Application of Artificial Neural Network (ANN) as a predictive tool for the removal of pharmaceutical from wastewater streams using biochar: a multifunctional technology for environment sustainability.

This study investigates biochar as an attractive option for removing pharmaceuticals from wastewater streams utilizing data from various literature sources and also explores the sensitivity of the characteristics and implementation of biochar. ANN 1 was designed to determine the optimal biochar characteristics (Surface Area, Pore Volume) to achieve the maximum percentage removal of pharmaceuticals in wastewater streams. ANN 2 was developed to identify the optimal biomass feedstock composition, pyrolysis conditions (temperature and time), and chemical activation (acid or base) to produce the optimal biochar from ANN 1. ANN 3 was developed to investigate the effectiveness of the biochar produced in ANN 1 and 2 in removing dye from water. Biomass feedstock with a high lignin content and high volatile matter at a high pyrolysis temperature, whether using an acid or base, achieves a high mesopore volume and high surface area. The biochar with the highest surface area and mesopore volume achieved the highest removal percentage. Regardless of hydrophobicity conditions, at low dosages (0.2), a high surface area and pore volume are required for a high percent removal. And with a higher dosage, a lower surface area and pore volume is necessary to achieve a high percent removal.

Comparative analysis of heavy metal content of unregulated facial whitening creams and branded facial whitening creams.

The present study was conducted to evaluate potential health risks of Omani cosmetics considering the dangers and adverse effects on health caused by unregulated and unlabelled cosmetic products. Therefore, this current study is to examine the toxic heavy metals of unregulated facial whitening creams that are available in the Omani market and compare them with branded facial whitening creams. A total twenty-two samples were purchased from the Souqs/markets of all eleven governorates of Oman and their heavy metals content was determined by using Inductively Coupled Plasma-Optical Emission Spectroscopy (ICP-OES). The sample was digested by using ultra wave microwave at 180 °C. The percentage of heavy metals present in the unregulated whitening creams were compared with the heavy metals content of two randomly selected and branded whitening creams. The results showed that most of the unregulated samples contain significant amount of chromium, cooper and lead. In comparison, the branded face creams contained only the permissible amount of the heavy metals tested. The maximum arsenic content was found in a sample collected from Al Batinah South region (1.74 ppm). The maximum cadmium content was found in a sample collected from Al Wusta region (2.02 ppm). The maximum cobalt and chromium content were found in the samples collected from Al Buraimi region (0.10 ppm) and Dhofar region (8.04 ppm) respectively. In conclusion, unregulated face creams are not safe for human consumption because they contain significant levels of heavy metals that exceed the permissible limits.

The Impact of Anxiety and Depression on Academic Performance: A Cross-Sectional Study among Medical Students in Syria.

Background The National Medical Unified Examination (NMUE) is a milestone in the life of medical students in Syria. The selection for residency programs depends mainly on the NMUE score, where competitive specialties require higher scores. Therefore, preparation for the NMUE might be a source of anxiety and depression. This study aims at evaluating the impact of anxiety and depression on the NMUE score. A secondary objective is to determine the effect of some factors (i.e., exercise, having breakfast, adequate sleep, and social media) on anxiety and depression. Methods A cross-sectional study was conducted using an online questionnaire and included medical students who were preparing for the October 2019 NMUE exam. The Generalized Anxiety Disorder scale (GAD-7) and the Patient Health Questionnaire (PHQ-9) were used to screen for anxiety and depression, respectively. NMUE scores were obtained from the official score report. Demographics and other potential confounding factors, such as Cumulative Grade Point Average, were obtained through the questionnaire. Results One hundred and thirty ( n = 130) students participated in the study, 83 of them were women (63.8%). The prevalence of anxiety and depression were 59.2 and 58%, respectively, with no difference between men and women. Both anxiety and depression were negatively correlated with the NMUE score. However, this relationship did not persist after controlling for other important predictors through multiple regression. Only exercising was statically significant in reducing PHQ-9 scores. None of the studied factors were significant in reducing GAD-7 scores. Conclusion Although participants with higher anxiety/depression had lower NMUE scores, this association does not imply causation. The high prevalence of anxiety and depression (approximately two-thirds of the participants) is concerning and may pose a great threat to students' well-being and adversely affect the quality of care provided by them as future health care professionals.

