#open acess publishers

[juniperpublishers-nutrition]

Obesity in Obstetrics

Mini review

The people in industrialized countries have experienced a dramatic increase in obesity in recent times. Prevalence of obesity has doubled in the last 25 years. In the United States, 17-th on the list of most obese places in the world - average BMI 28.8 Kg/m2, more than 60% of reproductive-age women are overweight and 35% are obese, representing a 70% increase in pre-pregnancy obesity. In Romania, 75th on the list- average BMI is 22.2 Kg/m2, the lowest average BMI in the European Union (9.4% obesity in 2016). [1] One of three Romanians is overweight, and one of four is obese. There are over 3.5 million obese in Romania. The highest obesity rate is recorded in Moldova, where the percentage is 23.8%. Only 10% of them see a doctor. Only one percent are included in a national obesity education program [2].

Not all ethnic groups are at equal risk. Of particular concern is the rapid increase in adolescent overweight and obesity. Concordantly, pregnancy obesity rates are also increasing. Obesity is associated with increased morbidity and 6- to 12-fold increase in mortality. Obesity is highly complex in terms of etiology and prevalence. Genetic predisposition, race, socioeconomic status, built environment (e.g., the presence of sidewalks or community design), accessibility of healthy and affordable foods, sleep habits, and geographic region all play a role. Lifestyle changes, which include consuming foods and beverages with a high glycemic index, increased food portion sizes, decreased structured physical activity, and increased screen-based sedentary behavior, have influenced the prevalence of obesity.

Antenatal Monitoring

An evaluation of dietary intake and exercise habits can provide insight into women at risk. All pregnant women without contraindications should participate in regular exercise. During prenatal visits women should be questioned and advised about their diet and exercise habits. Where available, nutritional counselling can be a helpful adjunct for women not meeting the weight gain recommendations.

The sonographer’s ability to evaluate fetal structures is largely dependent on maternal size. Approximately 15% of normally visible structures will be sub optimally seen in women with a BMI above the 90th percentile. In women with a BMI above the 97.5th percentile, only 63% of structures are well visualized. Obstetric care providers should take BMI into consideration when arranging for fetal anatomic assessment in the second trimester. Anatomic assessment at 20 to 22 weeks may be a better choice for the obese pregnant patient.

Use all available technical tools improving image quality in obesity: lower transducer emission frequencies; harmonic imaging; compound imaging; speckle reduction filters. Consider approaching the fetus through the four major abdominal areas with least subcutaneous fat: periumbilical area, suprapubic area, right and left iliac fossae. Consider using the transvaginal approach for the assessment of the central nervous system (CNS) in fetuses in vertex presentation.

Gently inform the patient and her partner that obesity will reduce the diagnostic accuracy of the scan. Consider including the BMI value among the demographic data in the report to document the presence or absence of maternal obesity. Report other cofactors of limited acoustic window, such as previous cesarean section (for the scar), twinning and myomata.

Pregnancy Complications

The risk of spontaneous abortion is increased in obese women. Lashen et al. identified an odds ratio for spontaneous abortion of 1.2 (95% CI 1.01 to 1.46) for obese women (BMI > 30 kg/m2). The authors also identified an increased risk of recurrent early miscarriages (more than 3 successive miscarriages < 12 weeks’ gestation) in the obese population, odds ratio 3.5 (95% CI 1.03to 12.01).[8] Similar risks have been identified in obese women undergoing in vitro fertilization treatment [3].

Pre-gestational diabetes is more prevalent in obese women. Therefore, testing during early in pregnancy for women with risk factors is recommended. Obese women are also at increased risk of developing gestational diabetes (GDM). Not surprisingly, obese women are also at increased risk of having a macrosomic child. Physical activity is inexpensive and can significantly reduce the risk of gestational diabetes. More relevant to the obese population, they also reported a 34% reduction in the development of gestational diabetes in women who did not participate in vigorous exercise but who did participate in brisk walking compared with those who participated in easy pace walking. Women with GDM have a 30% chance of developing type 2 diabetes later in life [4].

Intrapartum Complications and Management

Macrosomia and shoulder dystocia

The use of antenatal ultrasound to detect fetal macrosomia is associated with such obstetric interventions as labor induction and cesarean section. The rate of cesarean section is affected. Higher cesarean section is more frequent when ultrasound examination indicates a macrosomic fetus.

Fetal monitoring

The obese abdominal wall may make monitoring more difficult than in other cases, and of course, the positive predictive value of antenatal testing (e.g. cardiotocography, nonstress testing, biophysical profile assessment) is limited. There is no evidence to support the routine use of internal fetal monitoring in this population, but it may be more effective in some women. Monitoring contractions and ensuring adequate labor in obese women poses a special challenge. Obese women require more oxytocin in labor. Consider allowing longer first stage of labor before performing a cesarean for labor arrest. Although most obstetric care providers rely on manual palpation and/or external tocometry, the use of an intrauterine pressure catheter may be advantageous in some cases.

Cesarean section

The risk of cesarean section is increased in the obese parturient. The increase in cesarean section rate may be partly due to the fact that overweight and obese nulliparous women have a slower progression of the first stage of labor. When faced with lack of descent in the second stage of labor, some practitioners may opt for cesarean section rather than operative vaginal delivery because of concerns about fetal macrosomia and shoulder dystocia. This may explain the low rate of operative vaginal delivery in some series [5]. Obese women undergoing caesarean section experience more complications, including blood loss > 1000 mL, increased operative time, increased postoperative wound infection and endometritis, and need for vertical skin incision. The obese diabetic women who undergo cesarean section have an odds ratio for postoperative wound infection of 9.3 (95% CI 4.5 to 19.2), and those who require a vertical skin incision have a 12% rate of wound complication serious enough to require opening the incision [6].

For morbidly obese patients, two standard 50-cm-width operating tables secured together may be necessary. Specially constructed wider operating tables would be ideal. Weighing scales suited for obese patients are necessary not only to measure weight and evaluate weight gain during pregnancy, but also for calculating medication dosages. A wider delivery bed that is easy to move around and that may be used at all stages of delivery, including cesarean section, without the need to move the patient into another bed is most useful. Nursing care of obese patients requires ergonomic adaptation and knowledge about the special risks involved in caring for these patients. More trained nurses are necessary to care for morbidly obese patients.

The decision-to-delivery interval may be longer when an emergent or urgent cesarean section is required in obese parturient. Causes for this delay may include patient transport and bed transfer, the time to establish adequate anesthesia, and the operative time from incision to delivery. The 30-minute rule of emergency cesarean section is an arbitrary threshold rather than an evidence-based standard.

Vaginal birth after cesarean section

In the absence of contraindications, women who have had their first child by cesarean section are asked to consider vaginal birth in subsequent pregnancies. The success of vaginal birth after cesarean section is commonly quoted at 80% [7]. Obese women are less likely than their lean peers to be successful in delivering vaginally after previous cesarean section (VBAC). In women with a BMI > 29 kg/m2 the success rate is 54% to 68% [8]. The success rate is further reduced in even heavier women. Chauhan et al. found a 13% VBAC success rate in women >300 lbs (136 kg) [9].

Thromboembolism

The risk of thromboembolism is high in obese parturients. Edwards et al. reported 683 obese women (BMI > 29 kg/m2) who were matched to 660 normal weight women (BMI 19.8 to 26.0 kg/m2). The incidence of thromboembolism was 2.5% in the obese women, and only 0.6% in the controls.[29] BMI >30 plus one additional risk factor qualify for seven days of postpartum Clexane; BMI >30 plus two additional risk factors require Clexane antenatally and for 6 weeks postpartum; BMI>40 should be regarded as already having two risk factors. Clexane dosage should be calculated by weight:

Early mobilization and T.E.D. anti-embolism stockings are clinically proven to reduce the incidence of deep vein thrombosis by up to 50% and to promote increased blood flow velocity in the legs 138% of baseline by compression of the deep venous system.

Perinatal outcomes

Maternal obesity is also an established risk factor for stillbirth. The reported risk of stillbirth is 2-5 times higher in obese compared with normal-weight women. The risk of stillbirth associated with obesity increases with gestational age. Infant mortality rates increase from 2.4/1000 among normal weight women (BMI 18.5-24.9) to 5.8/1000 among women with grade 3 obesity (BMI ≥ 40.0). Maternal overweight and obesity are associated with increased risks of infant mortality due to increased mortality risk in term births and an increased prevalence of preterm births. Maternal obesity may increase the risk for intellectual disability or cognitive deficits in offspring from 1.3- to 3.6-fold. Maternal prepregnancy obesity and high gestational weight gain of > 18 kg was associated with a 3-fold increase in offspring IQ deficit (mean of 6.5 points lower) [10]. The majority of studies that have examined a link between high maternal BMI and childhood diagnosis of autism spectrum disorders have found a significant positive association. This risk may be further augmented by intrauterine growth restriction (IUGR), preterm birth, high gestational weight gain, gestational or pre-gestational diabetes, and preeclampsia [11].

Conclusion

A national information campaign is required to exploit women’s interest in having as healthy a pregnancy as possible by giving them the information they need to become fit and have a normal BMI before they consider pregnancy. Periodic health check-ups and other appointments for gynecologic care prior to pregnancy offer ideal opportunities to raise the issue of weight loss before conception. Women should be encouraged to enter pregnancy with a BMI < 30 kg/m2, and ideally < 25 kg/m2. Although obesity is not an indication for the transfer of routine obstetric care, consultation with or referral to physicians with expertise in obesity may be appropriate if the obstetrician cannot safely and effectively care for the patient because of the lack of the specialized training, experience or institutional resources.

