Alteration in DNA methylation patterns: Epigenetic signatures in gastrointestinal cancers

Abnormalities in epigenetic modifications can cause malignant transformations in - cells, leading to cancers of the gastrointestinal (GI) tract, which accounts for 20% of all cancers worldwide. Among the epigenetic alterations, DNA hypomethylation is associated with genomic instability. In addition, CpG methylation and promoter hypermethylation have been recognized as biomarkers for different malignancies. In GI cancers, epigenetic alterations affect genes responsible for cell cycle control, DNA repair, apoptosis, and tumorigenic-specific signaling pathways. Understanding the pattern of alterations in DNA methylation in GI cancers could help scientists discover new molecular-based pharmaceutical treatments. This study highlights alterations in DNA methylation in GI cancers. Understanding epigenetic differences among GI cancers may improve targeted therapies and lead to the discovery of new diagnostic biomarkers.

A computational approach to design a multiepitope vaccine against H5N1 virus

Since 1997, highly pathogenic avian influenza viruses, such as H5N1, have been recognized as a possible pandemic hazard to men and the poultry business. The rapid rate of mutation of H5N1 viruses makes the whole process of designing vaccines extremely challenging. Here, we used an in silico approach to design a multi-epitope vaccine against H5N1 influenza A virus using hemagglutinin (HA) and neuraminidase (NA) antigens. B-cell epitopes, Cytotoxic T lymphocyte (CTL) and Helper T lymphocyte (HTL) were predicted via IEDB, NetMHC-4 and NetMHCII-2.3 respectively. Two adjuvants consisting of Human β-defensin-3 (HβD-3) along with pan HLA DR-binding epitope (PADRE) have been chosen to induce more immune response. Linkers including KK, AAY, HEYGAEALERAG, GPGPGPG and double EAAAK were utilized to link epitopes and adjuvants. This construct encodes a protein having 350 amino acids and 38.46 kDa molecular weight. Antigenicity of ~ 1, the allergenicity of non-allergen, toxicity of negative and solubility of appropriate were confirmed through Vaxigen, AllerTOP, ToxDL and DeepSoluE, respectively. The 3D structure of H5N1 was refined and validated with a Z-Score of - 0.87 and an overall Ramachandran of 99.7%. Docking analysis showed H5N1 could interact with TLR7 (docking score of - 374.08 and by 4 hydrogen bonds) and TLR8 (docking score of - 414.39 and by 3 hydrogen bonds). Molecular dynamics simulations results showed RMSD and RMSF of 0.25 nm and 0.2 for H5N1-TLR7 as well as RMSD and RMSF of 0.45 nm and 0.4 for H5N1-TLR8 complexes, respectively. Molecular Mechanics Poisson-Boltzmann Surface Area (MM/PBSA) confirmed stability and continuity of interaction between H5N1-TLR7 with the total binding energy of - 29.97 kJ/mol and H5N1-TLR8 with the total binding energy of - 23.9 kJ/mol. Investigating immune response simulation predicted evidence of the ability to stimulate T and B cells of the immunity system that shows the merits of this H5N1 vaccine proposed candidate for clinical trials.

Emerging roles of miR-145 in gastrointestinal cancers: A new paradigm

Gastrointestinal (GI) carcinomas are a group of cancers affecting the GI tract and digestive organs, such as the gastric, liver, bile ducts, pancreas, small intestine, esophagus, colon, and rectum. MicroRNAs (miRNAs) are small functional non-coding RNAs (ncRNAs) which are involved in regulating the expression of multiple target genes; mainly at the post-transcriptional level, via complementary binding to their 3'-untranslated region (3'-UTR). Increasing evidence has shown that miRNAs have critical roles in modulating of various physiological and pathological cellular processes and regulating the occurrence and development of human malignancies. Among them, miR-145 is recognized for its anti-oncogenic properties in various cancers, including GI cancers. MiR-145 has been implicated in diverse biological processes of cancers through the regulation of target genes or signaling, including, proliferation, differentiation, tumorigenesis, angiogenesis, apoptosis, metastasis, and therapy resistance. In this review, we have summarized the role of miR-145 in selected GI cancers and also its downstream molecules and cellular processes targets, which could lead to a better understanding of the miR-145 in these cancers. In conclusion, we reveal the potential diagnostic, prognostic, and therapeutic value of miR-145 in GI cancer, and hope to provide new ideas for its application as a biomarker as well as a therapeutic target for the treatment of these cancer.

