Quality and Safety in Healthcare

Evaluating the adherence to guidelines for management of acute heart failure in the Gaza Strip hospitals: A medical chart–based review study Mohamedraed Elshami, Reem Dabbour, Mohammed Alkhatib, Tamer Abdalghafoor, Enas Alaloul, Mohamed Habib, Montaser Ismail, Bettina Bottcher Global Journal on Quality and Safety in Healthcare 2019 2(2):21-29 Objective: To evaluate adherence of clinicians to the European guidelines for management of acute heart failure (AHF). Materials and Methods: This was a medical chart–based review study conducted from January to December 2016, including 200 medical records of patients admitted to two major hospitals in the Gaza Strip, Palestine. The AHF management was compared to the European Society of Cardiology (ESC) Guidelines, 2016. Results: The patients’ mean age was 66.0±13.0 years. A total of 100 patients (50.0%) were women and 192 (96.0%) had comorbidities including hypertension, diabetes, and heart disease. The most notable finding was that of a very poor standard of documentation, especially for vital signs. Patient management showed mostly moderate to good adherence to guidelines with 189 (94.5%) patients undergoing electrocardiogram, 90 (45.0%) echocardiography, 97 (48.5%) chest X-ray, and 79 patients of 167 (47.3%) receiving vasodilators appropriately. Good adherence was found in checking glucose levels, 176 (88.0%), and application of oxygen (100% with SpO2 < 90%). Some aspects of care showed poor adherence, such as overuse of digoxin in 57 patients (28.5%), of which only 30 (53.4%) had atrial fibrillation and inappropriate use of beta-blockers in two patients who were hypotensive. Furthermore, brain natriuretic peptide was not used at all. Conclusion: The results of this study show suboptimal adherence to the ESC guidelines in management of AHF, reflecting the need to improve awareness of evidence-based medicine among clinicians.

Radiographs reject analysis in a large tertiary care hospital in Riyadh Khalid A Alyousef, Shatha Alkahtani, Raghad Alessa, Hajar Alruweili Global Journal on Quality and Safety in Healthcare 2019 2(2):30-33 Background: Analysis of rejected radiographs is an important quality indicator of any radiology department. At King Abdulaziz Medical City (KAMC), about 185,000 radiographs are performed annually. Methods: The rejected radiographs over a period of 5 years were analyzed using a dedicated electronic rejection system. The rejection is performed by a certified radiologist and communicated electronically to the concerned technologist. Results: A total of 455 rejected radiographs were reviewed and analyzed. Of the reviewed rejected radiographs, 247 were adults (60%) whereas 166 were pediatrics (40%). In terms of sex, 231 (56%) of the rejected radiographs were for men and 182 (44%) were for women. The most common reason for rejection was labeling (22%), followed by procedure protocol (20%). Other reasons included positioning (14%), processing (14%), artifacts (13%), wrong documentation (9%), and exposure error (6%). The rejection due to exposure error was very low (6%) owing to the utilization of digital systems that offer a wide exposure latitude. Reported data at hospitals that use analog systems show up to 67% of rejections were due to exposure error. In terms of body parts, the highest rejection was for extremities (43%) followed by chest (31%). The remaining rejected radiographs includes abdomen (9%), spine (8%), pelvis (5%), and head and neck (4%).Conclusion: The outcome of this study can be used to set up training programs to improve radiological services and reduce the unnecessary radiation exposure to the patients.

Rare event control charts in drug recall monitoring and trend analysis of data record: A multidimensional study Mostafa E Eissa Global Journal on Quality and Safety in Healthcare 2019 2(2):34-39 Background: Control of the quality of pharmaceutical and healthcare products in the market is mandatory to ensure the safety and efficacy of the delivered product to the final consumers. The United States Food and Drug Administration (FDA) is providing a continuous and comprehensive updated list for various healthcare issues including drug recalls. Methods: This study provides a multidimensional analysis using statistical process control (SPC) tools to evaluate the risk associated over a 3-year period (2016–2018). Results: The study showed a simple implementation of the combination of SPC tools, which demonstrated that the major contributors to recalls are microbiological quality issues, problems with product compositions, and packaging defects. Months that contributed by more than 60% of the total recalls were from May to August, November, and December. Conclusion: The general trend of drug recall rates is increasing yearly, which should be a warning signal for the regulatory agencies to take preventive measures to control and prevent excessive cases of recalls.

Safe patient handling: How many people do you need to safely lateral transfer patients? Austin J Smith, Michele Loder Global Journal on Quality and Safety in Healthcare 2019 2(2):40-45 Background: Although friction-reducing devices reduce the amount of force to complete a lateral transfer, the total force is significantly higher than the recommended pushing and pulling limits. Caregivers complete lateral transfers without knowing the amount of force required to laterally transfer patients, which subjects them to injury. Methods: This study was designed to identify the force to laterally transfer patients of any weight, in conditions similar to those found within the hospital of this study. There were 16 participants in this study. The participants were moved from a hospital bed to a hospital cart using two force gauges pulling two gait belts secured around the participant. Each participant was moved three times, resulting in 48 data points. A regression analysis was used to evaluate trends between two variables. A general linear model was applied and the coefficient of determination was calculated to show the percent fit to the trend line. Results: This study found a strong correlation between force of lateral transfer and the weight of the patient. Using this correlation, this study was able to predict the total force of a lateral transfer for any patient weight. The results from this study allowed for the creation of a guide to determine how many caregivers are required during a lateral transfer to maintain a safe amount of force per caregiver. Conclusion: Caregivers need to be given information regarding the forces required to complete physical movements so they can protect themselves from overexertion and injury. This study provides a guideline for caregivers to know how many people are needed to safely complete a lateral transfer.

The impact of post-discharge follow-up calls on 30-day hospital readmissions in neurosurgery Dorothy M Mwachiro, Jacqueline Baron-Lee, Frederick R Kates Global Journal on Quality and Safety in Healthcare 2019 2(2):46-52 Background: Hospital readmissions that occur within 30 days of the initial hospital stay are costly and potentially avoidable. Studies have shown that in addition to patients’ discharge instructions and education, follow-up calls post-discharge can significantly reduce readmission that occurs within 30 days of the initial hospital stay. Objective: To evaluate the effectiveness of nurse follow-up calls conducted in the neurosurgery service for discharged patients between October 2017 and February 2018 in reducing readmissions that occur within 30 days of initial hospital stay. Methods: An audit was initially conducted to assess compliance with conducting follow-up calls. Weekly discharge reports were used to check if patients received a follow-up call within 24–48h post-discharge. To capture the nurses’ feedback on follow-up calls, an anonymous survey was administered. Medical insurance claims data, also known as claims-based data in the American health care system, were reviewed and analyzed to assess whether there was any difference in number of days from initial discharge to readmission between patients who received a follow-up call and those who did not. Results: Results based on a multivariable regression model indicated that patients who received a follow-up call after they were discharged from initial admission stayed out of hospital longer (incidence-rate ratio = 1.54, 95% CI = [1.13, 2.10], p = 0.006) compared to those that did not receive a follow-up call. Conclusion: Readmitted patients who received post-discharge follow-up calls had significant improvements in the length of time out of the hospital. Future development could include developing additional call strategies.

Médecine & Droit

Rapport de la mission parlementaire sur la bioéthique : vers la procréation sans sexe pour tous Publication date: Available online 27 March 2019 Source: Médecine & Droit Author(s): Aude Mirkovic Résumé Le rapport parlementaire propose la « procréation sans sexe pour tous », laquelle passe par l'assistance médicale à la procréation pour les couples de femmes et les femmes seules, la procréation post mortem et le double don de gamètes. Abstract The parliamentary report proposes "non-sexual procreation for all", which goes through medically assisted procreation for couples of women and single women, post-mortem procreation and dual gamete donation.

