Discovery of dual-target natural antimalarial agents against DHODH and PMT of Plasmodium falciparum: pharmacophore modelling, molecular docking, quantum mechanics, and molecular dynamics simulations

Malaria is a lethal disease that claims thousands of lives worldwide annually. The objective of this study was to identify new natural compounds that can target two P. falciparum enzymes; P. falciparum Dihydroorotate dehydrogenase (PfDHODH) and P. falciparum phosphoethanolamine methyltransferase (PfPMT). To accomplish this, e-pharmacophore modelling and molecular docking were employed against PfDHODH. Following this, 1201 natural compounds with docking scores of ≤ -7 kcal/mol were docked into the active site of the second enzyme PMT. The top nine compounds were subjected to further investigation using MM-GBSA free binding energy calculations and ADME analysis. The results revealed favourable free binding energy values better than the references, as well as acceptable pharmacokinetic properties. Compounds ZINC000013377887, ZINC000015113777, and ZINC000085595753 were scrutinized to assess their interaction stability with the PfDHODH enzyme, and chemical stability reactivity using molecular dynamics (MD) simulation and density functional theory (DFT) calculations. These findings indicate that the three natural compounds are potential candidates for dual PfDHODH and PfPMT inhibitors for malaria treatment.

Impact of high-intensity statin therapy on glycemic control post-acute coronary syndrome using real-world data

Background

Statins use has been linked with increased risk of new onset diabetes and impaired glycemic control in the JUPITER trial and meta-analyses of randomized controlled trials. Nevertheless, the evidence is scarce in the real-world clinical settings, particularly among those receiving high-intensity statin post-acute coronary syndrome (ACS).

Methods

We conducted a retrospective observational study to determine the impact of statin use post-ACS on glycosylated hemoglobin (HbA1c) and the incidence of diabetes. The study included adults admitted with ACS between January 1, 2017 and December 31, 2018 and newly started on a high-intensity statin (rosuvastatin or atorvastatin). The outcomes assessed within 12 months of statin initiation were: (a) HbA1c before and after statin use among diabetic and non-diabetic patients; (b) incidence of diabetes. Paired sample t-test was used to compare HbA1c values pre and post statin use.

Results

Of the 1,253 patients included, 627 received rosuvastatin and 626 received atorvastatin following ACS. Most of the patients were Asian (77.3%), male (95.8%) with a median age of 51 years. The baseline HbA1c was 7.2±2.2% and 45% of the study population were diabetic at baseline. Among non-diabetic patients, statin use resulted in HbA1c increase from 5.7±0.7% to 6.0±0.8%, p<0.001, while among diabetic patients who were receiving treatment for diabetes, HbA1c decreased from 8.8±1.9% to 7.8±1.9%, p<0.001. New onset diabetes occurred in 41 (6%) of the non-diabetic patients, of whom 13 (1.9%) were receiving atorvastatin, while 28 (4.1%) were on rosuvastatin, p-value = 0.032. The use of both statins resulted in a significant increase of HbA1c among non-diabetic patients as demonstrated in Figure 1.

Conclusion

High intensity statin post-ACS was associated with increased HbA1c among non-diabetic patients. In particular, rosuvastatin significantly increased the new onset of diabetes compared to atorvastatin which might provide preference of atorvastatin use over rosuvastatin among non-diabetic patients post-acute coronary syndrome.

Funding Acknowledgement

Type of funding sources: None.

Functional outcome of open surgical A1 pulley release in diabetic and nondiabetic patients

PURPOSE

Trigger finger, also referred to as stenotic flexor tenosynovitis, is a common condition affecting the digits, with a lifetime incidence of 2.6% among the healthy population and up to 16.5% in diabetic patients. Diabetes mellitus is associated with multiple musculoskeletal conditions including trigger finger. In this study, we aimed to compare the functional outcome of trigger finger release in diabetic and nondiabetic patients to evaluate whether the management of trigger finger in diabetic patients should be the same as that in nondiabetic patients, or whether diabetic patients would benefit from a more tailored management plan to optimize results.

METHODS

A retrospective case-control study was performed at a single center among patients who underwent A1 pulley release from January 2013 to February 2017. Patients were diagnosed with trigger finger grades I to IV according to the Quinnell classification and assessed using the The Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire (Arabic version).