Blood culture-negative infective endocarditis presenting with atypical dermatologic manifestation: A rare case report and review of the literature

Infective endocarditis (IE) rarely presents with cutaneous manifestations due to earlier diagnosis and treatment. We present a case of middle-aged male patient presenting with an erythematous papular rash in the upper extremities and left knee, further progressing into painful ulcers with crusted and necrotic center in the arms and fingers. These cutaneous lesions were further followed by shaking chills and fever, which brought the patient to our hospital. Laboratory evaluation revealed elevated ESR (erythrocyte sedimentation rate) and C-reactive protein. Blood cultures taken were negative. Biopsy of the skin lesions were consistent with cutaneous leukocytoclastic vasculitis, and the gram smear revealed gram-positive cocci. The patient developed dyspnea and chest pain, which raised suspicion for IE. TEE (transesophageal echocardiography) demonstrated mild LV diastolic dysfunction, 1+ tricuspid valve regurgitation, mild mitral regurgitation, and vegetation-like lesions on the surface of mitral valve leaflets, consequently IE was confirmed. In conclusion, clinicians must look carefully for skin manifestations in cases with high likelihood of IE, even when other typical symptoms are absent.

Effect of a moderately carbohydrate-restricted diet on liver enzymes, steatosis and fibrosis in normal-weight individuals with non-alcoholic fatty liver disease: study protocol for a parallel randomised controlled clinical trial

INTRODUCTION

Non-alcoholic fatty liver disease (NAFLD) is a hepatic condition that is considerably prevalent across the world. Dietary intakes, in which macronutrient composition is precisely planned, might be able to reduce inflammation, steatosis and fibrosis among patients with NAFLD. A moderately carbohydrate restricted diet with weight loss has been demonstrated to improve liver fat content among overweight or obese patients. However, there is no information about the appropriateness of such a restriction, without weight loss, in normal-weight patients. This randomised clinical trial will be aimed at assessing the effect of moderate carbohydrate restriction on liver enzymes, liver steatosis and fibrosis in normal-weight patients with NAFLD.

METHODS AND ANALYSIS

This randomised controlled clinical trial will be conducted to evaluate the impact of a moderately carbohydrate restricted diet on liver enzymes, steatosis and fibrosis in 52 eligible normal-weight individuals with NAFLD. Transient elastography and controlled attenuation parameter with FibroScan will be applied to diagnose NAFLD. After individual matching based on body mass index, age and sex, patients will be randomly assigned to receive a moderately carbohydrate restricted diet or an isocaloric diet without carbohydrate restriction for 12 weeks. The primary and secondary outcomes in this study will be liver function indices, including liver steatosis and fibrosis, metabolic parameters and anthropometric measures. All these variables will be assessed at study baseline and postintervention.

ETHICS AND DISSEMINATION

The present clinical trial study was accepted by the ethics committee of TUMS (Tehran University of Medical Sciences) (code: IR.TUMS.MEDICINE.REC.1400.116).

TRIAL REGISTRATION NUMBER

IRCT20210119050086N1.

Resveratrol in Cancer Treatment with a Focus on Breast Cancer

Acute liver injury (ALI) is a critical and fatal disorder associated with excessive Although considerable advances have been made in the early diagnosis and treatment of breast cancer, it is still one of the major causes of global cancer-related death in women over the last several decades. Phytochemicals have been shown to be promising agents in the prevention and treatment of breast cancer. Resveratrol is an important plant-derived polyphenolic compound with a variety of potent biological activities. It has been suggested that resveratrol can be used to prevent and treat various types of cancer, including breast cancer. Resveratrol can affect numerous signaling pathways in vitro, leading to the induction of cell cycle arrest and apoptosis, suppression of proliferation, reduction of inflammatory responses, and the inhibition of angiogenesis and metastasis. Nevertheless, studies of resveratrol in animal models of breast cancer have so far been disappointing.

