Use of encapsulated pomegranate seed oil in novel coarse and nanosized materials for improving the storage life of strawberry

Different-sized pomegranate seed oil-based emulsions (coarse (CsP) and nanoemulsions (NsP): 1246 and 325 nm) were successfully prepared. Strawberries treated with NsP and CsP showed a significant decrease (p < 0.05) in yeast-mold counts (TMY) by 1.80 log CFU g-1, and mesophilic aerobic bacteria counts (TMAB) decreased (p < 0.05) by 0.91 log CFU g-1, respectively. CsP- and NsP-treated strawberries had a TPC of 74.45 and 82.35 mg GAE kg-1, respectively, while control samples had a TPC of 44.24 mg GAE kg-1. The strawberries treated with NsP exhibited the highest antioxidant capacity with 179.44 mol TEAC g-1. After treatment with a coarse emulsion, severity levels of A. niger and B. cinerea were 60 and 73 % while the nanoemulsion treatment significantly reduced severity levels to 55.3 and 56 %. The coarse and nanoemulsions may have potential use within the food industry owing to their antioxidant and antifungal properties as well as their ability to enhance strawberry quality and function.

Green synthesis of zinc oxide/Allium sativum nano-composite and its efficacy against murine cryptosporidiosis

Cryptosporidiosis is a global health problem threats life of immunocompromised patients. Allium sativum (A. sativum) is one of the therapeutic options for cryptosporidiosis. This study develops green synthesized ZnO-NPs based on A. sativum extract, and assesses its therapeutic application in treating experimental cryptosporidiosis in immunosuppressed mice. FTIR, scanning electron microscopy, and zeta analyzer were used for characterization of bio ZnO-NPs. The morphology of prepared materials appeared as sponge with many pores on the whole surface that allows the feasibility of bio ZnO-NPs for different biological activities. Its structural analysis was highly stabilized with negative charge surface which indicated for well distribution into the parasite matrix. Twenty-five immunosuppressed Cryptosporidium parvum infected mice, classified into 5 groups were sacrificed at 21th day after infection with evaluation of parasitological, histopathological, oxidative, and proinflammatory biomarkers. Treated mice groups with 50 and 100 mg/kg of AS/ZnO-NPs showed a highly significant decline (79.9% and 83.23%, respectively) in the total number of expelled oocysts. Both doses revealed actual amelioration of the intestinal, hepatic, and pulmonary histopathological lesions. They also significantly produced an increase in GSH values and improved the changes in NO and MDA levels, and showed high anti-inflammatory properties. This study is the first to report green synthesis of ZnO/A. sativum nano-composite as an effective therapy in treating cryptosporidiosis which gave better results than using A. sativum alone. It provides an economical and environment-friendly approach towards novel delivery synthesis for antiparasitic applications. RESEARCH HIGHLIGHTS: Green synthesis of ZnO-NPs was developed using A. sativum extract. The morphology of prepared ZnO-NPs appeared as sponge with many pores on SEM The study evaluates its therapeutic efficacy against murine cryptosporidiosis The green synthesized ZnO-NPs significantly reduced percent of oocyst shedding, improved the pathological changes, and showed high antioxidant and anti-inflammatory potentials.

Conjunctival vessel morphology in patients with type 2 diabetes mellitus: findings of a case-control study

OBJECTIVE

Diabetic retinopathy is a serious complication of diabetes mellitus that may lead to vision loss. Retinal problems are more likely to occur as the illness advances. Micro- and macro-vascular angiopathy is both linked to diabetes mellitus. Examining the impact of diabetes on blood vessels is one approach to understanding the disease's outward symptoms. The purpose of this research is to evaluate the morphology and breadth of conjunctival vessels in people with type 2 diabetes mellitus and to establish a correlation between these alterations and clinical retinal changes.

PATIENTS AND METHODS

A case-control study was conducted in the Department of Ophthalmology, KIMS, Koppal, Karnataka. The study included diabetic patients who voluntarily participated and were assessed at the Ophthalmology Outpatient Department (OPD). The general and ophthalmic history was taken for both cases and control. The best corrected visual acuity was estimated. Each subject, including cases and controls, had a general and ophthalmic history recorded. The anterior segment was evaluated with a slit lamp. After completing the clinical examination, the subjects underwent a conjunctival vessel imaging study using the slit lamp. The imaging included the study of conjunctival vessel morphology using ImageNet.

RESULTS

Both the test and control groups are comparable in terms of age and gender. The severity of diabetic retinopathy was shown to correlate with the conjunctival width range. Mild diabetic retinopathy is characterized by a conjunctival width of 30-34 microns (mean: 34.9), moderate diabetic retinopathy by 35-39 microns (mean: 37.3), severe diabetic retinopathy by 40-44 microns (mean: 42.4), and proliferative diabetic retinopathy by 50-54 microns (mean: 45.6).

CONCLUSIONS

Diabetes mellitus patients have larger conjunctival arteries as the disease becomes more severe. Dilated and tortuous conjunctival arteries are visible indicators that correlate with worsening diabetic retinopathy. This could be used for screening to ensure timely referral.

Newly fabricated zinc oxide nanoparticles loaded materials for therapeutic nano delivery in experimental cryptosporidiosis

Cryptosporidiosis is a global health problem that threatens the lives of immunocompromised patients. This study targets to fabricate and investigate the efficiency of zinc oxide nanoparticles (ZnO-NPs), nitazoxanide (NTZ)-loaded ZnO-NPs, and Allium sativum (A. sativum)-loaded ZnO-NPs in treating cryptosporidiosis. Further FTIR, SEM, XRD, and zeta analysis were used for the characterization of ZnO-NPs and loaded materials. The morphology of loaded materials for ZnO-NPs changed into wrapped layers and well-distributed homogenous particles, which had a direct effect on the oocyst wall. The charge surface of all particles had a negative sign, which indicated well distribution into the parasite matrix. For anti-cryptosporidiosis efficiency, thirty immunosuppressed Cryptosporidium parvum-infected mice, classified into six groups, were sacrificed on the 21st day after infection with an evaluation of parasitological, histopathological, and oxidative markers. It was detected that the highest reduction percent of Cryptosporidium oocyst shedding was (81.5%) in NTZ, followed by (71.1%) in A. sativum-loaded ZnO-NPs-treated groups. Also, treatment with A. sativum and NTZ-loaded ZnO-NPs revealed remarkable amelioration of the intestinal, hepatic, and pulmonary histopathological lesions. Furthermore, they significantly produced an increase in GSH values and improved the changes in NO and MDA levels. In conclusion, this study is the first to report ZnO-NPs as an effective therapy for treating cryptosporidiosis, especially when combined with other treatments that enhance their antioxidant activity. It provides an economical and environment-friendly approach to novel delivery synthesis for antiparasitic applications.

