The purple-spotted bigeye, Priacanthus tayenus, is a marine benthic fish native to the Indian and Pacific Oceans, including the Arabian Gulf in Saudi Arabia. This study identified a myxozoan parasite infecting wild P. tayenus from the Saudi Arabian Gulf. These parasites produced spherical to ovoid-shaped, white plasmodia enclosed within pseudocysts in the fish musculature. The annual infection rate was 5.1%, with the highest prevalence in summer (7.6%), followed by spring (6%), and autumn (2.5%), while no infections were observed in winter. The number of plasmodia per fish ranged from 100 to 150 (135.1 ± 16.2). Their dimensions were 4–4.7 mm (4.3 ± 0.3 mm) in length and 4.5–7 mm (6 ± 1.1 mm) in width. Milky-colored exudates within the plasmodia contained mature spores measuring 8–9 μm (8.6 ± 0.4 μm) x 6–7.5 μm (6.9 ± 0.5 μm). The polar capsules of the spores exhibited dimensions of 2–5 μm (3.5 ± 0.5 μm) x 2.5–4.5 μm (3 ± 0.45 μm). Both morphological and genetic analyses confirmed these plasmodia as a novel Kudoa species. Histopathological examination revealed atrophy in the surrounding muscles without an inflammatory response. This study documents the first occurrence of a novel Kudoa sp. in P. tayenus at the Jubail landing site in Saudi Arabia, emphasizing the need for further surveillance and investigations to elucidate its pathogenesis and implications for wild fish stocks.

SummaryBackground
Timely and safe elective health care facilitates return to normal activities for patients and prevents emergency admissions. Surgery is a cornerstone of elective care and relies on complex pathways. This study aimed to take a whole-system approach to evaluating access to and quality of elective health care globally, using inguinal hernia as a tracer condition.
Methods
This was a prospective, international, cohort study conducted between Jan 30 and May 21, 2023, in which any hospital performing inguinal hernia repairs was eligible to take part. Consecutive patients of any age undergoing primary inguinal hernia repair were included. A measurement set mapped to the attributes of WHO's Health System Building Blocks was defined to evaluate access (emergency surgery rates, bowel resection rates, and waiting times) and quality (mesh use, day-case rates, and postoperative complications). These were compared across World Bank income groups (high-income, upper-middle-income, lower-middle-income, and low-income countries), adjusted for hospital and country. Factors associated with postoperative complications were explored with a three-level multilevel logistic regression model.
Findings
18 058 patients from 640 hospitals in 83 countries were included, of whom 1287 (7·1%) underwent emergency surgery. Emergency surgery rates increased from high-income to low-income countries (6·8%, 9·7%, 11·4%, 14·2%), accompanied by an increase in bowel resection rates (1·2%, 1·4%, 2·3%, 4·2%). Overall waiting times for elective surgery were similar around the world (median 8·0 months from symptoms to surgery), largely because of delays between symptom onset and diagnosis rather than waiting for treatment. In 14 768 elective operations in adults, mesh use decreased from high-income to low-income countries (97·6%, 94·3%, 80·6%, 61·0%). In patients eligible for day-case surgery (n=12 658), day-case rates were low and variable (50·0%, 38·0%, 42·1%, 44·5%). Complications occurred in 2415 (13·4%) of 18 018 patients and were more common after emergency surgery (adjusted odds ratio 2·06, 95% CI 1·72–2·46) and bowel resection (1·85, 1·31–2·63), and less common after day-case surgery (0·39, 0·34–0·44).
Interpretation
This study demonstrates that elective health care is essential to preventing over-reliance on emergency systems. We identified actionable targets for system strengthening: clear referral pathways and increasing mesh repair in lower-income settings, and boosting day-case surgery in all income settings. These measures might strengthen non-surgical pathways too, reducing the burden on society and health services.
Funding
NIHR Global Health Research Unit on Global Surgery and Portuguese Hernia and Abdominal Wall Society (Sociedade Portuguesa de Hernia e Parede Abdominal).