Le consentement du patient aux actes de secours lors d'interventions extrahospitalières Publication date: Available online 26 March 2019 Source: Médecine & Droit Author(s): Bertrand Quaglierini, Nicolas Genotelle Résumé Le recueil du consentement de la personne aux soins qui lui sont proposés est un principe quasi-absolu. Ce recueil s'impose également aux secouristes intervenant comme primo-intervenants en amont de la chaîne de santé stricto sensu ; d'autant plus que, du fait de la régulation médicale par le SAMU, cette intervention s'assimile à un acte de soins. Le principe du consentement aux soins s'impose donc à la fois dans un but d'humanisme et dans celui de prévenir tout éventuel contentieux. Pour autant, il existe de nombreuses situations où la gestion du consentement de la personne secourue pourra poser des difficultés pour les secours non médicalisés. Il convient alors d'analyser comment les systèmes de secours peuvent gérer et limiter le risque face aux différentes situations de refus de prise en charge, afin de respecter la dignité des personnes, mais ne pas non plus commettre un abandon de soins. Un travail de concert entre secouristes et médecin régulateur est alors indispensable, surtout à défaut de consentement. Il permettra de déceler les hypothèses où la lucidité est altérée et de mettre en œuvre proportionnellement les mesures utiles. Il permettra également de délivrer une information efficace au patient, corollaire de la question du consentement, et de sensibiliser ce dernier sur les conséquences de sa décision, en veillant qu'elle ait été exprimée en parfaite connaissance de cause. Il semblerait alors utile que les référentiels et recommandations portant sur le secours d'urgence à personne et émanant de la Direction générale de la sécurité civile et gestion de crise, détaillent plus ces situations difficiles afin que les secouristes puissent les anticiper plus efficacement. Enfin, nous proposons un formalisme qui pourrait être envisagé et mis en place dans les cas de refus de prise en charge chez une personne lucide, et discutons les intérêts d'une telle mise en place. Abstract The acquirement of a person's consent to the medical care that is proposed to a patient is an absolute basic principle in rescue health care. This is mandatory for first arrival rescuers ; especially since their actions are, in view of the French Emergency Medical Service call centers, considered as being a medical act. The basic principle of consent to first medical care hence imposes itself as a humanitarian act as well as preventing any potential litigation. Nevertheless there are numerous situations where the management of the consent of the person in need of non-medical assistance will present difficulties. It is the necessary to analyze how the rescue health care system can manage and limit the risks s linked to the different situations when treatment is refused by the person in need of such help ; and this so as to respect the individual's dignity whilst not abandoning the needed health care. A collaboration between rescue personnel and the call center coordinating medical doctor is then mandatory especially when no consent is obtained. This will enable the detection of hypotheses where the individual's lucidity is altered and implement proportionately required and helpful measures. It will also equally enable the transmission of efficient information to the patient, in relation to the matter of patient consent and to ensure that the patient is aware of the consequence of his or her decision and that this decision was full y expressed. It would hence be deemed useful that the referenced work frame and recommendations, pertaining to the emergency rescue of a person, established by the General Management of Public Safety and Crisis Management detail more in detail these difficult and delicate situations so as to ensure that rescue personnel can better anticipate them. To conclude were commend a formalization of procedures that could be implemented in situations where a patient that has full mental capacities refuses the proposed health care, and that that the advantages of such a procedure be discussed.

Quelle juridiction est compétente pour juger des faits commis par un professeur des universités-praticien hospitalier qui sont en rapport avec son activité d'enseignement ? Publication date: February 2019 Source: Médecine & Droit, Volume 2019, Issue 154 Author(s): Frédéric Dieu Résumé Si les professeurs des universités-praticiens hospitaliers (PUPH) ou les maîtres de conférences des universités-praticiens hospitaliers peuvent faire l'objet de poursuites devant les juridictions de l'ordre dont ils relèvent pour tout fait lié à l'exercice de leurs fonctions, il n'en va toutefois pas de même pour ceux de ces faits qui seraient indétachables de leur activité universitaire. Ces faits ne peuvent donner lieu à poursuites que devant la juridiction spécialisée prévue par l'article L. 952-22 du Code de l'éducation. Il en va ainsi des faits ayant consisté, pour un PUPH, à donner à ses étudiants, dans le cadre de son enseignement universitaire, un sujet d'examen dont le libellé était susceptible de méconnaître les principes déontologiques résultant des articles R. 4127-3 et R. 4127-31 du Code de la santé publique. Abstract Constituted courts of ordinal authorities are not competent to judge facts committed by a university professor-hospital practitioner, which are related to his teaching activity. Only the court specific to hospital teachers, which is seized by the ministries of health and higher education, is competent to judge those facts.

Les remèdes du droit aux souffrances de la personne malade Publication date: February 2019 Source: Médecine & Droit, Volume 2019, Issue 154 Author(s): Augustin Boulanger Résumé Que peut le droit face à la souffrance des hommes ? L'on sait depuis plusieurs décennies qu'il œuvre à sa réparation, reconnaissant les souffrances d'origine physique et morale comme un préjudice réparable. Mais peut-il œuvrer à sa conjuration ? Non seulement il le peut, mais il s'y emploie en prévoyant des moyens humains et techniques facilitant leur évincement. Désormais, les personnes ont un droit au soulagement des souffrances, afin que leur mal disparaisse. Abstract Can law eliminate suffering? For a long time, the suffering has been only compensated. Indeed, the compensation of the physical and moral sufferings was allowed. But can law remove suffering? In fact, the French national law provides humans and technical means so as to eliminate pains. Now the law states that people's suffering justifies medical care and treatments.

Editorial Board Publication date: February 2019 Source: Médecine & Droit, Volume 2019, Issue 154 Author(s):

Le consentement en droit médical Publication date: February 2019 Source: Médecine & Droit, Volume 2019, Issue 154 Author(s): Romain Porcher Résumé Le droit médical, dérogatoire du droit commun, intéresse et interroge par ses particularités. Pour autant, l'arrêt Mercier de 1936 semble avoir nié cela en optant pour le forçage d'un classique « contrat médical » entre le médecin et son patient. Mais la relation médicale, bien au-delà d'une logique contractuelle, paraît ne pas pouvoir se fondre dans les éléments civilistes du droit des contrats. À ce titre, le consentement, clé de voûte de cette matière médicale, ne répond pas aux canons obligationnels du droit des contrats pourtant imposés de facto par la Cour de Cassation. Il s'agira dans le présent article de démêler et d'éclaircir les éléments singuliers de ce consentement pas tout à fait comme les autres. Abstract Medical law, which derogates from ordinary law, interests and questions by its particularities. However, the Mercier decision of 1936 seems to have denied this by forcing an ordinary "medical contract" between the doctor and his patient. But the medical relationship, far beyond a contractual logic, seems to be unable to blend into the civil law elements of contract law. As such, consent, keystone of this medical matter, does not meet the standards of contract law yet imposed by the Court of Cassation. This article aims to unravel and clarify the scope and regime of this consent not quite like the others.

Le juge, le médecin et le détenu. Regard critique sur la suspension de peine pour raison médicale Publication date: Available online 20 January 2019 Source: Médecine & Droit Author(s): Aline Chassagne, Aurélie Godard-Marceau Résumé L'article a pour objectif de porter un regard critique sur la suspension de peine médicale souvent considérée comme une loi « humaniste ». À partir d'une recherche menée sur l'expérience des personnes détenues en fin de vie, il ressort que de nombreux critères plus ou moins objectifs, interviennent dans la prise de décision de la sortie de prison. Dans ce cadre, les médecins et les magistrats tentent d'articuler leurs actions en s'appuyant sur un travail d'évaluation et d'expertise. L'octroi ou le refus d'une suspension de peine médicale dépend également de la perception de la personnalité du détenu par les différents acteurs. L'application du droit reflète ainsi les tensions et les alliances entre la médecine et la justice dans le traitement d'une population vulnérable et déviante. Abstract The purpose of the article is to give a critical view of the "suspension médicale" (a kind of compassionate release), which is often considered as a "humanist" law. Based on a research conducted on the experience of prisoners at the end of their lives, it appeared that many more or less objective criteria are involved in the decision-making process. In this context, physicians and magistrates try to articulate their actions according to expertise. The decision of granting or refusal also depends on the perception of the prisoner's personality. The application of the law thus reflects the tensions and alliances between medicine and justice in the treatment of a deviant and vulnerable population.

Enjeux majeurs de santé publique versus autonomie personnelle : le cas spécifique de l'obligation vaccinale Publication date: Available online 19 December 2018 Source: Médecine & Droit Author(s): Marion Travers Résumé Si la triple dimension individuelle, altruiste et collective de l'obligation vaccinale préventive sert un objectif de santé publique majeur, il n'empêche qu'en imposant une contrainte aux individus et en portant ainsi atteinte à plusieurs de leurs droits fondamentaux, un tel choix des pouvoirs publics va à l'encontre de la liberté personnelle. La première question soulevée est alors celle de la légitimité d'une telle politique. Des moyens moins coercitifs, et donc moins attentatoires aux droits et libertés fondamentaux, ne pourraient-il pas être déployés ? À défaut, à partir de quel(s) seuil(s) d'alerte ? de risque ? l'obligation vaccinale pourrait-elle se justifier ? Abstract While the triple individual, altruistic and collective dimension of the preventive vaccination obligation serves a major public health objective, it only prevents such a choice by public authorities, by imposing a constraint on individuals and thus violating several of their fundamental rights, from going against personal freedom. The first question raised is then that of the legitimacy of such a policy. Could less coercive means, and therefore less intrusive on fundamental rights and freedoms, not be deployed? If not, at what risk alert threshold(s) could the vaccination obligation be justified?

