Ashraf Abu-Seida

The high abundance and advantages of polysaccharides make them among the most widely used chiral stationary phases in liquid chromatography. However, extended analysis time and consumption of toxic organic solvents, associated with traditional columns, remain the main stumbling blocks of such methods’ sustainability. A new green chiral HPLC-separation, with just 0.45 mL ethanol in mobile phase per run utilizing a 50-mm column as a stationary phase, achieves a significant determination of alfuzosin (ALF) enantiomers along with solifenacin (SOL) simultaneously. Enantioseparation of ALF was firstly evaluated in the reversed-phase mode using five polysaccharide-based Lux columns (Amylose 2 and Cellulose 1–4), highlighting Lux Cellulose 2 to reach the best enantioselectivity. Central composite design with Derringer's desirability function was then adopted to optimize the chromatographic conditions for an acceptable resolution. A mobile phase composed of ethanol and phosphate buffer, pH 4, (30:70, v/v) at a rate of 0.5 mL/min with UV-detection at 215 nm, exhibits good separation of ALF-enantiomers from SOL with resolution values of 1.45 and 2.64, respectively. The method’s greenness profile has been assessed and compared with that of mostly reported ones via the newest comprehensive analytical method greenness score (AMGS) calculator. The proposed method is considered a straightforward approach towards safer, more economic, eco-friendly and comparatively favorable for the cited drugs’ quantification in their formulation.

Abstract In farmed saltwater fish, vaccination is considered the first barrier against pathogenic agents. In Egypt, the vaccine application can diminish the dilemma of summer mass kills of farmed marine fish. The efficacy of booster vaccination with a bivalent vaccine against vibriosis was studied in European seabass. Fish were vaccinated by direct immersion (DI) in water containing bivalent Vibrio alginolyticus and Vibrio parahemolyticus whole cells killed vaccine. Immersion vaccination is more applicable under semi-intensive fish culture, but less potent than injection. Accordingly, to increase antigen uptake and conferred protection, vaccinated fish randomly received booster vaccination via direct immersion (DI imm.) or intraperitoneal injection (i.p.) at 21 days post-prime vaccination (21 dpv). Vaccinated and unvaccinated fish were monitored for 3 months and challenged with V. alginolyticus and/or V. parahemolyticus at 42 dpv. Specific and non-specific immune responses were evaluated in blood samples. At 52 dpv (10 days post-challenge), the relative immunoglobulin T (IgT) expression was assessed in the gills, hindgut, head kidney and spleen. Notably, imm. + imm. and imm. + i.p. vaccination yielded significantly higher specific antibody titre at 70 dpv, whereas the former was associated with significantly higher IgT expression in the gills and hindgut (p < .05) than the latter. High IgT levels in mucosal organs (gills and hindgut) might be the first indicator of the involvement of IgT in mucosal immune responses. Relative per cent survival among booster-vaccinated fish ranged from 70% to 90%. The results support the use of this vaccination protocol as a highly effective tool to protect seabass from vibriosis and to improve fish health and environment. Booster doses are strongly recommended under farming environments.

