had the highest number of total publications (62). The United States of America (USA), Germany, China, and Canada, together with other European countries were the most productive. Institution-wise, the Helmholtz Zentrum für Umweltforschung, Germany had more publications while Max Plank Institute had the highest total collaborative link strength. Jehmlich N. was the most productive author whereas Hettich RL had the highest h-index of 63. Regarding Africa, only 2.2% of the overall publications were from the continent with more publication outputs from South Africa. More than half of the publications from the continent had an FWCI score ≥ 1.ConclusionThe scientific outputs of metaproteomics are rapidly evolving with developed countries leading the way. Although Africa showed prospects for future progress, this could only be accelerated by providing funding, increased collaborations, and mentorship programs.

The differential equations of pharmacokinetic models, obtained from the formulation based on the Fick's perfusion principle and law of conservation of mass action, deals with absorption, distribution, and elimination of drugs by the body systems. In the formulation, the ordinary differential equations obtained may result into highly stiff systems whereby suitable implicit methods have to be employed to solve accurately drug concentration in the body systems, owing to the complex nature of the exact solutions, if they exist. Further, because of the large and increasing interest in the problems of drug kinetics, it is necessary to apply considerably accurate implicit numerical methods in evaluating and in applying them to specific cases. These solutions are to help determine the distribution of drug concentration in different compartments (parts) of the human body network systems as a fundamental step to help in understanding and improving treatments. This is necessary since drug concentration in each compartment is different from one another because of the differences in drug affinity to tissues. From the study, the solution curves obtained show that drug level in the gastrointestinal tract decreases with the passage of time, while drug concentration in the blood increases from zero and reaches its maximum level and then decreases steadily again. We further, compared the model curves with some experimental data plots published in scientific papers. The results obtained from the study can be used extensively for various drug diffusion problems arising in pharmaceutical studies. The presented results widen the applicability of the continuous block implicit hybrid one-step collocation methods to diffusion process which have good number of applications in the drug control, drug dosage and other related problems in pharmaceutical and biomedical industries.

This study assessed the effects of sprouting and fermentation on total phenolic content, total flavonoid content and antioxidant property of pearl millet (Pennisetum glaucum) and sorghum (Sorghum bicolor). Pearl millet and sorghum were subjected to the treatment of sprouting and fermentation for 0 h, 24 h, 48 h, 72 h and 96 h. After each of the treatments, the samples were oven-dried at 60 oC for 24 h and milled into fine flour of 0.05 mm in size. The total phenolic content, flavonoid content and antioxidant capacities were quantified using standard methods. The results of the study revealed that sprouting significantly (p

Abstract Background Recent COVID-19 outbreak has prompted the search of novel therapeutic agents to treat the disease. The initial step of the infection involves the binding of the virus through the viral spike protein with the host angiotensin converting enzyme 2 (ACE2). In this study, the interaction of some ACE or ACE2 inhibitors and their analogues as well as selected compounds with the viral spike protein as a strategy to hinder viral-ACE2 interaction were investigated. SARS-CoV-2 spike protein as well as the ligands were retrieved from protein databank and ChEBI database respectively. The molecules were prepared before initiating the virtual screening using PyRx software. Discovery studio was used to further visualize the binding interactions between the compounds and the protein. Results The ACE inhibitors and their analogues fosinopril (1-), fosinopril and moexipril have the best binding affinity to the protein with binding energies

For many patients, diabetes Mellitus and Malignancy are frequently encountered comorbidities. Diabetes affects approximately 10.5% of the global population, while malignancy accounts for 29.4 million cases each year. These troubling statistics indicate that current treatment approaches for these diseases are insufficient. Alternative therapeutic strategies that consider unique signaling pathways in diabetic and malignancy patients could provide improved therapeutic outcomes. The G-protein-coupled estrogen receptor (GPER) is receiving attention for its role in disease pathogenesis and treatment outcomes. This review aims to critically examine GPER’ s comparative role in diabetes mellitus and malignancy, identify research gaps that need to be filled, and highlight GPER’s potential as a therapeutic target for diabetes and malignancy management. There is a scarcity of data on GPER expression patterns in diabetic models; however, for diabetes mellitus, altered expression of transport and signaling proteins has been linked to GPER signaling. In contrast, GPER expression in various malignancy types appears to be complex and debatable at the moment. Current data show inconclusive patterns of GPER expression in various malignancies, with some indicating upregulation and others demonstrating downregulation. Further research should be conducted to investigate GPER expression patterns and their relationship with signaling pathways in diabetes mellitus and various malignancies. We conclude that GPER has therapeutic potential for chronic diseases such as diabetes mellitus and malignancy.

This work aimed to assess the levels of heavy metal concentration in ipomoea batatas and spinach associated with uncontrolled municipal waste, motor vehicles fumes, pesticides and fertilizer in the urban west region, in Zanzibar. Twenty samples were randomly collected in local markets and three farms located along a roadside in the urban west region. The samples were analysed using an energy dispersive X-ray fluorescence method at Tanzania Atomic Energy Commission in Arusha. Essential and toxic elements: Mn, Cu, Fe, As, Zn, Pb, and Ni were detected in both ipomoea batatas and spinach. Ipomoea batatas was found to have a higher concentration of Cr, Fe, Cd and Zn while spinach had a higher concentration of Ni, Cr and Zn. The essential elements concentrations of vegetables analysed in the current study were found within safety baseline levels for human consumption. However, the concentration levels of toxic elements were above FAO/WHO permissible limits. The higher concentration levels of toxic elements in ipomoea batatas and spinach might be associated with contamination of municipal waste, chicken manure, motor vehicles fumes or pesticides. Therefore, vegetable cultivation along a roadside in the urban west region in Zanzibar and the use of fertilizer and chicken manure in vegetables introducing high levels of heavy metals in the food chain.

