The Impact of Parasitic Infestation on Nutritional Status and Micronutrients among Children

Background

Micronutrient deficiency is a great problem that is augmented by infection and poor nutrition. Iron, zinc, and selenium are trace elements needed for human growth.

Objective

To investigate the impact of parasitic infection on nutritional status and serum iron, zinc, and selenium in children attending Pediatrics Outpatient Clinic of Zagazig University Hospitals. Subjects and Methods. A case-control study included 140 parasitic infected children and one hundred age- and sex-matched controls. Anthropometric measures were evaluated using specific Egyptian growth charts. Parasites were detected in stool specimens using standard microscopic methods. Atomic absorption spectrophotometer was used for the detection of serum iron, zinc, and selenium. To examine the statistical relationship between intestinal parasitic infection and the relevant variables (gender, residence, socioeconomic status, and age group), the nonparametric chi-square (χ2) test was used. Data were analyzed statistically using SPSS version 25.

Results

Parasitic infected children showed a statistically significant low weight for age, height for age, and BMI. Serum iron, zinc, and selenium were significantly lower in parasitic infected children than controls. Serum iron, zinc, and selenium have significant positive correlations with weight, height, and BMI, respectively.

Conclusion

Studied serum micronutrients especially zinc and iron and anthropometric indices were significantly lower in parasitically infected children.

Efficacy of neuromuscular electrical stimulation of calf muscles on nocturnal symptoms and quality of life in asthmatic children

OBJECTIVE

To determine whether neuromuscular electrical stimulation of calf muscles could improve nocturnal symptoms and quality of life in asthmatic children.

PATIENTS AND METHODS

Sixty children (8-12 years) with moderate asthma were randomly allocated to three groups (A, B, and C). The three groups completed 12 weeks of supervised breathing exercises for 30 min. In addition, group A completed neuromuscular electrical stimulation of the calf muscles and group B completed aerobic exercise in the same period. The intervention was conducted five days a week for 12 consecutive weeks. Pre-and post-treatment evaluations involved pulmonary function tests, the Children's Asthma Control Questionnaire, calf muscle isometric muscle force, six-minute walk test, and Pediatric Asthma Quality of Life Questionnaire.

RESULTS

A significant increase in all measured variables was recorded in all groups in favor of group A (p < 0.001). However, calf muscle isometric muscle strength, and nocturnal symptoms were non-significant in group C (p > 0.05). There was a significant difference between groups A and C in all measured variables (p < 0.001) in favor of group A. Significant differences between groups B and C in all measured variables (p < 0.001) in favor of group B were also noted. No significant differences were seen between groups A and B (p > 0.05).

CONCLUSIONS

Neuromuscular electrical stimulation of calf muscles is an excellent adjunct to breathing exercise programs in improving nocturnal symptoms and quality of life in asthmatic children. Moreover, it can serve as a considerable alternative to traditional physical training in periods of disease exacerbation.

Effect of aerobic exercise on inflammatory markers in polycystic ovary syndrome: a randomized controlled trial

OBJECTIVE

Chronic low-grade inflammation has emerged as a key contributor to the pathogenesis of Polycystic Ovary Syndrome (PCOS). In this regard, the present study examined the potential effects of aerobic exercise on interleukin-6 (IL6), tumor necrosis factor (TNF), and C-reactive protein (CRP) in PCOS women.

PATIENTS AND METHODS

This was a randomized clinical trial that included 40 females aged 25-35 years diagnosed with PCOS. The participants were divided into two groups equal in number: the aerobic exercise group (AEM), and the metformin group (M). The AEM group performed aerobic exercise three times a week for 12 weeks in addition to metformin treatment. The M group received metformin only. Participants were assessed for IL-6, TNF-α, and CRP at baseline and after 12 weeks of intervention.

RESULTS

The findings showed a significant reduction in IL-6, TNF-α, and CRP values in both AEM and M groups (p=0.001, p=0.01, respectively) after the end of the 12 weeks of the intervention. However, the participants who received aerobic exercise plus metformin, group AEM, showed a greater reduction in IL-6, TNF-α, and CRP (p=0.01, p = 0.01 and p=0.001, respectively).

CONCLUSIONS

Aerobic exercise is effective in lowering IL-6, TNF-α, and CRP in polycystic ovarian women. Further clinical trials are recommended to assess the potential effects of aerobic exercise on PCOS-associated risk factors.