RESULTS

Sixty-nine patients, including 21 male (30.4%) and 48 female (69.6%), underwent A1 pulley release surgery. More than half of the participants included in this study were diabetic (n = 40, 58%) and 29 were nondiabetic (42%). The mean postoperative QuickDASH scores were 19.93 among diabetic patients and 17.15 among nondiabetic patients. There was no significant difference in the functional outcome between diabetic and nondiabetic ( p = 0.6) patients.

CONCLUSIONS

The postoperative functional outcomes are similar in diabetic and nondiabetic patients. Therefore, the management of trigger finger should be the same in both groups.

Outflow and clogging of shape-anisotropic grains in hoppers with small apertures

Outflow of granular material through a small orifice is a fundamental process in many industrial fields, for example in silo discharge, and in everyday's life. Most experimental studies of the dynamics have been performed so far with monodisperse disks in two-dimensional (2D) hoppers or spherical grains in 3D. We investigate this process for shape-anisotropic grains in 3D hoppers and discuss the role of size and shape parameters on avalanche statistics, clogging states, and mean flow velocities. It is shown that an increasing aspect ratio of the grains leads to lower flow rates and higher clogging probabilities compared to spherical grains. On the other hand, the number of grains forming the clog is larger for elongated grains of comparable volumes, and the long axis of these blocking grains is preferentially aligned towards the center of the orifice. We find a qualitative transition in the hopper discharge behavior for aspect ratios larger than ≈6. At still higher aspect ratios >8-12, the outflowing material leaves long vertical holes in the hopper that penetrate the complete granular bed. This changes the discharge characteristics qualitatively.

Morpho-Physiological and Biochemical Criteria of Acanthamoeba spp. Isolated from the Egyptian Aquatic Environment

BACKGROUND

The free-living amoebae Acanthamoeba spp., have been recognized as etiologic agents of amoebic encephalitis, keratitis, otitis, lung lesions and other skin infections mainly in immuno-compromised individuals. In this study, morpho-physiological and biochemical characterization of Acanthamoeba strains isolated from the Egyptian aquatic environment were surveyed.

METHODS

Some Acanthamoeba species were cultivated on non-nutrient agar. Isolated strains of Acanthamoeba were identification based on the morphology of trophic and cyst forms in addition to temperature and osmo-tolerance assays. Biochemical characterization of the isolated amoeba strains was performed using quantitative assay as well as qualitative determination of proteolytic activity in zymograph analysis.

RESULTS

Potentially pathogenic Acanthamoeba species were isolated from all of the examined water sources. Colorimetric assays showed protease activity in the heat-tolerant isolates of Acanthamoeba. All pathogenic isolates of Acanthamoeba exhibited higher protease activity than did the non-pathogenic ones. The zymographic protease assays showed various banding patterns for different strains of Acanthamoeba.

CONCLUSION

The incidence and prevalence of the pathogenic Acanthamoeba species in the aquatic environment using parasitological and biochemical diagnostic tools will provide baseline data against which the risk factors associated with waterborne transmission can be identified.

Gamma Radiation Hazards and Risks Associated with Wastes from Granite Rock Cutting and Polishing Industries in Egypt

Geological materials usually contaminated with naturally occurring radioactive materials (NORM) have become a focus of great attention. The gamma radiation in samples of a variety of natural tiling rocks (granites) collected from different factories in Egypt for use in the building industry was measured, employing high-resolution g-ray spectrometry. In order to assess the radiological impact from the granites investigated. The radiological hazard indices, annual effective dose equivalent (outdoor and indoor) (Deff), hazard indices (Hex and Hin), activity utilization indices (Ig, Ia) and excess life time cancer risk (ELCR) were calculated. The radiological hazard indices for most granite samples are higher than the internationally recommended values.

Predictors of ventricular tachycardia induction in syncopal patients with mild to moderate left ventricular dysfunction

BACKGROUND

In patients with mild to moderate left ventricular dysfunction (LVD) (35% pound LVEF pound 50%) who present with syncope, demonstration of tachy and/or brady-arrhythmia has prognostic value. In this group of patients electrophysiological study (EPS) is often necessary.

METHODS

A total of 53 consecutive patients with mild to moderate LVD and history of undetermined syncope underwent EPS. Sinus node function, His-Purkinje system conduction and ventricular electrical stability were evaluated.