Quartzite caves located on table-top mountains (tepuis) in the Guyana Shield, are ancient, remote, and pristine subterranean environments where microbes have evolved peculiar metabolic strategies to thrive in silica-rich, slightly acidic and oligotrophic conditions. In this study, we explored the culturable fraction of the microbiota inhabiting the (ortho)quartzite cave systems in Venezuelan tepui (remote table-top mountains) and we investigated their metabolic and enzymatic activities in relation with silica solubilization and extracellular hydrolytic activities as well as the capacity to produce antimicrobial compounds. Eighty microbial strains were isolated with a range of different enzymatic capabilities. More than half of the isolated strains performed at least three enzymatic activities and four bacterial strains displayed antimicrobial activities. The antimicrobial producers Paraburkholderia bryophila CMB_CA002 and Sphingomonas sp. MEM_CA187, were further analyzed by conducting chemotaxonomy, phylogenomics, and phenomics. While the isolate MEM_CA187 represents a novel species of the genus Sphingomonas, for which the name Sphingomonas imawarii sp. nov. is proposed, P. bryophila CMB_CA002 is affiliated with a few strains of the same species that are antimicrobial producers. Chemical analyses demonstrated that CMB_CA002 produces ditropolonyl sulfide that has a broad range of activity and a possibly novel siderophore. Although the antimicrobial compounds produced by MEM_CA187 could not be identified through HPLC-MS analysis due to the absence of reference compounds, it represents the first soil-associated Sphingomonas strain with the capacity to produce antimicrobials. This work provides first insights into the metabolic potential present in quartzite cave systems pointing out that these environments are a novel and still understudied source of microbial strains with biotechnological potential.

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Recently, the integrated different interdisciplinary studies derived the environmental solutions of the climate change impacts (e.g., cultivation, wastewater treatment, and managing groundwater resources) (Mesalhy et al. 2020, and Gobashy et al. 2021). Thus, this paper focused on the application of bioremediation to maximize the use of wastewater for new reclamation areas in the Northwest Egyptian desert (New Egyptian Delta (NED). In the NED project, the drainage water samples collected from Nile Delta drains will provide the main unconventional water resources for irrigation through the new Hammam canal. Therefore, three Pleurotus strains were grown moderately on two natural media, the first containing Salvia L. (sage) extract (MDA) and the second containing Thymus vulgaris L. (origanum thymus Kuntze, Thymus collinus Salisb) (TDA) extract replacing potato infusions in standard PDA. Pleurotus ostreatus (Jacquin; Kummer) strain records the highest growth among the three tested fungi on modified media. PO records 4.49 and 4.41 cm on (MDA) and (TDA), respectively. There is a marked decrease in the majority of heavy metal concentrations on sterile drainage water amended with PD broth and inoculated with three tested Pleurotus strains individually. At the end of the incubation period, Pleurotus ostereatus which expressed in abbreviation (PO) are more efficient in the removal of Al, Co, Cr, and Ni by 53.15, 95.87, 58.47, and 85.07%; respectively. Pleurorotus pulmonarius (Fr.) which symbolized (PP) is more potent in the removal of Cd, Si, Sn, Sr, and V by 70.37, 56.59, 41.19, 52.78, and 96.24%; respectively. Pleurotus floridanus (NZOR) which indicated as (PF) is actively over the former species in the removal of Ba, Fe, and Mo by 87.84, 46.67, and 97.34%; respectively. Cu, Mn, Pb, As, and Se could not be detected as the control sample recorded measurements below 0.009 mg L−1. An unexpected increase in Zn among the different treatments was detected from 05.04 to 07.01%.