Fabrication of Thermal Insulation Bricks Using Pleurotus florida Spent Mushroom

This study explores the potential for making lightweight bricks via the use of dry, pulverized spent mushroom materials (SMM) as a thermal insulator. There are five distinct replacement proportions of SMM that are used, and they range from 0% to 15% of the weight of the clay. The firing of the fabricated bricks at temperatures of 700, 800, and 900 °C led to the development of pores on the interior surface of the bricks as a consequence of the decomposition of SMM. The impact of SMM on the physicomechanical characteristics of fabricated bricks is assessed based on standard codes. Compressive strength, bulk density, and thermal conductivity decreased as the SMM content increased, reaching up to 8.7 MPa, 1420 kg/m³, and 0.29 W/mK at 900 °C and 15% substitution percentage. However, cold water absorption, boiling water absorption, linear drying shrinkage, linear firing shrinkage, and apparent porosity increased with the increase in SMM, reaching 23.6%, 25.3%, and 36.6% at 900 °C and 15% substitution percentage. In the study simulation model, there was a significant improvement in energy consumption, which reached an overall reduction of 29.23% and 21.49% in Cario and Jazan cities, respectively.

Impact of core stability exercises vs. interferential therapy on pelvic floor muscle strength in women with pelvic organ prolapse

OBJECTIVE

Pelvic organ prolapse (POP) is the descent of the pelvic organs into or through the vaginal walls. Females who have prolapse have symptoms that interfere with their daily lives, sexual function, and exercise. POP can have a negative effect on one's sexuality and body image. This study attempted to assess the significance of core stability exercises vs. interferential therapy on the power of the pelvic floor muscles in females with prolapsed pelvic organs.

PATIENTS AND METHODS

A randomized control trial was conducted on forty participants (aged between 40-60 years, diagnosed with mild degree pelvic organ prolapse participated in the research. Participants were randomly divided into two groups: (group A; n = 20) and (group B; n = 20). The participants were tested twice, before and after 12 weeks, during which group (A) performed core stability exercises while group (B) received interferential therapy. A modified Oxford grading scale and the perineometer were used to assess how the vaginal squeeze pressure changed.

RESULTS

The study's findings demonstrated that the modified Oxford grading scale values and vaginal squeeze pressure had a non-statistically significant difference (p-value ≥ 0.05) between both groups pre-treatment while had a statistically significant difference (p-value ≤ 0.05) between both groups post-treatment in favor of group A.

CONCLUSIONS

It was concluded that both training programs are efficient at strengthening the pelvic floor muscles, but the core stability exercises were more effective.

Diversity and Distribution Characteristics of Viruses from Soda Lakes

Viruses are the most abundant living things and a source of genetic variation. Despite recent research, we know little about their biodiversity and geographic distribution. We used different bioinformatics tools, MG-RAST, genome detective web tools, and GenomeVx, to describe the first metagenomic examination of haloviruses in Wadi Al-Natrun. The discovered viromes had remarkably different taxonomic compositions. Most sequences were derived from double-stranded DNA viruses, especially from Myoviridae, Podoviridae, Siphoviridae, Herpesviridae, Bicaudaviridae, and Phycodnaviridae families; single-stranded DNA viruses, especially from the family Microviridae; and positive-strand RNA viruses, especially from the family Potyviridae. Additionally, our results showed that Myohalovirus chaoS9 has eight Contigs and is annotated to 18 proteins as follows: tail sheath protein, tco, nep, five uncharacterized proteins, HCO, major capsid protein, putative pro head protease protein, putative head assembly protein, CxxC motive protein, terl, HTH domain protein, and terS Exon 2. Additionally, Halorubrum phage CGphi46 has 19 proteins in the brine sample as follows: portal protein, 17 hypothetical proteins, major capsid protein, etc. This study reveals viral lineages, suggesting the Virus's global dispersal more than other microorganisms. Our study clarifies how viral communities are connected and how the global environment changes.

Emamectin Benzoate-Induced Hepatotoxicity in Rats with Special Reference to Protective Potential of Nigella sativa Oil

This study was designed to explore the hepatotoxicity of emamectin in male rats and the possible effect of Nigella sativa oil (NSO) in ameliorating this. Twenty-eight male rats were used in this study. They were divided into four groups, Control group: rats orally administered distilled water; NSO group: rats administered NSO orally; EMB group: rats administered emamectin benzoate orally; and EMB+NSO group: rats orally co-administered NSO with EMB, with the administrations being performed every other day for 6 weeks. Body weight was measured, liver alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP) activities were determined, and total protein and albumin levels were recorded. Histopathological examination of the liver was also performed, along with caspase-3 and TNF-α immunostaining of liver tissue. EMB treatment resulted in decreased body weight, while the co-administration of NSO modulated the EMB-induced alterations in body weight. There were also increases in the activities of serum ALT, AST, and ALP and decreases in total protein and albumin levels in the EMB group. Co-treatment with NSO significantly reduced serum ALT, AST, and ALP and improved total protein and albumin levels. Histopathological examination of the liver in the EMB group revealed the presence of different histopathological alterations that were improved by the co-administration of NSO. Immunostaining of caspase-3 and TNF-α in the liver revealed strong expression in the EMB-treated group. Meanwhile, the EMB+NSO group showed weak positivity for immunoreactive cells.

Diagnosis of coronavirus disease 2019 and the potential role of deep learning: insights from the experience of Cairo University Hospitals

OBJECTIVES

Early detection of coronavirus disease 2019 (COVID-19) is crucial for patients and public health to ensure pandemic control. We aimed to correlate clinical and laboratory data of patients with COVID-19 and their polymerase chain reaction (PCR) results and to assess the accuracy of a deep learning model in diagnosing COVID-19.

METHODS

This was a retrospective study using an anonymized dataset of patients with suspected COVID-19. Only patients with a complete dataset were included (n = 440). A deep analytics framework and dual-modal approach for PCR-based classification was used, integrating symptoms and laboratory-based modalities.

RESULTS

Participants with loss of smell or taste were two times more likely to have positive PCR results (odds ratio [OR] 1.86). Participants with neutropenia, high serum ferritin, or monocytosis were three, four, and five times more likely to have positive PCR results (OR 2.69, 4.18, 5.42, respectively). The rate of accuracy achieved using the deep learning framework was 78%, with sensitivity of 83.9% and specificity of 71.4%.

