Removal Efficiency and Effectiveness of Four Different Fiber Posts Using Five Different Drill Systems in Multirooted Teeth

AIM

In comparing the effectiveness and efficiency of different types of post removal systems in removing different types of fiber posts (FPs), this study aims to shed light on the success of removal by currently available drill systems.

MATERIALS AND METHODS

A total of 200 maxillary first molars, were root canal treated and prepared to receive posts. The molars were divided into four groups corresponding to four different FPs: Group RX, Radix FP; Group RF, Reforpost Glass Fiber; Group HI; Hi-Rem Endodontic Post; and Group DT, D.T. Light-Post Illusion X-RO. Fiber posts were done with luting by Gradia Core (GC America, Inc.). Groups were again divided into five subgroups corresponding to the technique by which the FP was removed into as follows: Subgroup P, PD-25-1.1 Drill; subgroup G, GC FP Drill; subgroup E, EasyPost Precision Drill; subgroup R, Reaccess Carbide Double Taper Kit; and subgroup H; H-Endodontic Drill. After posts were removed, effectiveness and efficiency were documented. Data were tabulated and statistically analyzed.

RESULTS

Strong significant differences regarding efficiency among groups (FP type) and subgroups (drills used) (p = 0.00) were shown by the one-way analysis of variance (ANOVA) test. Subgroup DT-G scored the longest mean removal time (20.9 minutes) while Subgroup RX-R scored the shortest mean removal time (1.4 minutes) Regarding effectiveness, strong significant differences among groups (p = 0.00) and subgroups (p = 0.00) were shown by one-way ANOVA. Subgroup RF-G scored the highest scale (5.2) whereas subgroup HI-R scored the lowest mean scale (1.2).

CONCLUSION

The difference was strongly significant between tested post-removal kits and between tested FPs. Re-access Carbide Double Taper Kit performed superiorly in both effectiveness and efficiency, followed by PD-25-1.1 Drill. Hi-Rem post showed the best retrieving results among other FPs.

CLINICAL SIGNIFICANCE

Knowing the best technique and tools for post removal could spare the practitioner any unwanted complications during post removal. How to cite this article: Sayed M, Alahmad AM, Alhajji KS, et al. Removal Efficiency and Effectiveness of Four Different Fiber Posts Using Five Different Drill Systems in Multirooted Teeth. J Contemp Dent Pract 2024;25(1):72-78.

In-vitro and in-vivo evaluation for the bio-natural Alginate/nano-Hydroxyapatite (Alg/n-HA) injectable hydrogel for critical size bone substitution

Currently, bio-natural injectable hydrogels are receiving a lot of attention due to their ability to control, adjust, and adapt to random bone defects, in addition, to their ability to mimic the composition of natural bones. From such a viewpoint, this study goal is to prepare and characterize the injectable hydrogels paste based on the natural alginate (Alg) derived from brown sea algae as a polysaccharide polymer, which coupled with nano biogenic-hydroxyapatite (n-HA) prepared from eggshells and enriched with valuable trace elements. The viscosity and mechanical properties of the paste were investigated. As well as the in-vitro study in terms of water absorption and biodegradability in the PBS, biocompatibility and the capability of the injectable Alginate/n-Hydroxyapatite (Alg/n-HA) to regenerate bone for the most suitable injectable form. The injectable hydrogel (BP -B sample) was chosen for the study as it had an appropriate setting time for injecting (13 mins), and suitable compressive strength reached 6.3 MPa. The in vivo study was also carried out including a post-surgery follow-up test of the newly formed bone (NB) in the defect area after 10 and 20 weeks using different techniques such as (SEM/EDX) and histological analysis, the density of the newly formed bone by Dual x-ray absorptiometry (DEXA), blood biochemistry and the radiology test. The results proved that the injectable hydrogels Alginate/n-Hydroxyapatite (Alg/n-HA) had an appreciated biodegradability and bioactivity, which allow the progress of angiogenesis, endochondral ossification, and osteogenesis throughout the defect area, which positively impacts the healing time and ensures the full restoration for the well-mature bone tissue that similar to the natural bone.

Comparison of Fracture Resistance between Implant-supported Bis-acryl Interim 3-unit FDPs Using Six Different Strengthening Mechanisms: An In Vitro Study

AIM

To investigate six different strengthening mechanisms for three-unit implant-supported provisional restorations.

MATERIALS AND METHODS

Six techniques of provisional fixed prostheses (PFP) reinforcement were investigated and were assigned to different groups (n = 10): group (ZP) zirconia powder, group (SK8) silk thread wrapped as a figure-of-8 pattern around middle third of abutment, group (RC8) size 00 retraction cord wrapped as a figure-of-8 pattern around middle third of abutment, group (RF8) Resin impregnated glass fiber ribbon wrapped as a figure-of-8 pattern around abutment, group (KV8) Kevlar 29 cord wrapped as a figure-of-8 pattern around middle third of abutment, group (KV) Kevlar 29 strands incorporated in resin mix. Compared against unenforced bis-acryl as control group (CL). Seventy Metal Dies were 3D printed having Soft Tissue Gingiva Mask. Using a custom-made silicone Index, 70 PFP were fabricated (10 of each group) and were cemented to their corresponding metal dies using zinc polycarboxylate cement. All specimens were thermal cycled for 1000 cycles using order of 20 seconds at 55°C and 20 seconds at 5°C with 10 seconds transport. Fracture resistance test was done using universal testing machine. All specimens were loaded to failure. Data were collected, tabulated and statistically analyzed.

RESULTS

Kolmogorov-Smirnov normality test showed no significant difference between data in each group. So, data are normally distributed in each group. Descriptive statistics showed higher mean values of CL group (780.8 ± 164) followed by RF8 group (614.2 ± 158.2), followed by RC8 group (550.2 ± 339.2), followed by KV8 group (442.1 ± 198.4), followed by KV group (403.9 ± 306), followed by SK8 group (175.9 ± 90.8), and finally ZP group (136.5 ± 135.7). One-way ANOVA revealed significant difference between the tested groups (p = 0.036).

CONCLUSION

Bis-acryl provisional restorations had better mean fracture resistance values than all other strengthening mechanisms. Bis-acryl provisional restorations did not gain more strength by any of the added materials. One-way ANOVA revealed significant difference between all tested groups.

CLINICAL SIGNIFICANCE

Provisional restorations over implant should be strong enough to serve for the long period of bone and tissue healing. Current materials alone cannot survive for long. It serves as temporization between steps of fixed restorations construction. How to cite this article: Rayyan M, Sayed M, Hujeiry AM et al. Comparison of Fracture Resistance between Implant-supported Bis-acryl Interim 3-unit FDPs Using Six Different Strengthening Mechanisms: An In Vitro Study. J Contemp Dent Pract 2023;24(11):840-846.

Evaluation of Antibacterial Effect of New Sealer "Neoseal" and Two Commercially Used Endodontic Sealers against Enterococcus faecalis: An In Vitro Study

AIM

To evaluate the antibacterial activity of three endodontic sealing materials, Neoseal, CeraSeal, and AH Plus against Enterococcus faecalis bacteria in vitro.

MATERIALS AND METHODS

The antibacterial activity of three endodontic sealing materials including two bioceramic sealers; NeoSEALER Flo (group I), CeraSeal (group II), and one epoxy resin sealer; AH Plus (group III) was investigated against E. faecalis bacteria American Type Cell Culture Collection (ATCC) 29212 (ATCC, Rockville, Maryland, USA). Using modified direct contact test (MDCT). The endodontic sealers were tested in contact with bacterial suspension when unset (20 minutes after mixing) and after setting, assessing the antibacterial activity of aged sealers after 1, 3, 7, and 14 days. Analyzing the collected data has been done with version 25.0 of the statistical package for the social sciences (SPSS) IBM software (SPSS, Chicago, Illinois, USA). Descriptive analyses were calculated using standard deviation (SD) and mean. Shapiro-Wilk test was done to detect the normality of the result values. Kruskal-Wallis test was then performed to test the level of significance between groups.

RESULTS

After 20 minutes - Group I showed higher bacterial count mean values (5,500 ± 500) and 0 values for groups II and III groups. After 1 day, the highest bacterial count mean values were in group III (54,333.3 ± 4,041.5) and 0 values for groups I and II. After 3 days - group III again recorded the highest bacterial count mean values (45,000 ± 5,000) and 0 values for I and II groups. After 7 days - Group III still recorded the highest bacterial count mean values (53,333.3 ± 1,527.5) and 0 values for groups I and II. After 14 days - Group III recorded the highest bacterial count mean values (56,000 ± 1,000) followed by group II (6,333.3 ± 577.4), and the least was group I (2,000 ± 500). Kruskal-Wallis test showed significant values between groups in all tested durations, p > 0.05.

