Prevalence, Severity Patterns and Risk Factors of Bronchopulmonary Dysplasia in Preterm Infants Younger than 32 Weeks of Gestation in a Tertiary Centre in Oman.

Objectives: This study aimed to determine the rate and severity patterns of bronchopulmonary dysplasia (BPD) and identify antenatal and postnatal factors associated with BPD in preterm infants <32 weeks of gestational age (GA). Methods: This retrospective observational study included preterm neonates <32 weeks of gestation admitted into the neonatal intensive care unit between January 2010 and December 2017 at Sultan Qaboos University Hospital, Muscat, Oman. A data set of antenatal and perinatal factors were collected. BPD was defined as the need for oxygen and/or respiratory support at 36 weeks post-menstrual age (PMA). Infants with and without BPD were compared in their antenatal and perinatal factors. Results: A total of 589 preterm infants <32 weeks were admitted. Among them, 505 (85.7%) survived to 36 weeks' PMA and 90 (17.8%) had BPD. The combined BPD and mortality rate was 28.4%. Grades 1, 2 and 3 BPD constituted 77.8%, 7.8% and 14.4%, respectively. BPD was associated with lower GA, lower birth weight, need for intubation at resuscitation, lower Apgar scores, longer duration of ventilation, surfactant therapy and higher rates of neonatal morbidities. On binary logistic regression analysis, predictors of BPD were longer duration of ventilation, intraventricular haemorrhage (IVH) and necrotising enterocolitis (NEC). Conclusion: In an Omani centre, 17.8% of preterm infants (<32 weeks GA) developed BPD. Various perinatal and neonatal factors were associated with BPD. However, longer duration of ventilation, IVH grades 1 and 2 and NEC stages II and III were significant predictors. Future multicentre research is necessary to provide the overall prevalence of BPD in Oman to help optimise the resources for BPD prevention and management in preterm infants.

A Retrospective Cohort Study of the Impact of Implementing Volume-Targeted Compared to Pressure-Limited Ventilation in a Single-Center, Level III Neonatal Intensive Care Unit in Oman.

Background The use of volume-targeted ventilation (VTV) in neonatology has been introduced in the last decade. This study was performed to determine the impact of clinical implementation of volume-targeted conventional mechanical ventilation using the volume guarantee mode in mechanical ventilation of all neonates needing mechanical ventilation compared to pressure-limited ventilation (PLV) modes. The mortality rate, duration of mechanical ventilation, and bronchopulmonary dysplasia were the primary outcomes of the study. Methodology This retrospective cohort study was conducted at a level III-VI neonatal intensive care unit (NICU) within a tertiary academic hospital in Oman. All intubated neonates admitted to the NICU within two time periods, i.e., the PLV cohort: January 2011 to December 2013 (three years), and the VTV cohort: January 2017 to December 2019 (three years), were eligible for inclusion in the study. Neonates were excluded if they had multiple congenital anomalies, tracheostomy, and those with a Do Not Resuscitate status. A predetermined data set was collected retrospectively from electronic records. The PLV and VTV cohorts were compared, and SPSS version 25 (IBM Corp., Armonk, NY, USA) was used for data analysis. Results A total of 290 neonates were included (PLV: n = 138, and VTV: n = 152). The two cohorts were statistically similar in their baseline characteristics, including gestational age, birth weight, Apgar scores, indications for mechanical ventilation, age at intubation, need for surfactant therapy, and age at extubation. The VTV cohort had a significantly lower mortality rate (n (%) = 10 (6.6%) vs. 21 (15.3%), p = 0.02). An insignificant trend of lower duration of ventilation was observed in the VTV cohort (34.5 vs. 50.5 hours, p = 0.24). There was no significant difference in bronchopulmonary dysplasia (16 (21.3%) vs. 12 (17.8%), p = 0.18). VTV was associated with a significant reduction in pulmonary hemorrhage (1 (0.7%) vs. 8 (5.7%), p = 0.04), episodes of hypocapnia (2 vs. 3/patient, p = 0.04), and episodes of hypercapnia (0 vs 1/patient, p = 0.04). Conclusions The implementation of VTV in clinical practice in our level III-VI NICU was associated with significant advantages, including reduction in mortality, pulmonary hemorrhage, and episodes of hypercapnia and hypocapnia. A large prospective, randomized, and multicenter trial is recommended to confirm these findings.