Editorial Board Publication date: December 2018 Source: Médecine & Droit, Volume 2018, Issue 153 Author(s):

Secret médical en santé au travail Publication date: December 2018 Source: Médecine & Droit, Volume 2018, Issue 153 Author(s): Cécile Manaouil Résumé Les médecins du travail sont tenus, comme tout médecin, de respecter les obligations déontologiques s'imposant à leur profession, y compris dans l'exercice des missions spécifiques à la médecine du travail et contenues dans le Code du travail. Le médecin du travail n'est pas isolé et œuvre au sein d'une équipe pluridisciplinaire d'un service de santé au travail. Il se doit de communiquer avec d'autres professionnels de santé, mais aussi avec les employeurs, les instances représentatives du personnel… Le secret médical tient une place particulière dans la relation triangulaire entre le médecin du travail, le salarié et l'employeur. L'exercice médical dans le domaine de la santé au travail impose de suivre de nombreuses dispositions issues du Code du travail, dont le respect du secret de fabrication et d'une position de conseiller des employeurs et des salariés. Le médecin du travail doit communiquer avec l'employeur afin de réaliser au mieux sa mission, mais en pratique, il peut s'avérer difficile pour le médecin du travail de faire entendre ses préconisations et recommandations pour améliorer les conditions de travail des salariés sans pouvoir argumenter ses avis sur des informations médicales. Abstract The occupational physicians are obliged, like any doctor, to respect the ethical obligations imposed on their profession, including in the exercise of the missions specific to occupational medicine and contained in the Labor Code. The occupational physician is not isolated and works in a multidisciplinary team of a health service at work. He must communicate with other health professionals, but also with employers, representative bodies of staff. Medical confidentiality holds a special place in the triangular relationship between the occupational physician, the employee and the employer. The medical practice in the field of occupational health requires that many provisions of the Labor Code be followed, including the respect of the secret of manufacture and the position of advising employers and employees. The occupational physician must communicate with the employer in order to best achieve his mission, but in practice, it may be difficult for the occupational doctor to make his recommendations heard to improve the working conditions of employees without power, when he cannot argue his opinions on medical information.

Ethnopharmacology

Protective role of wild garlic on isoproterenol-induced myocardial necrosis in wistar rats Publication date: 12 June 2019 Source: Journal of Ethnopharmacology, Volume 237 Author(s): Saravanakumar Murugesan, Arunagiri Pandiyan, Lakshmi Saravanakumar, Kogi Moodley, Irene Mackraj Abstract Ethnopharmacological relevance Tulbaghia violacea Harv. (TVL) is a folk medicine, native to South Africa which has previously shown antioxidant, anti-hypertensive and anti-diabetic effects. The Aim of the study: The aim of the current study was to investigate the protective role of wild garlic or TVL on isoproterenol (ISO)-induced myocardial necrosis in rats. Materials and methods Animal (n = 6 each group) were pre and co-treated with TVL (60 mg/kg body weight) daily for 30 days. Myocardial necrosis was administrated by subcutaneous injection of ISO (85 mg/kg body weight) into rats on 29th and 30th day. On the 31st day, rats were anaesthetized and blood, heart samples were obtained for the biochemical, histopathological and molecular study. The specific protein target analysis from TVL was done by reverse docking study (reverse pharmacophore mapping) using PharmMapper. Results The levels of cardiac markers, lipid peroxidation products, and heart rate were considerably increased in ISO-induced myocardial necrosis in rats whilst plasma enzymatic antioxidants were significantly decreased. Myocardial necrotic mRNA genes were increased in ISO-induced myocardial necrosis in rats compared to controls. Pre and co-treatment with TVL and ramipril of myocardial necrosis in rats showed significant effects on all the biochemical and molecular studies evaluated. TVL reduced heart rate, prevented oxidative stress and downregulated the Fas-receptor and caspase-mediated apoptosis-signaling pathway, and heart muscle damage in myocardial necrosis in rats. The specific target protein [disulfide, bis (2-sulfhydrylethyl] from TVL mediates the protective effects. Conclusion Wild garlic or TVL extract has shown a protective effect on ISO-induced myocardial necrosis in rats by increasing antioxidant production confirmed with docking studies. Graphical abstract

Effect of saffron (stigma of Crocus sativus L.) aqueous extract on ethanol toxicity in rats: A biochemical, histopathological and molecular study Publication date: 12 June 2019 Source: Journal of Ethnopharmacology, Volume 237 Author(s): Alireza Rezaee-Khorasany, Bibi Marjan Razavi, Elahe Taghiabadi, Abbas Tabatabaei Yazdi, Hossein Hosseinzadeh Abstract Ethnopharmacological relevance Saffron (Crocus sativus L.) is considered in the Iranian traditional medicine because of many therapeutic properties such as sedative agent, strengthen the stomach and liver, improving the uterus disorders and infectious wounds. The detoxification of alcohol was one of the most important of saffron effects in ancient medicine. Aim of the study In the current research, the protective effects of saffron aqueous extract (Aq. Ext.) versus oxidative stress, apoptosis, inflammation, histopathological and biochemical abnormalities induced by ethanol were evaluated. Materials & methods The male Wistar rats were divided into seven groups consisted of 6 rats in control (distilled water), ethanol (5 g/kg - 50% v/v), Aq. Ext. (40, 80 and 160 mg/kg) plus ethanol, Aq. Ext. 80 and 160 mg/kg. Animals were treated for four weeks and at the end of treatment period, histopathological damages, biochemical markers, apoptosis, levels of MDA and GSH, TNF-α and IL-6 were evaluated. Results Ethanol induced nephrotoxicity and hepatotoxicity as evidenced by histopathological damages and biochemical abnormalities. The level of MDA was significantly enhanced while GSH content was remarkably reduced in ethanol-treated rats, but protective groups restored them. Also, the levels of TNF-α and IL-6 were regulated by Aq. Ext. Furthermore, the effects of ethanol on histopathological and biochemical parameters were improved by Aq. Ext. The ethanol increased the expression of Bax/Bcl2 ratio, caspase-3, -8, and -9. Real-time PCR and western blot analysis proved that Aq. Ext. treatment inhibited apoptosis induced by ethanol through decreasing the Bax/Bcl2 ratio (mRNA and protein) and caspases-3, -8, and -9 levels in the kidney and liver. Conclusion The results of this research demonstrated that Aq. Ext. could exert protective effects against ethanol toxicity in rat kidney and liver via antioxidant, anti-apoptosis, and anti-inflammatory effects. Graphical abstract

In vivo anti-inflammatory activity and UPLC-MS/MS profiling of the peels and pulps of Cucumis melo var. cantalupensis and Cucumis melo var. reticulatus Publication date: 12 June 2019 Source: Journal of Ethnopharmacology, Volume 237 Author(s): Shahira M. Ezzat, Mai Raslan, Maha M. Salama, Esther T. Menze, Seham S. El Hawary Abstract Ethnopharmacological relevance Cucumis melo var. cantalupensis and Cucumis melo var. reticulatus are the most famous varieties of netted muskmelon or cantaloupe in Egypt. Cantaloupe has a great reputation as an anti-inflammatory drug for hot inflammation of liver, cough, eczema, and kidney disorders such as ulcers in the urinary tract, and our objective was to confirm this use scientifically. Materials and methods Inflammation was induced in adult male Sprague Dawley rats by subcutaneous injection of 0.05 ml of carrageenan (1% solution in saline) into the plantar surface of the right hind paw 30 min after oral pretreatment of the rats with 95% ethanolic extracts of Cucumis melo var. cantalupensis peels (CCP) and pulps (CCU) and Cucumis melo var. reticulatus peels (CRP) and pulps (CRU) at doses of 25 and 50 mg/kg. Indomethacin (10 mg/kg) was used as a standard drug. The effect of the tested samples was measured on the oedema volume, as well as PGE-2, TNF-α, IL-6 and IL-1β levels. Metabolic profiling of the extracts was performed using UPLC-MS/MS analysis. Results Pretreatment of rats with the ethanol extract of the pulps and peels of the two varieties at doses of 25 and 50 mg/kg significantly inhibited the carrageenan-induced increase in the oedema volume of the rat paws after 3 h, except for the low dose of the French cantaloupe pulp. CRP at 50 mg/kg caused the most significant reductions in both TNF-α (P < 0.05) and IL-1β (P < 0.001) levels, while CCP caused the most significant reductions in PGE-2 and IL-6 (P < 0.05) levels. Increases in PGE-2, TNF-α, IL-6 and IL-1β levels were also significantly prevented by indomethacin (10 mg/kg). UPLC-MS/MS facilitated the identification of 44 phenolic compounds, including phenolic acids and flavonoids. Conclusion This is the first report of the chemical and biological study of the peels of Cucumis melo var. cantalupensis and Cucumis melo var. reticulatus. Graphical abstract