Long non-coding RNAs and melanoma: From diagnosis to therapy

Although extremely rare, malignant melanoma is the deadliest type of skin malignancy with the inherent capability to invade other organs and metastasize to distant tissues. In 2021, it was estimated that approximately 106,110 patients may have received the diagnosis of melanoma, with a mortality rate of 7180. Surgery remains the common choice for treatment in patients with melanoma. Despite many advances in the treatment of melanoma, some patients, such as those who have received cytotoxic chemotherapeutic and immunotherapic agents, a significant number of patients may show inadequate treatment response following initiating these treatments. Non-coding RNAs, including lncRNAs, have become recently popular and attracted the attention of many researchers to make new insights into the pathogenesis of many diseases, particularly malignancies. LncRNAs have been thoroughly investigated in multiple cancers such as melanoma and have been shown to play a major role in regulating various physiological and pathological cellular processes. Considering their core regulatory function, these non-coding RNAs may be appropriate candidates for melanoma patients' diagnosis, prognosis, and treatment. In this review, we will cover all the current literature available for lncRNAs in melanoma and will discuss their potential benefits as diagnostic and/or prognostic markers or potent therapeutic targets in the treatment of melanoma patients.

Evidence for the Benefits of Melatonin in Cardiovascular Disease

The pineal gland is a neuroendocrine gland which produces melatonin, a neuroendocrine hormone with critical physiological roles in the circadian rhythm and sleep-wake cycle. Melatonin has been shown to possess anti-oxidant activity and neuroprotective properties. Numerous studies have shown that melatonin has significant functions in cardiovascular disease, and may have anti-aging properties. The ability of melatonin to decrease primary hypertension needs to be more extensively evaluated. Melatonin has shown significant benefits in reducing cardiac pathology, and preventing the death of cardiac muscle in response to ischemia-reperfusion in rodent species. Moreover, melatonin may also prevent the hypertrophy of the heart muscle under some circumstances, which in turn would lessen the development of heart failure. Several currently used conventional drugs show cardiotoxicity as an adverse effect. Recent rodent studies have shown that melatonin acts as an anti-oxidant and is effective in suppressing heart damage mediated by pharmacologic drugs. Therefore, melatonin has been shown to have cardioprotective activity in multiple animal and human studies. Herein, we summarize the most established benefits of melatonin in the cardiovascular system with a focus on the molecular mechanisms of action.

The association between Dietary Diversity Score and odds of nonalcoholic fatty liver disease: a case-control study

OBJECTIVE

There is no previous study that investigated the association between Dietary Diversity Score (DSS) and odds of nonalcoholic fatty liver disease (NAFLD). The present study aimed to examine the association between DDS and its components and NAFLD among Iranian adults.

METHODS

In the case-control study, we enrolled 121 newly diagnosed cases of NAFLD and 122 with age, BMI and sex-matched controls. All NAFLD patients were diagnosed through ultrasonography methods by gastroenterologists. Anthropometric parameters of participants including weight, height, hip circumference and waist circumference were measured. A validated 147-item semi-quantitative food frequency questionnaire was applied to assess the usual dietary intakes of participants. Binary logistic regression was conducted to estimate the risk of NAFLD in relation to DDS and its components, including refined grains, vegetables, fruits, dairy and meats.

RESULTS

The mean age of study participants was 42.7 years of them 53.1% were male. Higher adherence to DDS [odds ratio (OR) = 0.48; 95% confidence interval (CI), 0.25-0.95] and vegetable group (OR = 0.34; 95% CI, 0.16-0.71) were remarkably associated with lower risk of NAFLD, after adjusting for several confounders including age, BMI, physical activity, energy intake, job, education, and antihypertensive drugs usage. Contrastingly, greater adherence to the refined grain (OR = 3.36; 95% CI, 1.44-7.87) and meat group (OR = 3.27; 95% CI, 1.25-6.90) was significantly associated with increased risk of NAFLD.