Impact of Schroth three-dimensional vs. proprioceptive neuromuscular facilitation techniques in adolescent idiopathic scoliosis: a randomized controlled study

OBJECTIVE

The aim of the study was to investigate the effect of proprioceptive neuromuscular facilitation (PNF) and compare its effect to the Schroth exercises on scoliosis angle, static plantar pressure distribution, and functional capacity in adolescent idiopathic scoliosis.

PATIENTS AND METHODS

Thirty-four girls (aged 14-16 years) with thoracolumbar curves were randomly distributed into two study groups of equal numbers. The Schroth group underwent Schroth exercises, whereas the PNF group underwent treatment using proprioceptive neuromuscular facilitation. Patients in both groups received treatment for one hour, three times per week for six successive months. Measurements of Cobb's angle, angle trunk rotation, total static plantar pressure on both lower limbs, and functional capacity using the six-minute walk test were performed just before and after six months of treatment.

RESULTS

A significant decrease in Cobb's angle and right total static plantar pressure with a significant increase in left total static plantar pressure post-treatment was noted in both groups, with a higher effect in the Schroth group. A significant increase was recorded in the six-minute walk test with a decrease in angle trunk rotation in the Schroth group, while no significant changes were recorded in the PNF group.

CONCLUSIONS

Based on the results obtained in this study, this program of PNF patterns did not show a significant improvement in angle trunk rotation, which is a critical aspect in correction of the curve in comparison to the Schroth exercises. These proprioceptive neuromuscular facilitation patterns are not recommended for the correction of adolescent idiopathic scoliosis.

Efficacy of different approaches on quality of upper extremity function, dexterity and grip strength in hemiplegic children: a randomized controlled study

OBJECTIVE

To investigate the effect of mirror therapy (MT) together with taping compared to modified constraint-induced movement therapy (mCIMT) and MT alone on the quality of upper extremity (UE) function, dexterity, and grip strength in children with hemiplegic cerebral palsy (CP).

PATIENTS AND METHODS

Sixty children with hemiplegic CP ranging in age from 6 to 8 years were enrolled. The participants were randomly distributed into three groups. The three groups underwent the same suggested upper limb (UL) exercise programme for 1h/5 days/week for 12 successive weeks. Group A performed the programme with MT and taping. Group B performed the same programme using mCIMT alone, while group C performed this programme with MT alone. In addition, the three groups underwent a routine physical therapy programme for 1 h. The quality of UE function, dexterity, and grip strength was measured using the Quality of Upper Extremity Skills Test (QUEST), Box and Block Test (BBT), and hand-held dynamometer before and after 12 successive weeks of treatment.

RESULTS

After treatment, the measurement of all variables in the three groups showed significant improvements with superior effects seen in group A.

CONCLUSIONS

Based on the results obtained in this study, MT with taping, mCIMT alone, and MT alone are good supplements to traditional physical therapy programmes in improving the quality of UE function, dexterity, and grip strength in children with hemiplegic CP with more superior effects seen after using MT together with taping.

Comparison of dienogest versus combined oral contraceptive pills in the treatment of women with adenomyosis: A randomized clinical trial

OBJECTIVE

To compare the efficacy and safety of dienogest with combined oral contraceptives (COCs) for treating adenomyosis-associated symptoms.

METHODS

This was a randomized clinical trial including women with symptomatic adenomyosis conducted from March 1, 2019 to August 1, 2020 at Assiut Woman's Health Hospital, Egypt. Participants were randomly assigned to the dienogest group or COCs group. The primary outcome was the level of adenomyosis-associated pain from before to 6 months after treatment measured by a visual analog scale (VAS). Changes in the uterine bleeding pattern, uterine volume, and uterine artery blood flow were also reported.

RESULTS

The VAS score of pain was significantly decreased in both groups; however, the decreased rate was more pronounced in the dienogest group (3.21 ± 1.18) in comparison with the COCs group (4.92 ± 1.22). Bleeding pattern was improved greatly; uterine volume and uterine artery blood flow decreased significantly in the dienogest group. However, women in the dienogest group reported a higher rate of side effects.

CONCLUSION

Dienogest and COCs are effective in treating adenomyosis-associated symptoms after 6 months of use but dienogest is more effective. The decrease in uterine volume and uterine artery blood flow may be the cause of the treatment effect. Dienogest carries a higher risk of side effects.

CLINICAL TRIAL

gov: NCT03890042.