RESULTS

Twenty eight patients (52.8%) had induction of sustained monomorphic ventricular tachycardia (VT) and five (9.4%) patients had a sustained ventricular arrhythmia other than monomorphic VT (ventricular flutter, ventricular fibrillation, and polymorphic VT) induced during EPS. Abnormal sinus node function and/or His-Purkinje system conduction was found in five (9.4%) patients. Age, gender, history of myocardial infarction, type of underlying heart disease and history of revascularization were not predictors of VT induction. Wide QRS morphology independently, and lower left ventricular ejection fraction and presence of pathologic q wave in precordial leads dependently, could increase risk of VT induction.

CONCLUSIONS

The EPS can determine which patient with syncope and mild to moderate LVD is likely to benefit from placing an ICD for prevention of sudden cardiac death. Pathologic precordial q wave, wide QRS morphology and lower left ventricular ejection fraction could be predictors of VT induction during EPS. Wide QRS morphology has an independent effect in this category.

Spectrophotometric, septrofluorimetric and LC determination of lisinopril

Three methods are described for the determination of lisinopril in the pharmaceutical tablets. The spectrophotometric method depends on the reaction of the lisinopril with sodium hypochlorite and phenyl hydrazine to form a condensation product measured at 362 nm. The spectrophotometric method was extended to develop a stability indicating method. The spectrofluorimetric method depends on reaction of the lisinopril with o-phthalaldehyde in the presence of 2-mercaptoethanol in borate buffer pH 9.5. The fluorescence of the reaction product was measured upon excitation at a maximum of 340 nm with emission wavelength at 455 nm. The HPLC method depends on using Hypersil silica column with a mobile phase consisting of methanol-water-triethylamine (50:50:0.1 v/v) and the pH was adjusted to 2.6 with 0.1 N perchloric acid. Quantitation was achieved with UV detection at 210 nm based on peak area.

Spectrophotometric and HPTLC-densitometric determination of lisinopril and hydrochlorothiazide in binary mixtures

Different spectrophotometric and HPTLC-densitometric methods are presented for the simultaneous determination of lisinopril and hydrochlorothiazide in pharmaceutical tablets. The spectrophotometric methods include third derivative (3D) ultraviolet spectrophotometry with zero crossing measurement at 217.4 and 233.4 nm, second derivative of the ratio spectra with measurement at 214.3 and 228.0 nm; both classical least squares and principal component regression were applied to the UV absorption and first derivative spectra of the mixture. The HPTLC method was based on separation of both drugs followed by densitometric measurements of their spots at 210 and 275 nm for lisinopril and hydrochlorothiazide, respectively. The separation was carried out on Merck HPTLC aluminum plates of silica gel 60 F254, using chloroform-ethylacetate-acetic acid (10:3:2 by vol.) as mobile phase. The linear and second order polynomial were used for the regression equation of lisinopril and hydrochlorothiazide, respectively.

Application of LC and HPTLC-densitometry for the simultaneous determination of benazepril hydrochloride and hydrochlorothiazide

Two methods are described for the simultaneous determination of benazepril HCl and hydrochlorothiazide in binary mixture. The first method was based on HPTLC separation of the two drugs followed by densitometric measurements of their spots at 238 and 275 nm for benazepril HCl and hydrochlorothiazide, respectively. The separation was carried out on Merck HPTLC aluminum sheets of silica gel 60 F(254,) using ethyl acetate-methanol-chloroform (10:3:2 v/v) as mobile phase. Second order polynomial equation was used for the regression line in the range 2-20 and 2.5-25 microg/spot for benazepril HCl and hydrochlorothiazide, respectively. The second method was based on HPLC separation of the two drugs on reversed phase, ODS column at ambient temperature using a mobile phase consisting of acetonitrile and water (35:65 v/v) and adjusting to pH 3.3 with acetic acid. Quantitation was achieved with UV detection at 240 nm based on peak area with linear calibration curves at concentration ranges 10-60 and 12.5-75 microg ml(-1) for benazepril HCl and hydrochlorothiazide, respectively. The two proposed methods were successfully applied to the determination of both drugs in laboratory prepared mixtures and in commercial tablets. No chromatographic interference from the tablets excipients was found.

Spectrophotometric determination of benazepril hydrochloride and hydrochlorothiazide in binary mixture using second derivative, second derivative of the ratio spectra and chemometric methods

Different spectrophotometric methods are presented for the simultaneous determination of benazepril hydrochloride and hydrochlorothiazide in pharmaceutical tablets. The first method depends on second derivative (2D) ultraviolet spectrophotometry, with zero crossing and peak to base measurement. The second derivative amplitudes at 214.8 and 227.4 nm were selected for the assay of benazepril hydrochloride and hydrochlorothiazide, respectively. The second method depends on second derivative of the ratio spectra by measurement of the amplitudes at 241.2 and 273.2 nm for benazepril hydrochloride and hydrochlorothiazide, respectively. Chemometric methods, classical least squares and principal component regression, were applied to analyze the mixture. Both the chemometric methods were applied to the zero and first order spectra of the mixture. The proposed methods were successfully applied for the determination of the two drugs in laboratory prepared mixtures and in commercial tablets.