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[juniperpublishersna]

Juniper Publishers wishes Happy Easter to you and your family members

[laceyspencer]

Behaviour-Education-Technology-Juniper Publishers

Education can really benefit from the many opportunities, although not always immediate and explicit, that technology makes available. Let’s consider the following example. The use of the Internet has determined, among others, the redefinition of the methods of creation and access to teaching and learning resources, of the physical spaces in which the education takes place, of the frequency and type of interaction between learners and teachers.

It is a phase of the education’s lifecycle that is neither stoppable nor preventable. We could consider that as a phase of renewal that can further enhance the whole educational process. In other words, new and interesting opportunities are opening for redefinition of educational models. Although the path of “educational evolution” has already begun, there is a lot of potential yet to be explored. As it’s well known, technology offers a wide range of opportunities but, ultimately, Universities and Schools are responsible for organizing themselves to manage and coordinate this educational evolution path.

In the managerial discipline the adoption of educational models that make use of experiments and, more generally, experiential learning models do not represent a novelty per se. Technology today has increased the value of these models for educational purposes. Leveraging on continuous feedback on their behaviors, students can verify their learning progress. The integration of behavioral analysis in economic disciplines is also consistent with the concept of “evidence-based economics” recently proposed by Nobel laureate Richard Thaler, according to which the use of descriptive models, through which to analyze the behavior of human beings, would help to increase the value of economic models.

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[crimson-biotechnology]

DFT, Quantum Chemical Study and Biological Effects of a Heterocyclic Molecular

Abstract In this paper, the title compound 5-chloro-1-(prop-2-yn-1-yl)indoline-2,3-dione (TZP) has been prepared by N-alkylation method with a good yield. The structure of the compound was further confirmed from the 1H NMR and 13C NMR Spectral data and It has been screened for its antibacterial activity. The results revealed that the compound exhibited good to moderate antibacterial activity. Through computational study based on density functional theory (DFT/B3LYP) using basis set 6-31G (d,p) a number of chemical Quantum descriptors were computed to predict the reactivity and the reactive sites on the molecules. The molecular geometry and the electronic properties such as frontier molecular orbital were investigated to get a better insight of the molecular properties. The Molecular electrostatic potential (MEP) for the compound was determined to check their electrophilic or nucleophilic reactivity. Read More About This Article: https://crimsonpublishers.com/jbb/fulltext/JBB.000519.php 

Read More Crimson Publishers Google Scholar Article: https://scholar.google.com/citations?view_op=view_citation&hl=en&user=7ghZqYoAAAAJ&citation_for_view=7ghZqYoAAAAJ:R3hNpaxXUhUC

[weaponizedmoth]

Stacy's great grandma, Whitney Amelia Earnest, was born in 1904. She was the eldest of four, and the only one gifted with the Earnest curse. She was the one who inherited the local family meat business through sheer force of will, and some cowardice on her family members' part, when her father committed suicide in 1929. She was the one who, at 25, started to sell some less than apt for consumption meat during the great depression, which made the meat cheap and acessible, and her a local celebrity. Weird disappearances did trace back to her sometimes, but because everyone ate her meat, the idea of something like this happening was considered to be completely absurd. The police and general law enforcement and government were acquainted and friendly with her. During her lifetime, she won several accolades, not only for her meat business, which was local and more than once inspected for animal cruelty, tests it passed with flying colors, but also for her cooking. She published a minor, obscure cooking book that every household in town seems to have a copy of, tucked away somewhere in an attic. Whitney's daughter, Amelia, named after herself, was likewise born in 1929, at the beginning of the crisis. Additionally, she had three sisters, a "spinster" called Evangeline (who had a female "roommate, lovely Meredith)", their sister Maria, who became a nun and lived in France, and the youngest, the most apt to bear the gift and who died taking this opening with her with her, a travesty that made the Cook hold the gift alone until Edwin was born. All the Earnest girls kept Whitney's last, for being the most famous, and for the fact that their father, a gambling addict, died under mysterious circumstances when they were young.

[molusca]

btw my first paper was published but since its not open acess i cant see it. i love science <3

[offlineflexi]

Spider man pc game 2002

Theres no reason to NOT let gaming be something acessible. Maybe even get a Switch Lite because now you have experienced the franchise and want tor be there at launch? But, I bet you would love if you could play Breat of the Wild on your PS5/PS4 at 4K 60 FPS right now before BoTW 2 came out. And I think this would be a valid way of handling exclusives in the future. If Xbox is not porting their games to Playstation, this is not an argument, wtf? We are consumers.Įxclusivity windows are one thing. There's not a single good reason to not bring games to every platform that can run it. The Amazing Spider-Man PC Game game is a professional video game. The Amazing Spider-Man PC Game is one of the most entertaining games in an Open World. And I could say the same for Sony games coming to Xbox and Nintendo, if possible. Title: The Amazing Spider-Man PC Game Download Full Version Genre: Action-adventure Developer: Beenox Publisher: Activision Release Date: JLanguages: English, French, Italian, German, Spanish, Arabic. In the game we play as a teenager Peter Parker, who becomes a heroic Spider-Man endowed with superhuman abilities.

Also, I would love if they came to Playstation, and Xbox. Action adventure game developed by Treyarch studio, based on the storyline of Hollywood superproduction film directed by Sam Raimi. I would LOVE if Nintendo games were ported to PC, we already play them thorugh emulation anyways. By your standards, it makes no sense for them to release their games on Steam if they already have their own storefront. Xbox releases all their exclusives on PC, and you know what? They release them Day One on GamePass, but also, on Steam. If the Playstation Browser could handle it, you would be able to play Xbox games just fine through gamepass! Actually, anyone can play Xbox's games whenever they want if they have anything capable of running xCloud.

[lupine-publishers-aoics]

Lupine Publishers|Straw Based Biorefinery

Abstract

In India energy security and exploring the production of valuable chemicals , which are otherwise mostly imported have become imperative necessity The advantage of abundant availability of paddy and its straws, specifically the rice straw in India are taken as an example to establish a perfect Bio-refinery . In these paper possibilities of production of chemicals and energy by Chemical, Biochemical and Thermo chemical platforms are explored. Possible alternatives on the problems of stubble burning in some stares of India are put forward. However, studies on the optimal design, and economic viability of each routes remain to be evaluated.

Introduction

Biorefineries similar to petroleum refineries is a facility developed, engineered and designed optimally where renewable energy (heat & power) and multiples of chemical products and can be profitably manufactured from biomass with best known environmentally benign process technologies through biochemical and thermo chemical platforms. The energy production from bipomass is also Greenhouse neutral. Cellulosic biomass, because of its massive availability, can be a truly biorefinery representing a feedstock for biofuels and valuable chemicals. Agricultural residues such as straws are ideal candidates for establishing a biorefinery in India. Presently major quantity of straws is used as domestic fuels in rural areas. Rice Straw is produced from Rice Paddy. The various products and by-products are shown in the schematic diagram (Figure 1). On an average, there is 20% husks, 10% bran, 3% polishings, 1-17% broken rice and 50-66% polished rice. Generally Rice Paddy by-products is on an average 30% weight of paddy3).

Figure 1: Products and Bye-products from Rice Paddy (2).

The residual wastes (stubbles) are usually burnt in the field which leads to severe air pollution problems due to discharge of gaseous pollutants including CO, Ozone , N2O, NOx, SO2 , CH4, particulate matters ,smokes and smogs, hydrocarbons. Open burning of crop stubble also results in the emissions of harmful chemicals like polychlorinated dibenzo-p-dioxins, polycyclic aromatic hydrocarbons (PAH’s) and polychlorinated dibenzofurans (PCDFs) referred as as dioxins, besides loss of nutritional values of soil intermas of organic carbon, nitrogen, phosphorous and potassium in many states of India, especially Punjab, Haryana, Rajasthan and Uttar Pradesh. This is not that extent in other part of India. The main reasons are: larger length of the stubbles remains after harvesting in those states which cannot be economically covered under soil to enhance the fertility of the land and attempts to burn these long projected straws over the agricultural land. In the following paragraphs some alternatives to straw stubble burning are suggested [1].

Due to continuous depletion of non-renewable energy resources and high cost of chemicals due to import, at present there is a worldwide attention towards development of renewable resources of energy and chemicals for sustainable development for the welfare of mankind. For example: Economic production of bioethanol from lignocellusic biomass. Conversion of lignocellulosic plant materials to biochemicals is also regarded as one of the most promising alternatives to fossil fuels. Most abundantly available biomass in the countries like India and China are straws (rice, wheat, oats, rye, barleys, Zea Mays, corn stalks etc.), out of which rice straw occupies the first position and followed by wheat straw in terms of availability in Eastern, and North Eastern Indian states (West Bengal, Bihar, Assam, Orissa, Manipur etc.) whereas reverse is true for Northern India (U.P. Haryana, Punjab, Rajasthan etc.).

Conventional but Economic Uses of Rice Straw and Stubbles

a) Soil improver to increase the fertility

b) Manuring/Composting with cowdung and others etc.

c) Briquettes

d) mats

e) Mushroom cultivation(as growth substrate)

f) Vegetables Cultivation

g) Animal Bedding material

h) Poultry Litter & Mulch

i) Feed for ruminants/Animal feed

j) Packaging goods for transporting goods &machineries

k) Frost prevention in horticulture

l) Strawberries (preventing damage to the fruit)

m) Thatching

n) Rope making

o) Traditional building materials, fibre boards,Particle board, insulation material

p) Energy (heat, power, fuels)

q) An intergrated solid state fermentation approach for production of enzymes from agro-wastes including straws

Lignocellulosic biomass could thus be utilized for both production of biofuels as well as biochemical’s due to its nature of renewability, low price, widespread availability and containing high content of pentose and hexose sugar polymers. These are detailed elsewhere [2-6]. Straw and Stubbles can be used for various Chemicals, valuable products and energy. The most notable products which can economically manufactured are: Pulp & Paper, Particle Board, Pulp and Paper Board, Straw board, board of rice husk.

