Middle East and North Africa Registry to Characterize Rate of RAS Testing Status in Newly Diagnosed Patients with Metastatic Colorectal Cancer

BACKGROUND

Rat sarcoma virus mutational status guides first-line treatment in metastatic colorectal cancer. This study was a multi center, multi-country ambispective, observational study in the Middle East and North Africa assessing regional rat sarcoma virus testing practices in newly diagnosed patients.

METHODS

The retrospective arm (2011-2014) included adults with metastatic colorectal cancer who had initiated first-line therapy with ≥1 post-baseline visit and survival data. The prospective arm (2014-2019) enrolled newly diagnosed patients with histologically proven metastatic colorectal cancer with ≥1 measurable lesion per Response Evaluation Criteria in Solid Tumors, and tissue availability for biomarker analysis. Data look-back and follow-up were 2 years; the rate of RAS mutation was evaluated.

RESULTS

RAS testing was ordered for patients in retrospective (326/417) and prospective (407/500) studies. In the former, testing was typically prescribed after first-line treatment initiation, significantly more in patients with stage IV disease (P < .005), resulting in the addition of targeted therapy (41.8% anti-epidermal growth factor receptor, 30.2% anti-vascular endothelial growth factor) in wild-type metastatic colorectal cancer, and significantly impacted the treatment of left-sided tumors (P = .037). In the latter, 58.4% were RAS wild-type; 41.6% were RAS mutant. Non-prescription of RAS testing was attributed to test unavailability, financial, or medical rea sons; predictors of testing prescription were older age, primary tumor in ascending colon, and high tumor grade. RAS status knowledge resulted in the addition of anti-vascular endothelial growth factor (20.4%) or anti-epidermal growth factor receptor therapy (21.2%).

CONCLUSION

Before 2014, RAS testing in patients with colorectal cancer in the Middle East and North Africa was often performed after first-line treatment. Testing is more routine in newly diagnosed patients, potentially shifting early treatment patterns.

Pharmacy practitioners' practice, awareness and knowledge about herbal products and their potential interactions with cardiovascular drugs

Background: Herbal medicine use is widespread among patients, as community pharmacies may provide such products. Therefore, pharmacy practitioners should be aware of potential herbal products' adverse effects and herb-drug interactions, particularly with medications for comorbid diseases, such as cardiovascular drugs, in which pharmacy practitioners need to have good knowledge to provide patients with relevant advice to get optimal and safe therapeutic outcomes. Accordingly, the study is designed to assess the knowledge and awareness of pharmacy practitioners regarding herbal product dispensing and cardiovascular drug interaction in Jordan and view their role in patients' counselling to set up safe and effective drug use. Methods: A cross-sectional study was conducted in Jordan using an online formatted questionnaire distributed to pharmacy practitioners working in community pharmacies. Descriptive and analytical statistics were performed for the responses using the Statistical Package for the Social Sciences (SPSS) software, version 26. Results: Out of 508 participants, 41.7% had medium knowledge of herbal products pertaining mainly to university education (68.1%); 55.1% of participants dispensed herbal products without prescriptions for obesity and weight reduction (72.8%) and gastrointestinal problems (70.9%); this is because respondents agreed that herbal remedies are safe (28.5%) and effective (38.4%). Whilst the knowledge level of respondents about herbal medicine interaction with cardiovascular medication was medium, with a mean of 1.94, as this interaction may result in potentially serious consequences, 40.7% of respondents strongly agreed to gain more knowledge about the side effects of herbal products and medicine interactions through educational courses. Conclusions: The pharmacy practitioners had medium knowledge of herbal products; however, more attention should be paid to herb-drug interactions in the pharmacy educational curriculum. Additionally, pharmacy practitioners need to refresh their knowledge by attending periodic educational courses and by using reliable resources for information about herbal products in order to provide effective and competent pharmaceutical care.