Silver-infused TiO2 nanowires and unveiling their potential for superior wastewater dye remediations.

Silver infused ultrathin TiO2 nanowires (NWs) were synthesized via a single step solvothermal approach. The crystallinity, structure, and morphology were determined to understand the physicochemical nature of the nanocomposites. The catalytic efficiency of the newly synthesized nanocatalysts was tested for the textile waste treatment taking methylene blue (MB) as model pollutant under solar light irradiations. Nearly 96% photodegradation efficiency for MB was achieved within 20 min. Furthermore, the recyclability of the photocatalyst was also studied, and the material remained stable and effective up to four consecutive runs. RESEARCH HIGHLIGHTS: Precise size-controlled synthesis of Ag-incorporated titania nanowires (ATNWs) Controlled aspect ratios, with tunable lengths and diameters (100-3 nm) via precursor and surfactant optimization Demonstrated ATNWs' efficiency in degrading toxic dye, methylene blue (MB) 96% photodegradation efficiency for MB achieved within 20 min using 3 nm thick annealed TiO2 NWs Recyclability efficiency of photocatalyst, which remained stable and effective for up to four consecutive runs.

Dammarane-type triterpene saponins from the roots of Panax notoginseng (Burk.) F. H. Chen and their neuroprotective effects.

Three undescribed dammarane-type triterpene saponins, 20(S)-sanchirhinoside A7-A9 (1-3), together with seventeen known ones, were isolated from the roots of Panax notoginseng (Burk.) F. H. Chen. The chemical structures of the new compounds were determined by HR-MS and NMR experiments along with chemical methods. To the best of our knowledge, compound 1 was the firstly reported fucose-containing triterpene saponin from plants in the genus of Panax. Moreover, the in vitro neuroprotective effects of the isolated compounds were evaluated. Compounds 11-12 displayed remarkable protective effects against PC12 cells injured by 6-hydroxydopamine.

Dynamic Analysis of Closed Die Electromagnetic Sheet Metal Forming to Predict Deformation and Failure of AA6061-T6 Alloy Using a Fully Coupled Finite Element Model.

This research presents a fully coupled 3D numerical model to analyse the dynamics of high-speed electromagnetic forming process for aluminium alloy AA6061-T6. The effect of Lorentz force distribution, velocity and kinetic energy on deformation, the bounce back effect and failure of the sheet has been investigated. Experiments were performed for AA6061-T6 alloy using an 18.750 KJ electromagnetic forming machine for varying the sheet thickness (0.5 mm, 1.02 mm and 1.63 mm) compared with the simulation results. The results showed that increasing the sheet thickness increases the Lorentz force due to a higher induced current. The inertial forces were more pronounced in thicker sheets (1.63 mm) as compared to the thinner sheets (0.5 mm and 1.02 mm), resulting in a higher bounce back effect for the thicker sheet. The numerical model accurately predicted the sheet failure for the 0.5-mm sheet, as also observed from the experimentation. The sheet deformation from simulations was found to be in good agreement with the experimental results.

Green synthesis, characterization, and antibacterial activity of silver nanoparticles using stem extract of Zanthoxylum armatum.

In this study, we report the green synthesis of silver nanoparticles (AgNPs) using Zanthoxylum armatum stem extract. The characteristic absorption at 385 nm suggested synthesis of AgNPs which was further confirmed by SEM, with a size in the range of 46.66 nm to 60.12 nm and a spherical shape, having an FCC structure, analyzed by XRD. FTIR analysis revealed the presence of phenol and secondary alcohol groups over the AgNPS. The elemental composition was further investigated by FESEM-EDX analysis which revealed the presence of silver in the synthesis nanoparticles. The synthesized silver nanoparticles exhibited antimicrobial activity against tested microorganisms with a zone of inhibition of 21 mm for Staphylococcus aureus, 17 mm for Pseudomonas aeruginosa, 18 mm for Salmonella enteric, and 18 mm for Escherichia coli. Overall, the results showed that the green silver nanoparticles could be safe, as they are capable of potential antimicrobial activity against S. aureus.