Energy technologies and thermal combustion consists of Non- Conventional uses of straws. Valuable chemicals include Cellulose, High Alpha cellulose, Plastics, Fuels and Energy,Bio-gas and in situ, Bio-oil, Nanocellulose and nano composites, Pentosans, Xylose, Xylitol, α-Cellulose, Glucose , Fructose, Hydroxy methyl Furan, Ethanol and host of many other chemicals [7-10]. These are shown in Figure 2.

Refineries based on Cellulose, Ethanol, Sucrose, Glucose, Lignin have been proposed and given elsewhere various Unit Operations and Processes involved to produce a biorefinery are as under:

a) Pulping

b) Gasification

c) Pyrolysis

d) Destructive distillation

e) Plasma Treatment

f) Chemical Treatment

g) Electron Irradiation

Chemical platform

a) Activated carbon

b) Chemical transformation through Catalyst(Sn-beta zeolites)

c) Synthetic Fuel using Solar Furnace

d) Cellulose nano crystals and nanocomposites:

Cellulose nanocrystals have been largely applied as reinforcing fillers in the preparation of nano composites materials with improved mechanical and barrier properties.

Figure 2: Products and Bye-products from Rice Paddy (2).

Bio-chemical platform

Bio-chemical platform

a) Renewable fuels: Ethanol, Biodiesel,Butanol, Hydrogen

b) Chemicals: Acetone,Furfurol,Propanediol, Ketones etc.

c) Organic Acids:Acetic, Lactic , Succinic, Gluconic, Butyric etc.

d) Bio-Energy: Lignate, Methane, Bio-gas, Heat, Electricity

e) Food & Feed: Single Cell Protein,Fat,Fiber, Sugar etc.

Chemistry of Formation

Go to

Monosachharides

D-Xylose,D-glucose, L-arabinose,Xylitol,fructose,D-mannose,Dgalactose

Hemicellulose

Furfural, through acid treatment, Biogas by anaerobic Digestion, concentrating to Animal Feed. Fructose /Fruit sugar →Hydroxymethyl furfural (HMF) →catalytic processes → Plastics, diesel fuel additives, or even diesel fuel [11,12].

Chemical or Biochemical Platforms: Dilute acid hydrolysis of lignocelluloses:

Acids: Carboxylic acids such as formic acid, acetic acid, 3-hydroxy propionic acids, succinic acid, fumaric acids, Malic acids, Itaconic acids, Levulinic acid, Glucaric acids, glucuronic acid, Vanillic acids, Syringic acids, Ferulic acids, p-coumarlic acid. Amino acids like Aspartic acids,Glutamic acids, Aldehyde: Syringaldehyde

Polyphenols: glycerol, Arabitol, Xylitol, Sorbitol Lactones such as 3-hydroxy butyrolactone

Phenolics: p-hydroxy benzoic acids and vanillin However,aldopentose xylose (20-40% of the total carbohydrates are normally found in agricultural residues.

Reaction Schemes (4,9,21,29,30)

Chemical reaction consists of series, parallel and combination of series-parallel reactions

Cellulose (Glucan)→ Oligosaccharides →Glucose →HMF→Levulinic acid

Hemicellulose →Oligosachharides→Sugars( xylose,arabinose, glucose, mannose, galactose)

Pentoses ( Xylose/ Arabinose)→ Furfural→ Furfural resinification and condensation products

Hexoses(Glucose/ Fructose ) → HMF→ Levulinic acid+Formic acid→Succinic acid

Furfural and HMF

Figure 3 Reaction Scheme and Kinetic models are developed (Pentosan( both xylan and arabinan) is hydrolyzed to both aldopentoses which are converted into two or more steps into furfural. Loss of furfural takes place due to side reactions which leads to condensation and to the formation of resins. Both levulinic acid and furfural can be produced from straw or any biomass & levulinic acid can be converted to succinic acid and formic acid [13].

Figure 3: Products and Bye-products from Rice Paddy (2).

Chemistry of formation

Xylan Xylose Furfural: Hexosan →Hexose (Unit Cellulose) → 5-hydroxymethyl-2-furfural + 5-methyl -2-furfural

Mechanism:

Hydrolysis:

xylan + water →H+Xylose

arbinan + water →H+arabinose

Dehydration:

Furan derivatives such as Furfural (2-furaldehyde), HMF (5-hydroxymethyl-2-furaldehyde), 2,5 furan dicarboxylic acids(33-35) are most important chemicals. HMF is produced industrially on a modest scale as a carbon-neutral feedstock for the production of fuels and other chemicals such as levulinic acid, gamma-valerolactone, or other byproducts. HMF itself has few applications and it is primarily produced in order to be converted into other more useful compounds [14-20]. Of these the most important is 2,5-furandicarboxylic acid, which has been proposed as a replacement for terephthalic acid in the production of polyesters. HMF can be converted to 2,5-dimethylfuran (DMF), a liquid that is a potential biofuel with a greater energy content than bioethanol. Hydrogenation gives 2,5-bis(hydroxymethyl) furan. Acid-catalysed hydrolysis converts HMF into gamma-valerolactone, with loss of formic acid. HMF is practically absent in fresh food, but it is naturally generated in sugar-containing food during heat-treatments like drying or cooking. Along with many other flavor- and color-related substances, HMF is formed in the Maillard reaction as well as during caramelization. In these foods it is also slowly generated during storage. Acid conditions favour generation of HMF. HMF is a well known component of baked goods. Upon toasting bread, the amount increases from 14.8 (5 min.) to 2024.8 mg/kg (60 min). It is a good wine storage time−temperature marker, especially in sweet wines such as Madeira and those sweetened with grape concentrate arrope [21-24].

Fermentation Technology

Bio-Ethanol

Sachharomyces cerevisiae, Zymomonous Mobilis, Clostidium thermocellum, Ruminococcus albus- a bacterium are generally used for conversion of cellulose to ethanol. Theoretically 1kg of sucrose on inversion, gives 1.053 kg of invert sugar, glucose and fructose combined together. Further,one tone of invert sugar yields 644.8 litres of absolute alcohol(ethanol of 100% ) or 678.7 litres of rectified spirit.The net CO2 emission of burning a biofuel like ethanol is zero since the cO2 emitted on combustion is equal to that aabsorbed from the atmosphere by photosynthesis during growth of the plant(sugarcane) used to manufacture ethanol.

Inversion: C12H22O11+H2O→C6H12O6+C6H12O6

Sucrose + Water →Invertase→Glucose + Fructose (Invert Sugars)

Fermentation: C6H12O6→2C2H5OH+2CO2+27.8kCals xymase

Oxidation: C2H6O+3O2→2CO2+3H2O+Δ

Combined equation: C6H12O6+6O2→6CO2+6H2O+Δ

6CO2+6h2O+hv(light)→C6H12O6+6O2

Butanol

Biobutanol is produced by microbial fermentation, similar to bioethanol, and can be made from cellulosic feedstocks such as straws. The most commonly used microorganisms are strains of Clostridium acetobutylicum and Clostridium beijerinckii, C. Saccharoperbutylacetonicum and C. saccharobutylicum. In addition to butanol, these organisms also produce acetone and ethanol, so the process is often referred to as the “ABE (acetone-butanolethanol) fermentation [25-30]. Production of lactic acid from straw derived cellulose,cellulase production with Tricoderma citriviridae on solid bed, use of acid hydrolysates for lactic acid production using various strains such as Lactobacillus delbrueckii or lactobacillus pentosus can be explored.A number of products can be produced from sucrose as shown in Figure 4.

Figure 4: Products and Bye-products from Rice Paddy (2).

Anaerobic Digestion

Biogas production (25,31-32), Anaerobic conversion of carbohydrate /cellulosics, especially of agricultural residues , has been considered for biogas ( methane) production which is typically, CH4=50-65%, CO2=35-50%, H2O=30-160g/m3, H2S=1.5-12.5g/ m3 inn presence of methane producing bacteria. Typically some of the methane forming microorganisms likes Methanaomonas, Methanococcous mazei n.sp. methannobacterium sohn genii n.sp. etc. are employed. The two best described pathways involve the use of acetic acid or inorganic carbon dioxide as terminal electron acceptors:

CO2+4h2→CH4+2H2O

CH3COOH→CH4+2CO2

During anaerobic respiration of carbohydrates, H2 and acetate are formed in a ratio of 2:1 or lower, so H2 contributes only ca. 33% to methanogenesis [31], with acetate contributing the greater proportion. In some circumstances, for instance in the rumen, where acetate is largely absorbed into the bloodstream of the host, the contribution of H2 to methanogenesis is greater.

Buswell and Symons universal equation:

CnHaOb+(n-a/4-b/2)H2O→(n/2-a/8+b/4)CO2+(n/2+a/8-b/4)CH4

Thermo-chemical platform

Gasification Technology

The basic principles of Gasification technology are as under:

a. Steam Reforming of Straws:

Superheated steam reacts endothermally (consumes heat) with the carbonaceous components of straws to produce hydrogen and carbon monoxide fuel gases (synthesis gas or syngas)

b. Steam Reforming reaction: H2 O +C + Heat → H2 +CO

Water –gas shift reactions also occur simultaneously with the steam reforming reactions to yield additional hydrogen and carbon dioxide.

c. Water gas shift reaction: H2 O +CO→ H2- +CO2

Conclusion

India being an agriculture based country with plenty of biomass renewable resources can produce potential bio-products and bio energy at a cheaper rate compared to other renewable sources. Being carbon neutral these resources is eco friendly, yields much less green house gaseous emissions compared to fossil fuels [32- 37]. In this present paper various alternatives for straw utilization, specifically the plausible solutions of current problems of straw stubble burnings in a few Indian states are highlighted. However detailed optimum design of process and plant with economic feasibility need to work out.