CONCLUSION

High DDS is inversely correlated with the risk of NAFLD. Hence, increasing the diversity score of diet by emphasizing the higher diversity scores for vegetables and less for meat and refined grains may be profitable for the management of NAFLD.

Application of Quercetin in the Treatment of Gastrointestinal Cancers

Many cellular signaling pathways contribute to the regulation of cell proliferation, division, motility, and apoptosis. Deregulation of these pathways contributes to tumor cell initiation and tumor progression. Lately, significant attention has been focused on the use of natural products as a promising strategy in cancer treatment. Quercetin is a natural flavonol compound widely present in commonly consumed foods. Quercetin has shown significant inhibitory effects on tumor progression via various mechanisms of action. These include stimulating cell cycle arrest or/and apoptosis as well as its antioxidant properties. Herein, we summarize the therapeutic effects of quercetin in gastrointestinal cancers (pancreatic, gastric, colorectal, esophageal, hepatocellular, and oral).

Inflammatory cytokines and sarcopenia in Iranian adults-results from SARIR study

Some studies suggested the effects of inflammatory cytokines in reducing muscle mass and muscle strength and, performance. This study aimed to compare pro-inflammatory cytokines in sarcopenic and non-sarcopenic subjects. 120 men and women were selected out from the cross-sectional study ‘sarcopenia and its determinants among Iranian elders’ (SARIR). Sarcopenia was defined based on the first ‘European Working Group on sarcopenia in older people’ (EWGSOP₁) guidelines. A fasting blood sample was taken from each participant to measure serum high-sensitivity C-reactive protein (hs-CRP), Interleukin 6 (IL-6), and tumor necrosis factor α (TNFα). A total of 120 participants were included in this study. Mean age was 66.7 ± 7.7 years and mean body mass index (BMI) was 27.3 ± 4.2 kg/m². Forty participants had the criteria of EWGSOP₁ sarcopenia. A statistically significant difference was seen between normal and abnormal groups of muscle strength in hs-CRP (P-value = 0.04). Furthermore, we did not observe any remarkable association between inflammatory biomarkers including IL-6 (OR 1.15; 95% CI 0.31–4.28), TNF-α (OR 0.68; 95% CI 0.17–2.77), and hs-CRP (OR 2.39; 95% CI 0.87–6.55) and the presence of sarcopenia even after controlling for plausible confounders. We found that inflammatory biomarkers level was not associated with odds of sarcopenia. The lack of correlation between inflammatory cytokines and sarcopenia could be due to the participants’ age and genetics. Future studies are required to confirm these findings.

The effect of daily consumption of probiotic yogurt on liver enzymes, steatosis and fibrosis in patients with nonalcoholic fatty liver disease (NAFLD): study protocol for a randomized clinical trial

Background

Given the increasing prevalence of non-alcoholic fatty liver disease, it is necessary to find an easy and cost-effective method in its management and treatment. Probiotics are a group of living microorganisms that might affect NAFLD through the intestinal-liver axis. The present clinical trial aims to examine the effect of probiotic yogurt consumption on liver enzymes, steatosis and liver fibrosis in patients with NAFLD.

Methods

Sixty-eight patients with NAFLD will be recruited in this study. After block matching for sex, BMI and age, patients will be randomly assigned to receive 300 g/d probiotic yogurt containing 10⁶ cfu/g of Lactobacillus acidophilus and Bifidobacterium lactis strains or 300 g/d plain yogurt daily for 12 weeks and those in the control group would receive similar amounts of plain yogurts. Weight, height, and waist circumference will be measured at study baseline and after the intervention. Biochemical indicators including plasma glucose, serum insulin, lipid profile, liver markers (ALT, AST and GGT) will be examined at study baseline and at the end of the trial. Insulin resistance and insulin sensitivity will be determined using the HOMA-IR and QUICKI equation. The degree of steatosis and hepatic fibrosis will also be assessed at the beginning and end of the intervention by the same gastroenterologist using elastography with fibroscan.