Analysis of floristic composition and species diversity of vascular plants native to the State of Palestine (West Bank and Gaza Strip).

This study aims at providing an updated checklist of the native vascular flora of the Palestinian West Bank and Gaza Strip (State of Palestine, SP), serving as a taxonomic and nomenclatural basis for botanical research and encouraging new floristic surveys and biosystematic studies. The study provides an up-to-date checklist of native vascular taxa of the SP and their distribution within the plant districts in the country. This is the very first annotated checklist for the native vascular plants of the SP which incorporates recent name changes, new distribution records, habitat, herbarium specimens catalouge, Red List criteria, wild edible plants, endemism and use in Traditional Palestinian Herbal Medicine. The quantitative analysis of the flora has shown that the SP hosts 1826 taxa, distributed in 686 genera and 108 families; five taxa are gymnosperms, nine taxa are Pteridophytes and 1812 taxa are angiosperms. The most represented families are Leguminosae (222 taxa, 12.2%), Asteraceae (197, 10.2%) and Poaceae (196, 10.7%), while the most represented genera are Trifolium (38, Leguminosae), Silene (32, Caryophyllaceae), Astragalus (27, Leguminosae), Medicago (26, Leguminosae), Allium (25, Amaryllidaceae) and Euphorbia (25, Euphorbiaceae). Annuals (52.4%), Hemicryptophytes (20.2%) and Chamaephytes (12.2%) are the most represented life-forms amongst the SP flora. The richest plant districts in the SP vascular plant taxa are Gaza Strip (GS) (1216 taxa), Jerusalem and Hebron Mountains (JHM) (1235) and Nablus Mountains (NM) (1126). Agglomerative hierarchical clustering (AHC) permitted the division of SP into two main regions, based on the existence of vascular plant taxa: Region 1 (western plant districts with 1128-1237 taxa) with higher water availability and temperate Mediterranean climate which permit the establishment of more than 65% of the total SP flora in these districts and Region 2 (eastern plant districts with 571-698 taxa), characterised by desert and semi-desert conditions, as well as the presence of alluvial and co-alluvial soils, which allow the survival of lower numbers of plant taxa. One hundred and sixty-five taxa of the SP flora are endemic and near-endemic. However, in comparison with some countries of the Mediterranean Basin, this number is below the average endemism concentration, along with other southern arid countries, such as Tunisia and Egypt. In total, there are 102 threatened plant taxa, belonging to 39 families and 83 genera representing 5.6% of the total plants in the SP. IUCN and the Conservation Measures Partnership (CMP) unified classification of direct threats for SP Red-Listed plants has shown a high extinction risk to the Palestinian threatened wild flora, with 76.5% of the threatened species being either critically endangered (CR) or endangered (EN); only 23.5% were vulnerable (VU). However, several taxa are threatened by numerous factors including small population size, human activities, for example, conversion of traditional to intensive agriculture accompanied by deep ploughing and the application of pesticides, urban development and construction, global climatic change, drying of marshes and wetlands, quarrying, fires and pollution. This checklist can help focus conservation efforts and provide a framework for research, protection and policy applications for the SP flora, especially for the endemic and threatened plants.

Isolation, identification, and antimycotic activity of plumbagin from Plumbago europaea L. roots, leaves and stems.

