Empowering patients and educating staff - An online solution for the COVID era and beyond!

BACKGROUND: Bowel disease is a significant cause of significant morbidity and mortality around the world. Though colorectal cancer is a major cause for concern, there are a variety of other conditions which are chronic, debilitating and/or socially embarrassing. While the internet provides excellent resources, there is often conflicting and confusing material of doubtful veracity. There is pressing need for trainees and patients/carers to be able to access reliable resources whenever and wherever they are. AIM: To create an integrated, interactive platform providing reliable information on aspects of bowel disease for patients while addressing educational needs of surgical trainees and other healthcare professionals. APPROACH: Since 2006, we have progressed from leaflets, diagrammatic booklets to DVDs and then downloadable applications all of which, though very successful, had significant limitations.Trainees struggle with balancing their educational needs with their service commitments. This online resource, www.colorectaleducation.com provides an opportunity to view detailed operative training videos on the go. The website also hosts detailed chapterised information videos for patients, care pathway videos and patient experiences. The modular design of the website allows for ease of updating and sequential expansion. The initial emphasis has been on colorectal cancer and the site is being gradually expanded to include a variety of other conditions. RESULTS: The website gained widespread popularity with Google Analytics revealing steadily rising global hit rate with very low bounce rate for both sections. Structured feedback showed 96% satisfaction on both patient and professional sections. CONCLUSION: On-demand information became the norm with the use of smartphones/tablets. This website provides patients, surgical trainees and healthcare professionals access to information and education in clear reliable format, anywhere in the world. This is particularly relevant now as pandemic reduced opportunities for face to face patients consultations as well as for learners with educators.

Field responses of Anopheles gambiae complex (Diptera: Culicidae) in Liberia using yeast-generated carbon dioxide and synthetic lure-baited light traps.

Malaria infection is a serious public health problem throughout Liberia, but vector surveillance is limited or nonexistent in remote regions of the country. To better understand the spatial and temporal distribution of malaria vectors in Liberia and to support vector and malaria activities of the Liberian Ministry of Health, a study was conducted to determine the efficacy of light traps baited with a synthetic lure and CO2 for capturing Anopheles gambiae sensu lato (Giles). Traps with a ultraviolet, light-emitting diode, and incandescent lights baited with a synthetic skin lure and CO2 combinations were evaluated at four field sites in three counties of Liberia for five consecutive nights every 8 wk during 2011. In total, 4,788 mosquitoes representing 56 species from nine genera were collected throughout the 30-wk study; An. gambiae s. l. comprised 32% and of the148 An. gambiae s. s. collected, 85% were of the S form. A greater percentage of An. gambiae s. l. were collected in ultraviolet traps baited with a synthetic lure and CO2 compared with any other trap configuration. The influence of trap configuration on conclusions from surveillance efforts, specifically with regards to An. gambiae is discussed.

The potential distribution of Phlebotomus papatasi (Diptera: Psychodidae) in Libya based on ecological niche model.

The increased cases of cutaneous leishmaniasis vectored by Phlebotomus papatasi (Scopoli) in Libya have driven considerable effort to develop a predictive model for the potential geographical distribution of this disease. We collected adult P. papatasi from 17 sites in Musrata and Yefern regions of Libya using four different attraction traps. Our trap results and literature records describing the distribution of P. papatasi were incorporated into a MaxEnt algorithm prediction model that used 22 environmental variables. The model showed a high performance (AUC = 0.992 and 0.990 for training and test data, respectively). High suitability for P. papatasi was predicted to be largely confined to the coast at altitudes <600 m. Regions south of 300 degrees N latitude were calculated as unsuitable for this species. Jackknife analysis identified precipitation as having the most significant predictive power, while temperature and elevation variables were less influential. The National Leishmaniasis Control Program in Libya may find this information useful in their efforts to control zoonotic cutaneous leishmaniasis. Existing records are strongly biased toward a few geographical regions, and therefore, further sand fly collections are warranted that should include documentation of such factors as soil texture and humidity, land cover, and normalized difference vegetation index (NDVI) data to increase the model's predictive power.

Efficacy of light and nonlighted carbon dioxide-baited traps for adult sand fly (Diptera: Psychodidae) surveillance in three counties of Mesrata, Libya.