Discussion

Probiotics have been suggested as a new strategy in the management of NAFLD. Their effects might be mediated through intestinal microbiota modification and production of short-chain fatty acids. Consumption of probiotic-enriched foods, rather than their supplements, might be a cost-effective method for long-term use in these patients. In case of finding the beneficial effects of probiotic yogurt consumption in the current clinical trial, its inclusion in the dietary plan of NAFLD patients can be recommended.

Trial registration This clinical trial was registered in Iranian Registry of Clinical Trials (www.irct.ir) at 2021-04-19 with code number of IRCT20210201050210N1.

Caffeine, Coffee, Tea and Risk of Rheumatoid Arthritis: Systematic Review and Dose-Response Meta-analysis of Prospective Cohort Studies

Objective

Prospective cohort studies on coffee, tea and caffeine in relation to the risk of rheumatoid arthritis (RA) have shown conflicting results. The aim of this study was to conduct a dose–response meta-analysis of cohort studies on the association between dietary caffeine, different types of coffee and tea consumption and the risk of RA.

Methods

PubMed/Medline, Scopus and EMBASE were searched up to July 2021 to identify relevant studies that had considered different types of coffee (caffeinated or decaffeinated), tea or caffeine exposure with RA as the main, or one of the, outcome(s). Two authors independently screened 742 publications. Finally, five prospective cohort studies were included in our meta-analysis. Pooled relative risks (RRs) were calculated by using a fixed-effects model. We also performed linear and non-linear dose-response analyses to examine the dose-response relations.

Results

Comparing extreme categories, we found a positive, significant association between coffee (RR: 1.30; 95% CI: 1.04–1.62; I² = 0%, n = 5) and decaffeinated coffee (RR: 1.89; 95% CI: 1.35–2.65; I² = 38.1%, n =3) consumption and risk of RA. One additional cup of coffee consumed per day was associated with an increased risk of RA by 6% (95% CI: 1.02–1.10; I² = 0%). This increase in the risk of RA for one cup/d of decaffeinated coffee was 11% (95% CI: 1.05–1.18; I² = 38). No significant association was observed between caffeinated coffee, tea or caffeine intake and the risk of RA.

Conclusion

We found that a higher intake of coffee and decaffeinated coffee was associated with increased risk of RA. No significant association between caffeinated coffee, tea or caffeine intake and the risk of RA was observed.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=227665, identifier: CRD42021227665.

Brucellosis presenting with sepsis and cholestasis: A rare presentation of an endemic disease with review of the literature

Brucellosis is a zoonotic disease endemic to the Middle East and Mediterranean basin. It has gained diagnostic challenge recently due to its increasingly non-specific and vague manifestations at presentation. Here, we report a 53-year-old man presenting with undulating fever and shaking chills and frequency, dysuria, hesitancy and malodorous urine. He had prior complicated urinary tract infection treated with intravenous antibiotics. Further evaluation revealed negative urine culture, intra-hepatic cholestasis due to underlying infection, elevated acute phase reactants and pancytopenia.The diagnosis of brucella was established as blood cultures grew Brucella melitensis and serum serology for Brucellosis returned positive. Following initiation of anti- brucella drugs, fever and laboratory abnormalities gradually returned to normal. Brucellosis should be always considered in the differential diagnosis of patients presenting with sepsis in endemic regions or when empiric antibiotic therapy fails to improve clinical and laboratory abnormalities. Diagnosis requires high level of suspicious based on the clinical history and constellation of symptoms.

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Remaining a major cause of mortality, sepsis requires prompt therapy.

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Brucella species are common zoonotic infections worldwide.

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Brucella infection may involve multiple organ systems, often with vague symptoms.

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Brucella –induced sepsis may be the primary presenting symptom of the disease.