Plumbago europaea L. is a plant utilized in Palestinian ethnomedicine for the treatment of various dermatological diseases. The current investigation was designed to isolate plumbagin from P. europaea leaves, roots and for the first time from the stems. Moreover, it aimed to evaluate the antimycotic activity against three human fungal pathogens causing dermatophytosis, also against an animal fungal pathogen. The qualitative analysis of plumbagin from the leaves, stems, and roots was conducted using HPLC and spectrophotometer techniques, while the structure of plumbagin was established utilizing Proton and Carbon-13 Nuclear Magnetic Resonance (NMR) and Infrared (IR) techniques. The entire plant constituents were determined by GC-MS. Moreover, the antimycotic activity against Ascosphaera apis, Microsporum canis, Trichophyton rubrum, and Trichophyton mentagrophytes was assessed utilizing the poison food technique method. The percentage of plumbagin recorded in the leaves, stems, and roots was found to be 0.51±0.001%, 0.16±0.001%, and 1.65±0.015%, respectively. The GC-MS examination declared the presence of 59 molecules in the plant extract. The plant extract and pure plumbagin exhibited complete inhibition against all tested dermatophytes at 6.0mg/mL for the extracts and 0.2mg/mL for plumbagin. P. europaea root is the best source of plumbagin and the plant extract could represent a potential drug candidate for the treatment of dermatophytosis infections. Further studies required to design suitable dosage forms from the natural P. europaea root extracts or plumbagin alone, to be utilized for the treatment of dermatological and veterinary ailments.

MDM2 as a target for ellagic acid­mediated suppression of prostate cancer cells in vitro.

Prostate cancer (PCa) is the most common cancer in men. Despite the available treatments for PCa, a significant number of patients relapse as the disease becomes hormonal­independent. p53 is a common tumor suppressor; however, its activity is diminished via the overexpression of murine double minute­2 (MDM2). The pomegranate, walnuts, and blueberries are widely consumed fruits and nuts that contain several polyphenolic compounds, mainly ellagic acid (EA). The present study focused on the influence of EA on the p53/MDM2 pathway in PCa cell lines. Three human PCa cell lines PCa LNCaP (p53+/+), 22RV1 (p53-/+), and PC3 (p53-/-) harboring different p53 genotypes were used in this research. We found that EA downregulated the gene and protein expression levels of MDM2 and increased the protein expression of p53 as determined by qPCR and western blot analyses. Moreover, by using western blot analysis, we determined that EA increased the protein expression of the p53 target proteins p21, p53 upregulated modulator of apoptosis (PUMA) [also known as Bcl­2­binding component 3 (BBC3)] and Phorbol­12­myristate­13­acetate­induced protein 1 (NOXA). Furthermore, we found that EA induced apoptosis in the absence of p53 by downregulating MDM2 and X­linked inhibitor of apoptosis protein (XIAP) protein expressions as determined by western blot analysis. We conclude that EA suppressed PCa cells in vitro partly by downregulating MDM2.

Detection and Phylogenetic Analysis of Viruses Linked with Fig Mosaic Disease in Seventeen Fig Cultivars in Palestine.

Fig mosaic is a viral disease (FMD) that spreads in Palestinian common fig ( Ficus carica L.) orchards. Recognizing the economic value of fig plants and the harmful nature of FMD, the disease poses a significant threat to the economy of the fig production in Palestine. We applied the reverse transcription and amplification (RT-PCR) and PCR technique to leaf samples of 77 trees and 14 seedlings of 17 fig cultivars. The samples were collected from orchards in the main fig-growing provinces of the Palestinian West Bank, to assess the prevalence of viruses associated with FMD, and confirm a possible link of symptoms with viruses detected. Four viruses were detected: Fig mosaic virus (FMV), Fig badnavirus-1 (FBV-1), Fig leaf mottle-associated virus 2 (FLMaV-2), and Fig fleck-associated virus (FFkaV). FMV and FBV-1 were found in all tested fig plants (100%), while FLMaV-2 and FFkaV were detected in 61.5% and 33% of the fig samples, respectively. The high incidence of FBV-1 in the newly propagated symptomatic and symptomless seedlings from different cultivars may be an indication that FBV-1 is integrated into the genome of the fig in a cultivar nondiscriminatory manner. Very weak or no association was detected between FMD symptoms severity in the 17 Palestinian fig cultivars with the various viruses' combinations observed (i.e., number of the viruses infecting the plant). These results support the notion that FMD symptom severity expression is likely to be controlled by a combination of FMV infection, cultivars, and environmental factors, rather than the number of viruses infecting the plant.

Hybrid Coils-Based Wireless Power Transfer for Intelligent Sensors.