Risk Factors of Extubation Failure in Intubated Preterm Infants at a Tertiary Care Hospital in Oman.

Objectives: This study aimed to determine extubation failure (EF) rate among intubated preterm infants (<37 weeks gestational age [GA]) admitted to a tertiary care neonatal intensive care unit (NICU) in Oman and identify the risk factors associated with EF. Methods: This retrospective study included all intubated preterm infants (<37 weeks GA) admitted to the NICU at Sultan Qaboos University Hospital (SQUH) from January 2013 to December 2017. EF was defined as reintubation within seven days of planned extubation. Demographics, ventilation parameters, blood gas values and other possible risk factors of EF were collected. Statistical analysis included comparisons between EF and extubation success (ES) groups and a binary logistic regression analysis. Results: A total of 190 preterm infants were intubated during the study period with 140 eligible for analysis. A total of 106 infants (75.7%) were successfully extubated while 34 (24.3%) failed extubation. GA <28 weeks (P = 0.029), lower 1-minute Apgar score (P = 0.023) and patent ductus arteriosus diagnosis (P = 0.018) were significantly associated with EF. After the multivariate analysis, only GA <28 weeks predicted EF with an adjusted odds ratio of 2.621 (95% confidence interval: 1.118 - 6.146). Conclusion: EF rate in preterm infants admitted at the NICU of SQUH was within international rates. GA <28 weeks was the only predictor of the identified extubation failure. Neonatal practitioners need to seriously consider extreme prematurity in the extubation process and consider implementing strategies to decrease extubation failure in this group of fragile infants.

Two new triterpenoid saponins derived from the leaves of Panax ginseng and their antiinflammatory activity.

BACKGROUND: The leaves and roots of Panax ginseng are rich in ginsenosides. However, the chemical compositions of the leaves and roots of P. ginseng differ, resulting in different medicinal functions. In recent years, the aerial parts of members of the Panax genus have received great attention from natural product chemists as producers of bioactive ginsenosides. The aim of this study was the isolation and structural elucidation of novel, minor ginsenosides in the leaves of P. ginseng and evaluation of their antiinflammatory activity in vitro. METHODS: Various chromatographic techniques were applied to obtain pure individual compounds, and their structures were determined by nuclear magnetic resonance and high-resolution mass spectrometry, as well as chemical methods. The antiinflammatory effect of the new compounds was evaluated on lipopolysaccharide-stimulated RAW 264.7 cells. RESULTS AND CONCLUSIONS: Two novel, minor triterpenoid saponins, ginsenoside LS1 (1) and 5,6-didehydroginsenoside Rg3 (2), were isolated from the leaves of P. ginseng. The isolated compounds 1 and 2 were assayed for their inhibitory effect on nitric oxide production in LPS-stimulated RAW 264.7 cells, and Compound 2 showed a significant inhibitory effect with IC50 of 37.38 µM compared with that of NG-monomethyl-L-arginine (IC50 = 90.76 µM). Moreover, Compound 2 significantly decreased secretion of cytokines such as prostaglandin E2 and tumor necrosis factor-α. In addition, Compound 2 significantly suppressed protein expression of inducible nitric oxide synthase and cyclooxygenase-2. These results suggested that Compound 2 could be used as a valuable candidate for medicinal use or functional food, and the mechanism is warranted for further exploration.

Outcome of Late-onset Neonatal Sepsis at a Tertiary Hospital in Oman.

OBJECTIVES: We sought to determine the prevalence, pattern of causative organisms, and mortality of newborns with culture-proven late-onset sepsis (LOS) and to determine and compare the risk factors linked to late-onset gram-positive and late-onset gram-negative sepsis in Sultan Qaboos University Hospital (SQUH). METHODS: We conducted a cross-sectional retrospective study of data obtained between 1 January 2007 and 31 December 2014 (eight years) from infants in the neonatal intensive care unit (NICU) at SQUH. Infants born in SQUH (inborn) and other institutions (outborn) with positive blood cultures were included in the study. RESULTS: The total number of live births and admissions during the study period were 26 289 and 3559, respectively. The total number of infants identified with LOS were 125 of whom 69 (55.2%) were gram-positive, 52 (41.6%) were gram-negative, and four (3.2%) were due to Candida species (spp.). The majority of infants (n = 113, 90.4%) were inborn; 69 (55.2%) were males and 56 (44.8%) were females. The prevalence of LOS among inborn admissions was 4.3 per 1000 live births. Most infections occurred in very low birth weight infants (n = 81, 64.8%). Eleven (8.8%) infants died due to gram-negative sepsis. Klebsiella pneumoniae followed by Pseudomonas aeruginosa were the leading cause of death. Maternal intrapartum antibiotics were the only independent risk factor correlating with gram-negative organisms in multivariate analysis (p = 0.003). CONCLUSIONS: LOS poses a burden in the NICU, which could be due to the increasing survival of premature babies. The main contributing organisms to LOS are gram-positive bacteria. Klebsiella spp. is a major cause of mortality in LOS. The use of intrapartum antibiotic prophylaxis in mothers might explain the positive correlation of maternal antibiotics as a risk factor with gram-negative infections.