CONCLUSION

The sealing material AH Plus showed a strong bactericidal effect at the beginning but lost its ability after 24 hours. CeraSeal showed strong bactericidal activity from the beginning till the end of the first week but showed bacterial count at 14 days. Neoseal took 24 hours to show bactericidal effect and similar to CeraSeal showed bacterial count at 14 days; CeraSeal recorded the best results within the study.

CLINICAL SIGNIFICANCE

Silicate-based (bioceramic) endodontic sealers can be the best available endodontic sealing material that is clinically beneficial in removing residual microbes which had survived irrigation protocols and chemomechanical preparation. How to cite this article: Basta DG, Reslan MR, Rayyan M, et al. Evaluation of Antibacterial Effect of New Sealer "Neoseal" and Two Commercially Used Endodontic Sealers against Enterococcus faecalis: An In Vitro Study. J Contemp Dent Pract 2023;24(11):871-876.

Comparison of Fracture Resistance between Different Treatment Modalities of Mutilated Endodontically Treated Teeth Using Polyether Ether Ketone

AIM

To compare fracture resistance of multiple treatment modalities intended for mutilated teeth using polyether ether ketone (PEEK) and zirconia materials.

MATERIALS AND METHODS

The study was divided into four groups according to treatment modality adopted (n = 14): fiber post (F), Nayyar core (N), endocrown (E), and Richmond crown (R). Each group was further subdivided into two groups (n = 7) according to the type of material used: zirconia (Z) and PEEK (P). Using computer-aided design/computer-aided manufacturing, restorations were constructed from both materials following tested treatment options and manufacturer direction. Finished restorations were then tried, seated, and cemented to their corresponding acrylic teeth. All specimens were tested for fracture resistance in universal testing machine with cross head speed of 0.5 mm/min speed until failure, which was confirmed by a sudden drop in the measurements of the testing machine. Results were recorded, tabulated, and statistically analyzed. Shapiro-Wilk normality tests were considered to evaluate the normality of the data distributions. One-way analysis of variance (ANOVA) followed by Tukey's post hoc analysis was conducted to analyze the fracture resistance significant differences.

RESULTS

Descriptive statistics of the restoration material revealed statistically a higher mean value for PEEK material (3609 ± 188.1) than zirconia (2404 ± 425.6). One-way ANOVA revealed statistically significant differences between zirconia group (p < 0.0001). Regarding zirconia group statistical significance was detected between fiber post vs endocrown (p = 0.0299), fiber post vs Richmond crown (p < 0.0001), and Nayyar core vs Richmond crown (p = 0.0004). However, there was no statistically significant difference between PEEK group (P = 0.1614).

CONCLUSION

Polyether ether ketone could present a reliable treatment option in endodontically treated teeth.

CLINICAL SIGNIFICANCE

Using one-piece Richmond crowns constructed of PEEK could present a viable treatment option against conventional treatment options of root canal treatment (RCT) single-rooted teeth.

Effect of Cement Type on Fracture Resistance and Mode of Failure of Monolith vs Bilayered Zirconia Single Crowns

AIM

To compare the fracture resistance and the mode of failure between monolith second-generation zirconia and bilayered first-generation zirconia single crowns cemented by resin cement and glass ionomer cement (GIC).

MATERIALS AND METHODS

A total of 36 maxillary first premolar crowns (5 mm in length × 4 mm in cervical diameter, with a base of 6 mm) were computer-aided design-computer-aided manufacturing (CAD-CAM) milled. They were divided into the following two groups (n = 18) according to the fabrication techniques: Group M - monolith zirconia crown (1-mm axial thickness and 2-mm occlusal thickness) and group B - bilayer zirconia crown (0.5-mm axial thickness and 1-mm occlusal thickness). Each group was further subdivided into the following two subgroups (n = 9) according to the cement used: Subgroup G - cemented using GIC; subgroup R - cemented using resin cement. All crowns were cemented to their corresponding resin dies and stored in distilled water for 72 hours. Each specimen was mounted to the lower member of the universal testing machine with a load cell of 5 kN and a crosshead speed of 0.5 mm/minute. Failure modes were analyzed for fractured parts using scanning electron microscopy (SEM).

RESULTS

Subgroup MR recorded the highest fracture resistance mean value (3616 ± 347.2 N) while the BG subgroup recorded the statistically significant lowest fracture resistance mean value (1728.7 ± 115.3 N). One-way analysis of variance (ANOVA) followed by pairwise Tukey's post hoc tests revealed a statistically significant difference (p = 0.0001) between groups M and B. One-way ANOVA followed by pairwise Tukey's post hoc tests also showed a statistically significant difference (p = 0.0297) between the types of cement used (subgroups G and R).

CONCLUSION

Monolith zirconia crowns had better mean fracture resistance than bilayered zirconia crowns. Resin cement improved the fracture resistance compared to GIC. Monolith zirconia crowns showed bulk fracture while bilayered zirconia crowns showed chipping fracture.

CLINICAL SIGNIFICANCE

Monolith zirconia crowns present a good prosthetic alternative overcoming the veneer chipping drawback of bilayered zirconia crowns. In addition, resin cement could increase the fracture resistance of zirconia crowns.

In vivo Evaluation of Shade Replication of Different Generations of Zirconia to Natural Teeth Using Digital Color Determinations

AIM

The color difference between the final shade of restorations milled from different zirconia blocks, and the control teeth in the esthetic zone is yet uncertain.

MATERIALS AND METHODS

For eight patients who required a singular maxillary central incisor restoration, twenty-four crowns made of zirconia were created. These were grouped into three categories based on the shade and nature of zirconia (Zr) utilized (white core, colored core, and monolithic high-translucency (ht) Zr crowns). The difference in color (ΔE) between the three zirconia crowns and the neighboring teeth was calculated by the use of Easyshade spectrophotometer. Two shades of resin luting cement were used. The measured ΔE values were evaluated based on a clinically acceptable color difference of 1.6ΔE, which is not visible to the human eye.

RESULTS

Among the three groups, no differences of statistical significance were observed in terms of ΔE with different Zr types and resin cement color.

CONCLUSION

Within the limits of this study, the usage of different shades of zirconia blanks and resin cements did not display a statistically significant effect on the final color of the crown.

CLINICAL SIGNIFICANCE

Changing the shade of resin cements does not appear to add value to the final shade of crown. In addition, the generation of zirconia does not influence the shade of the crown. Crowns made of zirconia can be cemented with opaque or transparent cement with no effect on the final color.

Secreted Extracellular Products of Flavobacterium covae as Potential Immunogenic Factors for Protection against Columnaris Disease in Channel Catfish (Ictalurus punctatus)

Columnaris disease caused by Flavobacterium covae leads to substantial economic losses in commercially important fish species worldwide. The US channel catfish (Ictalurus punctatus) industry is particularly vulnerable to this disease. Therefore, there is an urgent need to develop a vaccine to reduce the economic losses caused by this disease. Secreted extracellular products (SEPs) are considered to be essential bacterial virulence factors that often provide immunogenicity and protection. The current study sought to identify the main SEPs of F. covae and to evaluate their potential to provide protection in channel catfish against columnaris disease. SDS-PAGE analysis of SEPs revealed five protein bands with molecular weights ranging from 13 to 99 kDa. Mass spectrometry analysis showed that these SEPs were hypothetical protein (AWN65_11950), zinc-dependent metalloprotease (AWN65_10205), DNA/RNA endonuclease G (AWN65_02330), outer membrane protein beta-barrel domain (AWN65_12620), and chondroitin-sulfate-ABC endolyase/exolyase (AWN65_08505). Catfish fingerlings were vaccinated with SEPs, SEPs emulsified with mineral oil adjuvant, or heat-inactivated SEPs, or they were sham-immunized through intraperitoneal (IP) injection. After 21 days, an F. covae challenge showed 58.77% and 46.17% survival in the catfish vaccinated with the SEPs and the SEPs emulsified with adjuvant compared to the sham-vaccinated control (100% mortality within 120 h post-infection). However, the heat-inactivated SEPs failed to provide significant protection (23.15% survival). In conclusion, although SEPs contain potentially important immunogenic proteins, further work is needed to optimize their use for long-lasting protection against columnaris disease in fish. These results are significant given the economic impact of columnaris disease on fish farming worldwide.

A split-mouth randomized controlled trial to compare the rate of canine retraction after a soft tissue procedure compared against a corticotomy procedure for accelerated tooth movement

Background and Aim

Various methods to accelerate the orthodontic tooth movement have been used, among which corticotomy is considered to be the most common one. The suggested reasoning for such acceleration was the regional acceleratory phenomenon (RAP). Since the RAP is a property of both the hard and soft tissues, we designed a soft tissue flap procedure to compare the effects with the conventional corticotomy procedure. A split-mouth study was conducted where the two procedures were assessed in a single participant.

Patients and Methods

The total sample size was calculated to be 40 with 20 participants in each group. The rate of tooth movement was the primary outcome measure, and the secondary outcomes were dentoalveolar changes, which were studied in both the conventional corticotomy and the flap-only procedure based on a cone-beam computed tomography (CBCT) wherein the alveolar bone density (BD) around canines, tipping, and rotational changes in canines, premolars, and molars were assessed.