Most wearable intelligent biomedical sensors are battery-powered. The batteries are large and relatively heavy, adding to the volume of wearable sensors, especially when implanted. In addition, the batteries have limited capacity, requiring periodic charging, as well as a limited life, requiring potentially invasive replacement. This paper aims to design and implement a prototype energy harvesting technique based on wireless power transfer/magnetic resonator coupling (WPT/MRC) to overcome the battery power problem by supplying adequate power for a heart rate sensor. We optimized transfer power and efficiency at different distances between transmitter and receiver coils. The proposed MRC consists of three units: power, measurement, and monitoring. The power unit included transmitter and receiver coils. The measurement unit consisted of an Arduino Nano microcontroller, a heart rate sensor, and used the nRF24L01 wireless protocol. The experimental monitoring unit was supported by a laptop to monitor the heart rate measurement in real-time. Three coil topologies: spiral-spiral, spider-spider, and spiral-spider were implemented for testing. These topologies were examined to explore which would be the best for the application by providing the highest transfer power and efficiency. The spiral-spider topology achieved the highest transfer power and efficiency with 10 W at 87%, respectively over a 5 cm air gap between transmitter and receiver coils when a 200 Ω resistive load was considered. Whereas, the spider-spider topology accomplished 7 W and 93% transfer power and efficiency at the same airgap and resistive load. The proposed topologies were superior to previous studies in terms of transfer power, efficiency and distance.

Urolithin A induces prostate cancer cell death in p53-dependent and in p53-independent manner.

PURPOSE: Pomegranate and walnuts are widely consumed dietary sources and contain several bioactive compounds, including the ellagitannins (ETs). ETs are polyphenols that are metabolized in the gut microbiota to urolithin A (UA). p53 is a tumor suppressor that lost its activity through MDM2 activation in about half cancers. The purpose of this study was to investigate the influence of UA on the p53-MDM2 interaction pathway in prostate cancer cell lines. METHODS: Three human prostate cancer cell lines were used that harbor different p53 genotypes; LNCaP (p53+/+), 22RV1(p53-/+) and PC3 (p53-/-). Cell viability was determined by CellTiter-Glo Luminescent assay. Apoptosis was confirmed by measuring annexin V by flow cytometry. The expression of p53, its target proteins, and apoptotic markers were measured by western blotting. Real-time qPCR was used to measure the gene expression of p21, a main target gene of p53. Co-immunoprecipitation-immunoblotting was used to assess the inhibition of interactions between p53 and MDM2 and to assess the effect of UA on MDM2-mediated p53 polyubiquitination. RESULTS: We found UA inhibited CaP cells' viability and induced apoptosis. For 22RV1 and LNCaP, we found UA increased p53 protein expression and its main target protein, p21, and MDM2, forming an autoregulatory feedback loop. In addition, UA increased the p53 proapoptotic proteins PUMA and NOXA. Moreover, UA inhibited the interaction between p53 and MDM2 and inhibited MDM2-mediated p53 polyubiquitination. UA downregulated MDM2 and XIAP protein expression in PC3 cells and upregulated p21 and p14ARF in a p53-independent manner. CONCLUSION: The influencing of UA on p53-MDM2 pathway may partly contribute to its anticancer effect.

Effects of selected Palestinian plants on the in vitro exsheathment of the third stage larvae of gastrointestinal nematodes.

BACKGROUND: Gastrointestinal parasites are one of the main restrictions to small ruminant production. Their pathological importance is primarily related to the major production losses, in quantity or quality, induced by the direct action of worms. Control of these parasites is based exclusively on the frequent use of anthelmintic drugs. However, the resistance to anthelmintics in worm populations after commercialisation of chemical drugs is now widespread. Therefore, there is a need to find new natural resources to ensure sustainable and effective treatment and control of these parasites. The aim of this study was to evaluate the anthelmintic activity, as minimum inhibitory concentration (IC 50 mg/mL), of different plant extracts using larval exsheathment inhibition assay using a two-species but steady population of parasitic nematodes (ca. 20% Teladorsagia circumcinta and 80% Trichostrongylus colubriformis). RESULTS: The study showed that the ethanolic extracts of 22 out of the 48 plant extracts, obtained from 46 plant species, have an inhibitory effect >50% (at concentrations of 100 mg/mL) on the third stage larvae (L3) of the nematodes exhibited the strongest inhibition activity (94%) with IC 50 of 0.02 mg/mL, where other members of the Rhamnaceae family have shown to possess strong anthelmintic activity (70-89%). CONCLUSIONS: Plant extracts are potential rich resources of anthelmintics to combat helminthic diseases. Our results suggest that extracts from Rhamnus elaternus, Epilobium hirsutum, Leucaena leucocephala and Rhamnus palaestinus have promising anthelmintic activity, with potential applications in animal therapeutics and feed.