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The effect of the addition of nanoparticulate (organo-modified montmorillonite—MMT) into polyamide 66 (PA66) on the glass transition temperature (Tg), storage modulus (G′), and the electrical properties has been elucidated employing differential scanning calorimetry (DSC), dynamical mechanical analysis (DMA) and dielectric relaxation spectroscopy (DRS) techniques. The glass transition temperature decreases with the incorporation of clay nanoparticles. DMA technique is valuable and is the most sensitive thermal analysis technique for measuring Tg. It was noticed that as filler content increases the storage modulus increases meanwhile, it decreases as the temperature increases. Tested samples were formed to study the dielectric and conduction properties in the frequency range (10 mHz–10 MHz) at different temperatures in the range (+ 173 K to 503 K). One deduces that the dielectric constant (ε′) and ac electrical conductivity (σac) increase with increasing filler content and temperature. Referring to the loss tangent (tan δ)–temperature curve for all samples, three different relaxations (α, β and γ) were detected and the calculated activation energy of these peaks were found to increase with organo-modified montmorillonite contents. The correlated barrier hopping conduction mechanism predominates the mechanism of neat polymer and its nanocomposites. Addition of 29.2 wt % filler shifted the mileage of hopping (R) toward lower value by approximately 40%. Different theoretical models were used to evaluate the effective dielectric constant (εe) of the nanocomposites.

SummaryBackground
Safe anaesthesia and surgery are a public health imperative. There are few data describing outcomes for children undergoing anaesthesia and surgery in Africa. We aimed to get robust epidemiological data to describe patient care and outcomes for children undergoing anaesthesia and surgery in hospitals in Africa.
Methods
This study was a 14-day, international, prospective, observational cohort study of children (aged <18 years) undergoing surgery in Africa. We recruited as many hospitals as possible across all levels of care (first, second, and third) providing surgical treatment. Each hospital recruited all eligible children for a 14-day period commencing on the date chosen by each participating hospital within the study recruitment period from Jan 15 to Dec 23, 2022. Data were collected prospectively for consecutive patients on paper case record forms. The primary outcome was in-hospital postoperative complications within 30 days of surgery and the secondary outcome was in-hospital mortality within 30 days after surgery. We also collected hospital-level data describing equipment, facilities, and protocols available. This study is registered with ClinicalTrials.gov, NCT05061407.
Findings
We recruited 8625 children from 249 hospitals in 31 African countries. The mean age was 6·1 (SD 4·9) years, with 5675 (66·0%) of 8600 children being male. Most children (6110 [71·2%] of 8579 patients) were from category 1 of the American Society of Anesthesiologists Physical Status score undergoing elective surgery (5325 [61·9%] of 8604 patients). Postoperative complications occurred in 1532 (18·0%) of 8515 children, predominated by infections (971 [11·4%] of 8538 children). Deaths occurred in 199 (2·3%) of 8596 patients, 169 (84·9%) of 199 patients following emergency surgeries. Deaths following postoperative complications occurred in 166 (10·8%) of 1530 complications. Operating rooms were reported as safe for anaesthesia and surgery for neonates (121 [54·3%] of 223 hospitals), infants (147 [65·9%] of 223 hospitals), and children younger than 6 years (188 [84·3%] of 223 hospitals).
Interpretation
Outcomes following anaesthesia and surgery for children in Africa are poor, with complication rates up to four-fold higher (18% vs 4·4–14%) and mortality rates 11-fold higher than high-income countries in a crude, unadjusted comparison (23·15 deaths vs 2·18 deaths per 1000 children). To improve surgical outcomes for children in Africa, we need health system strengthening, provision of safe environments for anaesthesia and surgery, and strategies to address the high rate of failure to rescue.
Funding
Jan Pretorius Research Fund of the South African Society of Anaesthesiologists and Association of Anesthesiologists of Uganda.

