Eyitayo Omolara Owolabi1 • Tamlyn Mac Quene1 • Johnelize Louw1 • Justine I. Davies1,2,3 • Kathryn M. Chu1,4

Accepted: 10 March 2022 The Author(s) under exclusive licence to Socie´te´ Internationale de Chirurgie 2022

1 Centre for Global Surgery, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie Van Zijl Drive, Tygerberg, Cape Town 7505, South Africa

2 Institute of Applied Health Research, University of Birmingham, Birmingham, UK

3 Faculty of Health Sciences, Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, University of Witwatersrand, Johannesburg, South Africa

4 Department of Surgery, University of Botswana, Gaborone, Botswana

Abstract

       Background Access to timely and quality surgical care is limited in low- and middle-income countries (LMICs). Telemedicine, defined as the remote provision of health care using information, communication and telecommunication platforms have the potential to address some of the barriers to surgical care. However, synthesis of evidence on telemedicine use in surgical care in LMICs is lacking.

       Aim To describe the current state of evidence on the use and distribution of telemedicine for surgical care in LMICs. Methods This was a scoping review of published and relevant grey literature on telemedicine use for surgical care in LMICs, following the PRISMA extension for scoping reviews guideline. PubMed-Medline, Web of Science, Scopus and African Journals Online databases were searched using a comprehensive search strategy from 1 January 2010 to 28 February 2021. Results A total of 178 articles from 53 (38.7%) LMICs across 11 surgical specialties were included. The number of published articles increased from 2 in 2010 to 44 in 2020. The highest number of studies was from the World Health Organization Western Pacific region (n = 73; 41.0%) and of these, most were from China (n = 69; 94.5%). The most common telemedicine platforms used were telephone call (n = 71, 39.9%), video chat (n = 42, 23.6%) and WhatsApp/WeChat (n = 31, 17.4%). Telemedicine was mostly used for post-operative follow-up (n = 71, 39.9%), patient education (n = 32, 18.0%), provider training (n = 28, 15.7%) and provider-provider consultation (n = 16, 9.0%). Less than a third (n = 51, 29.1%) of the studies used a randomised controlled trial design, and only 23 (12.9%) reported effects on clinical outcomes.

       Conclusion Telemedicine use for surgical care is emerging in LMICs, especially for post-operative visits. Basic platforms such as telephone calls and 2-way texting were successfully used for post-operative follow-up and education. In addition, file sharing and video chatting options were added when a physical assessment was required. Telephone calls and 2-way texting platforms should be leveraged to reduce loss to follow-up of surgical patients in LMICs and their use for pre-operative visits should be further explored. Despite these telemedicine potentials, there remains an uneven adoption across several LMICs. Also, up to two-thirds of the studies were of low-to-moderate quality with only a few focusing on clinical effectiveness. There is a need to further adopt, develop, and validate telemedicine use for surgical care in LMICs, particularly its impact on clinical outcomes.

Jin-Hyung Lee,† Yong-Guy Kim,† Sagar Kiran Khadke and Jintae Lee* School of Chemical Engineering, Yeungnam University, Gyeongsan, Korea.

Summary

       Candida biofilms are tolerant to conventional antifungal therapeutics and the host immune system. The transition of yeast cells to hyphae is considered a key step in C. albicans biofilm development, and this transition is inhibited by the quorum-sensing molecule farnesol. We hypothesized that fatty acids mimicking farnesol might influence hyphal and biofilm formation by C. albicans. Among 31 saturated and unsaturated fatty acids, six medium-chain saturated fatty acids, that is, heptanoic acid, octanoic acid, nonanoic acid, decanoic acid, undecanoic acid and lauric acid, effectively inhibited C. albicans biofilm formation by more than 75% at 2 µg ml¯1 with MICs in the range 100–200 µg ml¯1 . These six fatty acids at 2 µg ml¯1 and farnesol at 100 µg ml¯1 inhibited hyphal growth and cell aggregation. The addition of fatty acids to C. albicans cultures decreased the productions of farnesol and sterols. Furthermore, downregulation of several hyphal and biofilm-related genes caused by heptanoic or nonanoic acid closely resembled the changes caused by farnesol. In addition, nonanoic acid, the most effective compound diminished C. albicans virulence in a Caenorhabditis elegans model. Our results suggest that mediumchain fatty acids inhibit more effectively hyphal growth and biofilm formation than farnesol.

       Received 2 July, 2020; revised 29 October, 2020; accepted 30 October, 2020. *For correspondence: E-mail: 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。. Tel. +82-53-810- 2533; Fax +82-53-810-4631. † These authors contributed equally to this work. Microbial Biotechnology (2021) 14(4), 1353–1366 doi:10.1111/1751-7915.13710

Funding information

       This research was supported by grants from the Basic Science Research Program through the NRF funded by the Ministry of Education (2018R1D1A3B07040699 to J.-H. Lee, 2019R1C1C1008329 to Y.-G. Kim), by the Korea Institute of Planning and Evaluation for Technology in Food, Agriculture and Forestry (IPET) through Innovational Food Technology Development Program, funded by the Ministry of Agriculture, Food and Rural Affairs (MAFRA) (119034-3), and by a grant from the Priority Research Centers Program through the NRF funded by the Ministry of Education (2014R1A6A1031189).

SagarKiranKhadke ,Jin-HyungLee,Yong-GuyKim,VinitRajandJintaeLee*

School of Chemical Engineering,Yeungnam University,Gyeongsan38541,Korea;该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。(S.K.K.); 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。(J.-H.L.);该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。(Y.-G.K.);该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。(V.R.)">该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。(J.-H.L.);该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。(Y.-G.K.);该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。(V.R.) *Correspondence:该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。;Tel.:+82-53-810-2533;Fax:+82-53-810-4631

Citation: Khadke, S.K.; Lee, J.-H.; Kim, Y.-G.; Raj, V.; Lee, J. Assessment of Antibiofilm Potencies of Nervonic and Oleic Acid against Acinetobacter baumannii Using In Vitro and Computational Approaches. Biomedicines 2021, 9, 1133. https://

doi.org/10.3390/biomedicines9091133

Academic Editor: Leonardo Caputo

Received: 19 July 2021

Accepted: 29 August 2021

Published: 1 September 2021

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/4.0/).

Abstract: Acinetobacter baumannii is a nosocomial pathogen, and its biofilms are tolerant to desiccation, nutrient starvation, and antimicrobial treatment on biotic and abiotic surfaces, tissues, and medical devices. Biofilm formation by A. baumannii is triggered by a quorum sensing cascade, and we hypothesized that fatty acids might inhibit its biofilm formation by interfering with quorum sensing. Initially, we investigated the antibiofilm activities of 24 fatty acids against A. baumannii ATCC 17978 and two clinical isolates. Among these fatty acids, two unsaturated fatty acids, nervonic and oleic acid, at 20 µg/mL significantly inhibited A. baumannii biofilm formation without affecting its planktonic cell growth (MICs were >500 µg/mL) and markedly decreased the motility of A. baumannii but had no toxic effect on the nematode Caenorhabditis elegans. Interestingly, molecular dynamic simulations showed that both fatty acids bind to the quorum sensing acyl homoserine lactone synthase (AbaI), and decent conformational stabilities of interactions between the fatty acids and AbaI were exhibited. Our results demonstrate that nervonic and oleic acid inhibit biofilm formation by A. baumannii strains and may be used as lead molecules for the control of persistent A. baumannii infections.

Keywords: Acinetobacter baumannii; biofilm formation; AbaI; computational studies; fatty acid; nervonic acid; virulence; quorum sensing; antibiofilm agents.