[lupine-publishers-ctbm]

Lupine Publishers | Whole-Cell Assays for Discovering Novel Efflux Inhibitors for Use as Antibiotic Adjuvants

Lupine Publishers | Journal of Biotechnology

Abstract

Antimicrobial resistance (AMR) is a growing problem worldwide. Resistance to antibiotics can occur in a number of ways, one of which is removal of the drugs from the cell via efflux pump macromolecular machineries. As such, efflux pumps can provide a background level of resistance to many different classes of antimicrobials and are a major contributor to AMR. Inhibition of efflux pumps therefore has the potential to reverse resistance to many antibiotics in one go and is an attractive potential for treating resistant infections. Whilst a number of efflux inhibitors are known, none are currently used clinically due to harmful side effects. Development of novel inhibitors is therefore imperative. The article aims to review accumulation assays and efflux assays, two of the most common laboratory techniques used to identify and characterise candidate efflux inhibitors.

Keywords:Efflux pumps; Efflux inhibitors; Efflux assays; Antimicrobial resistance; Drug discovery

Introduction

Globally, antimicrobial resistance is a rising public health challenge. Particular infections including pneumonia, Tuberculosis (TB), gonorrhoea, and salmonellosis are becoming more difficult to treat. Of new TB cases, 3.5% are either resistant to rifampicin (the most effective first line drug) or are multi-drug resistant, rising to 18% for previously treated individuals [1] Furthermore, there are fears that Neisseria gonorrhoeae has already developed resistance to all currently recommended treatments [2]. There is a desperate need for new antibiotics to treat these most resistant of infections, but the huge costs, long timescale and high attrition rate of drug discovery means that this is a slow process. Twenty classes of antibiotics were discovered between 1940 and 1962, yet only two have been developed since then [3]. Moreover, for any novel antibiotic developed, it is likely that resistance will quickly emerge once it is brought into clinical use, especially with the frequent misuse of antibiotics which drives selection for resistance. Therefore, other strategies must be taken in parallel to antibiotic development, or there will be a continuous arms race of drug development and resulting gain of resistance, a battle we are currently losing.

Figure 1: Schematic representation of the MFS, MATE, SMR, PACE, ABC and RND families of bacterial efflux pumps, plus an outer membrane protein channel (OPM), shown here in a Gram-negative bacterium. RND family efflux pumps comprise of a tripartite complex formed from an inner membrane efflux transporter, an outer membrane channel, and a periplasmic accessory protein. All six families, with the possible exception of the PACE family, also have representatives in both Grampositive and acid-fast bacteria. Bold arrows indicate the direction of drug efflux, and dashed arrows show ion movement.

Antibiotic resistance can occur via acquired or intrinsic mechanisms. Acquired resistance, typically via horizontal transfer or spontaneous mutation, often functions by altering the drug target or production of enzymes which degrade the antibiotic. Acquired resistance, gained in response to antibiotic treatment, is usually only effective against a single drug. Intrinsic resistance, on the other hand, refers to the non-specific mechanisms of antibiotic resistance evolved ancestrally, including the impermeable outer membrane of Gram-negative or acid-fast group of bacteria, and drug efflux pumps which remove drugs from the cell [4]. There are currently six families of bacterial efflux pumps identified: the ATPBinding Cassette (ABC) family, the Major Facilitator Superfamily (MFS), the Multidrug And Toxin Extrusion (MATE) family, the Small Multidrug Resistance (SMR) family, the Resistance-Nodulation-Cell Division (RND) superfamily and the Proteobacterial Antimicrobial Compound Efflux (PACE) family, which has not yet been structurally characterised. The ABC family hydrolyse ATP directly to drive efflux, whereas the other five utilise transmembrane ion gradients [5]. Whereas the RND family directly effluxes antibiotics across both membranes, the other five families only transport antibiotics across the inner membrane. From the periplasm, drugs can exit the cell via outer membrane protein channels or by entering the RND complex (Figure 1).

Efflux pumps are often non-specific, and as such can provide resistance to a wide range of antimicrobials. They have been implicated in contributing towards the multi-drug resistant phenotypes of Mycobacterium tuberculosis [6], Pseudomonas aeruginosa [7], Neisseria gonorrhoeae [8], and Streptococcus pneumoniae [9], amongst others. Inhibition of drug efflux is therefore an exciting prospect for treating drug resistant bacteria and may enable old antibiotics to re-enter clinical usage. There is compelling evidence that the use of efflux pump inhibitors as an adjuvant may aid treatment of resistant infections of many types [6-12]. However, despite a number of potent efflux inhibitors being known, none have entered clinical use. In most cases this is because the compounds are toxic at the concentrations required to inhibit efflux [13]. There is therefore a pressing need to develop novel clinical efflux inhibitors. To achieve this, assays are needed to validate the inhibitory activity of novel compounds. One way this can be achieved is by using standard antibiotic susceptibility testing, such as the resazurin-based microplate assay to determine if the putative inhibitor, at sub-MIC concentrations, is able to lower the MIC of a known antibiotic. This method has the benefit of being relatively easy and high-throughput; furthermore, it is possible to combine this method with mutants of efflux pumps to confirm that the effect on the MIC is occurring specifically via inhibiting efflux, and even to identify which efflux pump is inhibited [14]. However, using reduction of MICs to identify and validate efflux inhibitors is fairly insensitive, and so is of limited use. Only large changes to efflux will likely have an effect on MICs, and so less potent inhibitors may be dropped out. Furthermore, as this method does not measure efflux, it is difficult to directly attribute changes in MIC to efflux inhibition [15]

A more direct way is therefore needed to study the effect of candidate inhibitors on efflux. One way is to follow the movement of an efflux pump substrate, often a fluorescent molecule, into and out of bacterial cells, and use this as a measure of efflux activity. Many different molecules are used to measure efflux, with ethidium bromide and Nile red being two of the most common. Ethidium bromide fluoresces strongly when bound to DNA, and Nile red fluoresces when in non-polar environments such as the membrane [16,17]. This therefore gives these molecules the advantage that they fluoresce differentially in extra- and intracellular environments, providing a sensitive indication of rate of efflux from the cell, and helping eliminate background fluorescence. These methods fall into two main categories; those which follow the accumulation of the molecule within the cell, and those which follow its efflux.

Accumulation Assays

Whilst there are variations, most accumulation assays typically follow a similar procedure. At the start of the assay, there is no dye added to the bacteria. This is then added to the reaction, and its accumulation within the cells followed over time, typically by measuring the fluorescence with dyes such as ethidium bromide. Eventually, accumulation will tail off, with fluorescence reaching a steady state. This reflects an equilibrium being achieved between influx and efflux of the dye. This assay can be performed with added efflux inhibitors [18]. By inhibiting efflux, more dye accumulates within the cells compared to untreated ones, with steady state being achieved at a higher fluorescence. This assay can therefore be used as a very simple test to validate the inhibitory activity of a candidate efflux inhibitor [19]. Similarly, accumulation assays are often used to observe changes in efflux ability in knockout, knockdown or overexpression mutants.

If a knockout/knockdown mutant accumulates more dye, it can be assumed that the gene encoded a protein important for drug efflux, or a regulator of these, and vice versa with overexpression mutants. These two approaches can be combined, with different mutants treated with efflux inhibitors to see if they have a greater or lesser effect on dye accumulation than for wild-type cells. This can help determine which efflux pump the inhibitor affects [7]. However, there are problems with using accumulation assays, the most important being that accumulation is not a direct measure of efflux. Rather, it reflects a number of factors, predominantly the balance of influx and efflux rates. Influx depends greatly on the permeability of bacterial membranes, which can vary greatly between even closely related strains due to differing membrane compositions [20]. Therefore, unless influx rates are known, kinetic data cannot be obtained from accumulation assays and results remain qualitative. Whilst this limits usage of accumulation assays to comparisons between isogenic mutants, or groups treated with different inhibitors, the assay remains a conclusive way to determine if a molecule possesses inhibitory activity, and so is frequently used to validate new efflux inhibitors.

Efflux Assays

If a quantitative measure of efflux is required, then a more direct efflux assay should be used. This follows a similar premise to accumulation assays, but instead involves preloading the cells with dye and following its subsequent efflux. To achieve this, cells are incubated with a dye or other efflux pump substrate, and a known efflux inhibitor such as CCCP. This causes the dye to accumulate to a maximum level. Then, the cells are washed to remove the inhibitor and any remaining extracellular dye. The cells are then reenergised, typically with glucose, which restarts efflux. The movement of the dye out of the cells can be followed by recording the decreasing fluorescence [15]. As this method is a direct measure of efflux, kinetic data can be obtained for efflux rates, which allows comparisons to be made more broadly, rather than just between isogenic species. In much the same way as with accumulation assays, modifications can be made to study the effects of putative inhibitors or different mutations on efflux rates [12,21].

Efflux assays are very sensitive, and they allow for validation and characterisation of novel inhibitors, which may potentially have clinical usage. Whilst the efflux assay is widely used, it is not always applicable. Non-fermenter bacteria, including Pseudomonas and Acinetobacter, are unable to metabolise glucose, and so cannot be easily reenergised. This means that efflux assays can be unsuitable for some bacteria, and instead accumulation assays are more commonly used [7,22].