CONCLUSION

Loss of smell or taste, neutropenia, monocytosis, and high serum ferritin should be routinely assessed with suspected COVID-19 infection. The use of deep learning for diagnosis is a promising tool that can be implemented in the primary care setting.

Accuracy of the Traditional COVID-19 Phone Triaging System and Phone Triage-Driven Deep Learning Model

Objectives:

During the COVID-19 pandemic, a quick and reliable phone-triage system is critical for early care and efficient distribution of hospital resources. The study aimed to assess the accuracy of the traditional phone-triage system and phone triage-driven deep learning model in the prediction of positive COVID-19 patients.

Setting:

This is a retrospective study conducted at the family medicine department, Cairo University.

Methods:

The study included a dataset of 943 suspected COVID-19 patients from the phone triage during the first wave of the pandemic. The accuracy of the phone triaging system was assessed. PCR-dependent and phone triage-driven deep learning model for automated classifications of natural human responses was conducted.

Results:

Based on the RT-PCR results, we found that myalgia, fever, and contact with a case with respiratory symptoms had the highest sensitivity among the symptoms/ risk factors that were asked during the phone calls (86.3%, 77.5%, and 75.1%, respectively). While immunodeficiency, smoking, and loss of smell or taste had the highest specificity (96.9%, 83.6%, and 74.0%, respectively). The positive predictive value (PPV) of phone triage was 48.4%. The classification accuracy achieved by the deep learning model was 66%, while the PPV was 70.5%.

Conclusion:

Phone triage and deep learning models are feasible and convenient tools for screening COVID-19 patients. Using the deep learning models for symptoms screening will help to provide the proper medical care as early as possible for those at a higher risk of developing severe illness paving the way for a more efficient allocation of the scanty health resources.

Knowledge and awareness levels of diabetes mellitus risk factors among nondiabetic visitors of primary health care centers: a multicenter study

OBJECTIVE

People with a high risk of developing Type 2 Diabetes Mellitus are primarily due to lifestyle factors and can be reduced by implementing awareness programs. Therefore, this study evaluates the diabetic awareness level, risk factors, and lifestyle behaviors among nondiabetic participants.

PATIENTS AND METHODS

This is a cross-sectional study conducted among 538 nondiabetic participants based on American Diabetic Association (ADA) parameters via face-to-face interview. The sample was collected from five different primary health care centers from November 2019 to February 2020. The target population was nondiabetic with age ≥18 years and participants with other serious chronic illnesses, pregnant women, or unable to communicate effectively were excluded.

RESULTS

A total of 538 participants without diabetes data were analyzed, of which 363 (67.5%) were males. Good, moderate, and insufficient knowledge of Type 2 Diabetes Mellitus awareness was 34.6%, 52.4%, and 13.0%, respectively. The knowledge level in females' participants was significantly less than the males (OR=2.4; p=0.0005). About 44% had diabetic risk, and the prevalence of diabetes risk was significantly high in males (OR=1.7), obesity (OR=2.9), overweight (OR=2.3), and high blood pressure (OR= 2.2) (all p < 0.05). The risk of diabetes was increased in those participants who consumed more bakery items (p < 0.05). The diabetes risk score was negatively associated with diabetes awareness levels (r= -0.29, p= 0.063).

CONCLUSIONS

The risk of diabetes in the general population can be prevented by proactive public health awareness campaigns, particularly among elderly age group, with lower educational level, physically inactive, and obese.

Establishment of actinobacteria-Satureja hortensis interactions under future climate CO2-enhanced crop productivity in drought environments of Saudi Arabia

Drought is a significant global constraint on agricultural production and food security. As a promising approach to improve plant growth and yield under challenging conditions, plant growth-promoting actinobacteria has attracted much interest. Further, elevated levels of atmospheric CO2 (eCO2) may promote the plant-actinobacteria interactions which could be effective to improve the plant growth for food production. Herein, we have investigated the impact of actinobacteria and/or CO2 on biomass production, photosynthesis, macronutrients, levels of organic acids, amino acids, and essential oils as well as antioxidant activities of Satureja hortensis under water-deficit conditions. Among different actinobacterial isolates evaluated for development of secondary metabolites and biological activities, Ac9 was highly capable of producing flavonoids, and it also showed high antioxidant and microbial activities. It markedly induced the plant growth, photosynthesis, and global metabolic improvement, under water-deficit conditions. Interestingly, treatment with Ac9 in combination with eCO2 substantially minimized drought stress-induced biomass and photosynthesis reductions in Satureja hortensis. Improved photosynthesis by Ac9 and/or eCO2 induced the primary and secondary metabolisms in drought-stressed plants. The levels of the majority of the detected organic acids, essential oil, and amino acids were further improved as a result of the synergistic action of Ac9 and eCO2, as compared to the individual treatments. Furthermore, Ac9 or eCO2 significantly improved the antioxidant activities in stressed plants; however, much more positive impact was obtained by their synchronous application. Thus, the current study suggests that actinobacterial treatment induces global metabolic changes in water-stressed Satureja hortensis, the effects that have been much more strengthened under eCO2.

Barriers to Completing Therapy for Hepatitis C with Direct-Acting Antivirals: A Real-Life Experience from a Single Treatment Center in Egypt

Introduction

Interferon-based therapies against the hepatitis C virus had a poor adherence profile. On the other hand, new direct-acting antivirals (DAAs) are orally administered medications, show high efficacy against the hepatitis C virus in addition to a high safety profile. Therefore, adherence to this treatment is expected to improve. Assessment for treatment adherence is mandatory to assess the feasibility of achieving viral hepatitis elimination.

Aim

The study aims to assess the adherence rate and causes of non-adherence in Egyptian hepatitis C patients who received interferon-free treatment regimens.

Methods

Retrospective data analysis for 668 hepatitis C patient’s records from August 2014 to October 2019 was done. Assessment of treatment adherence was done by revising the records and phone calls. However, 172 patients were excluded due to the absence of contact data. Rest of patients (n = 496) was categorized into 2 groups: Adherent (n = 432) and non-adherent (n = 64). For whom comparative analysis was done.

Results

The adherent group (87%) achieved 100 % sustained virological response after 12 weeks (SVR 12). Non-adherence was reported in 12.9% of patients. Low awareness was the main cause of non-adherence (43.75%). BMI was the only significant risk factor for poor adherence (P = .04). Other Patient demographics, clinical, and laboratory data didn’t show any significant differences between both groups.