Sub-Saharan Africa is profoundly challenged with African Animal Trypanosomiasis and the available trypanocides are faced with drawbacks, necessitating the search for novel agents. Herein, the chemotherapeutic potential of phloroglucinol on T. congolense infection and its inhibitory effects on the partially purified T. congolense sialidase and phospholipase A2 (PLA2) were investigated. Treatment with phloroglucinol for 14 days significantly (p < 0.05) suppressed T. congolense proliferation, increased animal survival and ameliorated anemia induced by the parasite. Using biochemical and histopathological analyses, phloroglucinol was found to prevent renal damages and splenomegaly, besides its protection against T. congolense-associated increase in free serum sialic acids in infected animals. Moreover, the compound inhibited bloodstream T. congolense sialidase via mixed inhibition pattern with inhibition binding constant (Ki) of 0.181 µM, but a very low uncompetitive inhibitory effects against PLA2 (Ki > 9000 µM) was recorded. Molecular docking studies revealed binding energies of −4.9 and −5.3 kcal/mol between phloroglucinol with modeled sialidase and PLA2 respectively, while a 50 ns molecular dynamics simulation using GROMACS revealed the sialidase-phloroglucinol complex to be more compact and stable with higher free binding energy (−67.84 ± 0.50 kJ/mol) than PLA2-phloroglucinol complex (−77.17 ± 0.52 kJ/mol), based on MM-PBSA analysis. The sialidase-phloroglucinol complex had a single hydrogen bond interaction with Ser453 while none was observed for the PLA2-phloroglucinol complex. In conclusion, phloroglucinol showed moderate trypanostatic activity with great potential in ameliorating some of the parasite-induced pathologies and its anti-anemic effects might be linked to inhibition of sialidase rather than PLA2.

Objectives To assess the toxicopathologic effects of chronic exposure to the glyphosate-based herbicide Bushfire® on the pancreas of Wistar rats and the protective role of zinc. Methods We exposed the rats to daily doses of 14.4 to 750 mg/kg body weight of the glyphosate-based herbicide Bushfire® and to 50 or 100 mg/kg zinc, and measured blood glucose levels and serum insulin levels. Tissue samples were evaluated for histopathological alterations. Results Levels of both blood glucose and serum insulin increased in glyphosate-exposed rats, and moderate to severe degenerative changes were observed in both glandular pancreatic acinar cells and islets of Langerhans in all rats exposed to glyphosate. These effects were prevented by pretreatment with zinc. Conclusion Chronic exposure to glyphosate can alter pancreatic function and histoarchitecture, but zinc supplementation can mitigate these toxicopathologic effects.

Background: In terms of survival rate, recurrent oral squamous cell carcinoma (OSCC) after primary surgery is considered as a poor prognostic indicator., Objective: This study aims to determine the incidence of OSCC recurrence among patients treated at Khartoum Teaching Dental Hospital (KTDH) and possible risk factors associated with it., Methods: Records of 303 patients with a history of radical surgery were retrieved from the hospital's archives, and the histopathological records were retrieved from the archival specimens of Professor Ahmed Suleiman Oral Pathology Laboratory, Faculty of Dentistry, and University of Khartoum., Results: Advanced stages of OSCC (III, IV) were associated with higher recurrence rates, and the poorly differentiated OSCC was the commonest recurrent type., Conclusion: The condition of the surgical margin is a significant predictor of OSCC recurrence and tumor stage. The tumor site, the type of surgical resection, and the tumor differentiation were also identified as significant factors influencing the recurrence of OSCC., (© 2024. The Author(s).)

Dentinogenic ghost cell tumors are rare tumors, and few cases of them were reported in the literature. The presence of pigment in odontogenic lesions is a rare unexplained histological finding. In this report, we describe a unique case of a 7-year-old girl that was referred to the Department of Oral and Maxillofacial Surgery complaining of a left mandibular swelling. Clinical examination revealed a huge, ulcerated mass. Both incisional and excisional biopsies revealed a benign infiltrative odontogenic tumor with admixed ameloblast-like cells and pigmented ghost cells, consistent with a pigmented dentinogenic ghost cell tumor. To the best of our knowledge, this is the youngest case of intraosseous dentinogenic ghost cell tumor reported in the English literature and the second report of a pigmented variant. This rare variant should be included in the differential of pigmented odontogenic lesions to avoid misinterpretation, especially in small biopsies., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Transcatheter aortic valve implantation (TAVI) has increasingly been utilized in patients with aortic insufficiency (AI) with insufficient data on its safety. The Nationwide Readmissions Database (NRD) was queried to identify patients undergoing TAVI for AI. Net clinical events (composite of in-hospital mortality, stroke, major bleeding) and procedural complications were assessed using a propensity-score matched (PSM) analysis to calculate adjusted odds ratios (OR). A total of 185,703 (AI 3873, aortic stenosis [AS] 181,830) patients were included in the analysis. Due to a significant difference in the baseline characteristics, a matched sample of 7929 patients (AI 3873, AS 4056) was selected. At index admission, the adjusted odds of in-hospital NACE (aOR 2.0, 95% CI 1.59-2.51), mortality (aOR 3.06, 95% CI 2.38-5.47), major bleeding (aOR 1.53, 95% CI 1.13-2.06) and valvular complications (aOR 9.48, 95% CI 6.73-13.38) were significantly higher in patients undergoing TAVI for AI compared with those undergoing TAVI for AS. However, there was no significant difference in the incidence of NACE, mortality, stroke, major bleeding, and need for permanent pacemaker implantation at 30- and 180-days follow-up. TAVI in AI was associated with a higher risk of periprocedural NACE, mortality, and major bleeding. The risk of these complications attenuated at 30- and 180-day readmission., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Mitochondria play a vital role in the nervous system, as they are responsible for generating energy in the form of ATP and regulating cellular processes such as calcium (Ca 2+ ) signaling and apoptosis. However, mitochondrial dysfunction can lead to oxidative stress (OS), inflammation, and cell death, which have been implicated in the pathogenesis of various neurological disorders. In this article, we review the main functions of mitochondria in the nervous system and explore the mechanisms related to mitochondrial dysfunction. We discuss the role of mitochondrial dysfunction in the development and progression of some neurological disorders including Parkinson's disease (PD), multiple sclerosis (MS), Alzheimer's disease (AD), depression, and epilepsy. Finally, we provide an overview of various current treatment strategies that target mitochondrial dysfunction, including pharmacological treatments, phototherapy, gene therapy, and mitotherapy. This review emphasizes the importance of understanding the role of mitochondria in the nervous system and highlights the potential for mitochondrial-targeted therapies in the treatment of neurological disorders. Furthermore, it highlights some limitations and challenges encountered by the current therapeutic strategies and puts them in future perspective., Competing Interests: Declaration of competing interest The authors of this manuscript have no conflicts of interest to disclose., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objectives . Workplace inspection supports improving the working environment. Changes in workplaces following inspections are construed as the inspection's outcome. This study aimed to develop a tool for inspection performance assessment (TIPA) based on identified inspection prerequisites and evaluate the tool's appropriateness for performance assessment. Methods . Occupational safety and health experts ranked the prerequisites for effective inspection performance, based on their experiences and perception of importance of the prerequisites. The outcome formed the basis for weighting and assignment of values to the prerequisite subgoals. An assessment tool interface, with which inspectors can assess their workplace inspection performance was designed. Inspectors from different national authorities provided feedback on the tool's appropriateness for measuring inspection performance. Results . Results showed much agreement between the inspectors. A five-level performance consideration based on inspection performance index attained was implemented. High average ratings for the test criteria were obtained, with high inter-rater consistency, and reliability. Conclusion . TIPA provides a systematic inspection performance quantification supporting inspectors' self-actualization, improving performance. Furthermore, the tool's generality allows for use irrespective of the inspection area without affecting inspection areas' specificity adjustments. In addition, the ease of use adds to its utility, with agreement on the tool's appropriateness for inspection performance assessment.