Bifurcation analysis of a network-based SIR epidemic model with saturated treatment function

In this paper, we present a study on a network-based susceptible-infected-recovered (SIR) epidemic model with a saturated treatment function. It is well known that treatment can have a specific effect on the spread of epidemics, and due to the limited resources of treatment, the number of patients during severe disease outbreaks who need to be treated may exceed the treatment capacity. Consequently, the number of patients who receive treatment will reach a saturation level. Thus, we incorporated a saturated treatment function into the model to characterize such a phenomenon. The dynamics of the present model is discussed in this paper. We first obtained a threshold value R₀, which determines the stability of a disease-free equilibrium. Furthermore, we investigated the bifurcation behavior at R₀=1. More specifically, we derived a condition that determines the direction of bifurcation at R₀=1. If the direction is backward, then a stable disease-free equilibrium concurrently exists with a stable endemic equilibrium even though R₀<1. Therefore, in this case, R₀<1 is not sufficient to eradicate the disease from the population. However, if the direction is forward, we find that for a range of parameters, multiple equilibria could exist to the left and right of R₀=1. In this case, the initial infectious invasion must be controlled to a lower level so that the disease dies out or approaches a lower endemic steady state.

Population pharmacokinetic analysis of clopidogrel in healthy Jordanian subjects with emphasis optimal sampling strategy

AIM

Clopidogrel is metabolized primarily into an inactive carboxyl metabolite (clopidogrel-IM) or to a lesser extent an active thiol metabolite. A population pharmacokinetic (PK) model was developed using NONMEM(®) to describe the time course of clopidogrel-IM in plasma and to design a sparse-sampling strategy to predict clopidogrel-IM exposures for use in characterizing anti-platelet activity.

METHODS

Serial blood samples from 76 healthy Jordanian subjects administered a single 75 mg oral dose of clopidogrel were collected and assayed for clopidogrel-IM using reverse phase high performance liquid chromatography. A two-compartment (2-CMT) PK model with first-order absorption and elimination plus an absorption lag-time was evaluated, as well as a variation of this model designed to mimic enterohepatic recycling (EHC). Optimal PK sampling strategies (OSS) were determined using WinPOPT based upon collection of 3-12 post-dose samples.

RESULTS

A two-compartment model with EHC provided the best fit and reduced bias in C(max) (median prediction error (PE%) of 9.58% versus 12.2%) relative to the basic two-compartment model, AUC(0-24) was similar for both models (median PE% = 1.39%). The OSS for fitting the two-compartment model with EHC required the collection of seven samples (0.25, 1, 2, 4, 5, 6 and 12 h). Reasonably unbiased and precise exposures were obtained when re-fitting this model to a reduced dataset considering only these sampling times.

CONCLUSIONS

A two-compartment model considering EHC best characterized the time course of clopidogrel-IM in plasma. Use of the suggested OSS will allow for the collection of fewer PK samples when assessing clopidogrel-IM exposures.

An innovative pharmaceutical care practical course

The innovative practical course was developed to improve the students' ability to acquire pharmaceutical care skills. The primary components of the course were in-school training using small group discussions and hospital experience including identification, analysis, prevention and resolution of drug-therapy problems, patient counseling on their medications and diseases, and interaction with medical team. Specific objectives of the research were to (1) compare students' performance before and after the course, (2) measure students' perceptions of their pharmaceutical care skills before and after the course, (3) determine students' perception of the value of the course. Statistical comparison of pre-test and post-test grades indicated both a retention and acquiring pharmaceutical care skills. A pre-course and post-course survey instrument was designed to measure students' perception of their pharmaceutical care skills. Perception of most of the items of the survey was significantly improved at the end of the course. Overall, the majority of students were highly satisfied with the course. In conclusion, the present study demonstrates that the innovative pharmaceutical care practical course was successfully introduced.

Structural analysis of cDNA encoding thymidylate synthase in hepatic metastases of human colorectal tumors

The enzyme thymidylate synthase (TS) is an important target of 5-fluorouracil (FUra) that is utilized for the treatment of disseminated colorectal cancer. One determinant of clinical response to FUra-based therapy is TS expression. with high levels of expression being predictive of poor response. In the present investigation the levels of immunoreactive TS were analyzed in human colon metastases in the liver (n=l1). The levels of TS ranged from 0.30 to 4.60 pmol TS/g tissue. A good correlation was observed between the levels of immunoreactive TS and TS mRNA (n=6, r=0.69). Of the 11 metastases analyzed, 5 exhibited relatively high levels of TS expression. Two metastases with high TS expression were obtained from patients who received adjuvant therapy with FUra. In 4 metastases with relatively high levels of TS expression, TS gene copy number was analyzed. No evidence for amplification of TS gene sequences was observed. The basis for the high levels of TS expression was examined by structural analysis of TS cDNA. No nucleotide sequence differences were detected in the coding regions of the TS genes from the metastases. Mutations were detected at positions 961 and/or 1031 in the 3'-untranslated regions of the TS gene from the metastases; mutations at these sites were also detected in DNA isolated from normal colon mucosa (n=4) and primary colorectal tumors (n=4). No correlation was observed between TS expression and the nucleotide alterations at these positions. Polymorphism was observed in the 5'-untranslated regions of the TS gene in hepatic metastases (n=6). A general trend was observed between the structure of the 5'-untranslated region of the gene and TS expression.