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Prompt diagnosis and treatment of this condition is mandatory to resolve symptoms.

The role of non-coding RNAs in chemotherapy for gastrointestinal cancers

Gastrointestinal (GI) cancers, including colorectal, gastric, hepatic, esophageal, and pancreatic tumors, are responsible for large numbers of deaths around the world. Chemotherapy is the most common approach used to treat advanced GI cancer. However, chemoresistance has emerged as a critical challenge that prevents successful tumor elimination, leading to metastasis and recurrence. Chemoresistance mechanisms are complex, and many factors and pathways are involved. Among these factors, non-coding RNAs (ncRNAs) are critical regulators of GI tumor development and subsequently can induce resistance to chemotherapy. This occurs because ncRNAs can target multiple signaling pathways, affect downstream genes, and modulate proliferation, apoptosis, tumor cell migration, and autophagy. ncRNAs can also induce cancer stem cell features and affect the epithelial-mesenchymal transition. Thus, ncRNAs could possibly act as new targets in chemotherapy combinations to treat GI cancer and to predict treatment response.

Coumarins and Gastrointestinal Cancer: A New Therapeutic Option?

Cancers of the gastrointestinal (GI) tract are often life-threatening malignancies, which can be a severe burden to the health care system. Globally, the mortality rate from gastrointestinal tumors has been increasing due to the lack of adequate diagnostic, prognostic, and therapeutic measures to combat these tumors. Coumarin is a natural product with remarkable antitumor activity, and it is widely found in various natural plant sources. Researchers have explored coumarin and its related derivatives to investigate their antitumor activity, and the potential molecular mechanisms involved. These mechanisms include hormone antagonists, alkylating agents, inhibitors of angiogenesis, inhibitors of topoisomerase, inducers of apoptosis, agents with antimitotic activity, telomerase inhibitors, inhibitors of human carbonic anhydrase, as well as other potential mechanisms. Consequently, drug design and discovery scientists and medicinal chemists have collaborated to identify new coumarin-related agents in order to produce more effective antitumor drugs against GI cancers. Herein, we summarize the therapeutic effects of coumarin and its derivatives against GI cancer.

Neurofilament light chain as a biomarker for diagnosis of multiple sclerosis

The treatments for multiple sclerosis (MS) have improved over the past 25 years, but now the main question for physicians is deciding who should receive treatment, for how long, and when to switch to other options. These decisions are typically based on treatment tolerance and a reasonable expectation of long-term efficacy. A significant unmet need is the lack of accurate laboratory measurements for diagnosis, and monitoring of treatment response, including deterioration and disease progression. There are few validated biomarkers for MS, and in practice, physicians employ two biomarkers discovered fifty years ago for MS diagnosis, often in combination with MRI scans. These biomarkers are intrathecal IgG and oligoclonal bands in the CSF (cerebrospinal fluid). Neurofilament light chain (NfL) is a relatively new biomarker for MS diagnosis and follow up. Neurofilaments are neuron-specific cytoskeleton proteins that can be measured in various body compartments. NfL is a new biomarker for MS that can be measured in serum samples, but this still needs further study to specify the laboratory cut-off values in clinical practice. In the present review we discuss the evidence for NfL as a reliable biomarker for the early detection and management of MS. Moreover, we highlight the correlation between MRI and NfL, and ask whether they can be combined.

Joint application of biochemical markers and imaging techniques in the accurate and early detection of glioblastoma