Phytochemical characterisation of an important medicinal plant, Chenopodium ambrosioides Linn.

The project was intended to the phytochemical characterisation from the rudimentary methanolic extract of Chenopodium ambrosioides Linn., which escorts to the isolation of stigmasterol (1), ß-sitosterol (2), octadecanoic acid (3), scopoletin (4) and 1-piperoylpiperidine (5). Literature validates the medicinal authentication of these compounds extorted from other sources, while our previous findings regarding microbial activities of different solvent systems fractions are favouring the presence of medicinally important compounds in this species. Herein, however, we report these natural products for the first time from this species.

Homo-aro-cholestane, furostane and spirostane saponins from the tubers of Ophiopogon japonicus.

Phytochemical investigation of the tubers of Ophiopogon japonicus led to the isolation of five previously undescribed steroidal saponins, ophiojaponins A-E, together with twelve known ones. The structures of these isolated compounds were elucidated by detailed spectroscopic analyses and chemical methods. Ophiojaponins A-C are rare naturally occurring C29 steroidal glycosides possessing a homo-cholestane skeleton with an aromatized ring E. Ruscogenin 1-O-α-L-rhamnopyranosyl-(1 â†’ 2)-4-O-sulfo-ß-D-fucopyranosido-3-O-ß-D-glucopyranoside was isolated as single component and its full spectroscopic data was reported for the first time. The isolated steroidal saponins were evaluated for their cytotoxicities against two human tumor cell lines MG-63 and SNU387. Among them, five known spirostane-type glycosides showed cytotoxic activity against both MG-63 and SNU387 cell lines with IC50 values ranging from 0.76 to 27.0 µM.

A new irregular monoterpene acetate along with eight known compounds with antifungal potential from the aerial parts of Artemisia incisa Pamp (Asteraceae).

A new compound named as santolinylol-3-acetate (4-(2-hydroxypropan-2-yl)-2-methylhexa-1,5-dien-3-yl acetate) (3), along with seven known compounds; linoleic acid (1), benzoic acid (2), santolinylol (4), ethyl-(E)-p-hydroxy cinnamate (5), scopoletin (6), esculetin (7) isofraxidin (8) and eupatorin (9), were isolated from the aerial parts (ethanolic extract) of endangered species: Artemisia incisa Pamp (Asteraceae). The compounds' structures were determined through modern spectroscopic techniques, and comparison of data (physicochemical constants) with the literature. The relative stereochemistry of santolinylol-3-acetate (3) was determined by comparing its data of NOESY, and specific rotation with its diol analogue; santolinylol (4), isolated from the same plant; A. incisa. The results of the antifungal activity showed that coumarins are as whole less active compounds. Compounds 3 (25 and 300 µg/mL), and 4 (12.5 and 300 µg/mL), showed good activities against Candida albicans, and Aspergillus flavus, respectively, which justifies A. incisa as a traditional medicine for curing the said fungal infections.

Changing Survival Rate of Infants Born Before 26 Gestational Weeks: Single-centre study.

