OBJECTIVE: The main objective of this study was to explore oleaginous yeast, Yarrowia lipolytica isolated from soil and optimization of culture conditions and medium components to obtained better quality microbial oil for biodiesel production.
METHODS: Fifty yeast strains were isolated from soil from different regions of Lahore and eleven of them were selected for oil production. The isolated yeast colonies were screened to further check their lipid producing capabilities by the qualitative analysis. Five yeast strains were designated as oleaginous because they produced more than 16% of oil based on their biomass. To estimate the total lipid content of yeast cells, the extraction of lipids was done by performing the procedure proposed by Bligh and Dyer. The transesterification of yeast oils was performed by using different methods. There were three different strategies customized to transesterifying microbial oil using base catalyzed transesterification, acid catalyzed transesterification and enzyme-based transesterification. After completion of transesterification, sample was used for fatty acid methyl esters (FAMEs) were analyzed by gas-chromatograph with ionization detector type MS.
RESULTS: The isolate IIB-10 identified as Yarrowia lipolytica produced maximum amount of lipids i.e. 22.8%. More amount of biomass was obtained when cane molasses was utilized as carbon source where it produced 29.4 g/L of biomass while sucrose and lactose were not utilized by IIB-10 and no biomass was obtained. Similarly, meat extracts showed best results when it was used as nitrogen source because it resulted in 35.8 g/L biomass of Yarrowia lipolytica IIB-10. The culturing conditions like size of inoculum, effect of pH and time of incubation were also studied. The 10% of inoculum size produced 25.4 g/L biomass at 120 h incubation time, while the pH 7 was the optimum pH at which 24.8 g/L biomass was produced by Yarrowia lipolytica IIB-10. GC-MS analysis showed that biodiesel produced by transesterification contained similar fatty acids as found in vegetable oil for this reason it is widely accepted feedstock for biodiesel production.
CONCLUSION: The analysis of fatty acids methyl esters showed the similar composition of microbial oil as in vegetable oils and high amount of methyl esters were obtained after transesterification. Therefore, potentially oleaginous yeast could be used to generate a large amount of lipids for biodiesel production that will be the better substitute of petroleum-based diesel and will also control the environmental pollution.
STUDY DESIGN: A cross-sectional study, conducted across Punjab, Pakistan.
METHOD: The study deployed a validated survey to evaluate the competencies and practices of the community and hospital pharmacists.
RESULTS: 504 community pharmacists and 279 hospital pharmacists participated in the survey with an overall response rate of 85.5%. Almost half of the respondents 'never' or 'sometimes' made clinical notes in a journal or dispensing software to monitor ongoing opioid use. Generally, pharmacists were reluctant to collaborate with physicians or notify police regarding the abuse/misuse of opioids. Hospital pharmacists achieved significantly higher mean competency scores than chain and independent community pharmacists (p<0.05). In competency evaluation, three priority areas emerged that require additional training, that is, 'opioid overdose management', 'opioid use monitoring' and 'therapeutic uses of opioids'.
CONCLUSION: Both community and hospital pharmacists hold significant positions and potential to contribute meaningfully to the mitigation of harms and risks associated with opioids. Nevertheless, this study underscores notable deficiencies in the competence of pharmacists, whether in hospital or community settings in Punjab, concerning various aspects related to the dispensing and utilisation of opioids. It also highlights the pressing need for the development of strategies aimed at improving several practice areas including the documentation, the quality of patient counselling, the effectiveness of reporting mechanisms for opioid abuse and the stringent enforcement of regulatory policies to curtail opioid misuse. Thus, to mitigate the opioid epidemic in Pakistan, it is imperative to institute opioid stewardship initiatives aimed at rectifying the competency and procedural deficiencies within the pharmacist workforce.
PURPOSE: To evaluate the opioids dispensing competencies among the final year Pharm-D students in Punjab, Pakistan.
DESIGN: A multicenter cross-sectional study.
METHODS: A validated survey was used to evaluate 11 competencies related to opioid use from the final year Pharm-D students from diversely located accredited institutes. On a summative scale, correct response to each survey item was worth a score/point. Descriptive statistics was used for categorical variables while independent t-test computed group differences.
RESULTS: A total of n = 661 final year Pharm-D students from 28 institutes (8 public and 20 private) completed the survey with an overall response rate of 78.5%. Comparatively, the students who had either completed a community or hospital internship, or studying in the educational institutions located in the provincial capital demonstrated a significant higher competency score. There was no significant difference in the overall mean competency scores based on gender or system of assessment used in the Pharm-D degree programs. Among eleven opioid competencies, students received the lowest scores for "opioid overdose management", "opioid monitoring" and "therapeutic uses of opioids".
CONCLUSION: Pharm-D students in Pakistan require additional training and skills on many of the opioids related competencies to ensure patient's safety in healthcare settings. There is a need to revise the curriculum and teaching methodologies to improve the competencies of Pharm-D students in opioid dispensing.