Bodies of the plant and Animal Kingdom: An illustrated manuscript on materia medica in the Netherlands (ca. 1800) Publication date: 12 June 2019 Source: Journal of Ethnopharmacology, Volume 237 Author(s): Ingeborg Swart, Mieke Beumer, Wouter Klein, Tinde van Andel Abstract Ethnopharmacological relevance Around 1800, Amsterdam was a global trade hub for materia medica of Dutch, European and exotic origin. Contemporary knowledge on medicinal plants in academic circles has been well documented in local pharmacopoeia, illustrated herbals and catalogues of botanic gardens. Until the end of the ancient regime, physicians, surgeons and apothecaries were trained how to use plants in their specific guild or Collegium Medicum. Little is known, however, on how the plant collectors and merchants that provided the pharmaceutical substances to apothecaries learnt to recognise the variety of medicinal products. Aim of the study To analyse the content, origin, purpose and scientific importance of an anonymous, undated, hand-written Dutch manuscript on materia medica, entitled Corpora ex Regno Vegetabili/Animali (Bodies of the Plant/Animal kingdom) kept by the Artis Library of the University of Amsterdam, the Netherlands. Materials and methods We digitised the entire manuscript and dated the paper by means of its watermark. We identified the plant and animal species using the historic Dutch and Latin names, the illustrations and historic literature. We compared the plant properties and uses to contemporary literature to check whether the information in the manuscript was original or copied from another source. Results The paper was produced between 1759 and 1816 in Zaandam, the Netherlands. The manuscript contains 19 substances of animal origin, one mineral and 273 plants and plant-derived products, which belong to ca. 260 species. While most plants are native or cultivated in the Netherlands, 111 plant entries (105 spp.) represent exotic products, imported from as far as Madagascar and Australia. A total of 134 illustrations were cut out from a 1549 Dutch edition of the New Herbal by Leonhard Fuchs (1543), but only 69% correspond to the correct species. The manuscript contains detailed descriptions on growth locations, field characteristics, flowering season, provenance and quality of the medicinal products, including methods to detect forgery. The author mostly described humoral properties of the plants rather than listing medicinal recipes. We did not find evidence that he copied his texts from other sources, but the Dutch and Latin names correspond largely with the Amsterdam pharmacopoeia from 1795. Conclusions The author's extensive knowledge on trade names, quality and origin of materia medica and his refrain from using literature suggests he could have been a merchant, an intermediary between herb cultivators, overseas traders and apothecaries. This manuscript offers a unique insight in the global trade in medicinal products and the circulation of knowledge in non-academic circles around 1800. Graphical abstract

The anti-diabetic activities, gut microbiota composition, the anti-inflammatory effects of Scutellaria–coptis herb couple against insulin resistance-model of diabetes involving the toll-like receptor 4 signaling pathway Publication date: 12 June 2019 Source: Journal of Ethnopharmacology, Volume 237 Author(s): Chang-hua Zhang, Jun-qing Sheng, Surendra Sarsaiya, Fu-xing Shu, Tong-tong Liu, Xiu-ying Tu, Guang-qiang Ma, Guo-Liang Xu, Hong-xiang Zheng, Li-fen Zhou Abstract Ethnopharmacological relevance Scutellaria–coptis herb couple (SC) is one of the well-known herb couples in many traditional Chinese compound formulas used for the treatment of diabetes mellitus (DM), which has been used to treat DM for thousands of years in China. Aim of the study Few studies have confirmed in detail the anti-diabetic activities of SC in vivo and in vitro. The present investigations aimed to evaluate the anti-diabetic activity of SC in type 2 diabetic KK-Ay mice and in RAW264.7 macrophages to understand its possible mechanism. Materials and methods High-performance liquid chromatography with ultraviolet detection (HPLC-UV) and LC-LTQ-Orbitrap Pro mass spectrometry were used to analyze the active ingredients of SC extracts and control the quality. A type 2 diabetic KK-Ay mice model was established by high-fat diet. Body weight, fasting blood glucose levels, fasting blood insulin levels, glycosylated hemoglobin and glycosylated serum protein were measured. The effects of SC on total cholesterol (TC), high-density lipoprotein (HDL) and triglyceride (TG) levels were examined. The lipopolysaccharide (LPS), interleukin-6 (IL-6) and tumour necrosis factor alpha (TNF-α) levels were measured. Gut microbial communities were assayed by polymerase chain reaction (PCR) and PCR-denaturing gradient gel electrophoresis (PCR-DGGE) methods. The expressions of Toll-like receptor 4 (TLR4) and MyD88 protein in the colons were measured by western blot. In RAW264.7 macrophages, IL-6, TNF-α, TLR4 and MyD88 protein levels were measured by enzyme-linked immunosorbent assay (ELISA) kits or western blot, and the mRNA expression of IL-6, TNF-α and TLR4 was examined by the real time PCR. Results The present results showed that the SC significantly increased blood HDL and significantly reduced fasting blood glucose, fasting blood insulin, glycosylated hemoglobin, glycosylated serum protein, TC, TG, LPS, IL-6 and TNF-α levels (P < 0.05 or P < 0.01) in type-2 diabetic KK-Ay mice. Furthermore, SC could regulate the structure of intestinal flora. Additionally, the expressions of TLR4 and MyD88 protein in the colons were significantly decreased in the model group (P < 0.05 or P < 0.01). However, SC had no significant effect on weight gain. In RAW264.7 macrophages, SC containing serum (SC-CS) (5%, 10% and 20%) significantly decreased IL-6, TNF-α, TLR4 and MyD88 protein levels and the mRNA expression of IL-6, TNF-α and TLR4 (P < 0.05 or P < 0.01). Conclusions The anti-diabetic effects of SC were attributed to its regulation of intestinal flora and anti-inflammation involving the TLR4 signaling pathway. These findings provide a new insight into the anti-diabetic application for SC in clinical settings and display the potential of SC in the treatment of DM. Graphical abstract

An extract from Myracrodruon urundeuva inhibits matrix mineralization in human osteoblasts Publication date: 12 June 2019 Source: Journal of Ethnopharmacology, Volume 237 Author(s): Adriana Arruda Matos, Flávia Amadeu Oliveira, Alessandra Cury Machado, Luiz Leonardo Saldanha, Cintia Kazuko Tokuhara, Leonardo Perez Souza, Wagner Vilegas, Thiago José Dionísio, Carlos Ferreira dos Santos, Camila Peres-Buzalaf, Anne Lígia Dokkedal, Rodrigo Cardoso de Oliveira Abstract Ethnopharmacological relevance Phytotherapy based on plant-derived compounds is an alternative medicinal strategy for the relief of symptoms and the curing of diseases. The leaves of Myracrodruon urundeuva a medicinal plant also known as "aroeira", has been used in traditional medicine as healing, antiulcer and anti-inflammatory to treat skeletal diseases in Brazil, but its role in bone cell toxicity, as well as in bone formation, remains to be established. Aim of the study We sought to determine the in vitro osteogenic effects of a hydroalcoholic M. urundeuva leaves extract in primary human osteoblasts. Materials and methods Cell viability, reactive oxygen species (ROS) production, alkaline phosphatase (ALP) activity and matrix mineralization were evaluated by MTT assay, DCFH-DA probe, colorimetric-based enzymatic assay and Alizarin Red-staining, respectively. Besides, the matrix metalloproteinase (MMP)-2 and progressive ankylosis protein homolog (ANKH) gene expression were determined by real-time RT-qPCR and MMP-2 activity by zymography. Results Exposure of osteoblasts to M. urundeuva extract significantly decreased viability and increased reactive oxygen species (ROS) production, regardless of the extract concentration. The M. urundeuva extract at 10 μg/mL also downregulated matrix metalloproteinase (MMP)-2, while upregulating progressive ankylosis protein homolog (ANKH) gene expression. By contrast, the MMP-2 activity was unchanged. The M. urundeuva extract at 10 μg/mL also reduced alkaline phosphatase (ALP) activity and mineralization. Conclusions Overall, our findings suggest that the inhibition of osteogenic differentiation and matrix mineralization promoted by M. urundeuva may be due more to an increase in oxidative stress than to the modulation of MMP-2 and ANKH expression. Graphical abstract