OBJECTIVES: This study aimed to evaluate the changing survival rate and morbidities among infants born before 26 gestational weeks at the Sultan Qaboos University Hospital (SQUH) in Muscat, Oman. METHODS: This retrospective study assessed the mortality and morbidities of all premature infants born alive at 23-26 gestational weeks at SQUH between June 2006 and May 2013. Infants referred to SQUH within 72 hours of birth during this period were also included. Electronic records were reviewed for gestational age, gender, birth weight, maternal age, mode and place of delivery, antenatal steroid administration, morbidity and outcome. The survival rate was calculated and findings were then compared with those of a previous study conducted in the same hospital from 1991 to 1998. Rates of major morbidities were also calculated. RESULTS: A total of 81 infants between 23-26 gestational weeks were admitted to the neonatal unit during the study period. Of these, 58.0% were male and 42.0% were female. Median gestational age was 25 weeks and mean birth weight was 770 ± 150 g. Of the 81 infants, 49 survived. The overall survival rate was 60.5% compared to 41% reported in the previous study. Respiratory distress syndrome (100.0%), retinopathy of prematurity (51.9%), bronchopulmonary dysplasia (34.6%), intraventricular haemorrhage (30.9%) and patent ductus arteriosus (28.4%) were the most common morbidities. CONCLUSION: The overall survival rate of infants between 23-26 gestational weeks during the study period had significantly improved in comparison to that found at the same hospital from 1991 to 1998. There is a need for the long-term neurodevelopmental follow-up of premature infants.

Incidence and Risk Factors of Parenteral Nutrition-Associated Cholestasis in Omani Neonates: Single centre experience.

OBJECTIVES: Parenteral nutrition-associated cholestasis (PNAC) is one of the most challenging complications of prolonged parenteral nutrition (PN) in neonates. There is a lack of research investigating its incidence in newborn infants in Oman and the Arab region. Therefore, this study aimed to assess the incidence of PNAC and its risk factors in Omani neonates. METHODS: This retrospective study took place between January and April 2014. All neonates who received PN for ≥14 days during a four-year period (June 2009 to May 2013) at the neonatal intensive care unit (NICU) in Sultan Qaboos University Hospital, Muscat, Oman, were enrolled. RESULTS: A total of 1,857 neonates were admitted to the NICU over the study period and 135 neonates (7.3%) received PN for ≥14 days. Determining the incidence of PNAC was only possible in 97 neonates; of these, 38 (39%) had PNAC. The main risk factors associated with PNAC were duration of PN, duration of enteral starvation, gastrointestinal surgeries, blood transfusions and sepsis. Neonates with PNAC had a slightly higher incidence of necrotising enterocolitis in comparison to those without PNAC. CONCLUSION: This study found a PNAC incidence of 39% in Omani neonates. There were several significant risk factors for PNAC in Omani neonates; however, after logistic regression analysis, only total PN duration remained statistically significant. Preventive strategies should be implemented in NICUs so as to avoid future chronic liver disease in this population.

Factors responsible for the prolonged stay of surgical neonates in intensive care units.

OBJECTIVES: The length of hospital stay (HS) for patients is a major concern due to its social, economic and administrative implications; this is particularly important for neonates admitted to intensive care units (ICUs). This study aimed to determine the factors responsible for prolonged HS in surgical neonates. METHODS: This retrospective study was conducted at Sultan Qaboos University Hospital, in Muscat, Oman. The medical records of 95 neonates admitted to the neonatal ICU who underwent general surgical procedures between July 2009 and June 2013 were reviewed. Mann-Whitney U and Pearson's Chi-squared tests were used for non-parametric numerical and categorical variables, respectively. A multiple regression analysis was performed to find a relationship between the variables and to detect the most important factor responsible for prolonged HS. A P value of <0.05 was considered statistically significant. RESULTS: Gestational age, birth weight, number of days on a ventilator and postoperative morbidity were associated with prolonged HS. Furthermore, the age of neonates at first full enteral feed was associated with increased HS using both independent and multiple regression analyses. CONCLUSION: Prolonged HS can occur as a result of many factors. In this study, a number of factors were identified, including low gestational age, low birth weight, increased number of days on a ventilator and postoperative morbidity. Additionally, neonate age at first full enteral feeds also correlated with increased HS. Further research on this topic is suggested to explore this correlation in more detail and to inform future practices.

Isolation, structure elucidation and enzyme inhibition studies of a new hydroxy ester and other compounds from Berberis jaeschkeana Schneid stem.