Results

Corticotomy resulted in greater canine angulation, lesser canine rotation and premolar rotation, and greater molar rotation compared with flap elevation, but these differences were statistically insignificant.

Conclusion

Though the corticotomy resulted in higher BD, the differences were statistically insignificant. There was no significant difference in the rate of space closure assessed by the two techniques compared.

Comparison between Distal Extension Attachment-retained Removable Partial Prostheses with Integrated and Conventional Reciprocation Designs: A Clinical Trial

AIM

To compare marginal bone level (MBL) around the abutments in integrated and conventional reciprocation designs in attachment-retained removable partial prosthesis (A-RPP).

MATERIALS AND METHODS

Around 14 participants were indiscriminately selected and separated into two groups. For every group, an A-RPP with one of the studied reciprocation types was fabricated and assessed. Group I received A-RPP with integrated reciprocation and group II received A-RPP with conventional reciprocation. MBL around the crowned primary and secondary abutments was assessed on the day of A-RPP insertion, at 6 and at 9 months of denture use.

RESULTS

Comparison of MBL values at the primary and secondary abutments within each group showed no statistical difference from time of delivery and throughout the study. After using the A-RPP for 6 and 9 months, group I revealed lower mean values of MBL than group II which were statistically significant.

CONCLUSION

Distal extension A-RPP with integrated and conventional reciprocation designs were associated with raise in bone loss. Integrated reciprocation design revealed a lesser amount of bone loss than the conventional reciprocation design and therefore, it is considered as more preferable to be used.

CLINICAL SIGNIFICANCE

Distal extension A-RPP with integrated reciprocation is superior in terms of periodontium preservation around abutment teeth as compared to distal extension A-RPD with conventional reciprocation.

Evaluation of Edwardsiella piscicida basS and basR mutants as vaccine candidates in catfish against edwardsiellosis

Catfish farming is the largest aquaculture industry in the United States and an important economic driver in several southeastern states. Edwardsiella piscicida is a Gram-negative pathogen associated with significant losses in catfish aquaculture. Several Gram-negative bacteria use the BasS/BasR two-component system (TCS) to adapt to environmental changes and the host immune system. Currently, the role of BasS/BasR system in E. piscicida virulence has not been characterized. In the present study, two mutants were constructed by deleting the basS and basR genes in E. piscicida strain C07-087. Both mutant strains were characterized for virulence and immune protection in catfish hosts. The EpΔbasS and EpΔbasR mutants were more sensitive to acidic environments and produced significantly less biofilm than the wild-type. In vivo studies in channel catfish (Ictalurus punctatus) revealed that both EpΔbasS and EpΔbasR were significantly attenuated compared with the parental wild-type (3.57% and 4.17% vs. 49.16% mortalities). Moreover, there was significant protection, 95.2% and 92.3% relative percent survival (RPS), in channel catfish vaccinated with EpΔbasS and EpΔbasR against E. piscicida infection. Protection in channel catfish was associated with a significantly higher level of antibodies and upregulation of immune-related genes (IgM, IL-8 and CD8-α) in channel catfish vaccinated with EpΔbasS and EpΔbasR strains compared with non-vaccinated fish. Hybrid catfish (channel catfish ♀ × blue catfish ♂) challenges demonstrated long-term protection against subsequent challenges with E. piscicida and E. ictaluri. Our findings demonstrate BasS and BasR contribute to acid tolerance and biofilm formation, which may facilitate E. piscicida survival in harsh environments. Further, our results show that EpΔbasS and EpΔbasR mutants were safe and protective in channel catfish fingerlings, although their virulence and efficacy in hybrid catfish warrant further investigation. These data provide information regarding an important mechanism of E. piscicida virulence, and it suggests EpΔbasS and EpΔbasR strains have potential as vaccines against this emergent catfish pathogen.

Abstract C023: A microbiome-produced metabolite drives immunostimulatory macrophages and boosts response to immune checkpoint inhibitors in pancreatic cancer

The composition of the gut microbiome controls innate and adaptive immunity and has emerged as a key regulator of tumor growth and the success of immune checkpoint blockade (ICB) therapy. However, the underlying mechanisms remain unclear. Pancreatic ductal adenocarcinoma (PDAC) tends to be refractory to therapy, including ICB. We found that the gut microbe-derived metabolite trimethylamine N-oxide (TMAO) enhances anti-tumor immunity to PDAC. Delivery of TMAO given intraperitoneally or via dietary choline supplement to PDAC-bearing mice reduces tumor growth and is associated with an immunostimulatory tumor-associated macrophage (TAM) phenotype and activated effector T cell response in the tumor microenvironment. Mechanistically, TMAO signals through potentiating type-I interferon (IFN) pathway and confers anti-tumor effects in a type-I IFN dependent manner. Notably, delivering TMAO-primed macrophages alone produced similar anti-tumor effects. Combining TMAO with ICB (anti-PD1 and/or anti-Tim3) significantly reduced tumor burden and improved survival beyond TMAO or ICB alone. Finally, the levels of trimethylamine (TMA)-producing bacteria and of CutC gene expression correlate with improved survivorship and response to anti-PD1 in cancer patients. Together, our study identifies the gut microbial metabolite TMAO as an important driver of anti-tumor immunity and lays the groundwork for new therapeutic strategies.

Citation Format: Gauri Mirji, Alison Worth, Sajad Bhat, Mohamed Sayed, Toshitha Kannan, Aaron Goldman, Hsin-Yao Tang, Qin Liu, Noam Auslander, Chi Dang, Mohamed Abdel-Mohsen, Andrew Kossenkov, Ben Stanger, Rahul Shinde. A microbiome-produced metabolite drives immunostimulatory macrophages and boosts response to immune checkpoint inhibitors in pancreatic cancer [abstract]. In: Proceedings of the AACR Special Conference on Pancreatic Cancer; 2022 Sep 13-16; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2022;82(22 Suppl):Abstract nr C023.

Cross-cultural Study of the Personality Inventory for the DSM-5 (PID-5) across the Portuguese and the United Arab Emirates (UAE) Community and Clinical Populations

Aims

The present paper focused on compare the PID-5 mean score levels across two matched community and clinical samples of Portugal and the UAE.

Background

The generalizability and universality of the Alternative Model of Personality Disorders has been thoroughly studied through the Personality Inventory for DSM-5 (PID-5) across countries and languages. However, studies comparing Western and Middle Eastern countries are still limited, in particular those who assess the PID-5 measurement invariance.

Objectives

We examined measurement invariance of the PID-5 scales across matched Emirati and Portuguese clinical and nonclinical groups, as well as compare and contrast the PID-5 mean score levels across both countries and samples.

Methods

The Arabic and the Portuguese versions of the PID-5 was administered to Emirati community participants (N = 300, 80% women and 20% men, M_age = 27.95) which were matched with Portuguese community participants (N = 300, 80.3% women and 19.7% men, M_age = 28.96), as well as clinical participants of the UAE (N = 150, 61.3% women and 38.7% men, M_age = 31.29) and Portugal (N = 150, 52% men and 48% women, M_age = 44.97). We examined measurement invariance through an unrestricted Factor Analysis based program, and mean scores levels were compared and analyzed.

Results

Our findings supported the PID-5 measurement invariance across the Emirati and Portuguese clinical samples pointing to the universality and generalizability of the Alternative Model of Personality Disorders. The Emirati psychiatric sample exhibited somehow higher results than the Portuguese psychiatric participants, albeit the small effect size for most of the PID-5 scales.

Conclusion

Further research is needed to examine the applicability of the PID-5 across non-clinical representative samples of Portugal and the UAE, and other Middle Eastern countries.

Para-Hisian atrial tachycardia: A neglected cause of severe heart failure in children

Incessant focal atrial tachycardia (FAT) is the most common cause of tachycardia-induced cardiomyopathy in pediatric patients and is usually a reversible condition with effective management of tachycardia, either with medical treatment or ablation. These patients may be misdiagnosed, potentially leading to inappropriate treatment. Diagnosis is often late and should always be suspected in patients with congestive heart failure and unexplained persistent tachycardia. Para-Hisian atrial tachycardia is not an uncommon type of FATs; however, catheter ablation of anterior atrial septum-ATs has been a challenge because of its proximity to the AV node and the complex anatomy of its region.

Improvement of Pancreatic Steatosis and Indices of Insulin Resistance After Metabolic Surgery

Purpose

Obesity is associated with fat accumulation in ectopic sites such as the pancreas, the so-called pancreatic steatosis (PS). Bariatric surgery has been shown to be associated with reducing pancreatic fat. This study investigated the effect of laparoscopic sleeve gastrectomy (LSG) on pancreatic volume and its fat content and glucose homeostasis.

Methods

The study enrolled 54 patients subjected to LSG. Metabolic variables and pancreatic exocrine function were assessed immediately before surgery and 12 months after. MRI of the abdomen was performed to measure pancreatic fat content and its total volume and visceral adipose tissue (VAT).