Objectives. Researchers have shown that cleaning workers have an increased risk of asthma and rhinitis, mainly due to exposure to chemical substances present in the cleaning products they use. Among the important substances are glycol ethers, increasingly used as components in cleaning products. This study aimed to assess exposure levels of glycol ether in professional cleaning products and compare them to existing regulatory exposure limit values. Methods. Information from safety data sheets of the products is used to identify the glycol ethers present in the cleaning products and their respective concentrations. Other sources were used to obtain the relevant data required for use in the tool to generate exposure assessments. Exposure levels for various cleaning work exposure scenarios were estimated using the ConsExpo Web tool. Results. The estimated exposure values are significantly lower than the existing regulatory occupational exposure limit (OEL) values for the different glycol ethers. Conclusions . The study showed that the risk of exposure to glycol ethers by inhalation from professional cleaning products is minimal as exposure estimates were much below the regulatory OEL values.

Background: The late presentation of oral squamous cell carcinoma (OSCC) patients in Sudan, with advanced stages and wide field of cancerization (WFC), has a negative impact on these patients. The present study aimed to investigate the different clinical presentations of mucosal changes in WFC associated with OSCC in Sudanese patients., Methods: This a prospective longitudinal study of 93 OSCC cases. Tumor's associated field of cancerization was identified and related clinical mucosal changes were described., Results: Out of the 93 patients, 57 (61.3%) were males and 36 (38.7%) were females. Eighty-two percent of the patients presented with stage IV tumors. Ninety-two patients had multiple sites involved in the oral cavity with overlap of sites involved. The Gingivobuccal mucosa (74.2%) was the most frequent site involved. Eighty-three (89.2%) of the lesions were surrounded by mucosal changes, of them 32 (38%) surrounded by a grizzle (mixed dark and white) discoloration and 21 (26%) were surrounded by a white-smoke discoloration followed by 17 (20%) and 13 (16%) surrounded by cotton-white and Café au lait discolorations, respectively. Forty-four (47.3%) lesions had overlapping presentations and surrounded by erythematous patches., Conclusion: The present study showed that OSCC patients in Sudan present with advanced lesions, mostly associated with WFC, particularly the Toombak dippers. The different mucosal changes seen in the WFC associated with OSCC in these cases are in accordance with the known five mucosal presentations., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2023 Yousif Idris Eltohami and Ahmed Mohamed Suleiman.)

Background: We recently described the tumor immune microenvironment (TIME) in oral squamous cell carcinomas (OSCC) from Sudan by assessing the core of the lesions. However, the invasive tumor front (ITF) is the most active part of OSCC lesions; thus, TIME should also be characterized at the ITF in this patient cohort., Objectives: We aimed to evaluate patterns of immune cell infiltration at the ITF in a cohort of OSCC patients from Sudan previously investigated at the tumor center and their association with clinicopathological parameters., Methods: This study was performed on a prospective cohort of 22 OSCC patients attending Khartoum Dental Teaching Hospital with a median follow-up of 48 months. Inflammatory infiltrate densities of CD4-, CD8-, FoxP3-, CD20-, CD66b-, M1 (CD80/CD68)-, M2 (CD163/CD68)-, and PD-L1-positive cells were assessed at the ITF by immunohistochemistry, followed by digital quantitative analysis at the stromal and epithelial compartments separately. Histopathological parameters such as the worst pattern of invasion, differentiation, and tumor budding (TB) were also assessed. Correlations between clinicopathological parameters and survival analysis were investigated using SPSS., Results: All inflammatory cell subsets investigated were found to be higher in the stromal compartment as compared to the epithelial one, except for the PD-L1 + subset. Stromal infiltration with the CD8 + cell subset was associated with low TB. Kaplan-Meier analyses identified higher epithelial and stromal CD4 + cell subsets. The presence of PD-L1 was found to be associated with unfavorable overall survival. Further, Cox's regression analysis using an age- and tumor-stage-adjusted model identified epithelial PD-L1 expression at the ITF as the only independent prognosticator., Conclusions: Epithelial PD-L1 expression at the ITF was found to be an independent prognostic biomarker for OSCC in a cohort of Sudanese patients., (© 2022 The Authors. Clinical and Experimental Dental Research published by John Wiley & Sons Ltd.)