Limitations with these Assays

A fundamental problem with both types of assay is that using ethidium bromide or another dye to measure efflux or accumulation is of limited clinical relevance, and may not reflect well the efflux of any particular antibiotic. This can be due to the dye and antibiotic having very different kinetics of efflux, and furthermore, they may not even be substrates for the same efflux pumps. In addition, as ethidium bromide intercalates with DNA, there is a lag time in efflux in which it dissociates, followed potentially by a two-step efflux mechanism in which it is first transported to the periplasm. This can lead to underestimates of efflux rate, and so may be a poor reflection of efflux rates of antibiotics [23]. Therefore, where possible, it is better to use the antibiotic of interest itself as a direct measure of efflux, although this tends to be far more difficult experimentally. Certain antibiotics, such as fluroquinolones and tetracyclines have endogenous fluorescence which enables their accumulation to be followed [24]. For non-fluorescent antibiotics, Mass-Spectroscopy (MS) can be used to directly study their accumulation. A recent proposed joint protocol for spectrofluorimetric and MS analyses suggests that the two methods are complementary and together can accurately measure antibiotic accumulation, demonstrated with fluroquinolones [25]. MS analyses, rather than spectrofluorometric, may also provide a better way to screen natural compounds for efflux inhibitory activity. Many natural compounds have endogenous fluorescence, which can make it hard to isolate and interpret fluorescence changes due to dye accumulation or efflux. As before, the actual antibiotic, rather than a dye, could be used, and MS used to determine how much accumulates with and without the candidate inhibitor.

One of the biggest problems facing the development of novel efflux inhibitors is the lack of high-throughput assays to validate putative compounds. Whilst both the accumulation and efflux assays are relatively easy to perform and can reliably confirm if inhibition occurs, both are limited on throughput. Therefore, whilst some in silico screening has been performed [26], limitations in throughput have so far prevented large-scale screening of libraries in vitro. Instead, the search for novel inhibitors has relied extensively on prior knowledge to select candidates for validation. Whilst the hit rate with this has been relatively high, the overall number of new inhibitors found has been low, and it is rare to identify completely novel inhibitors in this way. This is in part why no inhibitors have made their way into clinical usage, as many are closely related and as such are similarly toxic. Development of high-throughput screening assays for novel inhibitors is therefore necessary if efflux inhibitors are to progress clinically. Recently, the Back assay was developed, which uses a 96-well plate format combined with MS. This was able to test in triplicate 12 compounds at 4 concentrations each, for two different Escherichia coli strains [27]. This progression to more high-throughput screening is likely to be the driving force behind development of novel efflux inhibitors, and further work needs to be done to optimise assays before large scale-screening of compound libraries can be performed. Ultimately, the development of clinical efflux inhibitors used therapeutically as antibiotic adjuvants may be what turns the tide in the battle against antibiotic resistance.

Acknowledgment

The authors would like to thank the British Society for Antimicrobial Chemotherapy, without whose funding this work would not have been possible. We also wish to thank Dr Arundhati Maitra for her time and advice when writing the article, as well as for help with ChemBioDraw.

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Relation Between Post Stroke Depression (PSD) and CT- Scan and MRI Findings and Estimation of Functional Degradation in Patients 2-7 Months after Stroke Abstract Background: Stroke is a syndrome characterized by acute onset of neurological symptoms for more than 24 hours. PSD is the most common mood disorder in patients that its prevalence in women was more than men. The aim of this study was to determine the relation between PSD and CT-scan and MRI findings and the degree of functional degradation in patients after the stroke. Methods: This descriptive-analytical study was performed on patients with stroke. All of them had depression based on Beck’s depression test. Necessary information including cardiovascular risk factors, type of ischemia, involved hemisphere, involved artery and extent of conflict were recorded in a checklist and the functional degradation in patients is calculated by scores of the Modified Rankin Scale (MRS). Collected data analyzed by statistical methods in SPSS version 21. Results: In this study, 100 patients (43 males and 57 females with an average age of 63.97 years) were studied. Of all patients, 71% had mild depression. Of all patients, 80% had ischemic lesions, 56% had involvement in right hemisphere, 39% in frontal and 39% in the cerebral- anterior. Conclusion: The results showed that depression in women is more than men. The prevalent degree of depression was mild, the form of stroke was ischemic type and the most area involved was right hemisphere of the brain. Keywords: Stroke; Depression; Ischemia; Hemorrhage Go to Introduction Cerebrovascular disease is an acute neuropathic disorder caused by abnormal blood flow to a part of the brain tissue that occur due to brain vessel obstruction as a result of blood coagulate or a rupture one of its feeding vessels. Post stroke depression is the most common and important neuropsychiatric consequences of stroke, which can result in longer hospital stay, compromise the effectiveness of rehabilitation, and reduce the patient’s quality of life [1]. According to the WHO report, the four main reasons for mortality in 2030 will be heart failure, stroke, chronic obstructive pulmonary disease and lower respiratory tract infections. Stroke is a non-communicable disease among the elderly population that is the third leading cause of death in developed countries after coronary artery diseases and cancers [2]. The stroke is divided into two types of ischemic and hemorrhagic. Ischemic type is the most common cause of strokeand caused by formation of a localized clot or an embolism from another place such as the heart.3 Multiple risk factors such as systolic and diastolic hypertension, hypercholesterolemia , using smoking , alcohol and oral contraceptive pills, diabetes, and genetic factors have main role in the incidence of stroke but most of the strokes are multi factorial which influenced by polygenic and environmental factors [3]. The occurrence of stroke leads to occupational, social and mood disorders in patients. The PSD is the most common mood disorder in patients with stroke. The prevalence of PSD is estimated to be about 41.3% [4-5]. Depression is one of the disabling psychological complications of stroke which has devastating effects on all social, occupational, interpersonal, emotional and cognitive aspects of patients. PSD is common and several risk factors such as the location of the lesions in the left hemisphere, female gender, younger agegroup, history of depression and stroke and being alone are related to PSD. The most likely occurrence of depression occur in the first 2 years after stroke and its pick is in the first 3 to 6 months [6-7]. Some of studies have suggested depression as the main cause of death in stroke patients.7 Also female gender , age less than 60 years old , live alone, divorce, alcoholism , inability to return to work, decreased social activity , change in communication with others and size of brain lesions are the risk factors for post stroke depression [4,6-7]. Studies have shown that the use of antidepressants has reduced the incidence of stroke complications and improved its outcome. Therefore, timely diagnosis of depression and quick actions in its treatment are effective in reducing recurrence of stroke, mortality and improving the quality of life of patients [6,8]. Considering the importance of post stroke depression in the prognosis of patients and its mortality and also considering the burden of disease, the aim of this study was to investigate the relation between PSD and CT-scan and MRI findings and estimation of functional degradation in patients 2 to 7 months after stroke. Go to Method This descriptive analytical study was done on 100 patients with post stroke depression who hospitalized in the neurology department of Alawi hospital in Ardabil city in 2016. Stroke confirmation was performed by a neurologist based on clinical symptoms and imaging. We used beck questionnaire included 21 questions about physical, behavioral and cognitive symptoms of depression. The questions in this questionnaire were scored based on 0-3 and the degrees of depression were classified from mild to severe. To determine the degree of functional degradation (degree of disability and dependency) we used Modified Rankin Scale (MRS) which included 6 questions with a score of 0-6. The collected data were analyzed by statistical methods in SPSS version 17. Go to Results Of all patients, 57% were female and the rest were male. 77% of the patients were over 50 years of age and the average age of the patients were 63.14 ± 14.67 years (range 32-86). In 80% of patients the stroke was ischemic, and the rest was hemorrhagic. 56% of the patients had right hemisphere involvement and the rest of them had left hemisphere involvement. 71% of patients had mild depression (Figure 1). 18% of patients had a historyof myocardial infarction, 50% hypertension and 65% had CVA for the first time (Table 1). The results showed that the most involved lob was the frontal lobe and the most involved artery was the cerebral- anterior region with 39%, respectively. In 29% of patients, 50% of the brain pathway was damaged. The average score of MRS in patients was 2.53±1.25 and the highest degree of disability and dependency was related to score 2 with 41% (Table 2). Click here to view Large Figure 1 Click here to view Large Table 1 Click here to view Large Table 2 Go to Discussion In this study, 44% of patients had left hemisphere damage, 35% had history of stroke and 57% were women. The results of this study showed that 71% of patients had mild depression and 21% had moderate depression. In Glamkovski et al. [9] study, the prevalence PSD was 66% that of them 51% had mild depression and 15% moderate to severe depression which was lower than the present study [9]. In the study of Robinson et al. [10] the prevalence of major depression was 21.7% and minor depression was 19.5% and in the study of Rajashekaran et al. [11] , the prevalence of major depression was 64.2% and in this study the prevalence of severe depression was 8% which was lower than that of Robinson and Rajashekaran studies [10-11]. In the study of Arseniou et al. [12], the incidence of PSD was reported between 6% to 79% [12]. In Iranmanesh et al. [13] study, the incidence of depression in women was significantly higher than men. In another study by Marie et al. [14] in Sweden, Ohira et al. [15] in Japan, the incidence of PSD was more common in women than in men [13-15]. Similar to other studies in this study, the prevalence of depression was more common in women. The findings of this study showed that the prevalence of PSD in women was more than men and female gender is a risk factor for PSD. In this study, the average age of patients was 63.97 which was similar to the study of Lashkaripoor et al.[16] with an average age of 69.62 [16]. CT- scan and MRI findings showed that 80% of patients had ischemic lesions 56% right hemisphere involvement, 39% frontal involvement and 39% had involvement of the anterior branch of the brain. In the study of Rajashekaran et al. [11], involvement of left cerebral lob lesions was 67.9% and focal and multifocal lesions were 64.3% and 35.7%, respectively [11]. In studies conducted by Sato et al. [18], Srivastava et al. [17] there was no significant relationship between location of lesions in stroke and depression [17-18]. However, in some studies there was a significant relationship between them [19-20]. In this study, more than half of the patients with right hemisphere involvement and most of the patients had ischemic lesion. In Gozzi et al. [21] study, 86% of patients had ischemic stroke and 53% had left lobe involvement. Dalvelan et al [1] in a study on patients in Iran showed that the prevalence of post stroke depression in Iran was 76.9% and was lower than the present study. Ebrahimi Rad et al [22] in a study in Ramsar showed that the prevalence of post stroke depression in patients was 45% which was lower than the present study [22]. Go to Conclusion It seems that due to the prevalence of mild PSD and its more prevalence among women as compared to men, women need more attention and care to recognizing and treating depression. The results showed that the prevalence of post stroke depression in this province was higher than the national average and it is necessary to identify the possible causes by carefully studying and planning to reduce it in the future.

