Empagliflozin protects against isoprenaline-induced fibrosis in rat heart through modulation of TGF-β/SMAD pathway

AIM

Cardiac fibrosis is characterized by excessive accumulation of fibrous tissue, particularly collagens, in the myocardium. Accumulated fibrous tissue renders myocardium stiffer and reduces its contractility. Empagliflozin is an oral hypoglycemic agent with extra-diabetic functional profile toward maintaining cardiac functions. The present study aimed to examine protective effect of empagliflozin against an in-vivo model of cardiac fibrosis induced by isoprenaline and targeting TGF-β/SMAD signaling as a possible pathway responsible for such effect.

MAIN METHODS

Sixty animals were divided into six groups; the first was normal, and the second was treated with isoprenaline only (5 mg/kg/day I.P.) as a control. The third received pirfenidone (500 mg/kg/day P.O.), and the remaining groups received graded doses (5, 10, 20 mg/kg respectively) of empagliflozin for 14 days before fibrosis induction by isoprenaline (5 mg/kg/day) for 30 days.

KEY FINDINGS

Isoprenaline increased cardiac enzymes, and cardiac tissues revealed elevated concentrations of transforming growth factor β (TGF-β1), monocyte chemoattractant protein 1 (MCP-1), tumor necrosis factor α (TNF-α), and c-jun N-terminal kinase (JNK) proteins. Expression of nuclear factor kappa B (NF-κB), alpha smooth muscle actin (α-SMA), collagens, suppressor of mothers against decapentaplegic (SMADs), connective tissue growth factor (CTGF), and fibronectin was upregulated. Empagliflozin improved the histological picture of heart tissue in comparison to fibrosis developed in controls, and protected against fibrosis through significant modulation of all mentioned parameters' concentrations and expressions.

SIGNIFICANCE

Empagliflozin demonstrated a promising protective approach against biological model of cardiac fibrosis through an anti-fibrotic effect through targeting TGF-β signaling pathways.

Validation of the ALK-Brain Prognostic Index for patients with ALK-rearranged lung cancer and brain metastases

BACKGROUND

Brain metastases (BMs) are a key challenge in the management of anaplastic lymphoma kinase-rearranged non-small-cell lung cancer (ALK+ NSCLC), but prognostic scores are complicated or rely on data before the era of tyrosine kinase inhibitors (TKIs). This study aimed to validate the novel ALK-Brain Prognostic Index (ALK-BPI), which was originally proposed based on 44 TKI-treated ALK+ NSCLC patients from Karolinska University Hospital, using an external clinical cohort.

PATIENTS AND METHODS

TKI-treated ALK+ NSCLC patients with BM from Heidelberg (n = 82, cohort 1) were retrospectively analyzed alone and together with the original Karolinska cohort (n = 126, cohort 2). Cox regression models were used to determine the association of clinical variables and scores with overall survival (OS) after BM diagnosis (BM-related OS).

RESULTS

Both cohorts showed a similar median age (58 years), roughly balanced sex distributions (52%-56% females), and Eastern Cooperative Oncology Group performance status (PS) 0-2 for most patients (87%-92%) at the time of BM development, which were present already at initial diagnosis in 36%-38% of the patients. Most patients had received next-generation ALK inhibitors (54%-63%), while 55%-56% of patients did not receive any radiotherapy. The ALK-BPI identified poor-risk patients (i.e. featuring ≥ 2/3 risk factors: PS > 2, male sex, development of BM after initial diagnosis) with a significantly shorter BM-related OS than other patients in both cohorts: 32/82 in cohort 1 with 21.3 versus 62.2 months in median [hazard ratio (HR) = 2.5, P < 0.001]; 59/126 in cohort 2 with 23.1 versus 67.2 months in median (HR = 2.6, P < 0.001). The five-parameter Lung-molGPA score did not achieve statistical significance and/or clear prognostic separation in all four groups, while the Disease-Specific Graded Prognostic Assessment score did not show consistent results.

CONCLUSIONS

The ALK-BPI is a reliable tool for easy prognostic dichotomization of TKI-treated ALK+ NSCLC patients with BM in daily clinical practice, without the complexity of previous models.

Detection, survival, and persistence of Staphylococcus capitis NRCS-A in neonatal units in England

BACKGROUND

The multidrug-resistant Staphylococcus capitis clone, NRCS-A, is increasingly associated with late-onset sepsis in low birthweight newborns in neonatal intensive care units (NICUs) in England and globally. Understanding where this bacterium survives and persists within the NICU environment is key to developing and implementing effective control measures.

AIM

To investigate the potential for S. capitis to colonize surfaces within NICUs.