Effect of water extract from Berberis heteropoda Schrenk roots on diarrhea-predominant irritable bowel syndrome by adjusting intestinal flora Publication date: 12 June 2019 Source: Journal of Ethnopharmacology, Volume 237 Author(s): Hui-min Zhu, Li Li, Song-ya Li, Qi Yan, Fei Li Abstract Background The aim of the present study was to investigate the antidiarrheal effect of Berberis heteropoda Schrenk roots (BHS), which are used by Chinese minorities to treat diarrhea, through regulation of intestinal flora and related signaling pathways. Methods Wistar rats were randomly divided into 6 groups: Control group (Con), Model group (Mod), three BHS groups (BHS-L (0.65 g/kg), BHS-M (1.955 g/kg), BHS-H (5.86 g/kg) and Bifidobacterium group (Bif). The model of diarrhea-based irritable bowel syndrome (D-IBS) was induced by intragastric administration combined with restraint stress. The CRD method was used to determine the AWR score and the Bristol fecal score. Quantification of the intestinal bacteria groups in feces was performed using colony counting on plates. The mRNA expression levels of Gpr41, Gpr43, TLR2, TLR4, and nuclear protein κB were determined by qRT-PCR, and the relative abundances of intestinal flora in the intestinal contents were determined by high-throughput gene sequencing ratios. Results Oral administration of BHS (L, M and H) significantly reduced the AWR score and the Bristol fecal score, significantly relieved diarrhea in D-IBS rats, reduced the number of Enterococci and Enterobacteria in feces, increased the number of Bifidobacteria and Lactobacilli, and upregulated the expression of SCFA in plasma. qRT-PCR analysis showed that the expression of TLR2, TLR4, Gpr41, Gpr43 and NF-κB in the BHS groups was downregulated. D-IBS rats reduced the abundance and diversity of intestinal flora and BHS (L, M and H) regulated the abundance and diversity of their intestinal flora. Conclusion The above data suggest that BHS potentially alleviates diarrhea, intestinal flora disorder and intestinal inflammation in D-IBS rats by regulating the immunological pathways. BHS is a promising agent in the treatment of D-IBS. Graphical abstract

In vitro genotoxic and antigenotoxic effects of cynarin Publication date: 12 June 2019 Source: Journal of Ethnopharmacology, Volume 237 Author(s): Esra Erikel, Deniz Yuzbasioglu, Fatma Unal Abstract Ethnopharmacological relevance Cynarin is an artichoke phytochemical that possesses a variety of pharmacological features including free-radical scavenging and antioxidant activity. The origin of artichoke species appears to be Mediterranean region. Two of these species, globe artichoke (Cynara cardunculus var. scolymus L.) and cardoon (Cynara cardunculus var. altilis DC), are widely cultivated and consumed. This vegetable, as the basis of the mediterranean diet, has been used as herbal medicine for its therapeutic effects since ancient times. Therefore, this study was performed to determine genotoxic and antigenotoxic effects of cynarin against MMC (mitomycin C) and H2O2(hydrogen peroxide) induced genomic instability using chromosome aberrations (CAs), sister chromatid exchanges (SCEs), micronucleus (MN), and comet assays in human lymphocytes. Materials and methods Lymphocytes obtained from two healthy volunteers (1 male and 1 female) were exposed to different concentrations of cynarin (12–194 μM) alone and the combination of cynarin and MMC (0.60 μM) or cynarin and H2O2(100 μM, only for comet assay). Results Cynarin alone did not induce significant genotoxic effect in the CA, SCE (except 194 μM), MN, and comet assays. The combination of some concentrations of cynarin and MMC decreased the frequency of CAs, SCEs and MN induced by MMC. Furthermore, the combination of cynarin and H2O2 reduced all comet parameters at all the concentrations compared to H2O2 alone. While the highest concentrations of cynarin significantly decreased mitotic index (MI), the combination of cynarin and MMC increased the reduction of MI induced by MMC alone. Conclusion All the results obtained in this study demonstrated that cynarin exhibited antigenotoxic effects rather than genotoxic effects. It is believed that cynarin can act as a potential chemo-preventive against genotoxic agents. Graphical abstract

Raffia palm (Raphia hookeri G. Mann & H. Wendl) wine modulates glucose homeostasis by enhancing insulin secretion and inhibiting redox imbalance in a rat model of diabetes induced by high fructose diet and streptozotocin Publication date: 12 June 2019 Source: Journal of Ethnopharmacology, Volume 237 Author(s): Ochuko L. Erukainure, Olajumoke A. Oyebode, Omamuyovwi M. Ijomone, Chika I. Chukwuma, Neil A. Koorbanally, Md. Shahidul Islam Abstract Ethnopharmacological relevance Raffia palm (Raphia hookeri) wine (RPW) is amongst the natural products from plants, utilized singly or in combination with other medicinal plants for the treatment of several ailments including Diabetes Mellitus (DM). However, there is a scientific dearth on its antidiabetic activity. Aim The antidiabetic effect of RPW and its possible mechanism of actions were investigated in diabetic rats. Methods Four groups of male SD rats were first supplied with 10% fructose solution ad libitum for 2 weeks instead of drinking water followed by an intraperitonial injection of streptozotocin (40 mg/kg) to induce diabetes. Two diabetic groups were administered RPW at 150 and 300 mg/kg bodyweight (BW) respectively; a group was administered with metformin, while the other one was served as a negative control. Two groups of normal rats were administered with water and RPW (300 mg/kg BW) and served as normal control and normal toxicology group, respectively. Results Five weeks treatment of RPW led to significant (p < 0.05) increase in serum insulin and HDL-c levels with concomitant reduction in blood glucose, fructosamine, ALT, uric acid, triglycerides and LDL-c levels in diabetic rats. Rats treated with RPW had elevated levels of GSH, SOD, catalase, ATPase and α-amylase activities, while reduced NO level and myeloperoxidase activity was observed in their serum and pancreatic tissues. RPW also improved pancreatic β-cell function and restored β- and acinar cells morphology, and capillary networks. The activities of glycogen phosphorylase, fructose 1,6 biphosphatase, glucose-6-phosphatase, and acetylcholinesterase were also inhibited in RPW-treated diabetic rats, with concomitant down regulation of Nrf2 gene expression. Conclusion The data of this study suggest that RPW modulates glucose homeostasis by enhancing insulin secretion as well as inhibiting redox imbalance in diabetic rats, which may be attributed to the synergetic effects of its phytochemical constituents as identified by GC-MS analysis. Graphical abstract

Essential oil from Fructus Alpinia zerumbet (fruit of Alpinia zerumbet (Pers.) Burtt.et Smith) protected against aortic endothelial cell injury and inflammation in vitro and in vivo Publication date: 12 June 2019 Source: Journal of Ethnopharmacology, Volume 237 Author(s): Yun-peng Ji, Ting-yu Shi, Yan-yan Zhang, Dan Lin, Ke-gang Linghu, Yi-ni Xu, Ling Tao, Qing Lu, Xiang-chun Shen Abstract Ethnopharmacological relevance Fructus Alpinia zerumbet (FAZ), a dry and ripe fruit of Alpinia zerumbet (Pers.) Burtt. et Smith, is widely used as a spice to treat cardiovascular diseases in clinic as a miao folk medicine in Guizhou Province of China. Essential oil extracted from FAZ (EOFAZ) is the key bioactive ingredients. Aim of the study This study aimed to examine the effects and mechanisms of EOFAZ on lipopolysaccharide (LPS)-induced endothelial cell injury, inflammation and apoptosis in vitro and in vivo. Materials and methods For the in vitro study, LPS-treated human aortic endothelial cells were used to perform PCR, western blot analysis and immunofluorescence. For the in vivo study, male mouse were divided into four groups, vehicle control group and LPS group received 0.5% Tween-80 in saline; and two EOFAZ groups receive different dose of EOFAZ (90 mg kg −1·day−1, 180 mg kg −1·day−1) respectively. Each group was fed for 7 days by intragastrical administration at daily base. Then, except vehicle control group received saline, mice in other three groups were administered with LPS (1 mg kg −1, dissolved in saline) by intraperitoneal injection. 24 h later, Aorta tissue was collected and frozen immediately in liquid N2, stored at −80 °C for western blot analysis. Results We found that EOFAZ completely prevented LPS-induced HAEC activation and inflammation in vitro and in vivo, as assessed by expression of endothelial adhesion molecules, ICAM-1 and VCAM-1. Similarly, EOFAZ significantly blunted LPS-induced endothelial injury, as tested by MTT assay, LDH release and caspase-3 activation. We further demonstrated that TLR4-dependent NF-κB signaling may be involved in the process. Conclusion EOFAZ protected against LPS-induced endothelial cell injury and inflammation likely via inhibition of TLR4-dependent NF-κB signaling. Graphical abstract

Conservation and Society

Folk Filmmaking: A Participatory Method for Engaging Indigenous Ethics and Improving Understanding Adam Pérou Hermans Amir Conservation and Society 2019 17(2):123-134 On an assignment to produce videos promoting Cross River gorilla conservation to indigenous communities in Nigeria and Cameroon, I invited community members to join me. I followed decolonising and feminist methodologies to develop a form of participatory video production, 'Folk Filmmaking', in which participants present their own accounts of wildlife, conservation, and environmental values by performing stories. Through the films, participants shared their knowledge as morality tales, providing contextual nuance to moral challenges, clarity on local concerns, and opportunities for better understanding of local conflicts with conservation. Most films use gorillas as a plot device but orient the moral issues not to the ape's plight but to communal struggles with challenges such as marginalisation, modernity, and corruption. The films do not say how best to conserve the last 300 Cross River gorillas but they help articulate indigenous values and show the challenges conservation must overcome. This paper shares an account of lessons learned during the project through continual, critical reflection on my process. It describes my methodology and the films produced then offers an analysis and evaluation of the project. It concludes with notes on the potential and pitfalls of participatory video in contexts of cross-cultural conflict over conservation.