Results

Surgery resulted in a significant reduction in body weight and BMI. HbA1c, fasting insulin, C-peptide levels, HOMA-IR, and Hs-CRP levels decreased significantly. Surgery resulted in significant improvement in lipid profile except for HDL-cholesterol and liver function tests. Total VAT volume decreased significantly. Total pancreas volume decreased by a mean of 9.0 cm³ (95% CI: 6.6–11.3). The median change of pancreatic fat was −26.1% (range: −55.6 to 58.3%). Pancreatic lipase decreased significantly (P < 0.001). There was a positive correlation between the percentage of total weight loss and decrease in pancreatic fat volume (r = 0.295, P = 0.030).

Conclusion

Weight loss after LSG is associated with a reduction of total VAT volume, total pancreatic volume, and pancreatic fat content. These changes are associated with improved glucose homeostasis, reduced systemic inflammation, and decreased pancreatic lipase secretion.

The introduction of tobacco excise taxation in the Gulf Cooperation Council Countries: a step in the right direction of advancing public health

BACKGROUND

The Gulf Cooperation Council (GCC) countries relied, until recently, solely on import duties for tobacco products. The agreement for the introduction of an excise and value added tax (VAT) in 2016 and 2017, respectively, in most GCC countries, was a major breakthrough for public health. There is, however, ample room for improvement.

METHODS

The study examines the outcomes of tax reforms, for both public health and public finances, based on the World Health Organization (WHO) recommendations and best practices worldwide. Tax simulations were performed using the WHO TaXSiM model. The study is based on data from Saudi Arabia, the only GCC country for which sufficient data existed.

RESULTS

We recommend a stepwise tax reform, which involves increasing the current ad valorem excise tax rate, phasing out import duties keeping total tax share constant and introducing a minimum excise, and finally switching to a revenue-neutral specific excise. Specific excises must be adjusted for inflation and income increases. If implemented, cigarette tax reform simulations show that the recommended reforms would lead to a higher than 50% increase in cigarette prices, 16% reduction in cigarette sales and almost 50% increase in total cigarette tax revenue. A significant number of cigarette-related deaths would be averted.

CONCLUSIONS

The recommended tax reforms are expected to lead to significant improvements in both public health and tobacco tax revenues. Our results provide useful insights that are of relevance to the whole GGC region. The effectiveness of the reforms, however, requires a strong tax and customs administration, including the establishment of a good database to monitor and advance public health.

WHO informal consultation on revision of guidelines on evaluation of similar biotherapeutic products, virtual meeting, 30 June – 2 July 2021

The WHO informal consultation was held to promote the revision of WHO guidelines on evaluation of similar biotherapeutic products (SBPs) adopted by the Expert Committee on Biological Standardization (ECBS) in 2009. It was agreed in the past consultations that the evaluation principles in the guidelines are still valid, but a review was recommended to provide more clarity and case-by-case flexibility. The opportunity was therefore taken to review the experience and identify areas where the current guidance could be more permissive without compromising its basic principles, and where additional explanation could be provided regarding the possibility of reducing the amount of data needed for regulatory approval. The meeting participants applauded the leading role taken by the WHO in providing a much-needed streamlined approach for development and evaluation of SBPs which will provide efficient and cost-effective product development and increase patient access to treatments. It was recognized that the principles as currently described in the draft WHO guidelines are based on sound science and experience gained over the last fifteen years of biosimilar approvals. However, since these guidelines when finalised will constitute the global standard for biosimilar evaluation and assist national regulatory authorities in establishing revised guidance and regulatory practice in this complex area, it was felt that further revision and clarity on certain perspectives in specific areas was necessary to dispel uncertainties arising in the current revised version. This report describes the principles in the draft guidelines, including topics discussed and consensus reached.

•

WHO guidelines serve as a basis for the development of national regulatory framework for biosimilars.

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Revision of guidelines is to provide more flexibility and clarification on data required for regulatory approval.

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Revised guidelines would contribute to improving consistency on regulatory decision and patient access to treatments.

Young-onset stroke complicating ulcerative colitis

A 16-year-old girl developed a proximal occlusion of the right middle cerebral artery during a flare-up of acute ulcerative colitis. Although mechanical thrombectomy led to successful middle cerebral artery recanalisation, she required an immediate second thrombectomy due to reocclusion of the same arterial segment. She developed a second ischaemic event 7 days later despite intravenous heparin infusion, later switched to low-molecular-weight heparin, and a third event after 3 days despite the addition of aspirin. We discuss stroke risks in people with inflammatory bowel disease and the uncertainties around anticoagulation and antiplatelet regimens in such cases.

Associations of measured resting energy expenditure with predictive equations, NUTRIC score, and patient outcomes

Background

Indirect calorimetry is the reference method for measuring resting energy expenditure (REE), but the necessary equipment and technical expertise are not always available. Meanwhile, the NUTrition Risk in the Critically ill (NUTRIC) scale is designed to identify patients who would benefit from nutrition therapy, but no data are available regarding the association of NUTRIC scores with REE. Several predictive formulas are available as alternatives to indirect calorimetry for calculation of energy requirements, but they have not been compared in a homogeneous group of critically ill patients. The purpose of the study is to examine the correlations between energy expenditure and NUTRIC scores or patient outcomes, and to compare measured REE with estimations of energy expenditure.

Methods

In this observational, prospective study, indirect calorimetry was performed on 50 mechanically ventilated patients. Energy expenditure was also estimated with the bodyweight-based, Faisy–Fagon, and Penn-State PSU_m equations.

Results

REE was higher in patients who survived treatment than in those who died, and was positively correlated with length of stay and duration of ventilation. NUTRIC scores did not correlate with REE. The Faisy–Fagon equation overestimated expenditure, whereas PSU_m was unbiased and accurate. Calculations based on 25 kcal/kg bodyweight/day overestimated expenditure, whereas 23 kcal/kg/day produced unbiased estimates with greater accuracy than PSU_m.

Conclusion

REE was positively associated with patient outcomes. Energy expenditure was accurately predicted by calculations of 23 kcal/kg bodyweight/day.

Thromboembolic risk is potentially reduced in mitral stenosis shortly after percutaneous mitral valvotomy

Background

Rheumatic mitral stenosis (MS) is a problem in the developing countries. Left atrium (LA) and appendage (LAA) dysfunction are considered determinant factors for thrombus formation even in patients with sinus rhythm (SR). Percutaneous mitral valvotomy (PMV) is a well accepted therapeutic option. However, no available data considers patients with SR as a low risk group for the development of thrombus.

Purpose

Studying short term impact of PMV on P wave morphology, NT-pro BNP as well as LAA properties in patients with MS and SR.

Methods

A prospective study was conducted in a tertiary University hospital including 41 patients with symptomatic uncomplicated MS having favorable morphology with sinus Rhythm. P wave duration, amplitude and dispersion, NT-pro BNP, transthoracic and transesophageal echocardiography were carried out directly before and 1 month following PMV. Student t-test was used to compare the variables before and after PMV. Correlation was calculated using Pearson's correlation and multivariate regression analysis was used for prediction of unfavorable outcomes.

Results

After PMV, 36 (87.8%) patients had a favorable outcome manifested with improvement of NYHA class, valve area, estimated systolic pulmonary artery pressure (sPAP) as well as grade of spontaneous echo contrast (SEC). P wave duration, P wave amplitude and P wave dispersion decreased after PMV (14.97±2.65 vs. 13.21±2.36 ms, 4.01±1.01 vs. 2.51±0.71 ms and 4.01±1.01 vs. 2.51±0.71mv; P&lt;0.001 respectively). NT pro-BNP also reduced (2.90±2.19 vs. 2.01±1.31 Pg/L; P&lt;0.001). TEE PW of LAA showed increase of early (E LAA) and late (A LAA) emptying velocities after PMV (41.70±19.50 vs. 48.82±20.18 and 31.31±21.99 vs. 38.48±19.86 cm/s; P&lt;0.001 respectively). By TDI, late wall motion (LAA A) velocity increased (7.41±2.50 vs. 8.23±3.01 cm/s; P&lt;0.001) with an improvement of LAA ejection fraction post procedural (50.80±13.11 vs. 55.75±10.12%; P&lt;0.001). Negative correlation between LAA EF and P wave amplitude (r=−0.40; P&lt;0.001) as well as a correlation between reduction in NT pro-BNP and the improvement of both LAA A velocity and E LAA wave were noticed (r=0.55; P=0.02 and 0.01 respectively). The grade of SEC was negatively correlated with E LAA (r=−0.55, P=0.02). Only 5 patients (12.2%) had an unfavorable outcome. Four patients had severe mitral regurge (7.8%), only one patient (2.4%) was indicated for surgery. AF developed in one patient (2.4%). The grade of SEC remains the same in 3 patients (7.3%). Both baseline estimated sPAP and Wilkins score were predictors for unfavorable outcome; sPAP (odd's ratio= 4.08; 95% CI=1.01- 7.17; P=0.04); Wilkins score (odd's ratio= 1.59; 95% CI=1.22- 5.98; P=0.01).