Background: We aim to conduct a comprehensive meta-analysis encompassing all studies to assess the efficacy of Vascepa in patients with diabetes mellitus (DM) in preventing or treating existing coronary artery disease (CAD)., Methods: Digital databases were queried. Odds ratios (OR) were calculated for the following outcomes: composite outcome, all-cause mortality, and cardiovascular mortality., Results: A total of 4 randomized control trials (33,092 patients; Vascepa n = 16586; Placebo n = 16506) were included in our analysis. The overall mean age was 64.3 years old (Vascepa = 64.3 years; Placebo = 64.3 years). The sample was 61.5% male (Vascepa = 60.8%; Placebo = 62.1%). In patients with DM, Vascepa was found to have no significant effect on the primary composite outcome (OR 0.97, 95%CI 0.91-1.04, p > 0.05), all-cause mortality (OR 0.96, 95%CI 0.90-1.03, p > 0.05), and cardiovascular mortality (OR 0.90, 95%CI 0.74-1.10, p > 0.05). Subgroup analysis by Vascepa type and treatment type was similarly non-significant., Conclusion: Our study concluded that Vascepa did not affect cardiovascular outcomes in patients with DM., Competing Interests: None declared by any authors involved in the manuscript., (© 2022 The Authors. Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.)

Background: Heart failure (HF) is a complex clinical syndrome with symptoms and signs that result from any structural or functional impairment of ventricular filling or ejection of blood. Limited data is available regarding the in-hospital outcomes of TAVR compared to SAVR in the octogenarian population with HF., Methods: The National Inpatient Sample (NIS) database was used to compare TAVR versus SAVR among octogenarians with HF. The primary outcome was in-hospital mortality. The secondary outcome included acute kidney injury (AKI), cerebrovascular accident (CVA), post-procedural stroke, major bleeding, blood transfusions, sudden cardiac arrest (SCA), cardiogenic shock (CS), and mechanical circulatory support (MCS)., Results: A total of 74,995 octogenarian patients with HF (TAVR-HF n = 64,890 (86.5%); SAVR n = 10,105 (13.5%)) were included. The median age of patients in TAVR-HF and SAVR-HF was 86 (83-89) and 82 (81-84) respectively. TAVR-HF had lower percentage in-hospital mortality (1.8% vs. 6.9%;p < 0.001), CVA (2.5% vs. 3.6%; p = 0.009), SCA (9.9% vs. 20.2%; p < 0.001), AKI (17.4% vs. 40.8%); p < 0.001), major transfusion (26.4% vs 67.3%; p < 0.001), CS (1.8% vs 9.8%; p < 0.001), and MCS (0.8% vs 7.3%; p < 0.001) when compared to SAVR-HF. Additionally, post-procedural stroke and major bleeding showed no significant difference. The median unmatched total charges for TAVR-HF and SAVR-HF were 194,561$ and 246,100$ respectively., Conclusion: In this nationwide observational analysis, TAVR is associated with an improved safety profile for octogenarians with heart failure (both preserved and reduced ejection fraction) compared to SAVR., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 Published by Elsevier B.V.)

Objectives. Earlier attempts to understand inspection work and improve inspection effectiveness are based on how controls are conducted and the interactions between the inspectors and inspection subjects. This study aimed to determine workplace occupational safety and health inspection effectiveness prerequisites using cognitive work analysis, an approach for design and evaluation of work domains, focusing on activities and work constraints. Methods. Data were collected through semi-structured interviews and a survey with labour inspection authority inspectors, and by reviewing inspection reports and earlier studies on workplace inspections. These were used in the first three cognitive work analysis phases to identify the prerequisites of effective workplace inspection and designing inspection strategies. Results. An abstraction hierarchy showing the affordances was prepared, with purpose-related functions identified as the inspection effectiveness prerequisites. A contextual activities template and a decision ladder for inspection work were prepared. Strategy maps for on-site control were created, allowing design of structured and organized workplace inspection strategies supporting the work domain's purposes. Conclusion. The analysis dimensions served the study sufficiently, providing the purpose-related functions with their respective subgoals and subsidiary functions that provided the prerequisite for effective workplace inspections and allowed for designing structured and organized strategies for on-site workplace inspection.

Background: Hepatitis B virus (HBV) infection is one of the public health diseases causing global health problems. It is a leading cause of cirrhosis and hepatocellular carcinoma. Blood transfusion is a major route of its transmission and screening of blood is suboptimal in our environment. Occult HBV infection describes the presence of HBV DNA in blood or liver tissue in patients who are hepatitis B surface antigen (HBsAg) seronegative. This study documented the common genotypes of HBV a blood-borne infection in the population of blood donors in Lagos., Methods: This was a cross-sectional study carried out at the blood donor clinics of ten Lagos State Government-owned hospitals in Lagos State. A total of 1400 participants were recruited consecutively from November 2020 to June 2021. All participants' samples were screened using Diaspot Rapid Test Kit (RTK) and Dialabenzyme enzyme-linked immunosorbent assay (ELISA) kit. Furthermore, some of the plasma samples were used for HBV DNA extraction and genotyping using the real time-polymerase chain reaction. Statistical analysis was carried out using the Statistical Package for the Social Sciences (SPSS) software version 26 and P value was considered significant at ≤0.05., Results: The sero-prevalence of HBsAg using RTK and ELISA was 19.9% and 22.4%, respectively. The prevalence of occult HBV infection was 5.2%. A total of 278 and 313 HBsAg RTK and ELISA positive samples were obtained, respectively. HBV genotype result had A (46.6%) as the most prevalent followed closely by B (44.7%), E (23.8%), D (20.9%) and C (11.2%)., Conclusion: HBV infection has a high prevalence among blood donors. ELISA is a more sensitive screening tool and its use should be advocated nationally. HBV genotype A is the most prevalent genotype from our study., Competing Interests: None

Introduction: rapidly rising population in Africa is of great concern, especially in Nigeria because of its impact on social stability. Nigeria has been unable to meet the set targets in respect of scaling up access to contraception, and increasing contraceptive prevalence. Thus, being projected to be the third most populous country by 2050 amidst a rising unemployment rate and a shrinking economy., Methods: a cross-sectional study was conducted among 350 pregnant women attending antenatal clinic (ANC) in General Hospital Argungu, Kebbi State, and data were obtained using an interviewer-administered questionnaire and analyzed using IBM SPSS version 22., Results: most 318 (90.9%) of the 350 respondents were aware of contraception. The prevalence of previous use of contraceptives among the respondents was 59.4%, while 70% of them intend to use contraception in the future. Concerns about the return of fertility 56 (50.9) after contraceptive use was a major reason given by respondents who had never used any form of contraceptive. Educational attainment, age at marriage, and occupation were the factors that were associated with awareness, previous use, and future use of contraception., Conclusion: this study underscores the need to promote girl-child education as a cardinal strategy in increasing the level of contraception among the populace., Competing Interests: The authors declare no competing interest., (Copyright: Ayotunde Sherif Azees et al.)