Glioblastoma is a primary brain tumor with the most metastatic effect in adults. Despite the wide range of multidimensional treatments, tumor heterogeneity is one of the main causes of tumor spread and gives great complexity to diagnostic and therapeutic methods. Therefore, featuring noble noninvasive prognostic methods that are focused on glioblastoma heterogeneity is perceived as an urgent need. Imaging neuro-oncological biomarkers including MGMT (O⁶-methylguanine-DNA methyltransferase) promoter methylation status, tumor grade along with other tumor characteristics and demographic features (e.g., age) are commonly referred to during diagnostic, therapeutic and prognostic processes. Therefore, the use of new noninvasive prognostic methods focused on glioblastoma heterogeneity is considered an urgent need. Some neuronal biomarkers, including the promoter methylation status of the promoter MGMT, the characteristics and grade of the tumor, along with the patient's demographics (such as age and sex) are involved in diagnosis, treatment, and prognosis. Among the wide array of imaging techniques, magnetic resonance imaging combined with the more physiologically detailed technique of H-magnetic resonance spectroscopy can be useful in diagnosing neurological cancer patients. In addition, intracranial tumor qualitative analysis and sometimes tumor biopsies help in accurate diagnosis. This review summarizes the evidence for biochemical biomarkers being a reliable biomarker in the early detection and disease management in GBM. Moreover, we highlight the correlation between Imaging techniques and biochemical biomarkers and ask whether they can be combined.

The effects of vitamin D supplementation on inflammatory biomarkers in patients with abnormal glucose homeostasis: A systematic review and meta-analysis of randomized controlled trials

FINDINGS

on the level of inflammatory cytokines following vitamin D supplementation among individuals with abnormal glucose homeostasis (AGH) are controversial. Therefore, the present study was conducted on AGH patients to assess the impact of vitamin D on inflammatory cytokines such as CRP, TNF-α and IL-6. A systematic search up to September 2020 was performed through PubMed and Scopus databases. All clinical studies which evaluated the effect of oral vitamin D supplementation on inflammation in patients with AGH were included. The random-effects model was applied to obtain pooled results. For dose-response analysis, we used a fractional polynomial model. Overall, 38 studies, with 46 effect sizes, were included in this study. Combining effect sizes, we found that vitamin D considerably decrease serum concentrations of CRP (weight mean difference (WMD): - 0.67 mg/l; 95%CI: - 0.92, - 0.43; P < 0.001), IL-6 (WMD: -1.93 pg/mL; 95%CI: -2.80, -1.07; P < 0.001) and TNF-α (WMD: -0.81 pg/mL; 95%CI: -1.59, -0.03; P = 0.04). In the dose-response analysis, we failed to find any correlation between dosage of supplements and inflammatory biomarkers concentrations. Summarizing earlier studies, we demonstrated that circulating concentrations of inflammatory cytokines such as CRP, TNF-α, and IL-6 might be decreased following vitamin D supplementation among individuals with AGH.

Nitrogen in Hydroponic Growing Medium of Tomato Affects the Demographic Parameters of Trialeurodes vaporariorum (Westwood) (Hemiptera: Aleyrodidae)

We evaluated the effects of different nitrogen levels (380, 310, 240, and 174 ppm) on the life history parameters of Trialeurodes vaporariorum (Westwood) (Hemiptera: Aleyrodidae) on hydroponically cultured tomato plants. Our data show that there is a positive correlation between the nitrogen content and the demographic parameters, as the intrinsic rate of increase of T. vaporariorum was the lowest (0.059 ± 0.007 day(-1)) at 174 ppm and the highest (0.088 ± 0.005 day(-1)) at 380 ppm of nitrogen. The net reproduction rate (R 0), finite rate of increase (λ), and mean developmental time (T) were significantly influenced by the nitrogen levels. The mean longevity of males and females showed a positive relationship with the nitrogen level, ranging from 64.8 ± 3.96 to 76.3 ± 2.44 for males and 61.6 ± 5.35 to 71.2 ± 2.44 for females, observed in the lowest and highest nitrogen levels, respectively. The relationship between nitrogen fertilization and T. vaporariorum management on tomato crops is discussed.

Vacuum epidural cyst with acute neurological presentation. A case report

The widespread use of MRI in the assessment of low back pain has led to increased detection of degenerative cysts of the spine, which was essentially a surgical diagnosis earlier. The awareness of degenerative cysts, the significance of their role in the etiology of radicular and back pain and their effective management is evolving. We describe a case of bilateral, gas-filled lumbar facet synovial/ ganglion cysts causing focal arachnoid inflammation and lateral lumbar canal stenosis.