Background: Multidimensional educational interventions to reduce or prevent medication dispensing errors (MDEs) in community pharmacies have not been investigated in Jordan. Objectives: The study aimed to assess whether educational interventions could improve the incidence, types, and severity of the MDEs in community pharmacies in Jordan. Methods: This was a randomised, two-arm, single-blinded, controlled trial conducted in community pharmacies in Jordan between 1st June and 15th September, 2020. Community pharmacies were randomised via a computer software to either control or intervention group. The pharmacists randomised into the intervention group were provided a multidimensional educational intervention delivered by experts of infectious diseases, family medicine, and clinical pharmacy. For outcome assessment, the trained data collectors performed a direct observation to detect MDEs in the control and intervention groups using a standardised data collection form. The errors were divided into prescription-related errors (PREs; errors that occurred during the dispensing of prescriptions) and pharmacist counselling errors (PCEs; errors that occurred when the pharmacist incorrectly dispenses a prescription-only medicine without a prescription). A multidisciplinary committee rated the clinical significance of MDEs. Results: The incidence of MDEs decreased from 21.4% (control) to 9.2% (intervention); the rates of MDEs based on pharmacist counselling and prescriptions were 11.4% and 10.0%, respectively, in the control group and 2.3% and 6.8%, respectively, in the intervention group. Types of errors and erroneous therapeutic categories across the two groups were different. The proportions of moderate and serious incidents were considerably decreased from 56.2 and 6.6% (control) to 12.9% and 3.2% (intervention), respectively. Most of the errors in the intervention group were caused by work overload (69.4%) and omission errors due to out-of-stock medications (9.7%). In the control group, physician poor handwriting (29.9%), inexperienced staff (27.0%), and interruptions (15.3%) were the major causes of MDEs. Conclusion: Educational interventions decreased the incidence of errors and reduced the clinical severity of incidents during dispensing. However, the effects of this approach on the system-induced errors (e.g. errors due to work overload and drug supply shortages) are limited. © 2021, The Author(s), under exclusive licence to Springer Nature Switzerland AG.

Adaptive seating is commonly used as an intervention method to enhance postural control. The aim of this study is to investigate the effect of using therapy ball as a seat alternative to using typical chair on grasping and visual motor integration in the children with hemiparetic cerebral palsy. For this aim, thirty children with hemiparetic cerebral palsy from both sexes were included in this study. The children ages ranged from 3 to 6 years old. The degree of spasticity was 1 to 1+ according to modified Ashworth scale. The children were able to sit independently and follow instructions. Children were randomly assigned into two groups (experimental group and control group). Each child was evaluated before and after 3 successive months of selected occupational therapy exercises program. All the children of both groups received the same selected occupational therapy exercises program, but the children in the experimental group performed the exercises while sitting on therapy ball, and the children in the control group performed the exercises while sitting on typical chair.

Summary We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05?1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4?7 days or ≥ 8 days of 1.25 (1.04?1.48), p = 0.015 and 1.31 (1.11?1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care.

Parasites often cause serious outbreaks of disease in farmed fish. The present study is the first to describe the antiparasitic efficacy of Acriflavine on Oreochromis niloticus parasitized with Centrocestus formosanus metacercariae and Trichodina centrostrigeata protozoa. A total of 550 O. niloticus suffering from respiratory distress were collected from a fish farm. Clinical and parasitological examinations of 150 fish revealed a mixed infestation with Centrocestus formosanus and Trichodina centrostrigeata. The median lethal dose (LC50) of Acriflavine (5, 10, 25, 50, & 100 mg/L) was calculated against 160 healthy O. niloticus. Results revealed that the 12 h and 96 h LC50 of Acriflavine was 114.61 and 35.196 mg/L. Further, an experimental design consisting of three fish groups was used to assess the efficacy of Acriflavine (10 mg/L, long-term bath) against Centrocestus formosanus- and Trichodina centrostrigeata-infested fish; the first group was treated with Acriflavine (treated fish), the second group was not treated (nontreated fish) and the third group was healthy fish (negative control). Acriflavine was effective against Centrocestus formosanus and Trichodina centrostrigeata, reducing the mean intensity of parasites by 91.1% and 95.6%, respectively, compared with infested fish (nontreated). Moreover, treated fish exhibited restoration of normal gill histoarchitecture and normal central cartilaginous support after treatment. Treated O. niloticus also showed significant downregulation of inflammatory-related enzyme (Cox-2) and pro-inflammatory cytokine (IL-1ß) genes compared with infested fish, as well as a significant reduction in lipid peroxidation (LPO) levels. Acriflavine provides a safe and efficient treatment for controlling Centrocestus formosanus metacercariae and Trichodina centrostrigeata protozoans, improving the health, productivity and welfare of Oreochromis niloticus.

Numerous epidemiological investigations and randomized clinical studies have determined that dyslipidemia is a major contributor to atherosclerotic cardiovascular disease (ASCVD). Consequently, the management of serum cholesterol and low-density lipoprotein levels has become a central objective in the effort to prevent cardiovascular events.