Serum sRAGE and sE-selectin levels are useful biomarkers of lung injury and prediction of mortality in calves with perinatal asphyxia

The objective of the present study was to evaluate the biomarkers specific to lung endothelial and epithelial damage in the determination of lung injury and its severity in calves with perinatal asphyxia and to evaluate their prognostic importance among survivors and non-survivor calves. Ten healthy calves and 20 calves with perinatal asphyxia were enrolled in the study. Clinical examination and laboratory analysis were performed at admission. Serum concentrations of soluble advanced glycation end-product receptor (sRAGE), soluble E-selectin (sE-selectin), clara cell secretory protein (CC16), and soluble intercellular adhesion molecule-1 (sICAM-1) were measured to assess lung injury. Venous pH, sO₂, HCO₃, and BE of calves with perinatal asphyxia were significantly lower than the healthy calves. sRAGE, sE-selectin, pCO₂, and lactate were significantly high in calves with asphyxia. ROC analysis showed that sRAGE, sE-selectin, pCO₂, lactate, and respiratory rate were higher while HCO₃ and BE were lower in the nonsurvivor calves than survivors. In conclusion, serum sRAGE and sE-selectin concentrations highlight the utility of these biomarkers in determining lung injury in calves with asphyxia. Also, pH, pCO₂, lactate, HCO₃, BE, and respiratory rate along with serum sRAGE and sE-selectin were useful indicators in the prediction of mortality.

Prevalence and prognostic significance of chronic respiratory diseases among hospitalized patients with COVID-19 infection: a single-center study

Background

WHO recognized the COVID-19 outbreak in China as a pandemic crisis on March 11, 2020. Patients with chronic respiratory diseases (CRDs) have limited physiological reserve; this lead to the assumption that COVID-19 infection in such patients could carry worse prognosis.

Aim of study

To detect the prevalence and prognostic significance of CRDs among hospitalized patients with COVID-19 infection.

Methods

The study was carried out at Minia Cardiothoracic University Hospital; all hospitalized COVID-19 patients during the period from January 2021 to August 2021 were included.

Patients were subjected to full medical history taking, full blood count, inflammatory markers (CRP, serum ferritin, serum lactate dehydrogenase (LDH), serum D-dimer, PCR for COVID-19 infection), and HRCT chest.

Need for and duration of mechanical ventilation whether invasive or non-invasive, duration of hospital stay, and condition at hospital discharge were recorded.

Diagnosis for chronic respiratory disease was considered when patients have documented previous history and investigations compatible with the diagnosis, e.g., previous pulmonary function tests, chest CT, or sleep study.

Results

Comorbid chronic respiratory diseases were present in 57 patients (17.6%). Regarding presenting symptoms, no significant difference exists between patients with and without CRDs except for sputum production which was more frequent among patients with underlying CRDs.

Elevated inflammatory markers (ferritin, D-dimer, and LDH) were more frequently observed in patients without CRDs (p < 0.0001, 0.033, and 0.008, respectively).

COVID-19 with comorbid CRDs patients were more hypoxemic at presentation than other patients (p = 0.032).

There was significant number of COVID-19 patients with CRDs were discharged on home oxygen therapy (p = 0.003).

Regarding mortality in our cohort of patients, no significant difference exist between patients with and without CRDs (p 0.374)

Among patients with comorbid CRDs, the highest mortality was observed on patients with OSA followed by ILDS and then COPD.

Conclusion

The presence of CRD was not found to be a poor prognostic value of COVID-19. Inflammatory markers (ferritin, D-dimer, and LDH) were significantly higher in COVID-19 patients without CRD than COVID-19 with CRD.

PADI4 (rs2240340), PDCD1 (rs10204525), and CTLA4 (231775) gene polymorphisms and polyarticular juvenile idiopathic arthritis

BACKGROUND

Certain single nucleotide polymorphisms (SNPs) in genes such as PADI4 (coding for peptidyl arginine deiminase 4), PDCD1 (coding for programmed cell death 1), and CTLA4 (coding for cytotoxic T-lymphocyte-associated protein 4) are linked to rheumatoid arthritis (RA). However, links between SNPs rs2240340, rs10204525 and rs231775 in PADI4, PDCD1 and CTLA4 respectively, and juvenile idiopathic arthritis (JIA), the commonest type of childhood arthritis, are unclear. We aimed to determine whether any of these SNPs are associated with JIA, and to clinical indices disease activity score (JADAS 71) and functional disability score (CHAQ).