Level of empathy among medical students in Kuwait University, Kuwait

OBJECTIVES

To evaluate the level of empathy among medical students in Kuwait University Medical School and its association with sociodemographic factors, stress levels and personality.

SUBJECTS AND METHODS

A cross-sectional survey of 264 medical students was conducted in the Faculty of Medicine, Kuwait University. Empathy levels were measured using the Jefferson Scale, personality was assessed using the Zuckerman-Kuhlman Personality Scale and the Perceived Stress Scale was used to measure stress levels. Factors associated with empathy were evaluated using t test/ANOVA for categorical variables and correlation for continuous predictors.

RESULTS

Mean empathy score was 104.6 ± 16.3. Empathy scores were significantly associated with gender, year of study, mother's level of education, household income, satisfactory relationship with the mother and stress levels. Male medical students in their clinical years also had significantly lower empathy levels. However, factors such as grade point average, desired specialty, marital status of parents, father's educational level and relationship with father were not significantly (p > 0.05) associated with levels of empathy. Stress scores were significantly and positively associated with empathy (r = 0.13; p = 0.041).

CONCLUSION

Medical students in Kuwait University had low empathy level and this may be a cause for concern; as such we suggest a possible inclusion of emphasis on empathy in the curriculum.

Simultaneous pattern visual evoked potential and pattern electroretinogram in strabismic and anisometropic amblyopia

BACKGROUND

Amblyopia is a relatively common condition in which visual acuity through an eye is subnormal despite no overt pathology. Pattern visual evoked potential (PVEP) can detect any defect from optic nerve to occipital cortex and pattern electroretinogram (PERG) can detect retinal defects specially the ganglion layers. This study was performed to evaluate the cortical and retinal activity in strabismic and anisometropic amblyopia.

METHODS

PVEP and PERG were recorded simultaneously in 40 amblyopes (20 strabismics and 20 anisometropics) and 20 normal control subjects. Normal subjects were age and sex matched with patients.

RESULTS

The P(100) latency in PVEP was increased in both groups of patients but the P(100) amplitude was reduced only in anisometropic group. In PERG, the amplitude of P(50) was reduced in all patients with no significant change in latency.

CONCLUSION

Beside reduced PVEP responses in strabismic and anisometropic amblyopia, the activity of retina reduced too. It is likely that retinal impulses can affect the development of visual system.

The Impact of Imaging on Management of Cervical Cystic Hygromas

Cystic hygromas occur most commonly in the neck, axilla, groin or retroperitoneal space. Occasionally a portion of a cervical cystic hygroma may reside within the mediastinum. It is also extremely rare for cystic hygroma to present in the back of the neck. Hence, we describe our experience of two cases of cystic hygromas in the neck, an extensive cervicomediastinal, and posterior cervical lesion. The different location and extent of each lesion, and different management decisions are discussed.

Metarrhizium anisopliae as a cause of sinusitis in immunocompetent hosts

Metarrhizium anisopliae is a common pathogen of insects and has even been used to control insect populations. It is rarely isolated from human or animal sources, but recently, there have been three reported cases of disease, two in humans and one in a cat. We present our experience with five isolates from human sources, including two that were the apparent causes of two cases of sinusitis in immunocompetent hosts. The first patient was a 36-year-old male with frontal and ethmoid sinusitis, and the second was a 79-year-old female with chronic sinusitis. Both patients underwent surgery, and pathology of the surgical specimens revealed branching hyphae. Cultures grew only Metarrhizium species. Neither patient received antifungal therapy, and both did well postoperatively. The other three isolates were cultured from bronchoalveolar lavage specimens but were not felt to be clinically significant. Antifungal susceptibility testing using the National Committee for Clinical Laboratory Standards macrobroth method revealed that all isolates were resistant to amphotericin B, 5-flucytosine, and fluconazole. Itraconazole and newer azole compounds were more active. Metarrhizium species may cause disease in humans, even those without evidence of immunosuppression, and are apparently highly resistant to amphotericin B in vitro.