METHODS

Surface swabs were collected from four NICUs with and without known NRCS-A colonizations/infections present at the time of sampling. Samples were cultured and S. capitis isolates analysed via whole-genome sequencing. Survival of NRCS-A on plastic surfaces was assessed over time and compared to that of non-NRCS-A isolates. The bactericidal activity of commonly used chemical disinfectants against S. capitis was assessed.

FINDINGS

Of 173 surfaces sampled, 40 (21.1%) harboured S. capitis with 30 isolates (75%) being NRCS-A. Whereas S. capitis was recovered from surfaces across the NICU, the NRCS-A clone was rarely recovered from outside the immediate neonatal bedspace. Incubators and other bedside equipment were contaminated with NRCS-A regardless of clinical case detection. In the absence of cleaning, S. capitis was able to survive for three days with minimal losses in viability (<0.5 log10 reduction). Sodium troclosene and a QAC-based detergent/disinfectant reduced S. capitis to below detectable levels.

CONCLUSION

S. capitis NRCS-A can be readily recovered from the NICU environment, even in units with no recent reported clinical cases of S. capitis infection, highlighting a need for appropriate national guidance on cleaning within the neonatal care environment.

Antitumor effect of trimetazidine in a model of solid Ehrlich carcinoma is mediated by inhibition of glycolytic pathway and AKT signaling

Disturbance in glucose metabolism was proposed to be a pathogenetic mechanism of breast cancer. Trimetazidine (TMZ) inhibits β-oxidation of fatty acids through blocking the activity of 3-ketoacylCoA thiolase enzyme, leading to enhancement of glucose oxidation and metabolic respiration. The present study aimed to examine the cytotoxic effect of TMZ in both in vivo and in vitro models of breast cancer, focusing on its impact on the expression of some glycolytic enzymes and AKT signaling. The cytotoxic effect of TMZ was screened against breast (MCF-7) cancer cell line at different concentrations [0.01-100 μM]. In vivo, graded doses (10, 20, 30 mg/kg) of TMZ were tested against solid Ehrlich carcinoma (SEC) in mice. Tumor tissues were isolated for assessment of the expression of glucose transporter-1 (GLUT-1) and glycolytic enzymes by quantitative PCR. The protein expression of AKT and cellular myelocytomatosis (c-Myc) was determined by western blotting, while p53 expression was evaluated by immunohistochemistry. Molecular docking study of TMZ effect on AKT and c-Myc was performed using Auto-Dock Vina docking program. TMZ showed a cytotoxic action against MCF-7 cells, having IC50 value of 2.95 μM. In vivo, TMZ reduced tumor weight, downregulated the expression of glycolytic enzymes, suppressed AKT signaling, but increased p53 expression. Molecular docking and in silico studies proposed that TMZ is an AKT and c-Myc selective inhibitor. In conclusion, TMZ demonstrated a viable approach to suppress tumor proliferation in biological models of breast cancer.

Percutaneous Closure of Post-Infarct Left Ventricular Pseudoaneurysm; A Review of Literature

Left ventricular pseudoaneurysm is a well-known complication of myocardial infarction and open-heart surgery and has recently been described as succeeding transapical transcatheter aortic valve replacement (TAVR). While surgical intervention is the conventional therapeutic approach, transcatheter closure can be considered in patients at high risk for surgical procedures. In this article, we present a post-myocardial infarction pseudoaneurysm for which closure was done via retrograde left ventricular (LV) access using an Amplatzer Septal Occluder, and provide a review of recent literature focusing on indications and outcomes of the different percutaneous techniques and devices.

Caffeine addiction and determinants of caffeine consumption among health care providers: a descriptive national study

OBJECTIVE

Caffeine is the most commonly used psychostimulant compound with a long history of worldwide consumption. Consuming low to moderate doses of caffeine is generally safe and quite beneficial; however, several clinical studies show that high doses could be toxic.  Additionally, caffeine users can become dependent on the drug and find themselves unable to reduce consumption despite impending and recurrent health problems associated with continued use. This study was conducted to explore the prevalence, determinants, and positive and negative effects of caffeine consumption among governmental health care providers (HCPs) who were caffeine users. It aims to determine the frequency of caffeine dependence and addiction in the Kingdom of Saudi Arabia (KSA) in January 2020.

SUBJECTS AND METHODS

This cross-sectional study recruited 600 randomly selected HCPs from all regions of KSA, who fulfilled the selection criteria through a self-administrated, online-validated questionnaire composed of three main parts using the DSM-IV to diagnose dependence and probable addiction.