ABSTRACT. Sand flies are important vectors of cutaneous leishmaniasis, especially along coastal towns of northwestern Libya where an estimated 20,000 cases have occurred from 2004 to 2009. Host-seeking traps are an important tool for sampling sand fly populations and surveying the incidence of Leishmania major and L. tropica within a given population. We evaluated the capture efficiency of CO2-baited BG-Sentinel, Centers for Disease Control and Prevention (CDC) light, CDC ultraviolet light, and nonbaited CO2 CDC light traps in 3 coastal townships during June, August, September, and November 2010. A total of 3,248 sand flies, representing 8 species from 2 genera, were collected; most sand flies were identified as either Phlebotomus papatasi or P. longicuspis. Three of the traps captured significantly more sand flies compared to the BG-Sentinel baited with CO2 (P < 0.001). Three of 456 DNA pools extracted from sand flies were positive for Leishmania DNA, indicating a minimum estimated infection rate of 0.83% and 0.47% for P. papatasi and P. longicuspis, respectively.

Eicosapentaenoic acid ablates valproate-induced liver oxidative stress and cellular derangement without altering its clearance rate: dynamic synergy and therapeutic utility.

The omega-3 fatty acid eicosapentaenoic acid (EPA) is a superb nature's medicine, with still unfolding health benefits. Because hepatotoxicity is a prominent adverse drug reaction, we currently attempted a new approach in which EPA was challenged to both alleviate hepatotoxicity and provide synergy with anticonvulsant effects of valproate (VPA). Besides, we verified whether EPA may kinetically modulate the clearance rate of VPA. VPA (500mg/kg p.o., for 2weeks) caused rat hepatotoxicity that was manifested as notable (2- to 4-fold) rise in serum liver enzymes (GGT, ALT, and ALP), increased hepatic levels of lipid peroxides and TNF-α (3- and 7-fold) and activity of myeloperoxidase (MPO, 4-fold), lowering of serum albumin (42%), and depletion of liver reduced glutathione (GSH, 36%). Furthermore, histopathologic examination revealed hepatocellular degeneration, focal pericentral necrosis, infiltration of inflammatory cells, and steatosis. Joint treatment with EPA (300mg/kg) blunted the oxidative stress, TNF-α levels and MPO activity, while enhanced levels of serum albumin and hepatic GSH. EPA also ameliorated most of the hepatocellular anomalies evoked by VPA. Additionally, in a mouse PTZ convulsion model, EPA markedly augmented the anticonvulsant effects of VPA far beyond their single responses. On the other hand, pharmacokinetic analyses revealed that joint EPA administration had no effect on serum VPA concentrations. Collectively, results demonstrate for the first time that the ω-3 FA (EPA) markedly alleviated VPA-induced hepatotoxicity, oxidative stress, and inflammation, while enhanced its anticonvulsant effects without altering its clearance. Therapeutically, these protective and synergy profiles for EPA foster a more safe and efficacious drug combination regimen than VPA.

Effect of intravenous dipyridamole on coronary flow parameters in patients with isolated coronary artery ectasia: assessment by transesophageal echocardiography.

BACKGROUND: In a prospective study design, we sought to assess the effect of dipyridamole on coronary flow parameters in patients with isolated coronary artery ectasia (CAE) as compared to subjects with normal coronaries. METHODS: We enrolled 30 patients with ectasia of the left anterior descending (LAD) artery (study group), and 10 subjects with normal coronaries (control group). All subjects underwent transesophageal echocardiography to record flow velocities in the proximal LAD coronary artery, and velocity time integrals were calculated. The diameter of the proximal LAD coronary artery was measured and flow was calculated. Dipyridamole (0.56 mg/kg) was administered intravenously and measurements were repeated 5 minutes later. RESULTS: At baseline, systolic and diastolic velocities, systolic, diastolic, and total velocity time integrals were significantly higher in the control group (P < 0.05 for all), yet, systolic, diastolic, and total coronary flow were significantly higher in the study group (P < 0.05 for all). Following dipyridamole administration, systolic, diastolic, and total coronary flow were still significantly higher in the study group (P < 0.05 for all), yet, there was no significant difference between the two groups regarding the other parameters, and regarding coronary reserve values (P > 0.05 for all). CONCLUSIONS: We concluded that patients with isolated CAE have a higher resting coronary flow as compared to control subjects with normal coronaries. Intravenous dipyridamole administration in these patients maintained a significantly higher coronary flow, with a coronary flow reserve similar to controls.