Conclusion

Interferon-free regimens are tolerable. Raising awareness is mandatory for proper treatment adherence and, subsequently, good clinical outcomes.

Diagnostic accuracy of magnetic resonance imaging in detecting depth of invasion of tongue cancers

The recent eighth edition of the American Joint Committee on Cancer (AJCC) staging system has introduced depth of invasion (DOI) as one of its important components. DOI is also important for deciding neck management in superficial tongue cancers. Magnetic resonance imaging (MRI) is mainly used to assess DOI, and in this study we have evaluated the efficacy of MRI to detect it. This is a retrospective study consisting of 60 treatment-naïve tongue cancer patients operated on between July 2017 and June 2019. Patients underwent MR imaging on an Optima MR450W 1.5T unit, and MRI was reported by two experienced ead and eck adiologistss. Postoperative histological DOI was considered the gold standard. The correlation coefficient was derived for postoperative DOI and MRI-detected DOI. A subgroup analysis of superficial tongue cancer was also done. The mean MRI DOI was 13.7 mm and the mean histological DOI 12.45 mm. The shrinkage factor was 0.6 mm. Pearson's correlation coefficient was 0.80 (p=<0.001) for Radiologist 1 and 0.85 (p=<0.001) for Radiologist 2. The interobserver variation was low, with a correlation coefficient between the two radiologists of 0.965 (p=<0.001). For superficial tongue cancers there was moderate correlation for MRI and histologically-detected DOI with a kappa value of 0.681 (p=0.03). As per the ROC curve, the cut-off value for MRI DOI to predict nodal metastasis was 4.6 mm. MRI has high reliability to predict the DOI of tongue cancers. The interobserver variation was low. The diagnostic accuracy in cases of superficial tongue cancer was moderate.

An Adapted Online Family Medicine Training for House Officers Amid Covid-19 Pandemic in Egypt

Introduction

The COVID-19 pandemic is an unprecedented challenge to house officers training programs because of the safety measures.

Objective

This current study aimed to introduce the adaptation of family medicine training for house officers during COVID-19 pandemic and gauge their level of satisfaction with the training.

Methods

Unfortunately, more than one-fourth of the house officers attending the family medicine training turned out to be hospital-admitted or in obligatory home isolation. A time-sensitive plan was proposed to maintain a competent training guaranteeing safety and support of house officers and fulfilling the training objectives in a virtual setting. Three mentors were assigned to each 10 house officers to provide continuous support and monitoring. Tutor and house officer interaction and reflection were maintained through a virtual clinical training session via Zoom application and a daily online discussion of a clinical scenario. Peer interaction was provided through post-webinar and small-group online discussion sessions.

Results

The adapted training was applied on thirteen cohorts of house officers. The response rate was 70% (666 out of 950). Most of them were satisfied with the training (84.6%). Their satisfaction with each modality of the training was encouraging.

Conclusions

During COVID-19 pandemic, successful adaptation of family medicine training has succeeded in fulfilling the training objectives and providing psychological support and engagement for house officers without burdening the hospital-admitted and home-isolated house officers.

Consensus Meeting Report "Technology Enhanced Assessment" in Covid-19 Time, MENA Regional Experiences and Reflections

PURPOSE

Majority of the assessments, appraisals and placements have been disturbed, with some being cancelled, postponed, or modified in design. New approaches for assessment should be well-thought-out. This work attempts at capturing the collective wisdom of educators in the Middle East and North Africa region (MENA), providing an understanding of the online assessment conceptual framework in the era of COVID-19 that tells the story rather than determining cause and effect, and identifying the biggest gaps that derail the digital transformation.

METHODS

A qualitative inductive study using the grounded theory approach was implemented following a synchronous virtual online meeting, a summary of the reflections as well as experiences of medical education experts was prepared. Data for this qualitative study were collected from the meeting. The meeting was video-recorded and transcribed by the researchers. Thematic analysis was performed by three separate researcher coders. The authors then discussed together until they reached a consensus.

RESULTS

Three main thematic areas were identified: 1) feasibility, 2) exam fairness/equity and 3) acceptable graduate attributes, society/community acceptance.

CONCLUSION

The COVID-19 era necessitated revisiting of our assessment strategies to cope with new changes within the available context. Rapid adaptation is required.

Study of Chronic Obstructive Pulmonary Disease patients in Gamal Abd El-Nasser Hospital in 2017

Background

COPD is characterized by non-remitting airflow limitation and persistent respiratory symptoms which is an enhanced inflammatory response to prolonged exposure to smoking or noxious gases or particles and manifested through chronic cough, effort dyspnea, expectoration and wheezing, symptoms that appears in context of airways hyper-responsiveness and may be partially reversible.

Objective

Assessment of COPD patients in Gamal Abd El Nasser Hospital during period from January 2017 to June 2017.

Subjects and Methods

This study was a cross sectional study that included 290 COPD patients recommended for spirometric assessment. The patients were classified into 2 groups: Outpatients and inpatients in the period from January 2017 to June 2017, they were subjected to full medical history, general and local examination, Pre and post bronchodilator spirometric study according to (GOLD,2017) and each patient will be subjected to the following questionnaire [Serial number, Name, Age, Sex, Occupation, Residence, Level of education, Smoking, Smoking index, Family history of COPD, Symptoms, Number and severity of exacerbation attacks in the last year, Number of Hospitalization during the last year, Vaccination status, Spirometry, Treatment prescribed by, Treatment, Inhalation therapy, Regulation of treatment, Non pharmacological therapy, Satisfaction of treatment, co morbidities, Complications, Outcome for inpatient]

Results

The study included 290 patients, 259 males and 31 females with age range of 29 _ 83 years, the majority of the studied cases were Current smoking but only 22.5% was ex-smoker. Mean FEV1% pred. Post-bronchodilator was 75.9± 16.9 in outpatients and mean FEV1% pred. Post – bronchodilator was 52.9 ± 13.4 in inpatient. The most common co morbidities in COPD patients were hypertension in 25% of cases. More than half of all studied cases had complications and the most frequent complication was Cor-pulmonale and respiratory Failure. In this study, Severity of COPD according to GOLD 2017 was 27.8% in mild stage, 34.2% in moderate stage, 35.8% in severe stage and 2.5% in very severe stage.