METHODS

We genotyped the three SNPs in 150 children with polyarticular JIA and 160 healthy children, recording standard health questionnaires, clinical features and laboratory markers.

RESULTS

The TT genotype of PADI4 rs2240340 (aOR/95%CI 2.64: 1.31-5.30, P = 0.006) and CT genotype of PDCD1 rs10204525 (aOR/95%CI 4.99: 2.98-8.36, P < 0.0001) were associated with JIA. The AG+GG genotype of CTLA4 rs231175 was modestly linked to disease activity (aOR/95%CI 2.44 (1.19-5.04), p = 0.015). PADI4 rs2240340 was linked to CHAQ score (genotypes p = 0.013, alleles p = 0.006), whilst PDCD1 rs10204525 was linked to anti-CCP antibodies (genotypes p = 0.004), RF (genotypes p = 0.01), and the CHAQ score (genotypes p = 0.005, alleles p = 0.013).

CONCLUSIONS

There are various roles for these SNPs in PADI4, CTLA4 and PDCD1 in the diagnosis and, potentially, in the management of JIA.

Spontaneous hemorrhage of an adrenal myelolipoma treated with transarterial embolization: A case report

Adrenal myelolipoma is a benign tumor of the adrenal cortex composed predominantly of fat and hematopoietic tissue. These lesions are usually asymptomatic, and most often incidentally detected on imaging. Uncommonly, they present with retroperitoneal hemorrhage, and these have been traditionally treated with emergent surgery. Although, transarterial embolization has been effectively and safely used in patients presenting with active hemorrhage from acute traumatic and nontraumatic causes, literature specifically pertaining to adrenal artery embolization is scant, perhaps due to smaller size and variability of adrenal arteries. With recent advances in endovascular techniques and imaging, there are emerging case reports and series of adrenal artery embolization in acute and nonacute settings. We report a case of spontaneous hemorrhage within an adrenal myelolipoma in a 43-year-old male patient, successfully treated with transarterial embolization, thereby avoiding major surgery. Our report adds to the growing body of literature pertaining to adrenal artery embolization.

One week stenting after pediatric laparoscopic pyeloplasty; is it enough?

INTRODUCTION

The use of ureteric stents for urinary diversion after pediatric dismembered pyeloplasty and its duration remain debatable. Classically, an indwelling Double J ureteric stent has to be left for 4-6 weeks. However, such a duration is not free of stent-related complications, in addition to the need to remove it under general anesthesia in the pediatric age group.

OBJECTIVES

This study aims to evaluate the outcome of short-term stenting after laparoscopic pyeloplasty in pediatric sector.

METHODS

A prospective randomized study of 37 children (less than 16 years-old) with pelvi-ureteric junction obstruction (PUJO) were managed by laparoscopic pyeloplasty by the same surgeon in the period between April 2015 and September 2017. In group A (18 patients), the DJ was removed after 4 weeks under general anesthesia, while in group B (19 patients), the DJ was fixed to the urethral catheter by a stitch, and it was removed with the urethral catheter after one week in the outpatient office. All patients were followed regularly for symptomatic improvement. Urine culture and sensitivity was done 1 month postoperatively. Abdominal ultrasound was done at 3, 6, 12 months and annually thereafter, while renal isotope scanning was done after 6 months.

RESULTS

There were no significant differences between both groups regarding operative duration, postoperative leakage, hospital stay, early postoperative complications. Both groups improved after pyeloplasty with no significant differences regarding symptoms, follow-up ultrasound, and renal scanning. The incidence of irritative symptoms and need for anticholinergics after catheter removal as well as urinary tract infection after 1 month were significantly higher in group A (P-value: 0.004 and 0.029, respectively) (Table).

DISCUSSION

To the authors knowledge, this is the first prospective controlled randomized study comparing short-term stenting with the classic 4 weeks stenting after laparoscopic pyeloplasty in the pediatric age group. In addition, the used technique of stenting not only allows stent removal on outpatient basis without anesthesia but also benefits from the pre-operative retrograde study so as not to miss any associated pathology in the ureter.