Exploring an herbal "wonder cure" for cancer: a multidisciplinary approach.

CONTEXT AND OBJECTIVES: The unmonitored use of herbal medicinal remedies by patients with cancer presents a significant challenge to oncology healthcare professionals. We describe an increasingly popular herbal "wonder drug," Ephedra foeminea (Alanda in Arabic), whose use has spread from the Palestinian patient population throughout the Middle East. We conducted a multicentered and multidisciplinary collaborative research effort in order to understand the potential benefits and harms of this popular herbal remedy. METHODS: We conducted an in-depth search of the medical literature, both traditional and modern, for any mention of the clinical use of Alanda for the treatment of cancer. We then tested the remedy, first for toxic ephedra alkaloid components and then for anticancer effects, as well as effects on the cytotoxic activity of chemotherapy agents (cisplatin and carboplatin) on breast cancer cell cultures. RESULTS: We found no mention in the literature, both conventional and traditional, on the use of Alanda for the treatment of cancer. Laboratory testing did not find any toxic components (i.e., ephedra alkaloids) in the preparation. However, in vitro exposure to Alanda led to a reduced cytotoxic effect of chemotherapy on breast cancer cell cultures. CONCLUSIONS: The use of an integrative ethnobotanical, laboratory and clinical research-based approach can be extremely helpful when providing nonjudgmental and evidence-based guidance to patients with cancer, especially on the use of traditional herbal medicine. The effectiveness and safety of these products need to be examined by integrative physicians who are dually trained in both complementary medicine and supportive cancer care.

Compared perspectives of Arab patients in Palestine and Israel on the role of complementary medicine in cancer care.

CONTEXT: Complementary medicine (CM) is extensively used by patients with cancer across the Middle East. OBJECTIVES: We aimed to compare the perspectives of two Arab populations residing in diverse socioeconomic-cultural settings in Palestine and Israel regarding the role of CM in supportive cancer care. METHODS: A 27-item questionnaire was constructed and administered to a convenience sample of Arab patients receiving cancer care in four oncology centers in northern Israel and Palestine. RESULTS: Each of the two groups had 324 respondents and was equally distributed by age and marital status. Compared with the Israeli-Arab group, Palestinian participants reported significantly higher CM use for cancer-related outcomes (63.5% vs. 39.6%, P < 0.001), which included more herbal use (97.6% vs. 87.9%, P = 0.001) and significantly lower use of dietary supplements, acupuncture, mind-body and manual therapies, and homeopathy. Most respondents in both groups stated that they would consult CM providers if CM was integrated in oncology departments. Related to this theoretical integrative scenario, Palestinian respondents expressed fewer expectations from their oncologists to actively participate in building their CM treatment plan. Treatment expectations in both groups focused on improving quality of life (QOL), whereas Palestinian respondents had fewer expectations for CM to improve fatigue, emotional concerns, sleep, and daily functioning. CONCLUSION: Arab patients with cancer from Palestine and Israel highly support CM integration within their oncology institutions aiming to improve QOL. Nevertheless, respondents differed in their perceived model of CM integration, its treatment objectives, and their oncologists' role in CM integration.

In vitro antioxidant and antitumor activities of six selected plants used in the Traditional Arabic Palestinian herbal medicine.