Conclusion

Spirometry had a great role in diagnosis of COPD and its differential diagnosis from asthma. Smoking is the major risk factors in developing COPD and this reflects on the disease occurrence and severity. Some of COPD patients refuse to use inhalers due to fear of addiction and incorrect method in using it. Inhaler steroids were preferred due to fear of systemic complications of steroids. There is great defect in vaccination and trials of quitting smoking as a non-pharmacological treatment for COPD patients.

Phoenix dactylifera, mentha piperita and montanide™ ISA-201 as immunological adjuvants in a chicken model

This study evaluated plant-based immune-adjuvants from crude extracts of Phoenix dactylifera and Mentha piperita as promising adjuvants for vaccines because of the limited side effects associated with plant extracts. In addition, Montanide™ ISA 201 previously used in vaccines in cattle. Eight different infectious coryza (IC) vaccines were prepared from three serovars [A (W strain and local strain), C (Modesto strain) and B (0222 strain)] with eight Avibacterium paragallinarum vaccines adjuvants formulae using liquid paraffin, Montanide™ ISA 71, Montanide™ ISA 201, and Montanide™ Gel adjuvants, P. dactylifera and M. piperita as immune-stimulants at a concentration of 1 mg and 2 mg incorporated with or without liquid paraffin oil as an adjuvant. These vaccines were applied in a chicken model. After a single immunization, the eight vaccine formulations were evaluated using the ELISA and Microplate agglutination test. Evidence of protection in the immunized birds was based on the results after challenge and bacterial isolation. The incorporation of the crude aqueous extract of P. dactylifera or M. piperita at a concentration of 2 mg in a liquid paraffin oil adjuvanted IC vaccine could be employed as an efficient adjuvant for chicken to IC vaccine to enhance immune responses. Also,Montanide™ ISA 201 may be the best adjuvant to be used to enhance the protective response against Av. paragallinarum. Our results confirm that aqueous extracts of M. piperita leaves and P. dactylifera fruit have immunomodulatory potentials in vivo and elevated serum antibodies against Av. Paragallinarum.

Evaluation of a human in vitro skin test for predicting drug hypersensitivity reactions

The occurrence of drug hypersensitivity reactions (DHRs) following administration of low molecular weight (LMW) drugs is an important health concern. However, in vivo animal models which could be used as tools for the prediction of DHRs are lacking. As a result, research has focused on development of in vitro tools for predicting DHRs. In this study a novel human in vitro pre-clinical skin explant test was used to predict T cell-mediated hypersensitivity responses induced by LMW drugs. Responses in the skin explant test for 12 LMW drugs associated with T cell-mediated hypersensitivity in the clinic (abacavir, amoxicillin, carbamazepine, diclofenac, lamotrigine, lapatinib, lumiracoxib, nevirapine, ofloxacin, phenytoin, propranolol, sulfamethoxazole) were compared with responses for 5 drugs with few/no reports of T cell-mediated hypersensitivity reactions (acetaminophen, cimetidine, flecainide, metformin, verapamil). Changes in skin histology following in vitro exposure to the drugs as well as T cell proliferation and interferon gamma (IFNγ) production were studied. The results of the skin explant assays showed a good positive correlation (r = 0.77, p < .001) between the test outcome (prediction of positive or negative) and the clinical classification of the tested drugs. The T cell proliferation assay showed a correlation of r = 0.60 (p < .01) and the IFNγ assay r = 0.51 (p < .04). The data suggest that the skin explant model could be a useful tool to predict the potential of LMW drugs to induce DHRs.

Aging changes in the retina of male albino rat: a histological, ultrastructural and immunohistochemical study

BACKGROUND

Degenerative changes caused by aging may affect the eye, especially the retina. Such changes occur as a part of normal physiological process and may be irreversible. The aim of the study was to demonstrate the influence of aging on the morphology of the retina to provide a basis to explain the pathogenesis of age-associated decline in visual acuity, scotopic and photopic sensitivity.

MATERIALS AND METHODS

Forty male albino rats were used and divided into four age groups (group I: age of cortical maturity, group II: middle-aged, group III: aged group and group IV: senile group). The rats were sacrificed, the eye balls were enucleated. Intra-vitreal injections of formalin for haematoxylin and eosin and immunohistochemical sections, glutaraldehyde for toluidine blue semithin and E/M ultra-thin sections were performed. Measurements and quantitative histomorphometric estimation of the layers of the retina were done.

RESULTS

Light microscopic examination revealed age-dependent attenuation of photoreceptor striations. Aged and senile groups presented pyknotic, widely- -spaced nuclei of the outer nuclear layer. The inner nuclear layer was thinned out to 2 or 3 cellular rows. Retinal capillaries showed progressive dilatation and congestion. Statistical analysis proved significant thinning of the retina with variable degrees of thinning of the constituting layers. Decreased arborisation with age was confirmed with quantification of synaptophysin-immunostained sections. Glial fibrillary acidic protein immunostaining revealed the picture of reactive gliosis. On the ultrastructural level, the retinal pigment epithelium exhibited major alterations with aging. Numerous phagosomes, lipofuscin and melanolipofusin granules appeared within the cells, together with exaggerated basal infoldings. The pho- toreceptor nuclei became degenerated and the perinuclear space was widened.

CONCLUSIONS

Rat retinae clearly undergo age-related morphological changes. Such changes provide a cellular base for explanation of decreased vision in humans with aging other than reflection errors. Effect of aging was not only qualitative, but also quantitative.

Hyperthermic Potentiation of Cisplatin Cytotoxicity on Solid Ehrlich Carcinoma

Background

Hyperthermia produces marked effects on many biochemical parameters of tumor cells and has been reported to potentiate the effect of many drugs. We therefore evaluated the possible synergistic effect between hyperthermia and cisplatin against solid Ehrlich carcinoma. The study was based on the measurement of some biologic characteristics in tumor tissues, namely: DNA, RNA, and protein content and their rate of synthesis as parameters for nuclear damage; total lipids and cholesterol as parameters for membrane damage; acid-phosphatase and acid-ribonuclease as parameters for lysosomal damage; and tumor volume as a direct parameter for tumor growth.

Methods

Treatment of solid Ehrlich carcinoma by hyperthermia at 43 °C for 30 min for 3 successive days produced a 41.5 % decrease in tumor volume, as well as a significant decrease in nucleic acids, protein contents and their rate of synthesis, in total lipids and cholesterol, and in acid-phosphatase and acid-ribonuclease. Chemotherapeutic management of the tumor by 5 mg/kg × 3 of cisplatin alone showed a continuous increase in tumor volume but at a lower rate than that of the untreated control. However, when cisplatin was given 1 h prior to hyperthermia, the tumor volume was significantly decreased by 82.6 %.