Conclusion

PMV has a favorable rapid impact on LA and LAA properties in patients with MS and SR. Our data suggests that PMV could potentially contribute to lowering the risk of future thromboembolic events in those patients.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Assiut University Hospital

The prognostic value of cardiac magnetic resonance in assessment of right ventricular function after percutaneous balloon mitral valvuloplasty

Background

Mitral stenosis (MS) results in right ventricular (RV) dysfunction secondary to chronic pulmonary hypertension. Poor outcomes have been reported in patients with persistent chronic RV dysfunction. Persistence RV dysfunction can affect the clinical improvement after percutaneous balloon mitral valvuloplasty (PBMV). Cardiac Magnetic Resonance (CMR) is emerged as a highly sensitive technique for assessment of RV function (RVF).

Purpose

To investigate RV function 3 months after PBMV using a variety of robust parameters associated with prognosis.

Methods

A prospective observational study was conducted in a tertiary University hospital included 31 patients with symptomatic uncomplicated MS with favorable morphology and having sinus rhythm who underwent PBMV. All patients were subjected to TTE and CMR examination 24 hours directly before and 3 months after PBMV for assessment of RV size and function.

Results

CMR showed reduced RV myocardial mass (36.1±6.1 vs 28.0±5.4g, P&lt;0.001), RV end-diastolic volume (RV EDV) (123.5±31.3 vs 109.5±22.7 ml, P=0.03) and TR regurgitant fraction (19.6±8.6 vs 14.7±4.9%, P&lt;0.001) On the other hand, there were increase in each of RV ejection fraction (60.0±10.4 vs 63.13±7.8%, P&lt;0.001), RV stroke volume (SV) (50.2±15.1 vs 33.2±12.2 ml, P&lt;0.001) and RV stroke index (44.2±7.7 vs 50.3±8.6 ml/beat/m2 &lt;0.001). TTE showed improved systolic RV function parameters measured by fractional area change (42.1±7.8 vs 51.7±5.4%, P&lt;0.00), Tei Index (0.6±0.1 vs 0.5±0.1, P&lt;0.001) and TAPSE (22.2±3.3 vs 25.7±5.1 mm, P=0.04). Among RV diastolic parameters, there were an increase in TV-TDI E' (12.0±3.0 vs 14.0±2.0 cm/s, P&lt;0.001), TV-TDI A' (13.0±3.0 vs 11.0±2.0 cm/s, P&lt;0.001) and TV-TDI E'/A' (1.0±0.5 vs 1.3±0.3, P&lt;0.001) with significantly decreased RV wall thickness (5.7±0.7 vs 4.3±0.8 mm P&lt;0.001) 3 months after PBMV. Among patients who showing improved RV parameters by TTE, ten patients (32,3%) showed non improved RV end systolic volume, EDV, SV and stroke index by CMR.

Conclusion

Follow-up of RV function by TTE after PBMV yielded nearly similar results compared to CMR. However, CMR identified a subgroup of patient with persistent RV dysfunction 3 months after PBMV. That contributes to define the role of cardiac MRI in the evaluation of the prognosis in patients with MS.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Assiut University hospital and Al Orman Institute

Evaluation of Ti/Al alloy coated with biogenic hydroxyapatite as an implant device in dogs' femur bones

The main target of the present research was a full assessment of the toxicity effects and biocompatibility of a Ti/Al-alloy device coated with biogenic hydroxyapatite (bHA) when implanted in dogs in comparison with those of an uncoated Ti/Al-alloy device. The coating of the alloy was carried out using controlled high-velocity suspension flame spray (HVSFS) technique. Both coated and uncoated devices were implanted in dogs' femur bones for different time periods (45 days and 90 days). Bone-formation ability and healing were followed up, and blood analysis was performed, at Time zero (immediately post surgery), and then at 3 days, 45 days, and 90 days post surgery. Bone mineral density checks, radiological scans of the femur bone, and histological analysis were also conducted. The in-vivo study results proved that implantation of a device made from bHA-coated Ti/Al alloy in dogs' femur bones is completely safe. This is due to the high osteoconductivity of the coated alloy, which enables the formation of new bone and a full connection between new and original bone material. At 90 days post surgery, the coated alloy had been completely digested within the original bone; thus, it appeared as a part of the femur bone and not as a foreign body. Both the scanning electron microscopy with energy-dispersive X-ray and histology analysis findings affirmed the results. Furthermore, the blood tests indicated no toxicity effects during the 90 days of implantation.

Virulence and live vaccine potential of Edwardsiella piscicida phoP and phoQ mutants in catfish against edwardsiellosis

Edwardsiella piscicida is a Gram-negative facultative intracellular bacterium causing edwardsiellosis in catfish, the largest aquaculture industry in the United States. A safe and effective vaccine is an urgent need to avoid economic losses associated with E. piscicida outbreaks. PhoP/PhoQ is a two-component signal transduction system (TCS) that plays an important role in bacterial pathogenesis through sense and response to environmental and host stress signals. This study aimed to explore the contribution of PhoQ/PhoP in E. piscicida virulence and develop live attenuated vaccines against E. piscicida infection in channel catfish (Ictalurus punctatus) and hybrid catfish (channel catfish ♀ × blue catfish (I. furcatus) ♂). In the current study, two in-frame deletion mutants were constructed by deleting phoP (ETAC_09785) and phoQ (ETAC_09790) genes in E. piscicida strain C07-087, and the virulence and protection efficacy of the constructed strains were evaluated in catfish following intraperitoneal injection. Both EpΔphoP and EpΔphoQ strains had a delayed adaptation to oxidative stress (0.2% H₂ O₂ ) compared to E. piscicida wild type. The EpΔphoP and EpΔphoQ mutants produced significantly less biofilm compared to wild-type E. piscicida. Notably, EpΔphoP and EpΔphoQ mutants were significantly attenuated in channel catfish compared with wild-type E. piscicida (6.63% and 4.17% versus 49.16% mortalities), and channel catfish vaccinated with EpΔphoP and EpΔphoQ were significantly protected (95.65% and 97.92% survival) against E. piscicida infection at 21 days post-vaccination. In hybrid catfish, EpΔphoP was significantly more attenuated than EpΔphoQ, but EpΔphoQ provided significantly better protection than EpΔphoP. EpΔphoP and EpΔphoQ strains both induced specific antibodies in channel catfish against E. piscicida at 14 and 21 days post-vaccination. This result indicated that EpΔphoP and EpΔphoQ mutants were safe and protective in channel catfish fingerlings, while EpΔphoP was safe in hybrid catfish. Our findings show that PhoP and PhoQ are required for adaptation to oxidative stress and biofilm formation and may help E. piscicida face tough environmental challenges; thus, functional PhoP and PhoQ are critical for a successful infection.

Non-alcoholic Fatty Liver and Vitamin D Levels in Extremely Obese Individuals: A Case–Control Study

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is currently one of the most prevalent liver diseases. NAFLD is exemplified by the deposition of fat in the liver, in the absence of other etiologies. The spectrum of histological features in NAFLD ranges from macro-vesicular steatosis and nonalcoholic steatohepatitis, and it can eventually end in fibrosis, cirrhosis, or hepatocellular carcinoma. Vitamin D deficiency (VDD) is the most common micronutrient deficiency worldwide. Obese subjects are more prone to VDD, particularly those with liver disease. Non-classic functions of Vitamin D may be involved in the metabolic pathways beyond NAFLD development and progression. AIM: The aim of the study was to evaluate the relationship between NAFLD and Vitamin D levels in extreme obese subjects, and the correlation between Vitamin D levels and NAFLD severity. MATERIALS AND METHODS: The study included 80 Egyptian subjects of both sexes, divided into two groups: 50 patients with Stage III obesity (defined as body mass index [BMI] ≥40 kg/m2) and NAFLD, their age ranging from 20 to <60 years, and 30 age- and sex-matched healthy volunteers as control subjects. All patients were recruited from nutrition outpatient clinic at endocrinology unit, Cairo University Hospitals during the period from January 2019 to June 2019. Diagnosis of NAFLD was done by ultrasonography and laboratory evaluation included Vitamin D level. Nutritional evaluation included BMI, waist circumference, and weight. RESULTS: Vitamin D was significantly lower in the NAFLD group versus healthy controls: About 34%, deficient, 32% insufficient, and 34% sufficient in NAFLD group versus 23.3% insufficient, and 76.7% sufficient only in control, p ˂ 0.001. The severity of NAFLD, as graded by ultrasonography, was positively correlated with BMI and inversely correlated with Vit D levels, p = 0.001 and 0.024, respectively. Multivariate linear regression proved that both BMI and Vit D were independent predictors for NAFLD progression, BMI in a positive manner and Vit D in a negative manner. A cutoff Vit D level of 27.75 had 64% sensitivity and 90% specificity in NAFLD detection, area under the curve was 0.821. CONCLUSION: Vitamin D is significantly lower in the NAFLD group versus healthy controls in this cohort. VDD and BMI were associated with increased NAFLD severity. VDD was found to be an independent predictor of NAFLD progression. Vitamin D supplementation may be added to lifestyle modifications to prevent NAFLD occurrence in obese subjects.