When Race and Social Equity Matters in Nature Conservation in Post-apartheid South Africa Regis Musavengane, Llewellyn Leonard Conservation and Society 2019 17(2):135-146 Current academic literature examining race and nature conservation in South Africa has relied mainly on secondary data analysis while neglecting the voices of local communities. This article draws on empirical experience to assess the extent of the impact of race and social equity in conservation, with the aim of promoting sustainable and more inclusive conservation practices in South Africa. Empirical results are drawn from different cases to examine racial equity in conservation. The findings suggest that conservation practices in post-apartheid South Africa are still exclusionary for the majority black population. Promoting more inclusive conservation is complex and requires a broader conservation agenda for more inclusivity and to genuinely tackle issues of poverty. There is a need for conservation groups to also include the previously marginalised in leadership structures and to incorporate indigenous knowledge systems. This will assist in changing the perception of marginalised people that particular persons dominate conservation. The paper further makes specific recommendations on how conservation can become more inclusive across social and race lines.

Multi-stakeholder Platforms and Protected Area Management: Evidence from El Vizcaíno Biosphere Reserve, Mexico Ludger Brenner Conservation and Society 2019 17(2):147-160 This article analyses the potentials and limitations of multi-stakeholder platforms (known as advisory councils in Mexico) involved in protected area and resource management in peripheral regions. Qualitative, in-depth expert interviews conducted in 2015 at one of the world's most prominent Biosphere Reserves focused on the sources of effective and inclusive stakeholder participation through collective decision-making and joint implementation. Results identified three key interrelated factors that explain the performance and effectiveness of the advisory council at the El Vizcaíno Biosphere Reserve: 1) comparatively favourable socioeconomic and political conditions at the outset; 2) efficient internal organisation that fosters informed decision-making by consensus; and 3) the ability to influence governmental institutions through collective lobbying. As a result, the council has been able to exclude several non-local actors from resource use, obtain public funding, and participate in diverse management activities. Due to the lack of a well-defined mandate; however, it still depends on centralised institutions and has no decisive stake in the governmental decision-making process yet. Therefore, despite notable progress, genuine stakeholder participation in protected area management still faces limitations in Mexico and probably other countries as well.

What the Gringos Brought: Local Perspectives on a Private Protected Area in Chilean Patagonia Elena Louder, Keith Bosak Conservation and Society 2019 17(2):161-172 Privately Protected Areas (PPAs) are a growing trend in conservation and have been promoted by global environmental institutions such as the International Union for the Conservation of Nature (IUCN) as an essential component for achieving conservation targets. PPAs are on the rise worldwide and particularly in Chile, where neoliberal reform has created new spaces in conservation management for private individuals and civil society. However, little empirical research examines their effects on local people. Drawing from critiques of the neoliberalisation of nature and the intertwining of capitalism and conservation, this research explores the case of a particular PPA in Chile, Patagonia Park; asking specifically: what are the impacts of this particular PPA on local residents? Based on in-depth, semi-structured interviews, this research finds that the park has been detrimental to local livelihoods, disrupted systems of production, and elicited emotional responses of pain, sadness, and loss. The relation between the park and community has been characterised by a lack of information and understanding, and reveals deeply contrasting views of nature held by park administrators and local residents. We find that, in this case, the social impacts of the PPA are similar to those that have long been documented and criticised in state-run, 'fortress conservation' models. When we look closely at the history of many state-run protected areas, we see that private capital has always played a central role in conservation. This research suggests then that there may be little truly novel about PPAs in terms of both process of development, and the ways that local people experience them.

The Displacement of Insufficiently 'Traditional' Communities:Local Fisheries in the Pantanal Rafael Morais Chiaravalloti Conservation and Society 2019 17(2):173-183 The rise of community-based conservation (CBC) from the 1980s, heralded a paradigm shift in the global conservation and development agenda, increasing the engagement of conservationists towards the cause of the needs of Indigenous people. As a result, many international agreements were implemented, such as Indigenous and Tribal Peoples Convention (1989) and the Convention on Biological Diversity (1992). In Brazil, a National Policy for the Sustainable Development of Traditional Peoples and Communities (PNDSPCT) was introduced in 2007, which came to recognise the rights and existing sustainable use practices of 'traditional communities'. This paper uses data from a long-term ethnography of both the local people and the conservation agenda in the Pantanal wetland, Brazil, to discuss how environmentalists used the PNDSPCT to justify the displacement of local people by claiming they do not fit in any traditional community category, and instead should be called 'rural poor'. Interview-based evidence from these communities shows the contrary—pointing out a long history of occupation in the region, customary practices that guarantee sustainable use and self-recognition as a culturally differentiated group. The results are used to explore how narrow notions of indigenous identity have been used to oppress communities in Brazil and in other parts of the global south. The paper concludes that a flexible and fluid categorisation of traditional peoples or indigenous groups should be used in order to avoid reinforcing the already oppressive restrictions placed on local communities that are close to or part of conservation initiatives.

Towards a Conceptualisation of Power in Fuelwood Access in Zimbabwe Ellen Fungisai Chipango Conservation and Society 2019 17(2):184-194 Fuelwood scarcity in sub-Saharan African countries is a pressing challenge to rural households. However, what is not appreciated is that the scarcity is conceived by the power dynamics constraints, which impede fuelwood access. That being so, the growing body of work on fuelwood does not as yet pay adequate attention to the relationship between power asymmetries and fuelwood access, hence there is a gap in fuelwood policy. In the face of this wider problem, the case of Buhera District demonstrates power dynamics of fuelwood access in Zimbabwe. Based on extensive qualitative fieldwork, the article illuminates the relations between state actors and the local people in accessing fuelwood. This is important because access is determined by the policing action taken by the powerful state actors. The questions at the centre of this article are how rural people's access to fuelwood is influenced by power dynamics and how these dynamics contribute to fuelwood scarcity in their villages. From the study it emerged that there are various techniques of power, which are used by state actors in controlling and regulating fuelwood access, leading me to draw two major conclusions. First, there is no one fuelwood scarcity (shortage in a specific location), but rather even where fuelwood is available, power relations play a role in determining accessibility. Second, hidden power is used to present fuelwood scarcity as apolitical, leading to flawed solutions which intensify rural people's plight. Accordingly, by showing the workings of power relations, I endeavour to provide the foundation for well-informed fuelwood policy.

Genealogies and Politics of Belonging: People, Nature and Conservation in the Nilgiri Hills of Tamil Nadu Ajit Menon, Manasi Karthik Conservation and Society 2019 17(2):195-203 The landscape of Gudalur, located in the Nilgiri Hills of Tamil Nadu, India, has been shaped and re-shaped by multiple waves of in-migration that date back to the mid-nineteenth century. The political-economic imperatives for these phases of migration have ranged from the development of capitalist relations within the estate economy to the compulsions of the Grow More Food Campaign to the political repatriation of 'Indian' Tamils from erstwhile Ceylon, now Sri Lanka. This article focuses on how the politics of belonging in Gudalur is a consequence of this history and has resulted in a sedentarist metaphysics shaping state policy and contestations around conservation. The article highlights how the state increasingly sees adivasis (=indigenous people) as a possible ethno-environmental fix for conservation and how non-adivasis project their environmental subjectivities to claim that they too belong. By unpacking the politics of belonging through a historical account of the making of conservation in the region, the article attempts to illustrate how conservation includes and excludes people from the hill landscape.

Creating Landscapes of Coexistence: Do Conservation Interventions Promote Tolerance of Lions in Human-dominated Landscapes? Guy Western, David W Macdonald, Andrew J Loveridge, Amy J Dickman Conservation and Society 2019 17(2):204-217 The range-wide decline of lions has led to their conservation becoming a top priority. Protection of free-ranging lion populations is dependent on securing space for lions but also on the ability and desire of local communities to coexist with lions. Our investigation takes a comparative and case study approach to explore the individual and societal desire to maintain current lion populations alongside communities in, or surrounding, Zimbabwe's Hwange National Park, Tanzania's Ruaha National Park, and Kenya's southern Maasailand. Using data from attitudinal questionnaire surveys, we compare the desire to maintain current lion populations as well as the prevalence and success of conservation interventions aimed at increasing human-lion coexistence. In Maasailand, 88% of the respondents expressed a desire to see current lion populations maintained, while only 42% of the respondents in Ruaha and only 5% of the respondents in Hwange expressed this desire. More respondents reported predation by lions (lion predation) on livestock in Maasailand than in Hwange; personal benefits from conservation were greatest in Maasailand; and exposure to conservation education was highest in Ruaha. The Hwange findings were confounded by Zimbabwe's political and economic climate. In Ruaha and Maasailand, communal and individual conservation benefits influenced desired changes to lion population. Once variation between sites was controlled for, twinning personal benefits and conservation education together was most likely to increase an individual's desire to see current lion populations maintained.