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Uterine Leiomyoma (UL) is the most prevalent benigngynecological tumor in the female population. The tumor originates from the smooth muscle of the myometrium [1-3]. As many as 1 in 5 women in child-bearing age may have UL, and between 20 to 80% of all women may have the tumor by the age of 50 [4]. It seems that UL is more common in black than white Caucasian women [5,6]. The exact a etiology of UL is unknown, but there is considerable evidence that it might be due to a combination of factors, such as: hormonal, environmental, chromosomal, genetic drivers, cellular modulation, and phenotypical changes [7-9,2,10,11]. The UL have different sizes, locations and growth pattern and it may attain enough volume to significantly distort the uterine cavity and endometrial surface and affect the menstrual flow [12,13]. It may also affect reproductive outcomes and may be associated with pregnancy loss, preterm birth, dystocia and fetal malpresentation [14-17]. The impact and the severity of the symptoms depend on: the size, the number and the site of the tumor, and black women are more likely to have severe or very severe symptoms [18]. Huge leiomyomata may be mistaken for pregnancy and in some conservative societies this can cause significant social embarrassment, especially to the single woman leading to lower self-esteem and negative impact on the quality of life. Although UL have no apparent effect on: libido, arousal, lubrication or, orgasm [19]. however, some women with UL reported pain during sexual intercourse [20-22], and this could possibly lead to anxiety, apprehension and sexual dysfunction and understandably sexual dissatisfaction and fear of pain during sex may dissuade the woman from sexual activity and can potentially lead to marital disharmony [18]. The association between UL and subfertility is controversial and lacks convincing evidence; however, a systemic review by Pritts and coworkers (2009) showed that UL, regardless of location, were associated with: reduction in pregnancy rates, live birth rates, and increase in miscarriage. These effects vary according to the type of fibroid itself, but the effect is more prominent with sub-mucous UL perhaps by distorting the implantation site [16]. UL are the leading cause of hysterectomy in the USA [23] and hysterectomy is considered a definitive treatment; however, recurrence and loss of reproductive potential could have psychosocial impacts on these women. Nonetheless, there are several alternative medical and less radical surgical modalities for the treatment of UL and the choice of treatment is dictated by many factors such as: the patient’s desire to become pregnant in the future, the importance of uterine preservation, the severity of symptoms, and the tumor characteristics

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Comparative study on some in vitro biological activities of freeze-dried leaves extracts of six advanced accessions of Ipomoea batatas (L.) Lam

Abstract

Sweet potatoes (Ipomoea batatas L.) are an excellent source of bio-active phytochemicals. In recent years, polyphenols and other naturally occurring compounds have become essential research targets for non-insulin-dependent diabetes. Precisely, substances and plant extracts that occur readily have been checked for α-glucosidase (AGH) enzyme inhibition. This study investigated the anti-diabetic, antimutagenicity, and antioxidant activity from sweet potato leaves in vitro. The anti-diabetic activities were tested using the enzyme –α-glucosidase obtained from the rat intestine using the p-nitrophenyl-α-D-glucopyranoside (PNP-G) substrate for inhibitory activities. The α-glucosidase inhibition assay evaluated the anti-diabetic activity, and the extract showed a considerable α-glucosidase inhibitory activity. Among the genotypes, AN-6 exhibited the highest a-glucoside inhibitory activity, followed by AN-4, and AN-2. The leaf extract showed the inhibitory activity ranging from 22.33% to 74.98 on a-glucosidase from 10 to 1000 mg/ml, which was increased steadily with increasing sample concentrations. The antimutagenicity in the leaves explored using the Salmonella typhimurium TA 98. The Ipomoea batatas genotypes effectively decreased the reverse mutation induced by Trp-P-1, and the mutagenic activities were dose-dependent. Furthermore, the extract also capable of reducing the reverse mutation persuaded by Trp-P-2, IQ, and DEGB extract of grilled beef. The AN-6 showed higher antimutagenicity followed by AN-5 at 100 μL concentrations. The fallouts demonstrate that antioxidant capacity (4.42 to 10.98 μmole Trolox g-1 DW) and total phenolic contents (7.68 to 16.96 μmole TA. g-1 DW) broadly fluctuate among the genotypes. Our data demonstrate that all the genotypes have the physiological functions studied, and AN-6 and AN-4 exhibited the highest activities. The sweet potato leaves extract showed a more potent inhibitory activity for all the physiological functions studied, which might have values in anticipation of certain human health conditions.

Keywords: Antioxidant; Polyphenol; Anti-diabetic activity; Antimutagenicity; Sweet potato tops

Introduction

Sweet potato (Ipomoea batatas L. Lam) is the sixth most important food crop in the world, and new uses for this crop have been identified [1]. It is one of the diversified crops supplying vitamins and minerals such as vitamin A, B, C, beta-carotene, iron, calcium, zinc, protein and has high energy [2]. Fresh leaves contain vitamin A on an average of 1600 IU 100g-1 [3]. Leaves are very nutritious compared to leaves of cassava, amaranth, mushrooms, taro and pumpkin [4]. It is also one of the plants selected by the US National Aeronautics and Space Administration to be grown in a controlled ecological life support system as a primary food source [5]. Recent studies show that it contains bio-active compounds as polyphenols, anthocyanins, flavonoids, dietary fiber, etc., which are essential for human health. Sweet poato storage roots are a source of carbohydrates, while its leaves and green stems contain nutritional compounds in higher than many commercial vegetables [6-8]. Sweet potato leaves are cooked as vegetables in different locations of the world. The eating of Ipomoea batatas L. leaves as a vegetable in many parts of the world indicates that they are acceptable as edible like other traditional leafy vegetables. They are rich in phytonutrients and are further tolerant of diseases and pests than many other green plants [9-12]. Phytonutrients act as bioactive composites and a diverse group of secondary metabolites commonly present in higher plants [7,13-19]. They play important roles and contribute to the structure of the plants and complicated by a significant number of metabolic pathways [20,21]. Thus, the phenolic plant complexes, because of their diversity and widespread distribution, are the most exceptional talented group of natural antioxidants and add to the organoleptic and nutritional qualities of fruit and vegetables.

Diabetes mellitus is a common disease with many complications, such as atherosclerosis, cardiac dysfunction, retinopathy, neuropathy, and nephropathy [22]. α-glucosidase (EC 3.2.1.20) catalyzes the final step in the digestive process of carbohydrates. Its inhibitors can retard the uptake of dietary carbohydrates and suppress postprandial hyperglycemia and could be useful for treating diabetic and obese patients [23]. α-Glucosidase inhibitors such as acarbose, miglitol, and voglibose are known to reduce postprandial hyperglycemia primarily by interfering with the carbohydrate digestive enzymes and by delaying glucose absorption. Free radicals can lead to a variety of physiological and biochemical lesions [24] and induce degenerative diseases such as coronary disease, diabetes, stroke, and cancer [25]. The new expansion of screening approaches for environmental carcinogens by determining their mutagenicity has allowed detecting numerous types of mutagens and carcinogens in foods [2,24-27]. On the other hand, it is now recognized that several types of inhibitors act against mutagens and carcinogens in food. They show a substantial part in plummeting the dangers of mutagenesis and carcinogenesis [28]. Several authors described that the nutritive constituents of sweet potato tops are comparable to those of commercial leafy vegetables [2,6,14-18,26,29-30]. However, the physiological function of sweet potato leaves has not yet been deliberate synthetically. In the current article, the effects of the extracts of the selected sweet potato accessions with the diverse polyphenolic levels on the antidiabetic activity, mutagenicity, and antioxidant capacity are explored.

Materials and Methods

The leaves from six Ipomoea batatas L. (sweet potato) advanced accessions, namely AN-1, AN-2, AN-3., AN-3, AN-4, AN- 5, and AN-6, were used for this study. Sweet potato roots were planted 2 inches deep and about 2 inches apart (density of 5 cm x 5 cm) in a greenhouse and field conditions in late February (greenhouse) to March/April in the University of Arkansas at Pine Bluff’s Agricultural Research Farm, Pine Bluff, AR. After two months, tips were harvested every 10-15 days. Chemical fertilizer (N: P: K = 8: 8: 8) was used at a rate of 500 lbs/acre, and compost was used at a rate of 8000lbs/acre in volume. After each harvest, 150 lbs/acre of ammonium sulfate was applied as additional fertilizer. After harvest, the leaves were washed softly, moved into pre-labeled separate vinyl bags, and directly frozen at -85 ℃. The next day all the frozen samples were freeze-dried for 48 h in a freeze dryer. The freeze-dried samples were ground in a blender and used for laboratory analysis. The extract was prepared from the lyophilized flour (1g) using 20 mL of ice-cold water for 1h. The suspension was centrifuged at 18000 x g for 20 min, and the resultant precipitate was re-extracted under the same conditions. The collected supernatant was lyophilized and used for analysis.

α-Glucosidase inhibitory assay

The α-Glucosidase inhibitory assay was performed according to a slightly modified method described by Islam [31]. One hundred microliters of 3 mM pNPG in 0.2 M sodium phosphate buffer (pH 6.8) was added as a substrate to the mixture of 50 μl of α-glucosidase (0.15 unit/ml) and 50 μl of sample to start the reaction. The reaction was conducted at 37 ℃ for 15 min and stopped by the addition of 750 μl of 0.1 M Na2CO3. The α-Glucosidase activity assessed by measuring the release of p-nitrophenol from pNPG at 405 nm. Acarbose used as a positive control. All tests were performed in independent triplicate (n=3), and data were expressed as mean ± SD.