Nano-sized arsenic oxide nanoparticles (As2O3-NP) limit crop growth and productivity. As2O3-NP represent a strong environmental hazard. The predicted rise in future atmospheric CO2 could boost plant growth both under optimal and heavy metal stress conditions. So far, the phytotoxicity of As2O3-NP and their interaction with eCO2 were not investigated at physiological and metabolic levels in crop species groups such as C3 and C4. We investigated how eCO2 level (620 ppm) alleviated soil As2O3-NP toxicity induced growth and mitigated oxidative damages through analysing photosynthetic parameters, primary (sugars and amino acids) and secondary (phenolics, flavonoids and anthocyanins) metabolism in C3 (barley) and C4 (maize) plants. Compared to maize, barley accumulated higher As2O3-NP level, which inhibited growth and induced oxidative damage particularly in barley (increased H2O2 and lipid peroxidation). Interestingly, eCO2 differently mitigated As2O3-NP toxicity on photosynthesis, which consequently improved sugar metabolism. Moreover, high carbon availability in eCO2 treated plants directed to produce osmo-protectant (soluble sugars and proline) and antioxidants (anthocyanins and tocopherols). In the line with increased proline and anthocyanins, their metabolism was also improved. Notable differences occurred between the two plant species. The ornithine pathway was preferred in maize while in barley proline accumulation was mainly through glutamate pathway. Moreover, under As2O3-NP stress, barley preferentially accumulated anthocyanins while maize accumulated total phenolics and flavonoids. This work contributes to improving our understanding of the differences in growth, physiological and biochemical responses of major crops of two functional photosynthetic groups (C3 and C4 plants) under ambient and elevated CO2 grown under As2O3-NP stress.

Pb, Ni, and Co are among the most toxic heavy metals that pose direct risks to humans and biota. There are no published studies on biochars produced at low temperatures (i.e., 300 °C), which possess high sorption capacity for heavy metal remediation and reclamation of contaminated sandy soils. This research studied the effect of catalytic microwave pyrolysis of switchgrass (SG) using bentonite and K3PO4 to produce biochar at low temperature (300 °C) with high sorption capacity for reducing the phytotoxicity of heavy metals, and investigated the synergistic effects of catalyst mixture on biochar sorption capacity. The quality of the biochars was examined in terms of their impacts on plant growth, reducing phytotoxicity and uptake of heavy metals in sandy soil spiked with Pb, Ni, and Co. All catalysts increased the micropore surface area and cation-exchange capacity of biochars, and resulted in biochars rich in plant nutrients, which not only decreased heavy metal phytotoxicity, but also boosted plant growth in the spiked soil by up to 140% compared to the sample without biochar. By mixing bentonite and K3PO4 with SG during microwave pyrolysis, the efficacy of biochar in reducing phytotoxicity and heavy metals uptake was further enhanced because of the highest micropore surface area (402 m2/g), moderate contents of Ca, Mg, K, and Fe for ion-exchange and moderate concentration of phosphorus for the formation of insoluble heavy metal compounds. Generally, the biochar created at 300 °C (300-30KP) showed similar performance to the biochar created at 400 °C (400-30KP) in terms of reducing heavy metal bioavailability.

This work aimed to formulate clotrimazole (CLZ), a water-insoluble antifungal drug, into a chitosan-coated microemulsion system for achieving enhanced ocular delivery. In this study, CLZ loaded microemulsions were firstly prepared according to 22 × 31 full factorial design in order to investigate the influence of different formulation variables on microemulsion properties. The selected microemulsion formulation (F4: oleic acid, Cremophor EL: Transcutol HP (1:1) and water (20, 70 and 10%, w/w, respectively)) showed nanosized spherical globules with a droplet size of 229.1 ± 0.989 nm, polydispersity index of 0.5085 ± 0.0095, and zeta potential of −33.3 ± 0.98 mV. The selected microemulsion was then coated with low molecular weight chitosan to increase the contact time with the eye surface. In vivo studies in albino rabbits demonstrated the superiority of chitosan-coated microemulsion over the uncoated microemulsion and drug suspension formulation concerning sustainment of antifungal activity over the eye surface. Moreover, the in vivo, ocular tolerance and histopathological studies conducted using male albino rabbits proved the safety of the prepared microemulsions after topical ocular application. Generally, the obtained results confirmed that CLZ chitosan-coated microemulsion could be promising for ocular CLZ delivery.