Indigenous Sacred Natural Sites and Spiritual Governance: the legal case for Juristic Personhood Bas Verschuuren Conservation and Society 2019 17(2):218-219

In Defense of Public Lands Megan Youdelis Conservation and Society 2019 17(2):220-221

Nature and Medicine

The prevalence of allergic rhinitis and its complications: A survey from Al-Ahssa, Saudi Arabia Noor Nabil Albaloushi, Khalid Alyahya Journal of Nature and Science of Medicine 2019 2(2):57-60 Objectives: Allergic rhinitis (AR) is an inflammatory disorder induced by immunoglobulin E-mediated response after allergen exposure. It is the most common allergic disorder with a high burden on patients and society. The purpose of this study is to report the prevalence and severity of AR and its complications among the population of Al-Ahssa in the Eastern Province of Saudi Arabia. Materials and Methods: This study analyzed observational, descriptive, cross-sectional data. Our sample includes males and females from all age groups from Al-Ahssa, Saudi Arabia, in October 2017. Our sample size was 807 with a confidence level of 95% and a confidence interval of 3.45. Results: The study suggested that 48% of the samples were diagnosed with AR, 28% had symptoms suggestive of AR, and 24% did not have any symptoms. Results suggest a great association between AR, eczema, and asthma. About 53% of patients who live near a farm were diagnosed with AR and 28% of them had symptoms. This indicates an association between living near a farm and AR. In addition, there was a clear relationship between owning a pet and AR. In 44% of cases, recurrence occurred in winter. Eighty-one percent of patients either with AR or who have symptoms of AR are triggered when exposed to a certain stimulus. Sixty-four percent reported that symptoms are provoked by dust. The most common symptoms reported were nasal itching followed by sneezing. Fifty-seven percent of patients who have AR or symptoms of AR have severe disease. Seventy-five percent of them complain of sleep disturbance. Twenty-seven percent of patients reported 0 effect on life, 14% scored 5, and 14% scored 10 on the daily activity scale. Conclusion: We concluded that 76% of the samples were either diagnosed with AR or have symptoms suggestive of AR. These symptoms are mainly triggered by dust and are associated with living near farms.

Recent insight into the prevalence, etiology, and outcome of epistaxis in a university hospital in Saudi Arabia Sami E Alharethy Journal of Nature and Science of Medicine 2019 2(2):61-63 Objectives: The objective of the study is to study the prevalence, pattern, etiology, and outcome of epistaxis in a tertiary university hospital. Methods: A retrospective study conducted at King Abdulaziz University Hospital, King Saud University, Riyadh, Saudi Arabia, from January 2014 to January 2017. Patients' demographics, causes of bleeding, and management techniques were recorded. This study was approved by the Institutional Review Board at King Saud University. Results: A total of 1126 patients had an epistaxis prevalence rate of 0.98% of all emergency visits. There were 462 males (41.0%) and 664 females (59.0%). The mean age was 39.1 years (from 6 to 74 years). The highest number of patients with epistaxis was 340 (30.2%) in age group of 41–50 years. The mean height was 144.6 cm and the mean weight was 56 kg. The most common cause of epistaxis was idiopathic in 353 (31.3%) patients. A total of 510 (45.3%) patients had an anterior bleeding site, while 152 (13.5%) had bilateral bleeding. The diagnosis was reached both endoscopic and clinical. The majority were treated with a nonsurgical method; anterior packing was successful in 840 (74.6%) patients and chemical and electric cautery in 80 (7.1%) patients. There was a history of recurrent epistaxis in 46 children (4.1%). No mortality occurred during the study period. Conclusion: Epistaxis is common in Saudi Arabia. The age group of 41–50 years is more prone to epistaxis with a prevalence of 30.2%. Exposure to dry, hot weather, idiopathic, and hypertension are the frequent causes. Packing and cauterization successfully treated epistaxis in most cases, and there were no cases with mortality.

Relationship between parasitic infection of Toxoplasma gondii, IL-2, TNF-α tryptophan and CD4+ count Mathew Folaranmi Olaniyan, Temitayo Afolabi, Nwachi Ogbona Idume Journal of Nature and Science of Medicine 2019 2(2):64-68 Study Background: Toxoplasma gondii a protozoan and zoonotic infection can stimulate innate and adaptive immune responses. Aims and Objectives: This work was designed to determine relationship between parasitic infection of T. gondii, interleukin-2 (IL-2), tumor necrosis factor-alpha (TNF-α), and Tryptophan and CD4+ count. Materials and Methods: A total of 150 individuals aged 21–73 years (male: 100 and female: 50) were recruited from Saki-West, Saki-East, and ATISBO local governments of Nigeria. Plasma TNF-α, IL-2, Tryptophan, anti-hepatitis C virus (anti-HCV), hepatitis B surface antigen (HBsAg), anti-HIV, Plasmodium, and T. gondii infections were determined in each of the subjects. The results were used to group the subjects into: Control (n = 104; individuals not infected with T. gondii noninfected, Plasmodium spp., HIV or HCV); T. gondii mono-infected patients (n = 9) and patients with T. gondii co-infection with Plasmodium spp., HIV, HBV, or HCV. Plasma TNF-α, IL-2, anti-HCV, HBsAg, and anti-HIV were determined by enzyme-Linked Immunosorbent Assay. Plasmodium spp., was identified by thick blood film-Giemsa staining technique. Plasma tryptophan was determined by fluorometry. Results: Of 150 subjects recruited for the work, the results obtained showed a frequency of occurrence of 69.3% (104) T. gondii noninfected control not infected with Plasmodium spp., HIV, HBV, and HCV; 8.0% (9) T. gondii-infected patients not infected with Plasmodium spp., HIV and HCV; 22% (33) were infected with at least one of the Plasmodium spp., HIV, HBV, and HCV; 2.7% (4) T. gondii patients co-infected with at least one of the Plasmodium spp., HIV, HBV, and HCV. There was a significant decrease in plasma tryptophan in T. gondii mono- and co-infection including T. gondii noninfected individuals but infected with at least Plasmodium spp., HIV, HBV, and HCV compared with the control [P < 0.05]. There was a significant decrease in CD4 count in T. gondii noninfected individuals but infected with at least one of the Plasmodium spp., HIV, HBV, and HCV and T. gondii co-infection compared with T. gondii mono-infection; controls and also in T. gondii noninfected individuals but infected with at least one of the Plasmodium spp., HIV, HBV, and HCV compared to T. gondii confection (P < 0.05). There was a significant increase in plasma TNF-α in T. gondii mono-infected patients compared with the controls; T. gondii noninfected individuals but infected with at least one of the Plasmodium spp., HIV, HBV, and HCV compared to controls; T. gondii confection compared to controls; T. gondii mono-infected patients compared to T. gondii noninfected individuals but infected with at least one of the Plasmodium spp., HIV, HBV, and HCV; T. gondii mono-infected patients compared to T. gondii co-infection and T. gondii noninfected individuals but infected with at least one of the Plasmodium spp., HIV, HBV, and HCV compared to T. gondii confection (P < 0.05). Conclusion: T. gondii and its coinfection with HIV, HCV, and HBV caused a significant immunological alterations in the plasma values of IL-2, TNF-α, Tryptophan, and blood CD4+ count.

Clustered regularly interspaced short palindromic repeats-Cas9 gene therapy: The top 50 most-cited papers Jude Howaidi, Ali Howaidi, Faisal Howaidi Journal of Nature and Science of Medicine 2019 2(2):69-76 Background: Clustered regularly interspaced short palindromic repeats/Cas9 (CRISPR/Cas9) is a gene-editing technique that creates advancement in biomedical technology. It is a form of gene alteration method that was investigated and examined from Streptococcus pyogenes dependable on Cas9 nuclease enzyme through microbiological and genetic examination. This system consists of a nucleic acid, RNA, specifically guide RNA (gRNA), and a nuclease enzyme, Cas9. The potential implications of CRISPR/Cas9 include cancer, cystic fibrosis, familial hypercholesterolemia, and Duchenne's muscular dystrophy. Objective: The objective was to show the most impactful publications through a bibliometric analysis of the top 50 most-cited papers regarding the topic of CRISPR/Cas9 gene-editing tool. Methods: The most-cited research articles relative to CRISPR Cas9 were collected using Scopus. The order of the most-cited papers was conducted by categorizing the studies in an ordinal manner from the most-cited to the least-cited studies. The studies were stratified by selecting the top 50 most-cited papers with the title “CRISPR Cas9.” Results: A number of 2230 research papers regarding CRISPR Cas9 were retrieved. 42% of the papers from the top 50 most-cited papers were published in 2014. The total citation count for each of the top 50 studies ranged from 183 to 1824, and the mean number of citations was 420. The first five articles were cited more than 1000 times and the remaining articles were cited more than 100 times. The journal “Nature” has published the most studies relevant to CRISPR Cas9 with a total of 23 studies, Cell with 8 studies, followed by Science and Nucleic Acids with 4 studies published and Genetics with 2 and the remaining journals with one publication each. Conclusion: It is clear that the future of CRISPR Cas9 is promising as demonstrated by the highly impactful studies in the topic with high citation counts in a relatively short period of time after publication.