The ability of wound dressing materials to tackle skin pathogens colonization that is associated with open wound infections is limited. Recently, green-synthesized metal oxide nanoparticles has received a lot of attention to overcome this limitation. However, titanium dioxide nanoparticles (TiO2-NPs) exhibit exceptional antibacterial properties. In this work, several concentrations (0, 1, 3, and 5 wt.%) of TiO2 NPs prepared using Aloe vera leaf extract were added to a blend of polyvinyl alcohol and sodium alginate (PVA:SA). This nanocomposite was designed to enhance the healing process of wounds. The interaction between the PVA:SA composite and the TiO2 NPs was confirmed by FTIR. The thermal behavior of the nanocomposite films was investigated using DSC and TGA. The experimental results indicate that the glass transition temperatures of the nanocomposites increased by increasing the added amount of TiO2 NPs to be 53.7 °C (1 wt.%), 55.8 °C (3 wt.%), and 60.6 °C (5 wt.%), which were consistently lower than the glass transition temperature of the matrix material (69.6 °C). The Dynamic Mechanical Analysis was examined. The nanocomposite doped with 5 wt.% of TiO2 NPs detected a high storage modulus (21.6 × 108). Based on swelling and degradation studies, the prepared PVA:SA:TiO2 nanocomposite films have an excellent swelling rate, and the inclusion of TiO2 NPs increases the stability of the polymeric matrix. The PVA:SA:TiO2 nanocomposite films exhibited a superior antibacterial efficacy against Gram-positive bacteria such as Bacillus cereus and Staphylococcus aureus, compared to their effectiveness against Gram-negative bacteria like Escherichia coli. Moreover, the nanocomposite films were biocompatible with Human Skin Fibroblast. Therefore, the developed PVA:SA:TiO2 nanocomposite films suit wound dressing applications.

The aim of this study is to identify the hidden etiologies of the black chromo-shifting transient phenomenon affecting Nile tilapia, Oreochromis niloticus, farmed in RAS-controlled ponds together with the assessment of the immunological reaction against the chronic irritating effects of the invasive agent. A total of 100 Nile Tilapia were collected from a private farm at Kafrelsheikh Province, located on the northern side of the Egyptian Nile Delta. The clinical history of the affected fish farm showed an unknown chromo-shifting phenomenon where tilapias were exhibiting severe black skin coloration, which gradually disappeared after removal from the tank’s water. A comprehensive gross examination of the collected fish; including parasitological examination of skin and gill scraps, was performed. Blood biochemical testing was performed on the infested blackish O. niloticus and control non-infested fish. The current study showed that the monogenean parasite, Gyrodactylus cichlidarum, was the abundant parasite detected in the infested fish leading to abnormal black discoloration of skin and disruption of the immune system represented by significant increase of cortisol levels, lysozyme activity and different liver enzymes compared to the control. Treatment trials have been applied with moderate degrees of success, where the monogenean count was sharply decreased, and the normal skin color was remarkably restored, at the end of day 14 post-treatment. A triple treatment plan was initiated through 7 days’ application of 0.7 g/m3 copper sulfates pentahydrate preceded by 1.5 ml/m3 hydrogen peroxide 40% solution for the same period. One day after the end of the initial treatment, a maintenance dosage of 0.095 ml/m3 of glutaraldehyde (15%)/quaternary ammonium compounds (QACs) mixture was administered for 3 days. As a supportive/immune-stimulant regimen, a weekly dosage of vitamin C (0.45 g g/m3) and Saccharomyces cerevisiae (0.45 g/m3) was added into the tank’s water to improve the general fish health.

Ovarian follicular fluid (FF) is a dynamic environment that changes with the seasons, affecting follicle development, ovulation, and oocyte quality. Cells in the follicles release tiny particles called extracellular vesicles (EVs) containing vital regulatory molecules, such as microRNAs (miRNAs). These miRNAs are pivotal in facilitating communication within the follicles through diverse signaling and information transfer forms. EV-coupled miRNA signaling is implicated to be associated with ovarian function, follicle and oocyte growth and response to various environmental insults. Herein, we investigated how seasonal variations directly influence the ovulatory and anovulatory states of ovarian follicles and how are they associated with follicular fluid EV-coupled miRNA dynamics in horses.