RESULTS

The majority of the studied HCPs were females (67.8%), nonsmokers (82.0%), and Saudis (80.5%), with a mean age of 35 years. According to the DSM-IV, the prevalence of caffeine consumption was 94.3%. Caffeine dependence was reported in 270 (47.7%), while 345 (60.9%) were diagnosed as addicts. The most commonly consumed caffeine-containing substances were coffee and its variants/types (70%), tea (59%), and chocolate (52%), with each person spending about 220 SR per week on them. The main reported adverse effects, in descending order, were sleep disturbances, stomach problems, and cardiac symptoms. The most positive effects reported of caffeine consumption were feeling active, alert, confident, and happy. These findings were significantly affected by sex, occupation, and general health.

CONCLUSIONS

Caffeine use, dependence, and addiction are common among government HCPs in KSA. Caffeine has both positive and negative effects on this population and further research is necessary to better understand the long-term consequences of caffeine consumption.

A Case of Antisynthetase Syndrome Initially Presented With Interstitial Lung Disease Mimicking COVID-19

In this case report, we present a case of antisynthetase syndrome which is a rare disease that can be easily missed, if not specifically looked for in adults, whose initial presentation is combination of myopathic and respiratory symptoms. In clinical practice, patients presenting with coronavirus disease 2019 (COVID-19) symptoms, whose computed tomography (CT) imaging is consistent with COVID-19, were accordingly isolated and treated as COVID-19 awaiting reverse transcription polymerase chain reaction (RT-PCR) results. However, there are many COVID-19 mimics on chest CT, which can make the CT-based diagnosis of COVID-19 unsafe.

Rhinoseptoplasty in a Blind Patient: A Case Report

Vision seems to be the first to recognize a potential threat, subconsciously recording and processing the image. Visual discrimination happens at a subcortical level after an environmental image is recorded in midbrain tissues. Aesthetics and beauty have been found to be decoded subconsciously in the amygdala, similar to a frightening threat. Therefore, blind patients can detect beauty by embodied primal senses other than vision. It could be processed without conscious thought, in the same way, that an immediate threat is. Here, we present a case of a 55-year-old male who has had bilateral blindness for 15 years and came to a rhinoplasty clinic seeking help for nasal obstruction and difficulty breathing due to an old history of trauma since adolescence, causing nasal deviation. He asked for both aesthetic and functional corrections. Rhinoseptoplasty was done successfully, significantly impacting the quality of life and psychosocial distress.

A Case of Delayed COVID-19-Related Macrophage Activation Syndrome

Although coronavirus disease 2019 (COVID-19) is primarily a respiratory illness, clinical experiences have shown that almost no system is exempted. The severity of the disease can also range from mild presentation with complaints such as headache, aches and pains, taste and sense of smell disturbances to a more severe presentation with acute respiratory distress syndrome (ARDS) that necessitate admission to intensive care units. In such severe presentation, hypercytokinemia, typically found in cytokine storm syndrome (CSS), particularly macrophage activation syndrome (MAS) is often present. CSS can result from diverse, heterogeneous conditions of different clinical phenotypes, such as infections, hematological, rheumatological or iatrogenic conditions leading to systemic hyperinflammation. Some clinical and laboratory findings may give clues to such a highly lethal syndrome and allow early diagnosis and introduction of effective therapy. In this case we describe a COVID-19 pneumonia patient who was discharged home following improvement in his respiratory symptoms to present few days later with a fatal form of CSS, presenting with ARDS, fulminant hepatic failure and coagulopathy.

A No-Math Primer on the Principles of Machine Learning for Radiologists

Machine learning is becoming increasingly important in both research and clinical applications in radiology due to recent technological developments, particularly in deep learning. As these technologies are translated toward clinical practice, there is a need for radiologists and radiology trainees to understand the basic principles behind them. This primer provides an accessible introduction to the vocabulary and concepts that are central to machine learning and relevant to the radiologist.

Invivo and invitro evaluation of antitumor effects of iron oxide and folate core shell-iron oxide nanoparticles