CONCLUSION

Short-term ureteric stenting after laparoscopic pyeloplasty in pediatric age group is safe and not inferior to the standard 4-week stenting. It also avoids the stent-related complications.

Sublimation thermodynamics of nucleobases derived from fast scanning calorimetry

Fast scanning calorimetry was utilized to measure the sublimation thermodynamics of nucleobases. The results were rationalized at the molecular level.

Afatinib in locally advanced/metastatic NSCLC harboring common EGFR mutations, after chemotherapy: a Phase IV study

Aim

The current study evaluated the efficacy and tolerability of second-line afatinib in patients with EGFR mutation-positive (EGFRm+) non-small-cell lung cancer (NSCLC) following chemotherapy.

Patients & methods

In this open-label, single-arm Phase IV study, patients with EGFRm+ (Del19/L858R) NSCLC who had progressed following platinum-based chemotherapy received afatinib (starting dose 40 mg/day). The primary end point was confirmed objective response.

Results

60 patients received afatinib for a median duration of 11.5 months. 50% of patients had a confirmed objective response, of median duration 13.8 months. Median progression-free survival was 10.9 months. The most common treatment-related adverse events were diarrhea (72%), rash (28%) and paronychia (23%).

Conclusion

Our data support the use of afatinib (40 mg/day) as an effective and well-tolerated second-line treatment in EGFRm+ NSCLC.

Melting of nucleobases. Getting the cutting edge of "Walden's Rule"

Walden's Rule is an empirical observation of an invariant fusion entropy during fusion of non-associated organic compounds. For the five nucleobases, adenine, thymine, cytosine, guanine, and uracil, surprisingly high fusion temperatures and enthalpies have been measured using a specially developed fast scanning calorimetry method that prevents decomposition. Even when nucleobases admittedly possess very high fusion temperatures, e.g. the value of 862 K measured for guanine really exceeds all expectations of the feasible dimension of the fusion temperature for such a relatively small and simple organic molecule. Hirshfeld surface analysis has been applied in order to find out an explanation for such extremely unusual thermal behavior of nucleobases. We rationalized the observed trends in terms of fusion entropy (Walden's constant = 56.5 J K^-1 mol^-1) as the entropic penalty of fusion not only for "non-associated", as proposed by Walden in 1908, but also for "ideal associated" systems like nucleobases.

The impact of single versus double blastocyst transfer on pregnancy outcomes: A prospective, randomized control trial

OBJECTIVE

To determine if elective single blastocyst transfer (e-SBT) compromises pregnancy outcomes compared to double blastocyst transfer (DBT) in patients with favorable reproductive potential.

METHODS

This Randomized Control Trial included 50 patients with SBT (Group 1) and 50 patients with DBT (Group 2). All women were <35 years and had favorable reproductive potential. Randomization criterion was two good quality blastocysts on day 5. Patients who did not get pregnant or who miscarried underwent subsequent frozen cycles with transfer of two blastocysts (if available) in both groups.

RESULTS

No significant difference was observed in the majority of the demographic data, infertility etiology, ovarian stimulation characteristics and embryology data between the two groups. There was a significantly lower clinical pregnancy (61.2% vs 80.0%), and delivery (49.0% vs 70.0%) rates, but no difference in implantation (59.2% vs 54.0%), miscarriage, or ectopic pregnancy rates between Group 1 and Group 2, respectively. There was a significantly higher multiple pregnancy rate in Group 2 (35.0%) compared to Group 1 (0%) [P=0.000]. When fresh and first frozen cycles were combined, there was a significantly lower cumulative clinical pregnancy (77.6% vs 96.0%, P=0.007) and delivery (65.3% vs 86.0%, P=0.016) rates in Group 1 compared to Group 2 respectively.

CONCLUSIONS

In patients with favorable reproductive potential, although e-SBT appears to reduce clinical pregnancy and live-birth rates, excellent pregnancy outcomes are achieved. Clinicians must weigh the benefits of DBT against the risk associated with multiple pregnancies in each specific patient before determining the number of blastocysts to be transferred.