CONTEXT: Despite several pharmacological applications of the medicinal plants in the Traditional Arabic Palestinian Herbal Medicine in Palestine (TAPHM), studies on their antioxidant properties are still scarce. OBJECTIVE: This work evaluates the antioxidant and antitumor activities of the ethanol extracts from different parts of six plants: [Arum palaestinum Boiss (Araceae), Urtica pilulifera L. (Urticaceae), Coridothymus capitatus (L.) Reichb (Lamiaceae), Majorana syriaca (L.) Rafin. (Lamiaceae), Teucrium creticum L. (Lamiaceae), and Teucrium capitatum L. (Lamiaceae)] used in the TAPHM. MATERIALS AND METHODS: The antioxidant activity was evaluated for the ethanol extracts by DPPH and ß-carotene-linoleic acid assays together with total contents of phenols and flavonoids. For the anti-carcinogenic evaluation, the extracts were tested for the ability to inhibit the proliferation of breast cancer cells (MCF-7) using the MTT reduction assay. RESULTS: Among the extracts, the U. pilulifera had the highest amount of total phenolics, possessing the second highest total flavonoids. It also showed a maximum cytotoxic activity (IC50 = 63 µg/ml), followed by C. capitatus, and A. palaestinum. Otherwise, the extract of T. creticum was demonstrated to be an efficient scavenger of O2 (IC50 = 83 µg/ml), followed by M. syriaca, C. capitatus, T. capitatum, A. palaestinum, and U. pilulifera. DISCUSSION AND CONCLUSION: The results suggest that the investigated plants have shown varied antioxidant capacities which were strongly correlated with their contents of phenolics. Accordingly, this study proposes that the therapeutic benefit of these plants can be, at least in part, attributed to its potential inhibition of oxidative processes.

Integrative oncology research in the Middle East: weaving traditional and complementary medicine in supportive care.

INTRODUCTION: Complementary and alternative medicine (CAM) has an important role in supportive cancer care in the Middle East and is often used in association with traditional medicine. This article provides a comprehensive review of published data on CAM research in supportive cancer care in the Middle East. METHODS AND RESULTS: A multi-disciplinary Middle-Eastern Research Group in Integrative Oncology (MERGIO) was established in six countries. Authors independently searched Medline database for articles in Arabic, Hebrew, French, and Turkish using oncology and CAM-related keywords. Articles were recorded according to the first author's affiliation with an academic or clinical institution in the Middle East. RESULTS: We identified 143 articles on CAM and cancer care that had been published in 12 Middle-Eastern countries. Eighty-five articles were directly related to cancer supportive care. The latter included studies on the prevalence of CAM use by patients with cancer, aspects related to of doctor-patient communication, ethics and regulation, psychosocial aspects of CAM, CAM safety and quality assurance, studies of CAM education for health care providers, and ethno-botanical studies and reviews. Twenty-eight articles referred to clinical research on supportive care, and the use of specific CAM modalities that included acupuncture, anthroposophic medicine, dietary and nutritional therapies herbal medicine, homeopathy, mind-body medicine, shiatsu, therapeutic touch, and yoga. CONCLUSIONS: CAM-related supportive care research is prevalent in the Middle East, a fact that may serve as a basis for future multinational-multidisciplinary research work in supportive care in oncology.

Extensive rearrangement of the Arabidopsis mitochondrial genome elicits cellular conditions for thermotolerance.

Three nuclear genes involved in plant mitochondrial recombination surveillance have been previously identified. Simultaneous disruption of two of these genes, MutS Homolog1 (MSH1) and RECA3, results in extensive rearrangement of the mitochondrial genome and dramatic changes in plant growth. We have capitalized on these changes in mitochondrial genome organization to understand the role mitochondria play in plant cellular and developmental processes. Transcript profiling of the double mutants grown under normal conditions revealed differential regulation of numerous nuclear genes involved in stress responses together with increased levels of polyadenylated mitochondrial transcripts. We show that extensive rearrangement of the mitochondrial genome in Arabidopsis (Arabidopsis thaliana) directly elicits physiological stress responses in plants, with msh1 recA3 double mutants exhibiting enhanced thermotolerance. Likewise, we show that mitochondrial transcriptional changes are associated with genome recombination, so that differential gene modulation is accomplished, at least in part, through altered gene copy number.

Participation of leaky ribosome scanning in protein dual targeting by alternative translation initiation in higher plants.