Effects of Long-Acting Testosterone Undecanoate on Behavioral Parameters and Na + , K+-ATPase mRNA Expression in Mice with Alzheimer`s Disease

Previous studies have shown that testosterone attenuates stress-induced mood dysfunction and memory deterioration. However, the exact mechanism is still unknown. This study was conducted to investigate the role of long-term testosterone undecanoate on the behavioral responses in AD induced by AlCl3 + D-galactose administration and the possible alteration of the gene expression level of the Na/K ATPase pump. Adult male mice received AlCl3 in drinking water (10 mg/kg/day) and (D-gal 200 mg/kg/day), subcutaneously for 90 consecutive days, then received a single intramuscular (I.M) injection of castor oil (vehicle) on day 91, while treated groups received a single I.M injection of either low (100 mg/kg/45 days) or high dose (500 mg/kg/45 days) respectively of long-acting testosterone undecanoate on day 91. The time spent in the interaction zone during the open field test, preference index to novel objects in the novel object recognition test, spontaneous alternation percentage (SAP) in Y-maze test, and escape latency time in the Morris water maze test were used to measure the locomotor activity, long-term memory, and spatial memory in mice, respectively. The results showed that testosterone undecanoate treatment improved locomotor activity, improved preference to novel objects, improved spatial memory, and reversed anxiety and depression induced by AlCl3 + D-galactose administration in male mice, suggesting the enhancement of behavioral and memory functions brought by testosterone treatment. Moreover, testosterone undecanoate treatment did alter gene expression levels of Na/K ATPase isoforms in the brain hippocampus. In most cases, altered gene expression was significant and correlated with the observed behavioral changes. Taken together, our findings provide new insight into the effects of long-acting testosterone undecanoate administration on locomotor activity, long-term memory, anxiety, and spatial memory in male mice with Alzheimer's disease.

Ablation of a life-threatening arrhythmia in a patient with Brugada syndrome

Brugada syndrome is an autosomal dominant arrhythmogenic disease associated with an increased risk of ventricular fibrillation and sudden cardiac death. The mainstay of treatment in high-risk patients is an implantable cardioverter-defibrillator (ICD), however radiofrequency ablation has been proposed over the past decade as an additional therapy in patients with recurrent ICD firing. We report a case of Brugada syndrome with an electrical storm which was successfully managed by radiofrequency ablation.

Zingiber officinale ethanolic extract attenuates oxidative stress, steroidogenic gene expression alterations, and testicular histopathology induced by sodium arsenite in male rats

Arsenic (As) indelibly exists in the environment and may reach to a food chain. Flavors and herbs are recognized sources of natural antioxidants that play imperative against harmful chemical pollutants. Ginger is utilized around the world as a zesty condiment. This study assessed the ability of ginger extract (GE) as a protector to improve regenerative disabilities initiated by sodium arsenate in reproductive functions in male rats. Thirty-two Sprague-Dawley male rats weighted 240 ± 10 g were arbitrarily relegated into four experimental groups (n = 8): the control group; the GE-treated group received at 100 mg/kg BW; the As-treated group received sodium arsenite at 10 mg/kg BW; the fourth group received sodium arsenite additionally GE at mentioned doses for 4 weeks. Phytochemical results of GE revealed that GE had good antioxidative characteristics and high content of total flavonoid, tannins, alkaloids, and total phenolic components. Simultaneously, treatment of GE showed protection against oxidative stress induced by As and restoration of the serum cholesterol, testosterone, LH, and sperm parameter to normal levels. GE significantly improved the antioxidant activities (GSH, SOD, and CAT) as well as H2O2 and MDA in rats received concurrently the GE and As compared with control group. Moreover, the expression of genes controlling the cholesterol transportation and testosterone synthesis (SR-B1, StAR, CYP11A1, 3b-HSD, 17b-HSD, and CYP17a) as well as LHR showed a meaningful improvement in rats treated by GE plus As compared with their expression in the As-treated group. Besides, GE treatment exhibited significant recovered testis histopathological alterations, reduced the arsenic content in testes, and improved the sperm parameters.

Serum MicroRNAs as predictors for fibrosis progression and response to direct-acting antivirals treatment in hepatitis C virus genotype-4 Egyptian patients

BACKGROUND

MicroRNA (miRNAs) are small non-coding molecules that play an important role in hepatitis C virus (HCV) replication and liver diseases progression. The current study aimed to evaluate serum miRNAs as potential biomarkers for diagnosis, monitoring of fibrosis progression and prediction of responses to direct-acting antivirals (sofosbuvir + daclatasvir + ribavirin) in HCV genotype-4 patients.

METHODS

The serum levels of four miRNAs (miRNA-21, 199, 448 and 181c) were assessed in 150 HCV patients and 50 healthy controls using quantitative real-time PCR. The diagnostic accuracy was determined using receiver operating characteristic (ROC) curve.

RESULTS

The four studied miRNAs showed significant upregulation in HCV patients compared with controls. There were significant upregulation of MiR-199 and significant downregulation of miR-448 in late stages of fibrosis with high diagnostic accuracy (area under the curve "AUC" = 0.989%; P < .001) and (AUC = 0.0.672; P > .001), respectively. Regarding response to treatment, only miR-199 showed a significant upregulation in non-responder patients with high diagnostic accuracy (AUC = 0.968; P < .001).

CONCLUSION

miR-199 and miR-448 could serve as valuable non-invasive biomarkers for assessment of liver fibrosis progression. Additionally, miR-199 could be also a potential biomarker for assessment of treatment efficacy among HCV patients. Therefore, miR-199 and miR-448 serum levels should be considered during the treatment of HCV genotype-4 patients in Egypt and the world.

Epigenetic targeting of Waldenström macroglobulinemia cells with BET inhibitors synergizes with BCL2 or histone deacetylase inhibition

Aim: Waldenström macroglobulinemia (WM) is a low-grade B-cell lymphoma characterized by overproduction of monoclonal IgM. To date, there are no therapies that provide a cure for WM patients, and therefore, it is important to explore new therapies. Little is known about the efficiency of epigenetic targeting in WM. Materials & methods: WM cells were treated with BET inhibitors (JQ1 and I-BET-762) and venetoclax, panobinostat or ibrutinib. Results: BET inhibition reduces growth of WM cells, with little effect on survival. This finding was enhanced by combination therapy, with panobinostat (LBH589) showing the highest synergy. Conclusion: Our studies identify BET inhibitors as effective therapy for WM, and these inhibitors can be enhanced in combination with BCL2 or histone deacetylase inhibition.

Severe preeclampsia is associated with postpartum diastolic dysfunction and non-dipping blood pressure profile pattern

Background

Left ventricular diastolic dysfunction and non-dipping profile, detected by ambulatory blood pressure monitoring (ABPM), are two features recorded to be associated with sustained hypertension. Both are predictors of an increased cardiovascular morbidity later in life. Complete normalization of blood pressure (BP) in preeclampsia is detected over a variable period of time.

Methods

A prospective cohort study was conducted in a tertiary university hospital including normotensive women with a history of preeclampsia in the current pregnancy enrolled within the first week postpartum. All cases were subjected to 24 h-ABPM and 2D trans-thoracic echocardiography three months post postpartum concomitantly with a clinical evaluation. Chi2-test was used to compare the qualitative data while student t-test was used to compare the quantitative data. Multivariate regression analysis was used for prediction of non-dippers and diastolic dysfunction in our cohort.

Results

Hundred twenty eight women were included in the study. Their mean age was 28.6±5.1 years and the mean basal BP was 123.1±6.4/74.6±5.9 mm Hg. Out of the studied women, 90 (70.3%) women were dippers and 38 (29.7%) women were non-dippers. It was noticed that diastolic dysfunction was presented in 28 (73.7%) of non-dippers while none of dippers had diastolic dysfunction. Women with severe preeclampsia had higher frequency of non-dipper (35.5% vs. 24.2%; P=0.02) and diastolic dysfunction (29% vs. 15%; P=0.01) in comparison to those women with mild preeclampsia. Severe preeclampsia and previous history of preeclampsia were significant predictors for non-dipping status (OR=1.1, 95% CI: 0.05–10.56 and 1.4, 95% CI: 0.30–4.26 respectively, R2 = 0.7; P&lt;0.001). They were also predictors for diastolic dysfunction in our studied population (OR = 1.6, 95% CI: 1.1–2.2 and 1.3, 95% CI: 1.2–2.2 respectively, R2 = 0.6; P&lt;0.05).