This work aimed to formulate clotrimazole (CLZ), a water-insoluble antifungal drug, into a chitosan-coated microemulsion system for achieving enhanced ocular delivery. In this study, CLZ loaded microemulsions were firstly prepared according to 22 × 31 full factorial design in order to investigate the influence of different formulation variables on microemulsion properties. The selected microemulsion formulation (F4: oleic acid, Cremophor EL: Transcutol HP (1:1) and water (20, 70 and 10%, w/w, respectively)) showed nanosized spherical globules with a droplet size of 229.1 ± 0.989 nm, polydispersity index of 0.5085 ± 0.0095, and zeta potential of −33.3 ± 0.98 mV. The selected microemulsion was then coated with low molecular weight chitosan to increase the contact time with the eye surface. In vivo studies in albino rabbits demonstrated the superiority of chitosan-coated microemulsion over the uncoated microemulsion and drug suspension formulation concerning sustainment of antifungal activity over the eye surface. Moreover, the in vivo, ocular tolerance and histopathological studies conducted using male albino rabbits proved the safety of the prepared microemulsions after topical ocular application. Generally, the obtained results confirmed that CLZ chitosan-coated microemulsion could be promising for ocular CLZ delivery.

SummaryBackground
Risk of mortality following surgery in patients across Africa is twice as high as the global average. Most of these deaths occur on hospital wards after the surgery itself. We aimed to assess whether enhanced postoperative surveillance of adult surgical patients at high risk of postoperative morbidity or mortality in Africa could reduce 30-day in-hospital mortality.
Methods
We did a two-arm, open-label, cluster-randomised trial of hospitals (clusters) across Africa. Hospitals were eligible if they provided surgery with an overnight postoperative admission. Hospitals were randomly assigned through minimisation in recruitment blocks (1:1) to provide patients with either a package of enhanced postoperative surveillance interventions (admitting the patient to higher care ward, increasing the frequency of postoperative nursing observations, assigning the patient to a bed in view of the nursing station, allowing family members to stay in the ward, and placing a postoperative surveillance guide at the bedside) for those at high risk (ie, with African Surgical Outcomes Study Surgical Risk Calculator scores ≥10) and usual care for those at low risk (intervention group), or for all patients to receive usual postoperative care (control group). Health-care providers and participants were not masked, but data assessors were. The primary outcome was 30-day in-hospital mortality of patients at low and high risk, measured at the participant level. All analyses were done as allocated (by cluster) in all patients with available data. This trial is registered with ClinicalTrials.gov, NCT03853824.
Findings
Between May 3, 2019, and July 27, 2020, 594 eligible hospitals indicated a desire to participate across 33 African countries; 332 (56%) were able to recruit participants and were included in analyses. We allocated 160 hospitals (13 275 patients) to provide enhanced postoperative surveillance and 172 hospitals (15 617 patients) to provide standard care. The mean age of participants was 37·1 years (SD 15·5) and 20 039 (69·4%) of 28 892 patients were women. 30-day in-hospital mortality occurred in 169 (1·3%) of 12 970 patients with mortality data in the intervention group and in 193 (1·3%) of 15 242 patients with mortality data in the control group (relative risk 0·96, 95% CI 0·69–1·33; p=0·79). 45 (0·2%) of 22 031 patients at low risk and 309 (5·6%) of 5500 patients at high risk died. No harms associated with either intervention were reported.
Interpretation
This intervention package did not decrease 30-day in-hospital mortality among surgical patients in Africa at high risk of postoperative morbidity or mortality. Further research is needed to develop interventions that prevent death from surgical complications in resource-limited hospitals across Africa.
Funding
Bill & Melinda Gates Foundation and the World Federation of Societies of Anaesthesiologists.
Translations
For the Arabic, French and Portuguese translations of the abstract see Supplementary Materials section.