Objectives: To present a new method to assess the cervical lymph nodes status in head and neck cancer patients., Methods: Twenty-five oral and maxillofacial cancer patients underwent preoperative CT imaging. The cervical lymph node features on CT scan were examined. Each parameter was given a score, and the total scores in each case was calculated and referred to as metastatic score (MS). Then, patients underwent neck dissection, and all dissected lymph nodes were sent for histopathology., Results: All cases with MS ≥ 6 were histopathologically positive, and all cases with MS ≤ 3 were histopathologically negative. All cases of nodal sizes > 3 cm were histopathologically positive, 82% of cases of nodal sizes between 2.1 and 3 cm were histopathologically positive, 40% of cases of nodal sizes between 1 and 2 cm were histopathologically positive, and all cases of lymph nodes sizes < 1 cm were histopathologically negative. Seventy-seven percent of cases which had a group of lymph nodes ≥ 3 nodes/region were histopathologically positive, while 79% of cases with rounded nodes were histopathologically positive, and all cases with necrotic lymph nodes were positive for malignancy., Conclusion: The proposed formula is a good assessment tool for cervical lymph nodes evaluation using helical CT scan in head and neck cancer patients., (© The Association of Oral and Maxillofacial Surgeons of India 2020.)

Background: The relative merits of the drug-coated balloon (DCB) versus uncoated balloon (UCB) angioplasty in endovascular intervention for patients with symptomatic lower extremity peripheral arterial disease (PAD) remains controversial., Methods: Online databases were queried with various combinations of keywords to identify relevant articles. Net adverse events (NAEs) and its components were compared using a random effect model to calculate unadjusted odds ratios (ORs)., Results: A total of 26 studies comprising 26,845 patients (UCB: 17,770 and DCB: 9075) were included. On pooled analysis, DCB was associated with significantly lower odds of NAE (OR: 0.47, 95% confidence interval [CI]: 0.36-0.61), vessel restenosis (OR: 0.46, 95% CI: 0.37-0.57), major amputation (OR: 0.68, 95% CI: 0.47-99), need for repeat target lesion (OR: 0.38, 95% CI: 0.31-0.47) and target vessel revascularization (OR: 0.62, 95% CI: 0.47-0.81) compared with UCB. Similarly, the primary patency rate was significantly higher in patients undergoing DCB angioplasty (OR: 1.44, 95% CI: 1.19-1.75), while the odds for all-cause mortality (OR: 0.96, 95% CI: 0.85-1.09) were not significantly different between the two groups. A subgroup analysis based on follow-up duration (6 months vs. 1 vs. 2 years) followed the findings of the pooled analysis with few exceptions., Conclusions: The use of DCB in lower extremity PAD intervention is associated with higher primary patency, lower restenosis, lower amputation rate, and decreased need for repeat revascularization with similar all-cause mortality as compared to UCB., (© 2022 Wiley Periodicals LLC.)

Background: Tumor immune infiltrate has been explored in oral squamous cell carcinoma (OSCC), but studies on simultaneous characterization of multiple immune cell subtypes separately in stromal and intraepithelial tumor compartments are limited., Objectives: We aimed to investigate the immune cell infiltrate in OSCC by using immunohistochemistry (IHC) for a panel of inflammatory cells in stromal and epithelial tumor compartments for a better characterization of the tumors., Methods: Thirty-six OSCC lesions and nine normal oral mucosa (NOM) samples from patients attending Khartoum Dental Teaching Hospital, Sudan were investigated for presence of tumor infiltrating lymphocytes, tumor-associated macrophages, tumor-associated neutrophils, and PD-L1 positive cells in the inflammatory infiltrate by single and double IHC. Digital quantitative analysis (Aperio Technologies Inc.) was performed separately for stromal and epithelial compartments., Results: OSCC cases displayed a higher inflammatory infiltrate in the associated stroma, but not in the epithelial compartment when compared to NOM. The immunosuppressive type of inflammatory infiltrate, that is, T regulatory cells (FoxP3 + cells) was identified to be significantly higher in the epithelial compartment of tumors with advanced clinical state. An immunoscore developed by combining intraepithelial FoxP3 + and CD4 + cells was found significantly higher in lesions from elderly patients, localized at toombak dipping-related sites, poorly differentiated OSCCs, or with loco-regional lymph node spreading., Conclusions: Despite heavy immune cell infiltration in tumor-associated stroma, the majority of OSCCs in this cohort displayed a low intraepithelial immune infiltration. An immunoscore based on combined CD4 and FoxP3 intraepithelial expression may serve as an indicator of advanced tumor progression and should be further investigated for its use as potential prognostic biomarker in OSCC., (© 2021 The Authors. Clinical and Experimental Dental Research published by John Wiley & Sons Ltd.)