Results

The effects observed on all the investigated parameters were intensified when cisplatin was combined with hyperthermia. The results obtained suggest that hyperthermia may enhance the penetration of cisplatin to its target site inside the tumor cells due to a membrane-damaging effect. The enhanced lethality of cisplatin on tumor cells may also be due to the inhibition of DNA repair processes by hyperthermia.

Do protons and X-rays induce cell-killing in human peripheral blood lymphocytes by different mechanisms?

Purpose

Significant progress has been made in the technological and physical aspects of dose delivery and distribution in proton therapy. However, mode of cell killing induced by protons is less understood in comparison with X-rays. The purpose of this study is to see if there is any difference in the mode of cell-killing, induced by protons and X-rays in an ex vivo human peripheral blood lymphocyte (HPBL) model.

Materials and methods

HPBL were irradiated with 60 MeV proton beam or 250-kVp X-rays in the dose range of 0.3–4.0 Gy. Frequency of apoptotic and necrotic cells was determined by the Fluorescein (FITC)-Annexin V labelling procedure, 1 and 4 h after irradiation. Chip-based DNA Ladder Assay was used to confirm radiation-induced apoptosis and necrosis. Chip-based DNA Ladder Assay was used to confirm radiation-induced apoptosis.

Results

Ex vivo irradiation of HPBL with proton beams of 60 MeV or 250 kVp X-rays resulted in apoptotic as well as necrotic modes of cell-killing, which were evident at both 1 and 4 h after irradiation in the whole dose and time range. Generally, our results indicated that protons cause relatively higher yields of cell death that appears to be necrosis compared to X-rays. The analysis also demonstrates that radiation type and dose play a critical role in mode of cell-killing.

Conclusion

Obtained results suggest that X-rays and protons induce cell-killing by different modes. Such differences in cell-killing modes may have implications on the potential of a given therapeutic modality to cause immune modulation via programmed cell death (X-rays) or necrotic cell death (proton therapy). These studies point towards exploring for gene expression biomarkers related necrosis or apoptosis to predict immune response after proton therapy.

Species-specific control of hepatocyte growth factor expression and production in adipocytes in a differentiation-dependent manner

Hepatocyte growth factor (HGF) is a mesenchymal cell-derived factor that regulates cell growth, cell motility, and morphogenesis. Since there are conflicting reports on HGF-producing cells, we herein examined HGF activity in conditioned medium (CM) of bovine and mouse preadipocytes before and after adipogenic differentiation. CM of bovine adipocytes and mouse preadipocytes induced the morphogenesis of mammary epithelial cells that was inhibited by an NK4 HGF antagonist, whereas CM of bovine preadipocytes and mouse adipocytes did not. HGF mRNA expression was increased by a treatment with dexamethasone and isobutylmethylxanthine in bovine as well as human cells, whereas it was decreased in rodent cells. It was unfortunate that HGF gene promoter activity failed to reflect HGF mRNA expression in these cells. After actinomycin D treatment, expression of HGF mRNA remained stable in pre- and differentiated bovine adipocytes and mouse preadipocytes, whereas rapidly decreased in mouse-differentiated adipocytes. These results indicate that expression and production of HGF are regulated in a species-specific adipogenic differentiation-dependent manner and suggest that the decrease in HGF mRNA in mouse differentiated adipocytes is, at least in part, mediated by differentiation-dependent loss of its stability.

Neuroprotective effects of quercetin in diabetic rat retina

Diabetic retinopathy (DR) is a severe complication of diabetes and the leading cause of blindness among working adults worldwide. DR is being widely recognized as a neurodegenerative disease of the retina, since, retinal neurons are damaged soon after diabetes onset. Diabetes-induced oxidative stress is considered as central factor that dysregulates neurotrophic factors and activates apoptosis, thereby damages neurons in the diabetic retina. Flavonoids being a powerful antioxidant have been considered to protect neurons in diabetic retina. The purpose of this study was to analyze the beneficial effects of flavonoid, quercetin to protect neurons in the diabetic rat retina. We quantitated the expression levels of BDNF, NGF, TrkB, synaptophysin, Akt, Bcl-2, cytochrome c and caspase-3 using Western blotting techniques in the diabetic retina with and without quercetin treatments and compared with non-diabetic rats. In addition, we employed ELISA techniques to determine the level of BDNF. Caspase-3 activity and the level of glutathione were analyzed by biochemical methods. Our results indicate that quercetin treatment to diabetic rats caused a significant increase in the level of neurotrophic factors and inhibited the level of cytochrome c and caspase-3 activity in the diabetic retina. Furthermore, the level of an anti-apoptotic protein Bcl-2 was augmented in quercetin treated diabetic retina. Thus, quercetin, may protect the neuronal damage in diabetic retina by ameliorating the levels of neurotrophic factors and also by inhibiting the apoptosis of neurons. Therefore, this study suggests that quercetin can be a suitable therapeutic agent to prevent neurodegeneration in diabetic retinopathy.

Verification of high efficient broad beam cold cathode ion source

An improved form of cold cathode ion source has been designed and constructed. It consists of stainless steel hollow cylinder anode and stainless steel cathode disc, which are separated by a Teflon flange. The electrical discharge and output characteristics have been measured at different pressures using argon, nitrogen, and oxygen gases. The ion exit aperture shape and optimum distance between ion collector plate and cathode disc are studied. The stable discharge current and maximum output ion beam current have been obtained using grid exit aperture. It was found that the optimum distance between ion collector plate and ion exit aperture is equal to 6.25 cm. The cold cathode ion source is used to deposit aluminum coating layer on AZ31 magnesium alloy using argon ion beam current which equals 600 μA. Scanning electron microscope and X-ray diffraction techniques used for characterizing samples before and after aluminum deposition.

Primary Health Care Physicians' Adherence and Attitude Towards Integrated Management of Childhood Illness Guidelines in Alexandria Governorate in Egypt

Background:

Integrated Management of Childhood Illness (IMCI) is a cost-effective strategy that improves the quality of care provided to under-five children. Alexandria was the first governorate that applied the Integrated Management of Childhood Illness guidelines in Egypt. The aim of this study was to assess the degree of primary health care physicians’ adherence and attitude towards those guidelines after 17 years of application.

Methods:

This cross-sectional study was carried out on a representative sample from the primary health care facilities in Alexandria from which physicians using IMCI guidelines were included in the study. The sample units were chosen randomly from all districts of Alexandria. Observational checklists were developed to assess the degree of adherence of physicians based on the guidelines booklet.