Bioassay-guided isolation and fractionation of Berberis jaeschkeana Schneid var. jaeschkeana stem resulted in the isolation and characterisation of a new long chain hydroxy ester named as berberinol (1) along with six known compounds (2-7). All the structures were established from 1D and 2D spectroscopic data. Crude extract, sub-fractions and all the isolated compounds were evaluated for their anti-fungal and urease enzyme inhibition properties. All of the sub-fractions and compounds showed good anti-fungal and urease enzyme inhibition properties. Minimum inhibitory concentrations (MICs) were calculated for all active samples in case of urease enzyme inhibition. MICs values were found to be in the range of 39.03-49.78 µg/mL for urease enzyme inhibition.

A new isoquinoline alkaloid with anti-microbial properties from Berberis jaeschkeana Schneid. var. jaeschkeana.

One new isoquinoline alkaloid named berberidione (1) along with four new source alkaloids berberine (2), palmatine (3), jatrorrhizine (4) and chondrofoline (5) and three new source non-alkaloids syringic acid (6), ß-sitosterol (7) and stigmasterol (8) was isolated and characterised from different fractions of Berberis jaeschkeana Schneid var. jaeschkeana. All the structures were determined from 1D and 2D spectroscopic data. Crude extract, sub-fractions and isolated compounds showed excellent anti-microbial properties. The toxicity level for the alkaloids was found to be very low on THP-1 cells.

Tissue quality assessment using a novel direct elasticity assessment device (the E-finger): a cadaveric study of prostatectomy dissection.

INTRODUCTION: Minimally invasive radical prostatectomy (RP) (robotic and laparoscopic), have brought improvements in the outcomes of RP due to improved views and increased degrees of freedom of surgical devices. Robotic and laparoscopic surgeries do not incorporate haptic feedback, which may result in complications secondary to inadequate tissue dissection (causing positive surgical margins, rhabdosphincter damage, etc). We developed a micro-engineered device (6 mm2 sized) [E-finger]) capable of quantitative elasticity assessment, with amplitude ratio, mean ratio and phase lag representing this. The aim was to assess the utility of the device in differentiating peri-prostatic tissue types in order to guide prostate dissection. MATERIAL AND METHODS: Two embalmed and 2 fresh frozen cadavers were used in the study. Baseline elasticity values were assessed in bladder, prostate and rhabdosphincter of pre-dissected embalmed cadavers using the micro-engineered device. A measurement grid was created to span from the bladder, across the prostate and onto the rhabdosphincter of fresh frozen cadavers to enable a systematic quantitative elasticity assessment of the entire area by 2 independent assessors. Tissue was sectioned along each row of elasticity measurement points, and stained with haematoxylin and eosin (H&E). Image analysis was performed with Image Pro Premier to determine the histology at each measurement point. RESULTS: Statistically significant differences in elasticity were identified between bladder, prostate and sphincter in both embalmed and fresh frozen cadavers (p = < 0.001). Intra-class correlation (ICC) reliability tests showed good reliability (average ICC = 0.851). Sensitivity and specificity for tissue identification was 77% and 70% respectively to a resolution of 6 mm2. CONCLUSIONS: This cadaveric study has evaluated the ability of our elasticity assessment device to differentiate bladder, prostate and rhabdosphincter to a resolution of 6 mm2. The results provide useful data for which to continue to examine the use of elasticity assessment devices for tissue quality assessment with the aim of giving haptic feedback to surgeons performing complex surgery.

Neolignans, lignans and glycoside from the fruits of Melia toosendan.

Four new neolignans, meliasendanins A-D (1-4), and a new glycoside, toosenoside A (5), together with ten known ones (6-15), were isolated from a n-BuOH partition of the fruits of Melia toosendan. Their structures were elucidated by analyses of extensive spectroscopic data and comparison of the NMR data with those reported previously. Meliasendanin A (1) was a rare neolignan containing isochroman moiety, and its absolute configuration was determined using a CD spectrum. Toosenoside A (5) was an unusual glycoside with a rare naturally occurring aglycone and its structure was confirmed by X-ray single crystal diffraction analysis. The antioxidant activity of the isolated neolignans and lignans was evaluated by ABTS radical-scavenging assay. Compounds 1 and 13 exhibited strong antioxidant activity, with IC50 values of 62.8 and 45.1 µM, respectively.