Assessment of coronary flow parameters by transesophageal echocardiography in patients with isolated coronary artery ectasia: effect of intravenous nitroglycerin.

BACKGROUND: We sought to assess coronary flow parameters in patients with isolated coronary artery ectasia (CAE) as compared to subjects with normal coronaries. METHODS: Consecutively, we enrolled 30 patients with ectasia of the left anterior descending (LAD) coronary artery (study group), and 10 subjects with normal coronaries (control group). All patients underwent transesophageal echocardiography to visualize the LAD. Spectral recordings of proximal LAD flow velocities were made and velocity time integrals were calculated. The diameter of the proximal LAD was measured and LAD blood flow was calculated. Nitroglycerin (0.3 mg) was administered intravenously and measurements were repeated 5 minutes later. RESULTS: The mean age of the whole series was 48.6 ± 8 years, 39 (97.5%) being males. A significantly higher baseline systolic, diastolic, and total coronary blood flow was found in the study group as compared to the control group (46.1 ± 34.3 vs. 23.1 ± 8.2, 123.9 ± 73.3 vs. 68.1 ± 21.6, 170.1 ± 97.9 vs. 91.1 ± 26.8 cm(3) /min, respectively, P < 0.05 for all). Within the study group, nitroglycerin administration caused a significant decrease in peak diastolic velocity; systolic, diastolic, and total velocity time integrals; and both diastolic and total coronary blood flow (P < 0.05 for all). Meanwhile, within the control group, nitroglycerin administration caused a significant increase in the total coronary blood flow (P < 0.05). CONCLUSIONS: Patients with CAE have higher resting coronary blood flow in comparison with subjects with normal coronaries. Intravenous nitroglycerin administration causes significant reduction of coronary blood flow in ectatic coronary arteries.

Percutaneous mitral valvotomy versus closed surgical commissurotomy. Up to 15 years of follow-up of a prospective randomized study.

BACKGROUND: Immediate and intermediate term results of percutaneous mitral valvotomy (PMV) are comparable to closed surgical commissurotomy (CSC). We aimed at exploring this relation in the long term. METHODS: Previously, we randomized 40 consecutive patients with moderate to severe mitral stenosis [defined as mitral valve area (MVA) less than 1.5 cm²] to undergo either PMV (PMV group = 20 patients) or CSC (CSC group = 20 patients). For all patients, full echocardiographic assessment was performed before the procedure/operation. Patients assigned to PMV underwent the double balloon technique. Echocardiographic assessment was done following both procedures before discharge and repeated 1 and 6 months later. Echocardiographic follow-up was performed, thereafter, on a yearly basis for up to 15 years, with a mean follow-up period of 99 ± 12 months. RESULTS: Immediate echocardiographic results showed no statistically significant difference between the 2 groups regarding the final MVA or mean diastolic gradient across the mitral valve. Two patients dropped out from the CSC group and one from the PMV group. MVA was 1.8 ± 0.3 cm² versus 1.8 ± 0.4 cm² (p > 0.05) and mean diastolic pressure gradient across the mitral valve was 7 ± 4 mmHg versus 6.6 ± 4 mmHg (p > 0.05) in the PMV and CSC groups, respectively. Mitral restenosis occurred in 5 (26.3%) patients in the PMV group versus 5 (27.8%) patients in the CSC group (p > 0.05). Kaplan-Meier curves for restenosis-free survival showed no difference between the 2 groups. CONCLUSION: PMV achieves comparable results to CSC both in the short and long term.

In vitro interactions of Caenorhabditis elegans dystrophin with dystrobrevin and syntrophin.

Dystrophin, the product of the gene mutated in Duchenne muscular dystrophy (DMD) is bound by its C-terminus to a protein complex including the related protein dystrobrevin. Both proteins contain a putative coiled-coil domain consisting of two alpha-helices. It has been reported that the two proteins bind to each other by the first one of the two alpha-helices. We have revisited this question using the Caenorhabditis elegans homologs of dystrophin and dystrobrevin. In vitro interaction occurs through the more conserved second helix. We propose a new model of dystrophin interactions with associated proteins.