First derivative spectrophotometric, TLC-densitometric, and HPLC determination of acebutolol HCL in presence of its acid-induced degradation product

Three methods are presented for the determination of acebutolol HCl in presence of its acid-induced degradation product. The first method was based on measurement of the first derivative amplitude of acebutolol HCl at 266.6 nm. The second method was based on separation of acebutolol HCl from its acid-induced degradation product followed by densitometric measurement of the spots at 230 nm. The separation was carried out on silica gel 60 F254, using ethanol-glacial acetic acid (4:1, v/v) as mobile phase. Second order polynomial equation was used for the regression line. The third method was based on high performance liquid chromatographic (HPLC) separation of acebutolol HCl from its acid-induced degradation product on a reversed phase, ODS column using a mobile phase of methanol-water (55:45, v/v) with UV detection at 240 nm. The first derivative spectrophotometric method was utilized to investigate the kinetics of the acid degradation process at different temperatures.

Human antibody responses to Wuchereria bancrofti infective larvae

Human IgG antibody responses to Wuchereria bancrofti third stage infective larvae (L3) surface and somatic antigens were studied by indirect immunofluorescence (IFA) and immunoblot with endemic Egyptian sera (n = 115) with the aim of identifying targets of protective immunity. Human sera variably recognized 14 major bands in L3 by immunoblot. The statistical significance of group differences in antibody prevalence was assessed by the chi-squared test. Children and young adults (aged 10-20 years) tended to have antibodies to more L3 somatic antigens than older adults, with significant differences for bands at 66, 60 and 5 kDa. Infected subjects had more consistent antibody responses to antigens at 55, 50 and 6 kDa than endemic normal subjects with negative serum filarial antigen tests, who are presumed to be uninfected. A 5 kDa antigen was preferentially recognized by the latter group. Antibodies to L3 surface antigens were equally prevalent in uninfected children (75%) and adults (90%) but less prevalent in people with microfilaremia (38%) than in amicrofilaremic subjects with or without filarial antigenemia (81%) (P < 0.001). IFA-positive sera showed significantly enhanced recognition of antigens at 66, 40 and 14 kDa in immunoblots relative to IFA-negative sera. Additional studies are needed to further characterize antigens identified in this study and to establish whether they are indeed targets of protective immunity in humans.

Hypercholesterolemia in Renal Transplant Recipients; contributing Factors, Effect of Dietary Modification and Fluvastatin Therapy

Hypercholesterolemia which frequently follows renal transplantation, places kidney graft recipients at an increased risk for atherosclerosis and cardiovascular diseases. We attempt in this study to determine the prevalence, and evaluate severity and treatment of hypercholesterolemia in kidney transplant recipients. We studied 78 renal transplant patients with a mean age of 42.1 years and mean transplant duration of 6.2 years (range from six months to 8.5 years). They were on triple immunosuppressive therapy and had serum creatinine level of less than 160micromol/L. Thirty-one patients (39.8%) were found to have blood cholesterol levels > 6.4 mmol/L. Significant positive correlation was found between hypercholesterolemia and cyclosporine blood levels above 200 ng/ml (p< 0.0009). Furthermore, proteinuria positively correlated with hypercholesterolemia (p< 0.0006). There was no significant correlation between cholesterol blood level and the patient age, sex, presence of diabetes, prednisolone, dose, or treatment with C.-blockers and diuretics. Dietary modification was not effective in reducing the blood cholesterol level in our patients, so we used fluvastatin in a dose of 20 to 40 mg daily for a period of three months. This drug was effective in lowering the mean cholesterol blood levels from 7.1 to 5.2 mmol/L (p< 0.005). One out of 19-electromyogram studies showed abnormal pattern. We did not notice change in the levels of creatinine phosphokinase, serum creatinine or lover enzymes. In conclusion, hyper-cholesterolemia is common in stable renal transplant patients. The presence of proteinuria and the high level of blood cyclosporine are significantly associated with hypercholesterolemia. Low-dose fluvastatin was well-tolerated and effective cholesterol lowering treatment.