Results:

The highest adherence score reported was that of writing disease classification (100%). As regards infants aged up to 2 months, the highest physicians’ adherence score reported was that of jaundice and possible bacterial infection assessment (100% and 95% respectively). And in spite of its importance, only 85.7% of physicians were complied with weight assessment and its plotting in the growth curve. For children aged from 2 months up to 5 years physicians were generally well complied with the guidelines especially for assessment of dangerous signs and possible bacterial infection.

Conclusion:

Despite being applied for years, IMCI guidelines still show certain areas of poor adherence, an issue that need further investigation in order to maximize physicians’ adherence and achieve the best of their performance.

Epidemiology of autistic disorder in Bahrain: prevalence and obstetric and familial characteristics

European and North American studies show that the prevalence of autistic disorder is inccreasing. This study was performed to identify the prevalence of autistic disorder in Bahrain, and determine some of the demographic and family characteristics. Using a case-control design, 100 children who received a diagnosis of autistic disorder according to DSM-IV-TR during the period 2000-2010 were selected. An equal numberofcontrols who had received a diagnosis of nocturnal enuresis and no psychopathology were selected, matched for sex and age group. The prevalence of autistic disorder was estimated as 4.3 per 10,000 population, with a male:female sex ratio of 4:1. Significantly more cases than controls were delivered by caesarean section and had mothers who suffered prenatal complications. The prevalence estimate in Bahrain is comparable to previous reports using similar methods. Obstetric complications and caesarean section delivery may be associated with autistic disorder.

Improvement of four anode rods ion source

In this work, an improved form of a saddle field ion source has been designed and constructed. It consists of four anode rods made from copper and two copper cathode discs. The two cathode discs are placed symmetrically on both sides of the four anode rods. The electrical discharge and output ion beam characteristics were measured at different pressures using argon gas. The optimum distance between each two anode rods was determined. Also the optimum distance between the four anode rods and any cathode disc was obtained. It was found that the optimum distance between each two anode rods equal to 6 mm, while the optimum distance between the four anode rods and any cathode disc equal to 16 mm, where a stable discharge current and maximum output ion beam current can be obtained. The effect of negative extraction voltage applied to both the extractor electrode and Faraday cup on the output ion beam current was studied. The sputter yield of copper and aluminum targets using argon ions of different energies was determined.

Short communication: Graph for calculating maximum local analgesic dose in millilitres for the paediatric population

AIM

Determination of the maximum local analgesic dosage in millilitres can be confusing. This article presents a new graph that easily allows the dental practitioner to determine a child's maximum local analgesic dosage in millilitres based on their weight.

BACKGROUND

Local analgesia is used daily in dentistry to manage pain, and different kinds of agents are available in the market that may be selected depending on the strength and duration of analgesia required. Each analgesic agent has a maximum recommended dose, and it is very important to calculate that dose, especially in children, to avoid the risk of toxicity that could lead to death. Currently a series of calculations are used to calculate the maximum recommended dose for local analgesic agents that could be taxing. This paper presents a newly-developed graph that makes it easier for dental practitioners to quickly identify the maximum recommended dose of the different local analgesic agents used in dentistry based on a patient's weight.

CONCLUSION

Dentists can utilize this graph to obtain the maximum local analgesic dose in millilitres based on the child's weight. This will save time and encourage dentists to routinely identify the maximum allowed dose and most importantly, decrease or eliminate the risks of toxicity and overdose especially when treating small children.

Quantitative assessment of posture stability using computerised dynamic posturography in type 2 diabetic patients with neuropathy and its relation to glycaemic control

INTRODUCTION

Patients with diabetic neuropathy have an imbalance, which comes with a higher risk of falls. The aim of this study was to assess posture stability using computerised dynamic posturography in type 2 diabetics mellitus patients with neuropathy as well as its relation to glycaemic control.

METHODS

54 type 2 diabetics mellitus patients with peripheral neuropathy were recruited, together with 18 type 2 diabetics mellitus patients without peripheral neuropathy acting as the control group. The first group was divided into two subgroups according to glycaemic control assessed by HbA1c (A1c), the first subgroup comprising 24 patients had good glycaemic control with A1c less than or equal to seven percent and the second subgroup with 30 patients had poor glycaemic control with A1c more than 7 percent. The postural stability was evaluated using dynamic posturography.

RESULTS

The composite equilibrium score, sensory organisation test 1, 2 and 3 conditions were significantly lower in the neuropathic group as compared to the non-neuropathic group (p-value is less than 0.001). A1c was significantly correlated with the composite equilibrium score in the neuropathic group with poor glycaemic control (r-value equal to -0.395) but not correlated in the neuropathic group with good glycaemic control (r-value equal to 0.151).

CONCLUSION

Posture instability in type 2 diabetic patients with peripheral neuropathy reflects an impairment of the somatosensory system; also, poor glycaemic control resulted in more posture instability. The early detection of imbalance using dynamic posturography and achieving good glycaemic control may be of great help in the prevention of falls in such patients.

Sickle cell-haemoglobin E (HbSE) compound heterozygosity: a clinical and haematological study

The paucity of clinical reports in the world literature suggests that, as a disease entity, haemoglobin SE compound heterozygosity is of negligible importance. In view of the significant community prevalence of this haemoglobinopathy in the Sultanate of Oman where it is the second most prevalent sickling disorder, a hospital study of 12 SE compound heterozygotes from six unrelated Arab families was undertaken to determine their clinico-haematological features. Our findings were compared with those reviewed in the literature. Clinical and haematological evaluation was carried out by conventional methods including chromatographic haemoglobin analysis. At least 50% of those studied were asymptomatic throughout the study period but sickling-related complications occurred in the rest and included the acute chest syndrome (1/12), severe vaso-occlusive skeletal pain (2/12), frontal bossing (1/12) possibly indicative of significant chronic haemolysis and recurrent infections of the urinary tract (1/12). Steady-state haemoglobin levels fell within the reference range while MCV and MCH values were, as expected, reduced in most cases; nevertheless, concomitant inheritance of alpha-thalassaemia trait was also likely. Red cell morphology was striking by the absence or rarity of pseudo-sickled cells in the blood films of many patients during the steady state and in crises. Bearing in mind the prevalence of 0.05% of SE compound heterozygosity in Oman, the findings in this single study of the largest number of SE patients and their relatives confirm the predominantly asymptomatic nature of this sickling disorder in individuals in the community at large. HbF levels do not appear to explain the heterogeneous nature of this haemoglobinopathy. Correlation of the variable clinical and haematological features of SE cases with their alpha-globin gene status and beta-cluster haplotypes (linked to the beta(s)- and beta(e)-genes) merits a separate investigation, which is being currently organized.

