Assessing outcome of diabetic foot ulcers and multidisciplinary foot clinic

Foot problem has been increasingly recognised as a major complication of diabetes, which is associated with a very high mortality and morbidity. Therefore Multi-Disciplinary Foot Clinics (MDFC) have been established all over the world to provide holistic care to these patients. There is a wide variation in the availability of a range of professional skills in the MDFC in different health economy. Therefore the care provided by these MDFC can vary from one place to other. It is very important to measure the outcome of these MDFC so that patients, regulatory authorities and funding bodies can compare them. Traditionally ulcer related outcomes such as the healing rate and the proportion of ulcers healed have been measured in many foot ulcer studies. Similarly the amputation rate is measured to determine the efficacy of diabetic foot management in an area of the health economy. However, these measures do not take into account other important factors such as the functional ability and the quality of life of patients. Therefore patient related outcomes such as the recurrence of ulcer, number of working days lost, the mobility of patient following treatment, survival following first episode of ulceration etc also needs to be measured, which are very important from the patient's perspective. This review looks into various patient related outcomes that can and should be measured to assess the quality of care provided by the MDFC.

Conservative management of diabetic foot osteomyelitis

In this retrospective study, 130 patients with diabetic foot osteomyelitis were analysed. 66.9% of these healed with antibiotic treatment alone and 13.9% needed amputation, of which 1.5% were major. Presence of MRSA was associated with adverse outcome (53.3% vs 21.1%, p=0.04) which was defined as death, amputation and failure to heal.

AhR and PPARa: antagonistic effects on CYP2B and CYP3A, and additive inhibitory effects on CYP2C11

The aryl hydrocarbon receptor (AhR) is a ligand-activated transcription factor that mediates a spectrum of toxic and biological effects of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) and related compounds. The peroxisome proliferator-activated receptor alpha (PPARalpha) is a member of the nuclear receptor super-family of ligand-activated transcription factors and it functions as an obligate heterodimer with retinoid X-receptor alpha RXRalpha. The aim was to investigate whether the negative cross-talk recently proposed by the present authors between AhR and PPARalpha on CYP4A and CYP1A has any impact on other cytochrome P450 enzymes. Treatment of male Wistar rats with a PPARalpha ligand clofibric acid (CA) induced CYP2B1/2 and CYP3A proteins, activities, and the mRNA expression of CYP2B1, CYP2B2, CYP3A1 and CYP3A2, and suppressed CYP2C11 protein, activities and mRNA expression. AhR ligand Sudan III (S.III) treatment decreased basal and CA-induced CYP2B, CYP3A and CYP2C11 protein, activities and mRNA expression. To the best of the authors' knowledge, this is the first study showing the presence of mutual effects of AhR and PPARalpha on CYP2B and CYP3A and an additive inhibitory effect on CYP2C11 in the livers of male rats.

Human scalp skin and hair follicles express neurotrophin-3 and its high-affinity receptor tyrosine kinase C, and show hair cycle-dependent alterations in expression

BACKGROUND

Neurotrophin (NT)-3 and its high-affinity receptor tyrosine kinase C (Trk C) are essential for nervous system development. These members of the NT family are also involved in murine hair morphogenesis and cycling. However, their role in human hair follicle (HF) biology remains to be elucidated.

OBJECTIVES

To explore the role of NTs in human skin and HF biology.

METHODS

The immunoreactivity (IR) of NT-3 and Trk C was studied in human scalp skin and HFs by immunofluorescent and light microscopic immunohistology. Skin biopsies were obtained from normal human scalp containing mainly anagen VI HFs from women (age 53-57 years) undergoing elective plastic surgery.

RESULTS

Both NT-3 and Trk C showed prominent, yet distinct, IR patterns in human scalp anagen HFs (anagen VI), whereas they were weakly expressed in catagen and increased again in telogen HFs. Within HF compartments, NT-3 IR was prominent in the outer root sheath, inner root sheath, dermal papilla and connective tissue sheath. Trk C IR was prominent in all HF epithelial and mesenchymal compartments. Outside the HF, both NT-3 and Trk C showed prominent IR in the epidermis, sebaceous glands and sweat glands.

CONCLUSIONS

These observations provide the first indication that NT-3 and Trk C are expressed in human scalp skin and HFs, and suggest that Trk C-mediated signalling is involved not only in murine but also in human HF biology. They may be useful in determining therapeutic strategies for the treatment of hair cycle and skin-related disorders.

Human pharmaceuticals, hormones, and personal care product ingredients in runoff from agricultural fields irrigated with treated wastewater

Irrigation of crops with treated wastewater has the potential to introduce effluent-derived organic microcontaminants into surface waters through agricultural runoff. To determine whether compounds indicative of the presence of treated effluent in irrigation water could be identified in agricultural runoff, surface runoff samples collected from effluent-irrigated and rain-fed cultivated fields were analyzed for a broad spectrum of organic compounds. A variety of compounds was identified that appeared to be associated with irrigation with treated wastewater. These compounds included human pharmaceuticals (e.g., carbamazepine, gemfibrozil, carisoprodol), personal care product ingredients (e.g., insect repellent, polycyclic musks), and alkyl phosphate flame retardant chemicals. Most of these compounds appear not to have been previously reported in agricultural runoff. These compounds were present at concentrations below the few published aquatic toxicology data available; however, their potential to elicit more subtle effects in aquatic organisms cannot be excluded. None of these compounds were detected by broad-spectrum analysis in samples from the same fields during runoff-producing rain events.