Extraction and Measurement of Total Phenolic

The total phenolic contents of the extracts were measured according to a slightly modified method described by Islam et al. [18]. The lyophilized sweet potato leaf extract was forcefully mixed with ten times its equivalent volume of 80% ethanol. The mixture was boiled for 5 min and centrifuged at 5000g for 10 min, and the supernatant was composed. The residue was mixed with an additional 80% ethanol and boiled for 10 min to re-extract the phenolic and centrifuged under similar conditions. The extracts were pooled and made up to 10 mL and used for to quantity of total phenolic. The alcohol extract was diluted to achieve an absorbance reading at the range of the standard tannic acid (TE). The results were stated as μmol TE g-1 DW (dry weight).

Antioxidant capacity in the DPPH assay

The radical-scavenging activity of the extracts was measured according to a slightly modified method described by Islam et al. [17]. A stock solution of DPPH (6 mM) was prepared by dissolving 0.0263g in 10 ml of ethanol (or methanol). The stock solution is diluted to develop a 60 μM working solution. Again, a ten mM stock solution of Trolox was ready for every sample tested. Dilutions were made for each sample tested. Dilution strength was dependent upon each extract’s relative antioxidant capacity. For each dilution, 20 μL were added to 2.5ml of DPPH solution and incubated in a dry bath at 37 ˚C for 30 min. Absorbances were measured at 520 nm on an ASYS UVM 340 plate reader. TEAC values were measured by comparing the slope of sample plots to the slope of Trolox. Antioxidant activity was reported as μmoles Trolox equivalent per gram dry weight sample (μmol TE/g DW).

Assay of antimutagenicity

The antimutagenicity assay was performed as described in earlier papers [27]. The antimutagenic activity was assessed for Salmonella typhimurium TA 98 using a mutagen, Trp-P-1. These mutagens need metabolic activation to induce mutation in TA 98. The s-9 mix containing 50 μmol of sodium phosphate buffer (pH 7.4), 4 μmol of MgCl2, 16.5 μmol of KCl, 2.5 μmol of glucose-6- phosphate, two μmole of NADH, 2 μmol of NADPH, and 50 μL of the S-9 fraction in a total volume of 0.5 mL. For the inhibition test, 0.1 mL of mutagen, 0.1 mL DMSO-dissolved polyphenolics solution, and 0.5 mL of S-9 mix or phosphate buffer were concurrently incubated with 0.1 mL of a bacterial suspension at 37 ℃ for 20 min and then dispensed into minimal-glucose-agar plates with 2 mL of soft agar. The colony number of each dish was accounted after 48 h cultivation at 37 ℃.

Statistical analysis

A randomized complete block design with three replications was adopted. Data for the different parameters were analyzed by analysis of variance (ANOVA) procedure, and the level of significance was calculated from the F value of ANOVA.

Results and Discussion

α-Glucosidase inhibitory effect

The α-glucosidase inhibition assay evaluated the antidiabetic activity, and the extract showed a considerable α-glucosidase inhibitory activity (Table 1). The leaf extract demonstrated a moderate to high inhibitory activity on α-glucosidase, among the genotypes, AN-6 (80% inhibition at 1000 μg/ml) exhibited the highest a-glucoside inhibitory activity, followed by AN-4 (75% inhibition at 1000 μg/ml) and AN-2 (80% inhibition at 1000 μg/ml). The results also suggested that the α-Glucosidase inhibitory effect in the sweet potato tops is dose-dependent (Table 1), and increasing the doses resulted in a higher rate of inhibition percentage. The leaf extract showed the inhibitory activity ranging from 22.33% to 74.98% on a-glucosidase from 10 to 1000 mg/ml, which was increased steadily with increasing sample concentrations. On the other hand, the control treatment (Acarbose) showed 98.01% inhibitory activity at the strength of 0.1 μg/ml.

One therapeutic approach for treating diabetes is to increase postprandial hyperglycemia. This is done by retarding the absorption of glucose through the inhibition of the carbohydrate hydrolyzing enzyme α-glucosidase in the digestive tract. Inhibitors of these enzymes delay carbohydrate digestion, causing a reduction in the rate of glucose absorption and consequently blunting the postprandial plasma glucose rise (Rhabasa and Chiasson, 2004) [32]. The results suggest that the Ipomoea batatas leaf extracts have the potentiality for treating diabetes by inhibiting α-glucosidase activity.

Total polyphenol content and antioxidant capacity

The antioxidant capacity (μmole Trolox/mg dry leaf powder) and total polyphenol (μmol TE g-1 DW) in the leaves of three genotypes are presented in Table 2. The genotypes fluctuated extensively in their total polyphenolic contents. The highest total phenolic found was 16.98 μmol TE g-1 DW, and the lowest was 7.68 μmol TE g-1 DW. The accessions AN-6 had higher content (16.98 μmol Trolox.g-1 DW) flowed by AN-4 (16.52 μmol Trolox.g-1 DW), and AN-5 (15.63 μmol Trolox.g-1 DW). The results showed that sweetpotato leaves had higher or similar content of total polyphenolics than other vegetables [12,17-18,21,29]. The data also suggested that there was a positive correlation between polyphenol contents and antioxidant activity. Because the accessions higher in total phenol contents also exhibited higher antioxidant activity. The above results also agree with the observations of Islam [6], where he added that sweet potato leaves, could serve as a new leafy vegetable. Acceptable tops should be tender, glabrous, and purplish. Those eating tops prefer the top 10 cm of tips, including both stem and leaves. Heads with the most significant number of leaves with petioles less than 4/10 of 1cm long are considered desirable because they are tender and suitable for vegetables. Petiole length varies widely with genotype and may range from approximately 10 to 40 cm [33]. (Table 2)

The antioxidant capacity of the genotypes ranges from 4.42 to 10.98 μmol Trolox g-1 DW. The accessions AN-4 (10.98 μmol Trolox.g-1 DW) had the highest contents of phenolic, followed by AN-6 (10.69 μmol Trolox.g-1 DW). The accessions AN-1 showed the lowest (4.42 μmol Trolox.g-1 DW) antioxidant activity followed by AN-2 (5.75 μmol Trolox.g-1 DW). The phenolic is pervasive bioactive compounds found in plant foods and beverages. The polyphenolic compounds show numerous biological functions, sweet potato leaves might also be expected to have physiologically active possessions because they comprise higher contents phytonutrients. The antioxidative substances contained in plant parts have attracted much consideration all over the world. Several researchers [17,27,34] have reported the radical scavenging and antioxidant activities of sweet potato leaves. The polyphenolics contents and antioxidant activity in sweet potato leaves, other different plants and foods showed a high correlation [6,16,17,26]. Usually, the antioxidant capacity of various plants is influenced by the genetic factor. Therefore, the extent of the antioxidant capacity may be a critical tool for use in plant breeding programs intended to improve antioxidant components available for human consumption. This result will be valuable for some chemical breeding programs to develop needed organoleptic and nutritional quality characteristics of crop plants.

Effects of water extract of leaves on the mutagenicity

The antimutagenic impact of the water extracts from sweet potato leaves of three genotypes were determined by antimutagenicity assays using Trp-P-1 at a dose of 0.075 μg/plate, and using three different doses of the sweet potato leaves extracts such as 100, 50 and 10 μg/plate (Table 3).

The results found that inhibitory activity was higher at higher doses in all genotypes studies. The inhibitory activity (%) ranged from 69 to 94 at 100μg/plate, 68 to 84 at 50μg/plate, and 61 to 73 at ten μg/plate doses. The highest activity found in the accessions AN-6 (90% inhibition at 100 ��L) followed by AN-5 (92% inhibition at 100 μL) while AN-2 (80% inhibition at 100 μL) had the lowest. Therefore, the results propose a wide disparity of antimutagenicity among the genotypes, and the extracts showed dose-dependent inhibitory activities. Similar trends were also found by several researchers [6,17,35,36]. The antimutagenic effect of the extract at low doses is relatively minor compared with the one from higher doses. (Table 4)

We also evaluated the antimutagenic activity of the extract using several mutagens, such as Trp-P-2, IQ, B[a] P, and DEGB (Table 4). The DEGB was utilized at a dose of 100 μL/plate without dilution. The s-9 mix was added for the assay using Trp-P-1, Trp-P-2, IQ, B[a] P, and DEGB to cause mutations in TA 98. The extract used in doses of 50, 10, and 5 μL/plate. The extract inhibited Trp-P-2 induced mutation by 14%, IQ by 88%, b[a] P by 27%, and Trp-P-1 by 71%, respectively, at the concentration of 10 μL/plate. Thus, the sweet potato leaf extract effectively decreased the reverse mutations induced by all purified mutagens tested. This study exhibited that Ipomoea batatas L. tops could be an outstanding source of natural active compounds with numerous biological functions with the aptitude to defend in contradiction of certain sorts of human illnesses. We tested several physiological functions of the leaves extracts in six advanced accessions. All the accessions tested accumulated higher physiological functions. The high biological activity in the leaves extracts, which might have values in the prevention of specific human conditions. Therefore, sweet potato leaves can be considered as a potential source of functional food and a pharmaceutical agent. Furthermore, the leaves with high phytonutrient content may be used as herb, tea, food ingredient, and a nutritional supplement that could be demanded to have a positive impact on human health.

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A Cross-Sectional Study of Cephalosporin Prescriptions for the Treatment of Respiratory and Urinary Tract Infections in Two Sudanese Hospitals

Abstract

Cephalosporins representing a wide variety of β-lactam antibiotics. Cephalosporins have some desirable features, including a convenience of administration, a reasonably broad spectrum of efficacy and a low incidence of toxicity. A descriptive cross-sectional study on the usage of cephalosporin for the treatment of respiratory tract infections (RTI) and urinary tract infections (UTI) was conducted at Ibnsinaa and Alshaab Hospitals in Khartoum state. The data were acquired via questionnaires sent to doctors and community pharmacists, as well as 48 patient files with UTI and RTI diagnoses. SPSS was used to examine the data. The study’s findings indicated that 90% of physicians and pharmacists do not follow cephalosporin prescription and dispensing recommendations. 73% of cephalosporins (3rd generation) are used to treat UTI, whereas 54% of cephalosporins (2nd generation) are used to treat RTI. At conclusion, the findings of this research reveal that the use of cephalosporin in these hospitals is often inconsistent with accepted therapeutic principles. To prevent the emergence of cephalosporin-resistant pathogens, healthcare providers should be cautious when prescribing antibiotics and remain current on recommended antibiotic practices and dosages.