Background: Inaccurate sizing of left atrial appendage (LAA) occlusion devices is associated with increased stroke risk. We compared the LAA size to implant the Watchman device assessed by computed tomography (CT) to transesophageal echocardiography (TEE)., Methods: Databases were searched to identify studies comparing LAA anatomical measurements and procedural outcomes across imaging modalities for the Watchman device implantation., Results: Seven studies were included in the analysis (242 patients on TEE, and 232 on CT). The LAA orifice was larger when sized with CT compared to TEE (CT mean vs TEE SMD 0.30 mm, 95%CI 0.09-0.51 mm, P < 0.01; and CT max vs TEE SMD 0.69 mm, 95%CI 0.51-0.87 mm, P < 0.001). Additionally, CT, including CT-based 3-dimensional models, had higher odds of predicting correct device size compared to TEE (OR 1.64; 95%CI 1.05-2.56; P = 0.03). CT resulted in a lower fluoroscopy time vs TEE (SMD -0.78 min, 95% CI -1.39 to -0.18, P = 0.012). No significant differences were found in device clinical outcomes., Conclusion: Compared to TEE, CT resulted in larger LAA orifice measurements, improved odds of predicting correct device size, and reduced fluoroscopy time in patients undergoing LAA occlusion with the Watchman device. There were no significant differences in other procedural outcomes.

Introduction: The relative safety and efficacy of polymer-free (PF) versus polymer-coated (PC) drug-eluting stents (DES) in patients with angina or acute coronary syndrome (ACS) undergoing percutaneous coronary intervention has received limited study., Method: Digital databases were queried to identify relevant studies. Major adverse cardiovascular events (MACE) and secondary outcomes were compared using a random effect model to calculate unadjusted odds ratios (OR)., Results: A total of 28 studies consisting of 23,198 patients were included in the final analysis. On pooled analysis, there was no significant difference in the odds of MACE (OR 0.98, 95% CI 0.91-1.08) and major bleeding (OR 0.87, 95% CI 0.61-1.24) between patients undergoing PF-DES versus PC-DES. Similarly, the odds of myocardial infarction, stroke, stent thrombosis, cardiovascular mortality and need for target vessel revascularization was similar between the two groups. PF-DES was favored due to significantly lower odds of non-cardiac death (OR 0.78, 95% CI 0.68-89) and all-cause mortality (OR 0.87, 95% CI 0.80-0.95), but had a higher need for target lesion revascularization (OR 1.2, 95% CI 1.02-1.42). A subgroup analysis based on follow up duration, clinical presentation, presence of diabetes and class of eluting drugs mirrored the net estimates for all outcomes with a few exceptions. A sensitivity and meta-regression analysis showed no influence of single-study and duration of antiplatelet therapy on pooled outcomes., Conclusion: In patients presenting with angina or ACS, PF-DES might be favored due to lower all-cause mortality and equal risk of ischemic adverse cardiovascular and major bleeding events compared with PC-DES., (© 2021 Wiley Periodicals LLC.)

The clinical efficacy of remote dielectric sensing (ReDS) monitoring is not well known. Digital databases were searched to identify relevant articles. Pooled unadjusted odds ratio (OR) for dichotomous outcomes were calculated using a random-effects model. Findings were reported as a point estimate with its 95% confidence interval (CI). A total of 985 patients across seven studies were included in the meta-analysis. Patients with heart failure monitored with ReDS had significantly lower odds of hospital readmission compared with non-ReDS patients (OR = 0.40; 95% CI 0.29-0.56; z = 5.43 p = 0.000, I2 = 0%). Subgroup analysis based on the duration of follow-up showed a lower odd of readmission within 30 days (OR = 0.36; 95% CI 0.18-0.71; z = 2.93; p = 0.003; I2 5.7%), as well as between 1 and 3 months (OR = 0.42; 95% CI 0.29-0.61; z = 4.54; p = 0.000; I2 = 0.0%). ReDS effect of lower readmissions of HF was observed irrespective of the duration of follow-up (<1-month vs 1-3 months). ReDS monitoring significantly lowers the odds of HF readmission within 3 months compared to participants not using ReDS., Competing Interests: No potential conflict of interest was reported by the author(s)., (© 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group on behalf of Greater Baltimore Medical Center.)

Background: The self-rated health of Arab Americans has been found to be worse than non-Hispanic whites. Psychosocial factors such as stress and acculturation may explain this disparity. As a result, we designed this survey to better understand the effects of stress and acculturation on the self-rated health of the Arab-American community., Materials and Methods: Using a convenience sample, we surveyed 142 self-identified Arab Americans regarding demographics, stress, acculturation, and self-rated health. Stress was measured using instruments assessing perceived stress, everyday discrimination, and acculturative stress. Acculturation was measured using a modified Vancouver Index of Acculturation. To measure self-rated health, participants were asked to rate their current health on a scale of 1 (very poor) to 5 (very good)., Results: A logistic regression model adjusted for age, sex, body mass index, and education did not find that stress significantly affected the odds of having poor self-rated health in Arab Americans. Heritage identity was associated with lower odds of having poor self-rated health (odds ratio = 0.37, 95% confidence interval [CI] 0.15, 0.94, P < 0.05). No association was found between acculturation and poor self-rated health., Conclusion: Greater levels of stress were not significantly associated with greater odds of poor self-rated health in Arab Americans. We also found that greater heritage identity significantly decreased the odds of poor self-rated health in Arab Americans. The effects of everyday discrimination, perceived stress, and acculturation on self-rated health in Arab Americans remain unclear and need to be examined further., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Family and Community Medicine.)

Objectives: Autoimmune bullous diseases vary in their clinico-epidemiological features and burden across populations. Data about these diseases was lacking in Sudan. We aimed to describe the epidemiological profile and to estimate the burden of autoimmune bullous diseases in Sudan., Methods: This was a retrospective cross-sectional study conducted at Khartoum Dermatological and Venereal Diseases Teaching Hospital. We used routinely collected health care data, and included all patients with an autoimmune bullous disease who presented to the hospital between 2001 and 2016., Results: Out of the 4736 patients who were admitted to the hospital during the study period, 923 (19.5%) had an autoimmune bullous disease. The average rate of patients at the hospital was 57.7 per year representing 1.3 per 100,000 population per year. After exclusion of patients where the final diagnosis was missing, 585 were included in the further analysis. Pemphigus vulgaris was the most common disease (50.9%), followed by bullous pemphigoid (28.2%), linear IgA disease/chronic bullous disease of childhood (8.4%), and pemphigus foliaceous (8.2%). Pemphigoid gestationis and IgA pemphigus constituted 1.4% and 1.2% of the cohort, respectively. Paraneoplastic pemphigus, mucous membrane pemphigoid, lichen planus pemphigoidis, bullous systemic lupus erythematosus, and dermatitis herpetiformis were rare. None of the patients had epidermolysis bullosa acquisita., Conclusions: The clinico-epidemiological characteristics vary among the types of autoimmune bullous diseases. Females were more predominant in most of them. Sudanese patients tended in general to present at a younger age than other populations. The pool of Sudanese patients with autoimmune bullous diseases is large which requires investigation for the local risk factors and presents a field for future trials., Competing Interests: The authors have declared that no competing interests exist.