Regional permeability of coenzyme Q10 in isolated rat gastrointestinal tracts

The objective of the study was to identify the region with the maximum permeability for low bioavailable coenzyme Q10 (CoQ) in the gastrointestinal tract. To evaluate the regional differences in permeability, male Sprague-Dawley rats, 250-300 g, were anesthetized and the gastrointestinal segments were isolated. Stomach, duodenum, jejunum, ileum and colon tissues were mounted on a Navicyte side-by-side diffusion apparatus. Radiolabeled CoQ (1 microM in DMEM, pH 7.4, 37 degrees C was added to the donor side and the samples withdrawn from the receiver compartment at predetermined time intervals were analyzed using a scintillation counter. Membrane integrity was monitored by 14C-mannitol permeability. The apical to basal permeability coefficients (Papp x 10(-6), cm/s) were 0.32 +/- 0.13, 3.14 +/- 0.89, 1.36 +/- 1.4, 0.83 +/- 0.40, and 1.59 +/- 0.13, for CoQ through rat stomach, duodenum, jejunum, ileum, and colon tissues respectively. The basolateral to apical permeability coefficients (Papp x 10(-6), cm/s) were 1.6 +/- 0.2, 2.2 +/- 1.2, 0.88 +/- 0.12, 1.6 +/- 0.42, and 1.9 +/- 0.41 respectively. Therefore the region of maximum CoQ permeability is duodenum followed by colon and ileum. Jejunum and stomach regions also have fairly high permeability. Therefore CoQ formulations should be made with an aim to target the duodenum to get maximum dosage effect.

Nematodes and water pollution in eastern part of Nile Delta

Examination of some represented water sites revealed presence larvae and eggs of the nematodes infecting man and animals. Eggs in a descending order of abundance were Trichostrongylus, Toxocara canis, T. vitolorum, and Ascaris sp., then Trichocephalus and Ancylostoma sp. Larvae in a descending order were Strongyloides, Trichostrongylus and Ancylostoma sp. No doubt contaminated or polluted water plays an important role as nematode-borne source.

IL-10 gene expression as a marker for detection of protective immunity levels with irradiated cercarial vaccine against experimental Schistosoma mansoni infection

Cercariae were obtained in a large number from the maintained life cycle of S. mansoni. They were attenuated at different doses (20 Kr, 50 Kr, 60 Kr, 70 Kr and 80 Kr) of gamma radiation. Laboratory bred Swiss Albino mice were classified into 7 groups. Five groups were immunized with +/-500 S. mansoni cercariae. Two groups were used as positive and negative controls. All animals were sacrificed after 8 weeks. Spleen cell proliferative responses to Phytohaemagglutinin (PHA) were assessed in all groups. IL-10 was measured by ELISA in serum and splenic cells secretion in-vitro. RNA extracted from freshly isolated liver cells was analyzed for detection of mRNA of IL-10 by reverse transcriptase polymerase chain reaction (RT-PCR). The results showed augmentation of proliferative cell from the spleen in all vaccinated groups except with 80 Kr, irradiated cercariae group. The highest percentage of lymphocytes transformation was recorded among the mice immunized with 60 Kr, irradiated cercariae. After challenge, splenic responses in all groups declined progressively to the control level. IL-10 secretion from spleen cells of all vaccinated groups increased after challenge with the least level in 60 Kr, immunized challenged group. IL-10 mRNA expression was higher among 60 Kr, immunized with irradiated cercariae mice group than 70 Kr, one, but with no expression among 80 Kr, cercariae immunized ones.

Coccidiosis among immuno-competent and -compromised adults

There was significant increase in coccidia positive cases among Hodgkin lymphoma receiving chemotherapy as compared to control group (p < 0.05). The increase was highly significant in the group of acute lymphocytic leukaemia receiving chemotherapy as compared to control group (P < 0.01). The total percent of cases with single type of coccidia were 12.2% compared to multiple coccidial infections (4.3%). The most commonly associated parasite was Cryptosporidium. The total cryptosporidial infections (single and mixed with other coccidia) were 12.1% of the total studied cases. In the immunocompromised the prevalence was 14.3%. In the immunocompetents with diarrhoea, was 8.3% and in control was 5.6%. Microsporidial infections (single and mixed with other coccidia), being the least detected among the four intestinal spores forming coccidia, were 2.4% in the immunocompromised groups. No Microsporidium was detected in the immunocompetent or adult control groups. The total cyclosporal infections (single and mixed with other coccidia) were 6.3% of the total studied cases. In the immunocompromised groups, the prevalence was (8.3%) where in immunocompetent group, was 2.8%. None was detected in the control subjects. Single cyclospora was 3.0% while mixed Cyclospora represented 3.3% of all studied cases. The Isospora infections (single and mixed) were 3.8% of total patients. The prevalence among immunocompromised group was 5.2% and in immunocompetent patients was 2.8%.

Coccidiosis among malnourished children in Mansoura, Dakahlia Governorate, Egypt

Stool samples of 36 malnourished and 36 healthy control children were examined for oocysts of Cryptosporidium parvum, Cyclospora cayetanensis, Isospora belli and Microsporidium. C. parvum infection (single and mixed) was detected in 13.9% and 5.6% in malnourished and control children respectively. C. cayetanensis oocysts were detected in 5.6% malnourished children and in 2.8% of control group. I. belli oocysts were detected only in malnourished children 2.8%. On the other hand, no Microsporidium oocysts were detected in both malnourished and control children.