Pulmonary manifestations and radiographic findings in granulomatosis with polyangiitis patients in a university teaching hospital in Saudi Arabia Abdurhman Saud Al Arfaj, Najma Khalil, Sultan M Al Mogairen, Hussain Al Arfaj, Abdulaziz Al Khalaf, Mohammad Al Bedaiwi Journal of Nature and Science of Medicine 2019 2(2):77-80 Objectives: Granulomatosis with polyangiitis (GPA) affects respiratory system very often. In this report, we document the pulmonary manifestations and computed tomography (CT) findings in GPA patients. Subjects and Methods: We conducted retrospective study of GPA patients followed up at King Khalid University hospital, King Saud University, Riyadh, during the period 1990–2014. Various disease manifestations, X-ray and CT findings, therapy, and outcome in GPA patients with pulmonary involvement were retrieved. Results: Among 23 cases of GPA, 14 were males and 9 were females. Mean age at onset of disease was 42.1 ± 14.5 (range: 11–63) years. Respiratory tract was the most frequently involved system (82.6%); upper airways were affected in 56.5% and lungs in 65.2% patients. Among 19 patients with respiratory system involvement antineutrophil cytoplasmic antibody (ANCA) was positive in 18 (94.7%) patients; c-ANCA was positive in 15 (78.9%) and p-ANCA was positive in 3 (15.8%) patients. Chest CT findings in 15 patients showed that lung nodules were the most frequent pathologies, seen in 12 (80.0%) patients, and were cavitated in 8 (53.3%) patients. Airspace opacification was seen in 73.3%, air bronchogram in 20.0%, and ground-glass opacities in 33.3%. CT results at follow-up showed resolution of lung nodules in 9 (60.0%) patients. Lung biopsies showed chronic granulomatous inflammation with vasculitis and necrosis. Intravenous cyclophosphamide was received by 63.2% patients and 10.5% required rituximab therapy along with other drugs. Conclusion: Respiratory system involvement in our GPA patients was similar to previous reports but with variation in certain parameters. Disease outcome was good, and lung CT at follow-up showed resolution of nodules with treatment.

The association between smartphone addiction and dry eye disease: A cross-sectional study Ayman Mohammed Baabdullah, Abdulmalik Ghassan Abumohssin, Yara Aedh Alqahtani, Ismail Ahmed Nemri, Dania Abdulelah Sabbahi, Nizar Mohammed Alhibshi Journal of Nature and Science of Medicine 2019 2(2):81-85 Background: The use of smartphones has increased exponentially. Excessive usage of smartphones has been shown to have a negative impact on ocular health. This study aimed to evaluate the relationship between smartphone addiction and dry eye disease (DED) and determine the risk factors of DED in participants associated with smartphone addiction. Materials and Methods: This cross-sectional study was conducted in May 2017. Participants were selected from the Faculty of Medicine at King Abdulaziz University in Jeddah, Saudi Arabia. Stratified random sampling technique was used to recruit participants according to their academic year with an equal allocation of males and females. Only participants owning smartphones were included in the study. DED was assessed using the ocular surface disease index (OSDI) questionnaire and a short-version of the smartphone addiction scale (SAS-SV) was used to assess smartphone addiction among the participants. Data were analyzed using Pearson's Chi-squared test and binary logistic regression. Results: A total of 443 completed questionnaires were received, providing a response rate of 94%. Almost half of the participants were found to have DED (49.4%). There was no significant association between smartphone addiction and DED (P = 0.102). However, significant associations were observed between DED and contact lens use, eye drops, eye disease, and Vitamin A therapy (P < 0.05). Conclusion: Contrary to what was locally reported, DED had a lower prevalence. Despite no significant correlation with smartphone addiction, DED was found to be associated with the use of contact lenses, Vitamin A therapy, and eye drops. Several risk factors and clinical predictors of DED might exist, which highlight the importance of performing a complete clinical ophthalmological assessment.

Clinical profile of Saudi patients with multiple myeloma Alanoud Abdulaziz Alhuqayl, Zahid Shakoor, Adel Almogren, Rim Sghiri, Rana Hasanato, Rawan Abdulaziz Albadia Journal of Nature and Science of Medicine 2019 2(2):86-89 Background: Multiple myeloma (MM) is a neoplasm of plasma cells. Ethnic variations among the clinical features of MM have been reported. Objectives: This study was performed to assess the clinical features of Saudi MM patients. Patients and Methods: Data were collected retrospectively from the medical records of patients between November 2014 and September 2017 at King Khalid University Hospital, Riyadh, Saudi Arabia. During the study period, MM was diagnosed among 36 patients (mean age: 65.2 ± 11.2 years) comprising of 19 females and 17 males of Saudi nationality. Results: Out of the 19 female patients, 15 (78.9%) had κ chain restriction, whereas among the 17 male MM patients, 14 (82.3%) had λ light-chain restricted disease. All the patients (100%) had anemia (median 93 g/L; interquartile range [IQR] 22.5), 35/36 (97.2%) patients had increased red cell distribution width (RDW) (median 18.3%; IQR 4.5), 34/36 (94.4%) patients had increased monocyte percentage (median 13.7%; IQR 3.4), and 34/36 (94.4%) patients had diabetes mellitus. Conclusion: Gender preferences for κ and λ light chain among MM patients and the association of increased RDW with MM require validation in large-scale studies.

The overall survival rate for patients with hepatocellular carcinoma who underwent hepatic resection or radiofrequency ablation procedure for curative intent Aisha K Al-Raddadi, Mohammed A Jameel, Alaa A Al-Zulfi, Waleed K Al-Shammari, Weam S Hussein, Ester A Robles, Faisal Al-Saif, Faisal Al-Alem, Abdulsalam Al-Sharabi, Ahmad Madkhali, Mazen Hassanain Journal of Nature and Science of Medicine 2019 2(2):90-94 Background: Hepatocellular carcinoma (HCC) is currently one of the leading causes of cancer-related deaths worldwide. According to the data obtained from the last Saudi Cancer Registry 2014, liver cancer represents 4.3% of all cancers diagnosed in Saudi Arabia. This study aimed to measure the overall outcome and “disease-free” survival rates of HCC patients who underwent either a liver resection or radiofrequency ablation (RFA) rehabilitation procedures in Riyadh, Saudi Arabia. Methods: A retrospective study was conducted in Riyadh, Saudi Arabia, examining 41 patients with HCC who underwent either liver resection or RFA with curative intent from 2011 to May 2016. The study took place in King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia, and utilized prospectively collected data. Among the patients who were studied, 7 patients underwent surgical resection and 34 patients underwent RFA. Patients' characteristics, overall survival (OS), and recurrence-free survival were analyzed. Results: Out of the 34 participants who underwent RFA, 17 (50%) experienced recurrence compared to only 3 (42.9%) participants who underwent liver resection. Seven (20.6%) patients who underwent RFA died out of a total of 34. However, only one patient (14.3%) from a total of seven who underwent liver resection died. Conclusion: When comparing the two treatment modalities, it was deemed that there was no significant difference in both recurrence and the OS in both groups.

Stress among staff nurses: A hospital-based study Nandita Kshetrimayum, Darshana Bennadi, Sibyl Siluvai Journal of Nature and Science of Medicine 2019 2(2):95-100 Background: Stress can be described as a dynamic and reciprocal relationship between the person and the environment. Nursing is an occupation with a constellation of circumstances leading to stress. Work-related stress (occupational stress) can be damaging to a person's physical as well as mental status, which directly and indirectly affecting their quality and productivity of work. Hence, an attempt has been made with an aim to assess stress-perceived stress among staff nurses in Mysore city, India. Methodology: The descriptive cross-sectional study was conducted among 500 staff nurses selected from eight hospitals in Mysore City, India, using multistage sampling technique. Study duration was 5-month period and response rate was 100%. A structured questionnaire was administered to assess stress using Perceived Stress Scale (PSS) and Expanded Nursing Stress Scale (ENSS). Results: A cross-sectional study consisted of 500 staff nurses. Majority of the participants (467 [93.4%]) had diploma and 454 (90.8%) nurses worked on day shift. Nearly 277 (55.4%) had a moderate level of perceived stress and 249 (49.8%) had moderate occupational stress. Significant positive correlation (r = 0.144, P < 0.001) between ENSS and PSS. Conclusion: A positive correlation was found between perceived stress and occupational stress among staff nurses of Mysore City. This shows that those with general stress also have occupational stress.

Anaphylaxis secondary to ingestion of pumpkin seeds in a child: A case report Sarah F Alsukait, Abdullah A Alangari Journal of Nature and Science of Medicine 2019 2(2):101-102