Postendosymbiotic evolution has given rise to proteins that are multiply targeted within the cell. Various mechanisms have been identified to permit the expression of proteins encoding distinct N termini from a single gene. One mechanism involves alternative translation initiation (aTI). We previously showed evidence of aTI activity within the Arabidopsis thaliana organellar DNA polymerase gene POLgamma2. Translation initiates at four distinct sites within this gene, two non-AUG, to produce distinct plastid and mitochondrially targeted forms of the protein. To understand the regulation of aTI in higher plants, we used Polgamma2 as a model to investigate both cis- and trans-acting features of the process. Here, we show that aTI in Polgamma2 and other plant genes involves ribosome scanning dependent on sequence context at the multiple initiation sites to condition specific binding of at least one trans-acting factor essential for site recognition. Multiple active translation initiation sites appear to operate in several plant genes, often to expand protein targeting. In plants, where the mitochondrion and plastid must share a considerable portion of their proteomes and coordinate their functions, leaky ribosome scanning behavior provides adaptive advantage in the evolution of protein dual targeting and translational regulation.

An Evaluation of Use of Trans-Obturator Tape (TOT) Sling Procedure in the Current Surgical Management of Female Stress Urinary Incontinence.

OBJECTIVE: To assess the role of TOT sling procedure in current surgical management of female Stress Urinary Incontinence (SUI) in terms of post-operative results, cost effectivenss, pt acceptance and complications. METHOD: From June 2006 to September 2008, 30 patients of SUI were treated surgically by TOT-sling procedure. Pre-operatively the patients were evaluated by thorough history taking, clinical examination and different diagnostic test depending upon the individual clinical scenario. Patients were explained in their own language the nature of procedure and the principle behind it. Any complication(s) (intra/postoperative) were noted. After discharging the patients they were followed up by atleast 3 visits (follow-up visits) at 1, 3 & 6 month interval. Any complications of the procedure and patient acceptance were evaluated at each follow-up. RESULTS: The mean age of the total patients (n=30) was 39.5 yrs and 28 (93.33%) were multiparous. Involuntary loss of urine on straining was the most common complaint present in 25 (83.33%) patients and 22 (73.33) patients were having duration of symptoms less than 3 yrs. 9 (30%) patients were having mild cystocele pre-operatively which resolved after surgery. All the 30 (100%) patients were continent post-operatively while 7 (23.33%) were having lower urinary tract symptoms (LUTS). No major intra/post-operative complication was seen but, urgency, dysuria, fever and haematuria was seen post-operatively which resolved after few days. The operative time was 24 ± 3.8 months and catheter was removed on 2.7 ± 1.7 days post-operatively. Hospital stay was 6 ± 2.4 days (3 - 11) and app. Cost of the treatment was Rs3253 ± 360 (2700,3900). CONCLUSION: TOT Sling procedure is currently the Gold Standard for management of female SUI. It is very important to diagnose SUI and rule out other causes of incontinence because only the former one (Genuine SUI) is improved by TOT sling and other types may be even worsened by this procedure.

Mitochondrial genome dynamics in plants and animals: convergent gene fusions of a MutS homologue.

Mitochondrial processes influence a broad spectrum of physiological and developmental events in higher eukaryotes, and their aberrant function can lead to several familiar disease phenotypes in mammals. In plants, mitochondrial genes directly influence pollen development and the occurrence of male sterility in natural plant populations. Likewise, in animal systems evidence accumulates to suggest important mitochondrial functions in spermatogenesis and reproduction. Here we present evidence for a convergent gene fusion involving a MutS-homologous gene functioning within the mitochondrion and designated Msh1. In only plants and soft corals, the MutS homologue has fused with a homing endonuclease sequence at the carboxy terminus of the protein. However, the endonuclease domains in the plants and the soft corals are members of different groups. In plants, Msh1 can influence mitochondrial genome organization and male sterility expression. Based on parallels in Msh1 gene structure shared by plants and corals, and their similarities in reproductive behavior, we postulate that this convergent gene fusion might have occurred in response to coincident adaptive pressures on reproduction.