The Impact of Hepatitis C Infection and Antiviral Therapy on clinical Outcome in Renal Transplantation Recipients

Hepatitis C viral infection (HCV) is presently a major problem in renal transplant recipients (RTR) with a high risk of chronicity resulting in liver cirrhosis. We screened 120 RTR (50 live related, 53 live unrelated, and 17 cadaveric); mean age of 45.2 years and mean post-transplant period of 6.8 years. Positive HCV antibodies using RIBA-2 test were detected in 43 patients (35.8%). Polymerase chain reaction was performed on 37 seropositive patients and confirmed viremia in 100% of hem. Forty-one seropositive patients (95.3%) had previous dialysis prior to transplantation; a mean of 4.5 years. Liver disease manifested in only five (11.6%) of the seropositive patients and hypertransaminasemia was detected in 14 (32.6%). Twelve seropositive patients with elevated transaminase levels and/or clinical evidence of liver disease, who all had positive PCR, underwent liver biopsy. Inflammation restricted to portal area was noticed in two, persistent hepatitis in three, chronic active hepatitis in four and cirrhosis in three. There was significantly higher incidence (P< 0.03) of acute graft rejection in the seropositive (23.3%) compared to the seronegative patients (9.1% ). While the difference did not amount to statistical significance for chronic rejection (9.3% and 6.5% respectively). Two patients had acute cellular rejection related to interferon therapy. The leading cause of death was related to liver failure in the seropositive patients and coronary artery disease in he seronegative RTR. In conclusion, there is high incidence of HCV in or renal transplant recipients associated with relatively high morbidity and mortality. At present we are lacking an efficient and well-tolerated antiviral drug.

Acute renal failure: six months pilot study in qatar

Over a period of six months, 55 patients out of 11,216 (0.49%) admitted to the hospital developed acute renal failure (ARF). The diagnosis of ARF was based on the usual criteria, a sudden rise in blood urea nitrogen and creatinine with or without oliguria. Patients age ranged between 15 and 81 years with a mean of 51.9 years. Renal ischemia (69%) and nephrotoxic drugs (16.3%) were the two main etiologic factors. Among the causes of ischemia, septic shock was the commonest (29%), followed by severe hypotension due to several causes such as hemorrhage, burns, severe diarrhea and cardiogenic shock (25.4%), and ACE inhibitors (10.9%). ARF was associated with an average of 15.8 days stay in hospital versus 5.1 days for the overall hospital admissions. Immediate management of hypotension by intravenous fluid replacement, vasopressor agents and the necessary surgical intervention was appropriately considered. Intravenous frusemide was used for oliguric patients. Intermittent hemodialysis was used in 18 patients and continuous venovenous hemofiltration in six patients. Twelve patients with ARF due to ischemia died, while there were no deaths in the nephrotoxic group (p < 0.05). The overall mortality was (21.8%), which had no correlation with patient age. All non-oliguric patients survived with the mortality being exclusively in the oliguric group.

A new species of Neyraia Joyeux et Timon-David, 1934 (Cestoda: Dilepididae) from the Egyptian wild birds

A new species of the genus Neyraia Joyeux et Timon-David, 1934 is described from Egyptian wild birds; Neyraia epops from the hoopoe Upupa epops. The new species is compared and with the other related species of the genus. The erection of the new species was based primarily on differences in the number of testes and number of the rostellar hooks.

Academic difficulty among male Egyptian university students. I. Association with psychiatric morbidity

A survey was made of academic difficulties among undergraduate students at Ain Shams University, Cairo, during the academic year 1979-1980. Almost 6% of students dropped out before graduating and a further 8% required substantial extra time to complete their course of study: these figures were almost identical for both sexes. Psychiatric disorders were diagnosed in 42% of male students with academic problems (compared with 9% among the academically successful), with neuroses accounting for nearly half of the cases and schizophrenia for a quarter. Serious psychiatric illness was nearly four times as frequent among 3rd-year students as among 1st-year students.

Psycho-demographic study of anxiety in Egypt: the PSE in its Arabic version

This is the first attempt to study the socio-demographic aspects of anxiety disorders in Egypt and to apply the Arabic version of the PSE in evaluating the profiles of clusters and symptoms of anxiety in a sample of 120 patients with anxiety. There were significant differences in some presentations between males and females, between illiterate and educated groups, and between those exposed to mild and severe crowding. Structured interviews like PSE will help in transcultural comparisons of clinical psychiatric disorders.