Keywords: Antibiotics; Cephalosporin; UTI; RTI; Infections; Sudan

Introduction

Infectious diseases were a major cause of morbidity and death before to the turn of the twentieth century. Even in the industrialized world, the average life expectancy at birth for men and women was 46 and 48 years, respectively. Plaque, diphtheria, smallpox, pneumonia, cholera, typhoid fever, syphilis, tuberculosis, typhus, and other contagious illnesses were common [1]. Alexander Flemming’s discovery of the first antibiotic (penicillin) in 1928 revolutionized medicine and saved millions of lives [2]. Following the end of Second World War, the golden era of antibiotic discovery began. From the 1950s until the 1970s, dozens new antibiotics were discovered each year, and they revolutionized medicine. Without antibiotics, routine treatments such as open-heart surgery, chemotherapy for cancer patients with compromised immune systems, and organ transplantation would be impossible [3-5]. However, bacteria quickly evolved resistance to antibiotics, and the frequency of infections caused by multidrug-resistant bacteria is growing globally. Since the turn of the twenty-first century, the threat of untreatable diseases has loomed [6,7].

Cephalosporins were not discovered by chance. World War II needs pushed the quest for antibiotics generated by microorganisms [8]. Cephalosporins are antibiotics with a beta-lactam ring that are derived from the Acremonium fungus, commonly known as cephalosporium, this important antibiotic is widely used against bacteria in a variety of serious diseases, including respiratory tract infection (RTI), skin infection, and urinary tract infection (UTI) [9]. Cephalosporins currently come in five generations. With the development of fifth generation cephalosporins, infection management has become even more difficult. However, their use must be strictly limited because if bacteria develop resistance to the fifth generation cephalosporins, infection management will become very difficult [10] Over the last few decades, the rise and spread of beta-lactam resistance in nosocomial Enterobacteriaceae, Acinetobacter baumannii, and Pseudomonas aeruginosa, has become a major global concern. Particularly concerning is the rising resistance to third- and fourth generation cephalosporins [11].

Antibiotics are widely utilized in Sudan, and the majority of hospitals in the country rely heavily on cephalosporin antibiotics, especially in surgical departments, as the preferred option for prophylaxis [12]. Accordingly, the current study aimed to evaluate use of cephalosporin in the treatment of respiratory and urinary tract infections in two Sudanese hospitals (Ibnsinaa and Alshaab Hospitals).

Methodology

Study design

This study used a descriptive cross-sectional survey to confirm and/or refute assumptions about the attitudes of health professionals in two hospitals in Khartoum that treat patients with UTI and RTI with cephalosporins, as well as to evaluate the results in order to comprehend and resolve the study’s issue.

Study area

The study took place in two hospitals in Khartoum, Sudan’s capital: Ibnsinaa and Alshaab Hospitals in the state of Khartoum.

Study duration

Two months, between May and July 2018, the surveys were performed utilizing a questionnaire to gather data.

Data collection

The sample size was chosen to be 96 prior to completing the survey. The questionnaire was anonymous. It elicited data on cephalosporins administered for UTI and RTI under treatment recommendations, the Protocol for Dispensing Cephalosporin, the Mode of Prescription, the Common Cephalosporin Used to Manage UTI and RTI, and Counseling Patients About Drugs.

Ethical approval statement

The research used a cross-sectional design. The study protocol was authorized by the ethical committee at Alneelain University’s Faculty of Pharmacy in Khartoum, Sudan, in accordance with the Helsinki Declaration for the conduct of human experimentation. Each participant completed an informed permission form after receiving a thorough verbal summary of the process.

Statistical analysis

The statistical analyses were performed, classified, and analyzed using SPSS. The descriptive data and results were presented using tables and figures. To compare and correlate variables, the chi-square test was utilized.

Results and Discussion

Cross-sectional studies often enable researchers to gather a large amount of data fast. Self-report questionnaires are often used to acquire data affordably. However, causal correlations might be difficult to deduce from cross-sectional data [13].

According to our current study, numerous significant facts were discovered throughout the present cross-sectional investigation. As seen in (Table 1), the protocol for treating RTI and UTI infections at the respective institutions which should be followed by healthcare providers. Clinical guidelines are gaining popularity as a tool for clinicians to use to influence their practice. No guideline, however, can be sufficiently detailed to apply to all clinical circumstances [14].

Additionally, 90 % of healthcare personnel (physicians and pharmacists) at these two hospitals do not adhere to cephalosporin prescription and dispensing guidelines (Table 2). These intriguing results highlight a global concern, especially in developing countries where antibiotic stewardship is poor. Regretfully, the irrational use of antibiotics in Sudan is well-documented [15,16]. According to previously published data, even developing countries with a better health situation than Sudan, a significant amount of antibiotics is provided without a prescription, and a large percentage of antibiotics supplied are unsuitable for the illnesses being treated [17]. The WHO acknowledged irrational antibiotic usage as a significant role in the development of antimicrobial resistance in its two publications, ‘Global Strategy for Antimicrobial Resistance Containment’ and ‘The Pursuit of Responsible Medicines’ and therefore, health authorities in developing countries should tackle this concern [18].

In our study, as shown in (Figure 1-3), 90 % of healthcare providers at these hospitals did not follow specific manner in prescription of cephalosporins for UTI and RTI patients. 4% of participants prescribed first generation cephalosporins, 17% prescribed second generation, 73% prescribed third generation, and 6% prescribed other antibiotics, as shown in Figure 2 & 3. As a result, the third-generation cephalosporin is the most often used antibiotic to treat urinary tract infections. Additionally, our survey found that 6% of respondents prescribed the first generation of cephalosporins to control RTI infections, 54% used the second generation, 31% used the third generation, and 8% used others, as shown in Figure 2 & 3. As a result, we discovered that second generation cephalosporins are effective in treating RTI infections in our investigation.

Numerous clinics worldwide give cephalosporins to patients in excess of what is necessary and with an excess of extravagance that borders on abuse, necessitating medical monitoring and control to prevent the establishment of anti-cephalosporin infections [19,20]. Fortunately, several institutions have recognized the negative repercussions and created control procedures aimed at possibly limiting antibiotic usage and abuse [21]. These control strategies must be implemented as soon as possible in developing countries such as Sudan, since some countries have reported infections and the rise of cephalosporin-resistant pathogens. For instance, Acinetobacter baumannii strains was detected highly resistant to cephalosporins and β-lactamases in Syria [22], In the United Kingdom, Enterobacter cloacae reported resistant to third generation cephalosporins [23], and Klebsiella infection which was found resistant to late-generation cephalosporins in a nosocomial outbreak in the United States [24]. Finally, Effective antibiotic resistance prevention strategies are available and should be adopted aggressively in critical care units. These strategies fall into three categories: nonpharmacologic infection control, antibiotic management and increasing existing efforts to avoid antibacterial resistance, particularly given the expected future scarcity of novel antibacterial medication classes [25].

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The Harmonious Interactions of the Dancer and the Body

The Harmonious Interactions of the Dancer and the Body by Brandon Monzon* in Research & Investigations in Sports Medicine_ Movement Research

Opinion

How do dancers efficiently use motion in modern dance to create elegant movement with their instruments? Professor Bill DeYoung is exploring that question. Advances in kinesiology and Movement Research during the last half-century have enabled DeYoung to develop the Aesthetics of Balance Project (ABP). The goal is to help dancers become more aware of how the human instrument works by developing training tools that enable them to identify specific muscle connections to enhance technical performance. The ABP, which is funded by research grants from U-M’s Office of Research and SMTD, comprises two teams. One team is focusing on developing a wearable “inertial measurement unit” (IMU) that provides sound feedback to enable balance training tools for dancers. The other team is developing smart phone delivery of physical therapy exercises for dancers. DeYoung developed the ABP by partnering with physicians, physical therapists, biomechanical engineers, and cinematographers-along with SMTD dance faculty, alumni, and current students.

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Awareness about Liver Cancer in Biotechnology Students_Crimson Publishers

Awareness about Liver Cancer in Biotechnology Students by Muhammad Imran Qadir in Novel Approaches in Cancer Study 

Liver cancer is a major disease caused by sudden mutation occurred in the genes. To cure this disease gemcitabine seems to be affective. Gemcitabine is anticancer agent that has profile containing mild toxicity. It seems to be affective in solid tumors. To check its effectiveness, a questionnaire was developed and the awareness about liver cancer is checked in the post graduate students. All the students were fully aware of this disease.

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Consideration of the Light and Dark Sides of Medicines: The Thalidomide Example_Crimson Publishers

Consideration of the Light and Dark Sides of Medicines: The Thalidomide Example by Fumihiko Hinoshita* in Advancements in Case Studies

It is easy to imagine that the use of medicines, even though primitive, started with the history of human beings. There seems to have been numerous medicines in ancient Egypt [1] thousands of years ago and also in ancient China where there were many kinds of herbal medicines [2,3]. Traces of herbal or medicinal plants, which might have been utilized, were discovered in ancient ruins in various places throughout the world. Similarly, all of the people living in the world with advanced medical and pharmaceutical sciences cannot live without the medicines of today, even though the current medicines are markedly progressed compared with those of the ancient times. In fact, we receive great benefits from a variety of extremely effective drugs.

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