Introduction: The safety of renin-angiotensin-aldosterone system inhibitors (RAASi) among COVID-19 patients has been controversial since the onset of the pandemic., Methods: Digital databases were queried to study the safety of RAASi in COVID-19. The primary outcome of interest was mortality. The secondary outcome was seropositivity improvement/viral clearance, clinical manifestation progression, and progression to intensive care units. A random-effect model was used to compute an unadjusted odds ratio (OR)., Results: A total of 49 observational studies were included in the analysis consisting of 83,269 COVID-19 patients (RAASi n = 34,691; non-RAASi n = 48,578). The mean age of the sample was 64, and 56% were males. We found that RAASi was associated with similar mortality outcomes as compared to non-RAASi groups (OR 1.07; 95% CI 0.99-1.15; p > 0.05). RAASi was associated with seropositivity improvement including negative RT-PCR or antibodies, (OR 0.96; 95% CI 0.93-0.99; p < 0.05). There was no association between RAASi versus control with progression to ICU admission (OR 0.99; 95% CI 0.79-1.23; p > 0.05) or higher odds of worsening of clinical manifestations (OR 1.04; 95% CI 0.97-1.11; p > 0.05). Metaregression analysis did not change our outcomes for effect modifiers including age, sex, comorbidities, RAASi type, or study type on outcomes., Conclusions: COVID-19 is not a contraindication to hold or discontinue RAASi as they are not associated with higher mortality or worsening symptoms. Continuation of RAASi might be associated with favorable outcomes in COVID-19, including seropositivity/viral clearance.

Background: Maternal morbidity occurs several times more frequently than mortality, yet data on morbidity burden and its effect on maternal, foetal, and newborn outcomes are limited in low- and middle-income countries. We aimed to generate prospective, reliable population-based data on the burden of major direct maternal morbidities in the antenatal, intrapartum, and postnatal periods and its association with maternal, foetal, and neonatal death in South Asia and sub-Saharan Africa., Methods and Findings: This is a prospective cohort study, conducted in 9 research sites in 8 countries of South Asia and sub-Saharan Africa. We conducted population-based surveillance of women of reproductive age (15 to 49 years) to identify pregnancies. Pregnant women who gave consent were include in the study and followed up to birth and 42 days postpartum from 2012 to 2015. We used standard operating procedures, data collection tools, and training to harmonise study implementation across sites. Three home visits during pregnancy and 2 home visits after birth were conducted to collect maternal morbidity information and maternal, foetal, and newborn outcomes. We measured blood pressure and proteinuria to define hypertensive disorders of pregnancy and woman's self-report to identify obstetric haemorrhage, pregnancy-related infection, and prolonged or obstructed labour. Enrolled women whose pregnancy lasted at least 28 weeks or those who died during pregnancy were included in the analysis. We used meta-analysis to combine site-specific estimates of burden, and regression analysis combining all data from all sites to examine associations between the maternal morbidities and adverse outcomes. Among approximately 735,000 women of reproductive age in the study population, and 133,238 pregnancies during the study period, only 1.6% refused consent. Of these, 114,927 pregnancies had morbidity data collected at least once in both antenatal and in postnatal period, and 114,050 of them were included in the analysis. Overall, 32.7% of included pregnancies had at least one major direct maternal morbidity; South Asia had almost double the burden compared to sub-Saharan Africa (43.9%, 95% CI 27.8% to 60.0% in South Asia; 23.7%, 95% CI 19.8% to 27.6% in sub-Saharan Africa). Antepartum haemorrhage was reported in 2.2% (95% CI 1.5% to 2.9%) pregnancies and severe postpartum in 1.7% (95% CI 1.2% to 2.2%) pregnancies. Preeclampsia or eclampsia was reported in 1.4% (95% CI 0.9% to 2.0%) pregnancies, and gestational hypertension alone was reported in 7.4% (95% CI 4.6% to 10.1%) pregnancies. Prolonged or obstructed labour was reported in about 11.1% (95% CI 5.4% to 16.8%) pregnancies. Clinical features of late third trimester antepartum infection were present in 9.1% (95% CI 5.6% to 12.6%) pregnancies and those of postpartum infection in 8.6% (95% CI 4.4% to 12.8%) pregnancies. There were 187 pregnancy-related deaths per 100,000 births, 27 stillbirths per 1,000 births, and 28 neonatal deaths per 1,000 live births with variation by country and region. Direct maternal morbidities were associated with each of these outcomes., Conclusions: Our findings imply that health programmes in sub-Saharan Africa and South Asia must intensify their efforts to identify and treat maternal morbidities, which affected about one-third of all pregnancies and to prevent associated maternal and neonatal deaths and stillbirths., Trial Registration: The study is not a clinical trial., Competing Interests: We have read the journal’s policy and the authors of this manuscript have the following competing interests: ZAB is a member of the Editorial Board of PLOS Medicine. Remaining authors declared no competing interests.