Summative assessment of under graduate medical student's performance in physiology by structured oral examination

To evaluate the importance and efficiency of structured oral examination (SOE). This is a retrospective study, has been designed to compare the newly adopted structured oral examination (SOE) with that of the traditional oral examination (TOE). This study was conducted at the department of physiology during the year 2006, on 607 2nd year medical students of Mymensingh Medical College and 106 students from some other medical colleges who appeared in the first professional examination under Dhaka University from 2003-2006. For this purpose, scores achieved by the students in physiology in first professional examination for 4 successive years (2003-2006) were analyzed. The examinations in (2003-2004) and (2005-2006) were conducted under TOE and SOE respectively. Mean score achieved in SOE and TOE was 67+/-.02 and 57+/-.003 respectively. The difference is statistically significant. The pass percentage in SOE is 94.70% and 90.3% in TOE and the difference is significant. Maximum number of students in SOE attained score in the range of 60-69 but in TOE scores attained by maximum frequency fall in the range of 50-59. This observation indicates improvement in student's performance by quality and success rate in SOE. Therefore SOE is a more effective, skill full technique and superior to TOE in assessing student's competency and cognitive ability. The need and skill of SOE over the TOE in assessing oral part of examination has been proved.

Nephrogenic Fibrosing Dermopathy/Nephrogenic Systemic Fibrosis in 2 Patients With End-Stage Renal Disease on Hemodialysis

Nephrogenic fibrosing dermopathy/nephrogenic systemic fibrosis (NFD/NSF) is a newly recognized disorder occurring in patients with renal failure. It is manifested by progressive cutaneous and systemic fibrosis involving the extremities and the trunk with usual sparing of the face and internal organs. NFD/NSF can lead to joint contractures and painful disability. The etiology is unknown and there are no proven effective treatments. NFD/NSF must be distinguished from other clinically similar disorders such as scleroderma, scleromyxedema, and eosinophilic fasciitis among a myriad of others. NFD/NSF can pose many diagnostic challenges to physicians; however, a team of experienced rheumatologists, nephrologists, dermatologists, and dermatopathologists is essential in identifying this disorder. We report 2 new cases of NFD/NSF in patients on hemodialysis.

Thyroid dysfunction and thyroid autoimmunity in Saudi type 2 diabetics

Diabetes mellitus and thyroid disease are common endocrine disorders in the general population. To investigate the association between thyroid dysfunction, thyroid autoimmunity and Saudi type 2 diabetics, a random sample of 100 Saudi type 2 diabetics and 100 age- and sex-matched controls were studied. The mean age was 54 years for diabetics and 55 years for controls while the male:female ratios were 1:1.6 and 1:14 respectively. GAD65ab were found in 26% diabetics and 2% controls (p=0.001). Thyroid autoimmunity were detected in 10% diabetics vs. 5% controls (p=0.05), while thyroid dysfunction was found in 16% and 7% respectively (p=0.03). In GAD65ab-positive diabetics, thyroid autoimmunity was observed in 27% vs. 4% GAD65ab-negative diabetics (p=0.02) and thyroid dysfunction was reported in 42% and 7% respectively. We conclude that thyroid dysfunction and autoimmunity are common in Saudi type 2 diabetics. Further studies are needed on the cost effectiveness of thyroid screening in diabetics.

Genetic haemochromatosis presenting as porphyria cutanea tarda

Porphyria cutanea tarda (PCT) is the commonest form of porphyria. It can be inherited or acquired. We present a case of genetic haemochromatosis with associated PCT. Venesection led to improvement in both conditions. We highlight the need for the awareness of PCT and its associated conditions.

Metallic stents in large bowel obstruction: experience in a District General Hospital

INTRODUCTION

Metallic stents are used increasingly in the palliation of malignant large bowel obstruction. Stenting has also been used in the setting of acute obstruction, allowing appropriate patient preparation for an elective colectomy.

METHODS

Uncovered metallic stents were inserted using a combined endoscopic/radiological technique in patients presenting with large bowel obstruction.

RESULTS

Seventeen patients (10 female, mean age 75.2 years) presented with large bowel obstruction, 14 due to malignancy and 3 secondary to diverticular stricture. Technical success was achieved in 13/17 with clinical success in 12 of these 13. There were no perforations or procedure related deaths. One stented patient had elective surgery. The five patients with clinical/technical failure required emergency surgery.

CONCLUSION

The result of our preliminary experience in the use of metallic stents is encouraging. Metallic stents should be available in all hospitals as part of a multimodality approach in treating large bowel obstruction.

Effect of memantine on the levels of glial cells, neuropeptides, and peptide-degrading enzymes in rat brain regions of ibotenic acid-treated alzheimer's disease model

It has been implicated that glia activation plays a critical role in the progression of Alzheimer's disease (AD). However, the precise mechanism of glia activation is not clearly understood yet. In our present studies, we confirmed our previous results where change the levels of neuropeptides and peptidases in ibotenic acid (IBO) infusion into the rat nucleus basalis magnocellularis, an animal model of AD. Furthermore, we extended our study to investigate a possible protection effect of co-administration on the changes of neuropeptides, and neuronal and glial cells in IBO-infused rat brain by memantine treatment. The levels of substance P and somatostatin were decreased in the striatum and frontal cortex 1 week after IBO infusion, and recovered to the control level by memantine treatment, indicating the involvement of neuropeptides in AD pathology. Furthermore, the immunohistochemical and enzymatic studies of GFAP and CD 11b, and peptidylarginine deiminase, markers of glia, in the striatum and frontal cortex showed the increase in IBO-treated rat brain as compared with controls, while co-administration of memantine and IBO no increase of astrocytes and microglia activation was observed. The present biochemical and immunohistochemical results suggest that glia activation might play an important role to the pathology of AD, and correlate with the changes of neuropeptide levels in AD brain that is recovered by memantine treatment.

Esophageal involvement in cicatricial pemphigoid: a rare cause of dysphagia

Cicatricial pemphigoid is a rare, autoimmune, blistering disorder affecting the mucous membranes and skin. Esophageal involvement affects a small proportion of affected individuals and may present up to 10 years after the initial onset of the disease. We present a case of esophageal cicatricial pemphigoid that presented initially as linear IgA disease. We describe the successful treatment of dysphagia by graded esophageal dilatations.