Segmental analysis of SPECT 99mTc-methoxy isobutyl isonitrile and 201Tl myocardial imaging in ischaemic heart disease

To study the potential usefulness of 99mTc-methoxy isobutyl isonitrile (99mTc-MIBI) as a substitute for 201Tl in assessing patients with ischaemic heart disease, 24 patients underwent 1 day rest and exercise 99mTc-MIBI single photon emission computerised tomography (SPECT) 1 week after SPECT exercise 201Tl. All patients were catheterized within 1 month after myocardial imaging. In 17 patients, resting first pass radionuclide angiography (FPRNA) was performed with 99mTc-MIBI. The heart to lung ratio for 99mTc-MIBI and 201Tl was calculated both at rest and exercise. The segmental analysis for myocardial perfusion reveals that 87/96 segments (91%) were correctly classified by SPECT 201Tl and 84/96 segments (88%) were correctly classified by 99mTc-MIBI. A significant correlation was present between LVEF measured by 99mTc-MIBI FPRNA and contrast ventriculography (r = 0.85, P less than 0.0001). The heart to lung ratio both at rest and exercise for 99mTc-MIBI is significantly higher than 201Tl (P less than 0.01 and less than 0.001 respectively). We conclude that 99mTc-MIBI is a promising agent for simultaneous evaluation of myocardial perfusion and cardiac function.

First derivative spectrophotometric determination of anhydrotetracyclines in tetracyclines

A rapid method is presented for detection and determination of anhydrotetracycline-HCl (ATC-HCl) and 4-epianhydrotetracycline-HCl (4-EATC-HCl) in tetracycline-HCl (TC-HCl). The method determines the 2 compounds as a sum, not individually. The first derivative absorption curve has a trough (D1) at 460 nm which is linearly related to concentration (1-10 mg/mL). ATC-HCl + 4-EATC-HCl content was determined in TC-HCl powder and capsules by the D1 and the compensation D1 spectrophotometric methods. The results were compared with those obtained using U.S. Pharmacopeia and British Pharmacopoeia methods.

New nonsurgical technique for multiple pericardial biopsies

We report a new, nonsurgical technique for obtaining multiple pericardial biopsies in patients with pericardial effusion. A short catheter is introduced by the Seldinger technique under fluoroscopy through the subxiphoid approach. The pericardial fluid is aspirated and the catheter replaced by an 8F teflon sheath with a curved tip. A bioptome is inserted through the sheath, and air is allowed to enter the pericardium. This method outlines the parietal percardium. The curved sheath directs the bioptome to the left or right wall. Eighteen consecutive patients had an average of eight pieces of pericardium removed. On histological examination, three patients had malignancy. Six had tuberculous granuloma, and mycobacterium tuberculosis was cultured from all six tissue specimens but only once from the fluid. Tissue smears showed acid fast bacilli in four out of six, whereas the fluid was negative in all. The biopsy yielded diagnostic information in nine out of ten patients with a thickened pericardium. There were no complications.

A comparison of two radionuclide ejection-fraction techniques with contrast angiography in ischemic heart disease and valvular heart disease

First-pass radionuclide angiography (FPRA) in the 30 degree right anterior oblique and equilibrium gated radionuclide angiography (EGNA) in the 45 degree left anterior oblique were used for quantitative measurements of left ventricular ejection fraction (LVEF). Equipment used was a 400T gamma-camera interfaced with a Simis III Informatek computer. The results were compared with contrast angiography (CA). The aim of this study was to determine the sensitivity of both radionuclide techniques. The present data are based on 65 patients in whom CA and EGNA were performed. In 47 patients both FPRA and EGNA were performed. Results suggested that in ischemic heart disease (IHD) and valvular heart disease (VHD) the EGNA technique is well correlated with CA (r = 0.9 and 0.73, respectively). FPRA correlated well only with CA in IHD (r = 0.86), but not in VHD (r = 0.18). This study indicates that both FPRA and EGNA are sensitive, noninvasive techniques for measuring ejection fraction in IHD, while in VHD, EGNA is more sensitive technique than FPRA.