Conclusion

Women with a history of preeclampsia have the risk for developing cardiovascular events later in life. The severity and recurrence of preeclampsia were significant predictors for both non-dipping profile and diastolic dysfunction.

Funding Acknowledgement

Type of funding source: Public hospital(s). Main funding source(s): Orman Heart Hospital-Assiut University; Women Health Hospital-Assiut University

Dual time point [18F]Flurodeoxyglucose (FDG) Positron Emission Tomography (PET)/Computed Tomography (CT) with water gastric distension in differentiation between malignant and benign gastric lesions

Objectives

To assess diagnostic accuracy and added value of dual time point ¹⁸F-FDG PET/CT after gastric distention using oral water in differentiating malignant from benign gastric lesions.

Methods

Patients (n = 30, 19 males, mean age 58.6 ± 16.4 years). All patients are known or suspected oncology patients. All patients underwent whole body ¹⁸F-FDG PET/CT scan and 2 h delayed PET/CT abdominal images following oral water gastric distension. The best cut off values for early SUVmax (SUVmax1), delayed SUVmax (SUVmax2) and SUVmax2-SUVmax1 (ΔSUVmax) to differentiate benign from malignant lesions were set based on ROC analysis. Data analyzed included in addition; age, sex and ¹⁸F-FDG uptake pattern in delayed images. Suspicious gastric lesions were correlated with biopsy in 18 patients (60 %) and with clinical and follow-up imaging (¹⁸F-FDG PET/CT, CT or MRI) in 12 patients (40 %). Unpaired t-test was used to compare the mean deference in continuous variables between patients with gastric malignancy and those with benign gastric lesions. Fisher's exact test was used to analyze categorical variables. Logistic regression analysis was performed to identify the most powerful factors to predict malignant lesions.

Results

Fifteen patients (50 %) had confirmed malignant gastric lesions. Patients with confirmed gastric malignancy were older (65 ± 13 vs 52 ± 17; p = 0.023) and had significantly higher mean ΔSUVmax (1.29 ± 1.76 vs -0.89 ± 1.59; p = 0.003). The mean SUVmax1 (6.99 ± 6.66 vs 5.31 ± 2.53; p = 0.367) and SUVmax2 (8.29 ± 7.41 vs 4.44 ± 3.34; p = 0.077) although both higher in patients with malignant lesions, they did not reach statistical significance. Sensitivity, specificity, PPV, NPV, and accuracy to detect malignant gastric lesions were highest for lesions with localized uptake pattern in delayed images post water oral contrast as well as for lesions with ΔSUVmax>0. Regression analysis revealed both variables as independent predictors for malignant lesions with odd ratios of 22.9 and 9.5 respectively and final model Chi-Square of 19.9 (p < 0.0001). The model correctly identified 12/15 (80 %) malignant lesions and 13/15 (86.7 %) benign lesions with 2 false positives confirmed as chronic active gastritis with helicobacter pylori and 3 false negatives including 1 signet ring gastric cancer and 1 low grade gastrointestinal stromal tumor (GIST), both with poor 18 F-FDG uptake.

Conclusion

Localized uptake pattern in delayed PET/CT images following gastric distention with oral water contrast as well as ΔSUVmax>0 are powerful independent variables to identify malignant gastric lesions with fairly high sensitivity and reasonable accuracy. Malignancies with inherently low ¹⁸F-FDG avidity are the main cause of false negatives while active gastritis is the main cause of false positives.

Influence of the thermal treatment on the characteristics of porous geopolymers as potential biomaterials

Highly porous sodium geopolymer structures were successfully produced through the chemical direct foaming approach at ambient temperature. The impact of the thermal treatment, as well as the influence of various additions of hydrogen peroxide, as a foaming agent, on the porosity, microstructure and mechanical characteristics of the produced geopolymers was investigated. The evaluation of bioactivity was carried out by assessing the formation of an apatite layer on the samples' surface, using scanning electronic microscopy and inductively coupled plasma spectrometry for the simulated body fluid solution, in which the geopolymer samples were kept up to 28 days. In addition, the biodegradability was estimated through the weight change of the samples and pH-measurements. The results demonstrated that the geopolymer foams, produced using 4.5 vol% H₂O₂ and heat-treated at 500 °C for 1 h, possessed a high open porosity (71 vol %), excellent compressive strength (3.56 ± 0.27 MPa), and suitable chemical stability. The pH value of SBF solutions, in which these geopolymers were immersed for 28 days, remained close to the physiological one. The in vitro study indicated that the developed geopolymer foams possessed bioactivity, as demonstrated by the formation of apatite particles on their surface after immersion in the simulated body fluid solution for 28 days.

Economic cost of smoking and secondhand smoke exposure in the Gulf Cooperation Council countries

BACKGROUND

The economic cost of smoking has been determined in many high-income countries as well as at a global level. This paper estimates the economic cost of smoking and secondhand smoke (SHS) exposure in the six Gulf Cooperation Council (GCC) countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and the United Arab Emirates), for which no detailed study exists.

METHODS

We used data from the Global Burden of Diseases Study 2016 and the cost-of-illness approach to estimate direct costs (healthcare expenditures) and indirect costs (productivity losses due to morbidity and mortality). Indirect cost was estimated with and without the inclusion of musculoskeletal disorders, using the human capital approach.

RESULTS

Total cost of smoking and SHS was estimated to be purchasing power parity (PPP)$ 34.5 billion in 2016, equivalent to 1.04% of the combined gross domestic product (GDP). SHS accounted for 20.4% of total cost. The highest proportion of indirect cost resulted from smoking in men and middle-aged people. The main causes of morbidity cost from smoking and SHS were chronic respiratory diseases and type 2 diabetes mellitus, respectively. Cardiovascular diseases were the main contributor to mortality cost for both smoking and exposure to SHS. Including musculoskeletal disorders increased total cost to PPP$ 41.3 billion (1.25% of the combined GDP).

CONCLUSION

The economic cost of smoking and SHS in the GCC states is relatively low compared with other high-income countries. Scaling-up implementation of evidence-based policies will prevent the evolution of a tobacco epidemic with its negative consequences for health and public finances.

Correlation between corneal demarcation line depth in epithelium-off and trans-epithelium accelerated corneal cross linking and keratoconus progression

AIM

To compare corneal demarcation line (DL) depth in both accelerated epithelium-off and trans-epithelium cross linking (CXL) using anterior segment optical coherence tomography (AS-OCT) and its relation to maximum keratometry (Kmax) progression in both techniques.

METHODS

A prospective comparative interventional study where patients with mild to moderate keratoconus (KC) were classified into two groups: accelerated epithelium-off and trans-epithelium CXL based on corneal pachymetry. Assessment of corneal DL depth was carried out after 3mo by AS-OCT. Kmax readings were evaluated after one year follow up using the Scheimpflug imaging system.

RESULTS

Study included 74 eyes of 44 patients. Group A underwent epithelium-off CXL (41 eyes), while Group B underwent trans-epithelium CXL (33 eyes). At 3mo follow up, mean corneal DL depth in Group A was 219.9±58.4 µm while in Group B was 127.2±7.8 µm (P<0.05). The mean Kmax changed from 51.9±3.9 to 51.3±4.2 diopters in Group A and from 53.1±4.1 to 53.6±5 diopters in Group B with insignificant difference in Kmax changes in either group (P>0.05). In addition, no significant change in corneal pachymetry was found in both groups (mean change at 1y: 6.4±4.7 and -10.1±2.3 µm in Groups A and B respectively).

CONCLUSION

Despite a significantly deeper corneal DL depth created by accelerated epithelium-off CXL technique compared to accelerated trans-epithelium CXL, there is no significant impact on keratoconus progression.

Molecular Epidemiology and Mechanisms of High-Level Resistance to Meropenem and Imipenem in Pseudomonas aeruginosa

Purpose

Pseudomonas aeruginosa possesses a large number of resistance mechanisms to different antimicrobials with carbapenems being the most powerful in treating resistant P. aeruginosa. Hence, it is imperative to explore different mechanisms of carbapenems-resistance in P. aeruginosa to achieve successful treatment through the design of new drugs acting on this interaction to combat against antimicrobial resistance.

Strains and Methods

A total of 634 P. aeruginosa clinical isolates were collected from various patient sources and their MIC levels were measured. Molecular evaluation of carbapenem resistance was assessed by investigating the presence of bla_IMP1, bla_IMP2, bla_VIM1, bla_VIM2, bla_SPM and bla_NDM genes and the gene expression of the following multi-drug efflux pump systems: MexAB-OprM, MexCD-OprJ, MexEF-OprN and MexXY-OprM and its correlation with MIC. Isolates were typed by Random Amplified Polymorphic DNA (RAPD)-typing.