Visine eye drops are a commonly used topical drug for irritation of the eye. The active component in Visine eye drops is tetrahydrozoline. Tetrahydrozoline is an imidazoline derivative found in several ophthalmic and nasal decongestants. Exposure is common in young children, who unintentionally ingest it, but cases have been rising in the adult population. The main systemic effects are bradycardia and hypotension due to activation of the central alpha-adrenergic receptors. In this case report, a 76-year-old man presents with bradycardia after 24 hours following ingestion of 120 mL of 0.05% tetrahydrozoline (eight bottles of Visine eye drops) in a suicide attempt. His initial ECG demonstrated complete heart block and QT prolongation. Subsequent ECGs showed unremitting first-degree atrioventricular block and QT prolongation. Here, we are presenting the first case of complete heart block following tetrahydrozoline consumption., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: To introduce surgical safety checklists and time outs to future physicians through early incorporation of time outs in the first year gross anatomy course., Setting: The Wayne State University School of Medicine Anatomy Lab., Participants: Approximately 300 first year medical students per year participated in the intervention., Interventions: An educational presentation on medical errors focusing on surgical errors was developed. Students in 2017-2018 viewed the presentation and completed two time outs, one with the first anatomy dissection and a second with the last dissection. Preintervention and postintervention surveys were completed and results compared. Students completed a second postintervention survey after the second time out. Students in 2018-2019 were asked to complete the time outs before every dissection. Time out procedure sheets were collected to determine completion rates. The intervention was further modified for academic year 2019-2020 and time out sheets were again collected., Outcome Measures: Four domains of learning were surveyed: (1) major components and goals/limitations of universal protocol, (2) medical error lexicon, (3) components of a time out, and (4) confidence in completing time out checklists., Results: Postintervention surveys demonstrated significant improvement in each domain. Students found time outs easy to complete and developed confidence in performing time outs. Following a successful pilot, time outs were incorporated into every dissection. Students continued to perform this procedure despite absence of adverse consequences for not doing so., Conclusion: Students found the time outs easy to complete and developed the confidence and ability to perform a surgical time out early in their medical education. The new skills, knowledge and attitudes that these medical students have developed will hopefully improve the care they provide to patients, thereby advancing the practice of quality improvement and patient safety in the clinical setting., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Evasion of apoptosis is associated with treatment resistance and metastasis in colorectal cancer (CRC). Various cellular processes are associated with evasion of apoptosis. These include overexpression of pro-apoptotic proteins (including p53 and PD-L1), anti-apoptotic proteins (BIRC7/Livin and Bcl-2), chemokine receptors (including DARC), and dysregulation of DNA mismatch repair proteins (including MSH2 and PMS2). The aim of this study was to determine the effect of folinic acid, 5-FU and oxaliplatin (FOLFOX) as a single agent and aspirin plus FOLFOX in various combinations on the aforementioned proteins in human CRC, SW480 cell line and rat models of N-Methyl-N-Nitrosourea (NMU)-induced CRC. In addition, effects of the NMU-induced CRC and chemotherapeutic regimens on haematological and biochemical parameters in the rat models were studied. Immunohistochemistry, immunofluorescence and immunoblot techniques were used to study the expression pattern of the related proteins in the human CRC cells pre- and post-treatment. Double contrast barium enema, post-mortem examination and histological analyses were used to confirm tumour growth and the effect of the treatment in vivo in rat models. Notably, we found in human mucinous CRC, a significant increase in expression of the BIRC7/Livin post-FOLFOX treatment compared with pre-treatment (p = 0.0001). This increase provides new insights into the prognostic role of BIRC7/Livin in evasion of apoptosis and facilitation of treatment resistance, local recurrence and metastasis particularly among mucinous CRCs post-FOLFOX chemotherapy. These poor prognostic features in the CRC may be further compounded by the significant suppression of DARC, PD-L1, PMS2 and overexpression of MSH2 and anti-apoptotic Bcl-2 and p53 proteins observed in our study (p < 0.05). Importantly, we found a significant reduction in expression of BIRC7/Livin and reactivation of DARC and PD-L1 with a surge in Annexin V expression in rat models of CRC cells post-treatment with a sequential dose of aspirin plus FOLFOX compared with other treatments in vivo (p <0.05). The mechanistic rational of these effects underscores the importance of expanded concept of possible aspirin combination therapy with FOLFOX sequentially in future CRC management. Validation of our findings through randomized clinical trials of aspirin plus FOLFOX sequentially in patients with CRC is therefore warranted., Competing Interests: The authors have declared that no competing interests exist.

Background and Objectives: Elderly patients constitute a large segment of healthcare receivers. Considering the functional deterioration of multiple organ systems with aging, achieving a safe perioperative approach is challenging. Our aim is to study the safety and effectiveness of a genuinely regimented co-induction technique in order to minimize anesthesia-related complications. Materials and Methods: One hundred and five patients were assigned to three groups according to the induction technique: propofol, sevoflurane and co-induction group. Inclusion criteria: patients with age ≥65 and American Society of Anesthesiologists physical status classification (ASA) II-III who underwent endoscopic urological procedures. The propofol group received a dose of 1.5 mg kg -1 of propofol over two minutes for induction. The sevoflurane group received 8% of sevoflurane and 100% oxygen through a plastic facemask with the fresh gas flow set at 8 L min -1 . The co-induction group received 4% sevoflurane through plastic facemask for two minutes, followed by a 0.75 mg kg -1 dose of propofol. After ensuring full range jaw relaxation, the laryngeal mask airway (LMA) was inserted. Results: Overall, the co-induction technique had a favorable profile in terms of respiratory adverse events, while the sevoflurane group had a favorable profile in terms of hemodynamic stability. Furthermore, 24 (68.6%) patients receiving inhalational sevoflurane had episodes of transient apnea, which constitutes 77.4% of the 31 episodes of transient apnea in the studied sample ( p < 0.001). Moreover, six (17.1%) patients in the sevoflurane group had an episode of partial laryngospasm ( p = 0.034). Compared with the co-induction group, we found that the propofol group had significantly less systolic and diastolic blood pressures in the second minute, with p values of (0.018) and (0.015), respectively. Conclusions: The co-induction technique utilizing 4% sevoflurane at 8 L min -1 flow of oxygen inhaled over two minutes followed by 0.75 mg kg -1 of propofol achieved less respiratory adverse events compared with the sevoflurane group, and less hemodynamic instability compared with the propofol group.