METHODS: In this open-label, phase 3, multicentre randomised trial, patients aged 21-80 years with cT3 or cT4 gastric cancer undergoing curative resection were enrolled at 22 centres from South Korea, China, Japan, Malaysia, Hong Kong, and Singapore. Patients were randomly assigned to receive surgery and EIPL (EIPL group) or surgery alone (standard surgery group) via a web-based programme in random permuted blocks in varying block sizes of four and six, assuming equal allocation between treatment groups. Randomisation was stratified according to study site and the sequence was generated using a computer program and concealed until the interventions were assigned. After surgery in the EIPL group, peritoneal lavage was done with 1 L of warm (42°C) normal 0·9% saline followed by complete aspiration; this procedure was repeated ten times. The primary endpoint was overall survival. All analyses were done assuming intention to treat. This trial is registered with ClinicalTrials.gov, NCT02140034.
FINDINGS: Between Sept 16, 2012, and Aug 3, 2018, 800 patients were randomly assigned to the EIPL group (n=398) or the standard surgery group (n=402). Two patients in the EIPL group and one in the standard surgery group withdrew from the trial immediately after randomisation and were excluded from the intention-to-treat analysis. At the third interim analysis on Aug 28, 2019, the predictive probability of overall survival being significantly higher in the EIPL group was less than 0·5%; therefore, the trial was terminated on the basis of futility. With a median follow-up of 2·4 years (IQR 1·5-3·0), the two groups were similar in terms of overall survival (hazard ratio 1·09 [95% CI 0·78-1·52; p=0·62). 3-year overall survival was 77·0% (95% CI 71·4-81·6) for the EIPL group and 76·7% (71·0-81·5) for the standard surgery group. 60 adverse events were reported in the EIPL group and 41 were reported in the standard surgery group. The most common adverse events included anastomotic leak (ten [3%] of 346 patients in the EIPL group vs six [2%] of 362 patients in the standard surgery group), bleeding (six [2%] vs six [2%]), intra-abdominal abscess (four [1%] vs five [1%]), superficial wound infection (seven [2%] vs one [<1%]), and abnormal liver function (six [2%] vs one [<1%]). Ten of the reported adverse events (eight in the EIPL group and two in the standard surgery group) resulted in death.
INTERPRETATION: EIPL and surgery did not have a survival benefit compared with surgery alone and is not recommended for patients undergoing curative gastrectomy for gastric cancer.
FUNDING: National Medical Research Council, Singapore.
MATERIALS AND METHODS: A retrospective database review was conducted of patients undergoing primary laparoscopic sleeve gastrectomy between 2009 and 2013 in 14 centres from Singapore, Malaysia, Taiwan, Hong Kong, Japan, Korea, India, Australia, Switzerland, and the USA. All patients with available follow-up data at 12 months and 36 months post-surgery were included in this study. Outcome measures used were percentage excess weight loss (%EWL) and percentage total weight loss (%TWL). Differences in outcomes between ethnicities were analysed after adjusting for age, gender, baseline body mass index (BMI), and presence of diabetes.
RESULTS: The study population (n = 2150) consisted of 1122 Chinese, 187 Malays, 309 Indians, 67 Japanese, 259 Koreans, and 206 Caucasians. 67.1% were female and 32.9% were male. Mean age was 37.1 ± 11.2 years. Mean pre-operative BMI was 40.7 ± 8.1 kg/m2. With the Caucasian population as reference, Japanese had the best %TWL (3.90, 95% CI 1.16-6.63, p
METHODS: A committee of 61 well-known metabolic and bariatric surgeons from 24 countries was created to participate in the Delphi consensus. The committee voted on 45 statements regarding recommendations and controversies around fasting after MBS. An agreement/disagreement ≥ of 70.0% was regarded as consensus.
RESULTS: The experts reached a consensus on 40 out of 45 statements after two rounds of voting. One hundred percent of the experts believed that fasting needs special nutritional support in patients who underwent MBS. The decision regarding fasting must be coordinated among the surgeon, the nutritionist and the patient. At any time after MBS, 96.7% advised stopping fasting in the presence of persistent symptoms of intolerance. Seventy percent of the experts recommended delaying fasting after MBS for 6 to 12 months after combined and malabsorptive procedures according to the patient's situation and surgeon's experience, and 90.1% felt that proton pump inhibitors should be continued in patients who start fasting less than 6 months after MBS. There was consensus that fasting may help in weight loss, improvement/remission of non-alcoholic fatty liver disease, dyslipidemia, hypertension and type 2 diabetes mellitus among 88.5%, 90.2%, 88.5%, 85.2% and 85.2% of experts, respectively.
CONCLUSION: Experts voted and reached a consensus on 40 statements covering various aspects of fasting after MBS.
METHODS: Eighty-nine recognized MBS surgeons from 42 countries participated in the Modified Delphi consensus to vote on 30 statements in two rounds. An agreement/disagreement among ≥ 70.0% of the experts was regarded to indicate a consensus.
RESULTS: Consensus was reached on 29 out of 30 statements. Most experts agreed that before getting privileges to perform MBS, surgeons must hold a general surgery degree and complete or have completed a dedicated fellowship training program. The experts agreed that the learning curves for the various operative procedures are approximately 25-50 operations for the LSG, 50-75 for the OAGB, and 75-100 for the RYGB. 93.1% of experts agreed that MBS surgeons should diligently record patients' data in their National or Global database.
CONCLUSION: MBS surgeons should have a degree in general surgery and have been enrolled in a dedicated fellowship training program with a structured curriculum. The learning curve of MBS procedures is procedure dependent. MBS surgeons must demonstrate proficiency in managing postoperative complications, collaborate within a multidisciplinary team, commit to a minimum 2-year patient follow-up, and actively engage in national and international MBS societies.