Results

Carbapenem resistance was detected in 32 (5%) isolates, which were all imipenem resistant (of which 29 were meropenem resistant). High-level resistance (≥64mg/mL) to imipenem was found in 27 (84.3%) isolates, and to meropenem in 28 (96.5%) isolates. The carbapenemase bla_VIM-1 was found in 31 isolates, while bla_NDM was detected in 4 isolates. None of the isolates possessed either bla-_VIM-2, bla_IMP-1, bla_IMP-2 or bla_SPM. The majority of the isolates displayed over-expression of MexCD-OprJ (75%) followed by MexXY-OprM efflux pump (62%), while MexAB-OprM and MexEF-OprN efflux pumps were overexpressed in 21.8% and 18.7% of the isolates, respectively, with no down-regulation of oprD in any of the isolates. A strong correlation was found between CDJ efflux pump expression and meropenem, imipenem resistance (r=0.532, 0.654, p<0.001, <0.001) respectively. Four major clusters were detected by RAPD-typing: group 1(10 isolates), group 3 (9 isolates), group 2 (8 isolates) while the fourth group (4) included 4 isolates (12.5% polymorphism).

Conclusion

High-level carbapenem resistance reported in this study was allied to multiple mechanisms including carbapenemase production and efflux-pump over-expression. Threatening cross-infection is possible inside the hospital and stringent infection control measures are crucial.

Modulating Expression of Thioredoxin Interacting Protein (TXNIP) Prevents Secondary Damage and Preserves Visual Function in a Mouse Model of Ischemia/Reperfusion

Retinal neurodegeneration, an early characteristic of several blinding diseases, triggers glial activation, resulting in inflammation, secondary damage and visual impairment. Treatments that aim only at neuroprotection have failed clinically. Here, we examine the impact of modulating thioredoxin interacting protein (TXNIP) to the inflammatory secondary damage and visual impairment in a model of ischemia/reperfusion (IR). Wild type (WT) and TXNIP knockout (TKO) mice underwent IR injury by increasing intraocular pressure for 40 min, followed by reperfusion. An additional group of WT mice received intravitreal TXNIP-antisense oligomers (ASO, 100 µg/2 µL) 2 days post IR injury. Activation of Müller glial cells, apoptosis and expression of inflammasome markers and visual function were assessed. IR injury triggered early TXNIP mRNA expression that persisted for 14 days and was localized within activated Müller cells in WT-IR, compared to sham controls. Exposure of Müller cells to hypoxia-reoxygenation injury triggered endoplasmic reticulum (ER) stress markers and inflammasome activation in WT cells, but not from TKO cells. Secondary damage was evident by the significant increase in the number of occluded acellular capillaries and visual impairment in IR-WT mice but not in IR-TKO. Intervention with TXNIP-ASO prevented ischemia-induced glial activation and neuro-vascular degeneration, and improved visual function compared to untreated WT. Targeting TXNIP expression may offer an effective approach in the prevention of secondary damage associated with retinal neurodegenerative diseases.

Evaluation of serum adiponectin levels in diabetic nephropathy

INTRODUCTION

Diabetic nephropathy is one of the major microvascular complications of diabetes mellitus. Adiponectin is an adipose tissue-derived cytokine that was identified in a human adipose tissue cDNA library. Serum adiponectin levels are found to be reduced in various pathological states including obesity, diabetes mellitus, ischaemic heart disease and arteriosclerosis obliterans and elevated in end stage renal diseases.

OBJECTIVE

to assess the level of plasma adiponectin as an early predictor of microvascular complications in patients with type 2 diabetes mellitus.

METHODS

44 patients with type 2 diabetes recruited from outpatient diabetes clinic in Kasr Alainy hospital. All patients were subjected to full laboratory work-up including: Fasting blood glucose and Post prandial blood glucose, Glycated haemoglobin A1C, Serum creatinine, Serum total cholesterol, Triglycerides, Low density lipoprotein, High density lipoprotein, C-reactive protein titre, serum adiponectin and Urinary albumin/creatinine (UAC) ratio.

RESULTS

The present study demonstrated that serum adiponectin concentrations had significant positive correlation with UAC ratio (r = 0.534, p = 0.0001). Adiponectin levels showed significant positive correlation in patients with diabetes and hypertension with microalbumiuria (p = .001) or normoalbumiuria (p = 0.004).

CONCLUSION

Serum adiponectin level can be a good predictor of diabetic nephropathy in patients with type 2 diabetes mellitus.

Simultaneous treatment of ischaemic bowel and ischaemic stroke with intravenous thrombolysis therapy

Novel treatment of simultaneous mesenteric and cerebral ischaemia with systemic thrombolysis. A 75-year-old man presented to the acute stroke team with aphasia, right-sided weakness and distressed with a pain he was unable to localise. He was treated with intravenous thrombolysis with tissue plasminogen activator for a left middle cerebral artery stroke. Decompensation on the ward during thrombolysis with worsening abdominal distension and pain, hypotension and tachycardia prompted a CT angiogram scan, which displayed proximal inferior mesenteric artery occlusion. Thrombolysis treatment resulted in excellent improvement of both his dysphasia and weakness from the left cerebral ischaemic stroke and reperfusion of the ischaemic bowel, without surgical intervention.

Cholecalciferol for the prophylaxis against recurrent urinary tract infection among patients with benign prostatic hyperplasia: a randomized, comparative study

PURPOSE

To explore the role of cholecalciferol for the prophylaxis against recurrent urinary tract infection (UTI) in patients with benign prostatic hyperplasia (BPH).

METHODS

Our randomized, uncontrolled prospective study included 389 naïve BPH patients with moderate/severe symptoms, consecutively. The patients were randomly allocated to two groups; group-A included 193 patients who received tamsulosin, while group-B included another 196 patients who received tamsulosin with cholecalciferol. The study population was followed up for 2 years after the start of the treatment. For all the patients enrolled, clinical evaluation, imaging studies (abdominal and trans-rectal ultrasonography), and laboratory investigations [including urinalysis, urine culture with antibiotic susceptibility testing for positive cultures and estimation of prostate-specific antigen (PSA) level] were provided.

RESULTS

The incidence rate of recurrent UTI was 9% among the study population; it was significantly higher among group-A patients compared to those of group-B (13.5% vs. 4.6%, p 0.003, OR 2.7, 95% CI 1.5-4.3). Compared to patients of group-A, those of group-B developed a significantly lower level of PSA at the end of treatment period (0.16 ± 0.03 ng/mL vs. 0.27 ± 0.08 ng/mL, p 0.043, OR 1.9, 95% CI 1.2-6.8).

CONCLUSIONS

Adjuvant cholecalciferol supplementation may be protective against recurrent UTI among patients with BPH receiving tamsulosin therapy without extra adverse effects.

High incidence of MBL-mediated imipenem resistance among Pseudomonas aeruginosa from surgical site infections in Egypt

INTRODUCTION

Surgical wound infection is a serious problem, especially with metallo-beta lactamases (MBLs)- producing gram-negative bacteria as Pseudomonas aeruginosa. The main objective of this work was to evaluate for the first time in Minia- Upper Egypt, the incidence of imipenem-resistant Pseudomonas aeruginosa infection of surgical wounds particularly that mediated by MBL production.

METHODOLOGY

P. aeruginosa was isolated from infected wounds by swabs and underwent full microbiological identification and Antibiotic Susceptibility testing. MBL production was tested by E-test and PCR was used for imipenemase (blaIMP) and Verona integron-encoded metallo-beta-lactamase (blaVIM) gene detection.

RESULTS

Out of 200 pus samples collected from surgical site infections, P. aeruginosa had the prevalence rate of 35%. Imipenem resistance was found in 28.57% of the isolated Pseudomonas aeruginosa. The prevalence of MBL-producing isolates among Imipenem-resistant P. aeruginosa (IRPA) was 85 % by phenotypic method with 29% of them harboring blaVIM gene. High resistance rates to other classes of antibiotics were reported among the isolates with multi-drug resistance (MDR) detected in 97.3% of the isolates.

CONCLUSION

To our knowledge, this is the first report in Minia, Upper Egypt describing the relatively high incidence of IRPA in infected surgical wounds with MBLs involved in the majority of isolates.

Investigation the impact of ZTA addition on the properties of nano biogenic hydroxyapatite

The target of the recent study is to achieve a significant inexpensive and eco-friendly way for getting ZTA/HA composites, based on the nano-HA derived from the eggshell biogenic source. Combining simultaneously the porous structure; which is considered as a bone formation key, with developed mechanical properties and adequate biocompatibility, is another purpose of this study. Furthermore, the impact of ZTA addition from 10-30 mass-%, fabricated by uniaxial pressing and sintering at 1200-1300 °C for 2 h, on the physical and mechanical properties, microstructure and phase composition of ZTA/HA composite bodies was investigated. The results demonstrated that the increasing of ZTA content increases the bodies' apparent porosity and decreases the bulk density due to the decomposition of HA into β-TCP. Where the formation of β-TCP possessed the predominant impact on the mechanical properties of the sintered ZTA/HA composites. ICP, SEM, EDX and thin film XRD results of composites containing 20 mass-% ZTA affirmed the excellent bioactivity of the bodies.