Efficacy and safety of alternating norfloxacin and rifaximin as primary prophylaxis for spontaneous bacterial peritonitis in cirrhotic ascites: a prospective randomized open-label comparative multicenter study

BACKGROUND AND AIM

Primary prevention of spontaneous bacterial peritonitis (SBP) is an important strategy to reduce morbidity and mortality in cirrhotic patients with ascites. Efficacy and safety of alternating rifaximin and norfloxacin as primary prophylaxis is questionable.

METHODS

Three hundred thirty-four cirrhotic patients with high SAAG (≥1.1) ascites, protein level in ascitic fluid less than 1.5 g/dL with advanced liver disease (Child-Pugh score >9 points with serum bilirubin level >3 mg/dL) or renal impairment (serum creatinine level >1.2 mg/dL, blood urea nitrogen level >25 mg/dL, or serum sodium level <130 mEq/L) were included in an open-label, randomized study aimed at comparing alternating use of norfloxacin and rifaximin vs. norfloxacin or rifaximin alone as primary prophylaxis for SBP. Both intention-to-treat and per-protocol efficacy analyses were done after 6 months of treatment by assessment of ascitic fluid neutrophil count. Safety analysis was done for all intention-to-treat populations.

RESULTS

Alternating norfloxacin and rifaximin showed superior prophylaxis by intention-to-treat (74.7 vs. 56.4% vs. 68.3%, p < 0.048). Pairwise analysis showed that alternating regimen had lower probability to develop SBP when compared to a norfloxacin-based regimen in intention-to-treat (p = 0.016) and per protocol analysis (p = 0.039). There was no difference among the studied groups regarding the incidence and severity of adverse events reported.

CONCLUSIONS

Alternating norfloxacin- and rifaximin-based primary prophylaxis for SBP showed higher efficacy with the same safety profile when compared with monotherapy of norfloxacin.

Activation of nuclear factor erythroid 2-related factor 2 (Nrf2) and Nrf-2-dependent genes by ischaemic pre-conditioning and post-conditioning: new adaptive endogenous protective responses against renal ischaemia/reperfusion injury

AIM

To investigate the impact of ischaemic pre-conditioning (Ipre) and post-conditioning (Ipost) on expression of nuclear factor erythroid 2-related factor 2 (Nrf2) gene and its dependent genes, haem oxygenase-1 (HO-1) and NADPH-quinone oxidoreductase-1 (NQO-1); inflammatory cytokines TNF-α, IL1β and ICAM-1; and apoptotic markers such as caspase-3 in renal ischaemia/reperfusion (I/R) injury.

METHODS

One hundred and fifty male Sprague Dawley rats were classified into five groups (each consisted of 30 rats): sham, control (I/R), Ipre + I/R, Ipre without I/R and Ipost + I/R. Serum creatinine and blood urea nitrogen (BUN) were measured at 2, 24 and 48 h after ischaemia. In kidney tissues, mRNA of Nrf2, HO-1, NQO-1, TNF-α, IL-1β and ICAM-1 and immunohistochemical expression of Nrf2 and caspase-3 were assessed.

RESULTS

Serum creatinine and BUN improved significantly in Pre + I/R group; however, they did not show any significant improvement in Post + I/R group. Also, Ipre-I/R group showed non-significant change in serum creatinine and BUN. The expression of Nrf2, HO-1 and NQO-1 is increased significantly in Pre + I/R and Pre - I/R groups, while the enhancement in Post + I/R group was non-significant. Moreover, the expression of proinflammatory cytokines (TNF-α, IL-1 and ICAM-1) and apoptotic (caspase-3) markers showed high significant attenuation in Pre + I/R group, but slight significant attenuation in Pre + I/R group.

CONCLUSION

The renoprotective action of Ipre might include early activation and enhanced expression of Nrf2 gene and its dependent antioxidant genes, HO-1 and NOQ1, as endogenous adaptive renoprotective genes, as well as reduction in TNF-α, IL-1β, ICAM-1 and caspase-3.

Early pregnancy screening for hypertensive disorders in women without a-priori high risk

OBJECTIVES

To evaluate the performance of mean arterial pressure, uterine artery pulsatility index and soluble endoglin level alone or in combination in screening for hypertensive disorders in pregnant women without a-priori high risk.

METHODS

This was a nested case-control study of women with singleton pregnancies without a-priori high risk who developed pregnancy-induced hypertensive complications. Women were enrolled into the study at 11-14 weeks' gestation, when mean arterial pressure and uterine artery pulsatility index were recorded and a blood sample was taken for measurement of soluble endoglin. Women were followed up in the clinic to detect development of any hypertensive disorder. Each affected case was matched with two normotensive control women with uncomplicated pregnancies that resulted in phenotypically normal infants. Mean values for each variable were compared between cases and controls. Sensitivities, positive predictive values and negative predictive values at fixed specificity were derived from receiver-operating characteristics (ROC) curves.

RESULTS

During the study period, 2120 patients were examined. Of these, 170 (8.02%) were excluded because they were lost to follow-up and in 52 (2.45%) there was fetal death or miscarriage before 24 weeks' gestation. Thus, 1898 cases formed the cohort population. Of these, 89 (4.69%) patients developed complications (study group), including 16 (0.84%) cases with early pre-eclampsia (PE), 60 (3.16%) with late PE and 13 (0.68%) with gestational hypertension (GH). There were 49 (2.58%) cases of spontaneous preterm delivery before 34 weeks. The rest of the cohort population (1760 (92.73%) patients, the base cohort) were not affected by PE or GH. The control group comprised 178 patients. The best model for the prediction of any of the types of hypertensive disorders was one that combined mean arterial pressure with soluble endoglin (area under the ROC curve (AUC), 0.83). The predictive value of the three combined markers was highest for screening for early and late PE (AUC, 0.86 and 0.83, respectively). When each marker was considered alone, the highest prediction of any type of hypertensive disorder was achieved by mean arterial pressure (AUC, 0.73). Sensitivity was lowest for detection of GH when screening both by individual and by combined markers.

CONCLUSION

First-trimester screening can be useful in predicting women at high risk of developing hypertensive disorders of pregnancy but more prospective longitudinal studies are needed.

Subclinical atherosclerosis in patients with chronic psoriasis: a potential association

BACKGROUND

The immunological abnormalities that lead to the development of psoriasis suggest that these patients may be at increased risk for other inflammatory state which may enhance atherosclerosis.

OBJECTIVE

To assess the presence of subclinical atherosclerosis in psoriatic patients who haven't associated traditional cardiovascular risk factors, and to correlate these findings with colour Doppler echocardiographic parameters.

METHODS

The study included 80 patients with chronic psoriasis together with 50 age and sex matched healthy volunteers served as control group. Patients who had classic cardiovascular risk factors or had cardiovascular or cerebrovascular events were excluded. Carotid artery intima-media thickness (IMT) and carotid plaques were measured in the carotid arteries by using high-resolution B-mode ultrasound. Also, echocardiographic study was performed using ultrasound imaging system in all cases and controls.

RESULTS

Patients with psoriasis had increased carotid artery IMT compared with controls (means 0.9 +/- 0.2 mm vs. 0.7 +/- 0.1 mm; P < 0.001). Carotid IMT positively correlated with patients age, duration of the disease and severity of psoriasis. There was no significant difference in echocardiographic parameters in psoriatic patients compared with controls, also no significant correlation between carotid IMT and echocardiographic parameters were observed in psoriatic patients.

CONCLUSION

The increased carotid artery IMT in patients with chronic psoriasis suggesting that chronic psoriasis is associated with subclinical atherosclerosis with increased risk of cardiovascular disease. So, dermatologists should advice their patients to avoid traditional cardiovascular risk factors and to routinely checkup to reduce cardiovascular morbidity and mortality.

High level of expression and stability of the cloned alkaline protease (aprA) gene in Bacillus subtilis

Gene expression and plasmid stability of the cloned alkaline protease (aprA) gene in Bacillus subtilis were investigated. B. subtilis cells harboring the multicopy aprA gene were grown on sporulation medium and the activity of the alkaline protease was monitored throughout the cultivation time. Results presented indicate that the expression of the aprA gene occurred late during the stationary phase and the plasmid that carries the aprA gene was segregationally and structurally stable.