Nanoparticles are considered viable options in the treatment of cancer. This study was conducted to investigate the effect of magnetite nanoparticles (MNPs) and magnetite folate core shell (MFCS) on leukemic and hepatocarcinoma cell cultures as well as their effect on the animal model of acute myelocytic leukemia (AML). Through current study nanoparticles were synthesized, characterized by various techniques, and their properties were studied to confirm their nanostructure. Invivo study, nanoparticles were evaluated to inspect their cytotoxic activity against SNU-182 (human hepatocellular carcinoma), K562 (human leukemia), and THLE2 (human normal epithelial liver) cells via MTT test. Apoptotic signaling proteins Bcl-2 and Caspase-3 expression were inspected through RT-PCR method. A cytotoxic effect of MNPs and MFCS was detected in previous cell cultures. Moreover, the apoptosis was identified through significant up-regulation of caspase-3, with Bcl-2 down-regulation. Invitro study, AML was induced in rats by N-methyl-N-nitrosourea followed by oral treatment with MNPS and MFCS. Biochemical indices such as aspartate and alanine amino transferases, and lactate dehydrogenase activities, uric acid, complete blood count, and Beta -2-microglubulin were assessed in serum. Immunophenotyping for CD34 and CD38 detection was performed. Liver, kidney, and bone marrow were microscopically examined. Bcl-2 promoter methylation, and mRNA levels were examined. Although, both MNPs and MFCS depict amelioration in biochemical parameters, MFCS alleviated them toward normal control. Anticancer activity of MNPs and MFCS was approved especially for AML. Whenever, administration of MFCS was more effective than MNPs. The present work is one of few studies used MFCS as anticancer agent.

Cost-comparison study of reusable and disposable rhinolaryngoscopes in a large English teaching hospital

OBJECTIVE

This study aimed to compare the cost per use of video-rhinolaryngoscopy using reusable and disposable devices in a tertiary referral centre.

METHODS

A cost-comparison study was performed that utilised retrospective cost data and prospective utilisation data to compare the total costs of using reusable video-rhinolaryngoscopes versus a single-use alternative.

RESULTS

It was estimated that 4776 and 1821 procedures were performed annually with reusable and disposable video-rhinolaryngoscopes, respectively. The cost per use was £66.61 for reusable devices versus £150.00 for disposable devices. The break-even point (i.e. when cost per use was equal, occurred at 1374 procedures per year). Thereafter, it was cheaper to use reusable devices.

CONCLUSION

Disposable rhinolaryngoscopes may present a cheaper solution to services with low rates of rhinolaryngoscope utilisation. However, for larger services considering replacement of their reusable rhinolaryngoscopes with disposable units, it is likely that the recurring costs will be prohibitive in the medium to long term.

Causes, Prevention, and Correction of Complications of Primary and Revision Septorhinoplasty

Background: Rhinoplasty is one of the most challenging esthetic operations as it demands an optimal esthetic and practical outcome. Complications of rhinoplasty may occur intraoperatively or postoperatively during wound healing and contracture.

Objectives: The aim of this study was to assess the complications of septorhinoplasty at King Abdullah Medical City Hospital (KAMCH) and to evaluate the satisfaction scores of the patients and the doctors after primary and revision septorhinoplasty.

Materials and methods: In the last five years, 32 out of 425 patients (7.5%) underwent revision septorhinoplasty to correct complications of the previous operations performed at KAMCH.

This is a retrospective single descriptive study that included Saudi patients aged 18 years and above who underwent primary and revision septorhinoplasty at KAMCH from January 2015 to March 2020. We reviewed the medical records of the patients to identify postoperative complications. Data were analyzed using SPSS statistical program (versions 7 and 8; SPSS Inc, Chicago).

Results: The mean age of the 32 patients who underwent revision septorhinoplasty was 26 ± 8.5 years. Most of the complications involved the nasofrontal angle and the columellolabial angle. Statistically significant improvements in the satisfaction scores of the patients and the doctors were observed before the first surgery, after the first surgery, and after the second surgery (P = 0.000 for each time point).

Conclusion: The satisfaction levels of the patients and the doctors improve after the second surgery.

Health system and patient-level factors serving as facilitators and barriers to rheumatic heart disease care in Sudan

BACKGROUND

Rheumatic heart disease (RHD) remains a leading cause of morbidity and mortality in Sub-Saharan Africa despite widely available preventive therapies such as prophylactic benzathine penicillin G (BPG). In this study, we sought to characterize facilitators and barriers to optimal RHD treatment with BPG in Sudan.

METHODS

We conducted a mixed-methods study, collecting survey data from 397 patients who were enrolled in a national RHD registry between July and November 2017. The cross-sectional surveys included information on demographics, healthcare access, and patient perspectives on treatment barriers and facilitators. Factors associated with increased likelihood of RHD treatment adherence to prophylactic BPG were assessed by using adjusted logistic regression. These data were enhanced by focus group discussions with 20 participants, to further explore health system factors impacting RHD care.

RESULTS

Our quantitative analysis revealed that only 32% of the study cohort reported optimal prophylaxis adherence. Younger age, reduced primary RHD healthcare facility wait time, perception of adequate health facility staffing, increased treatment costs, and high patient knowledge about RHD were significantly associated with increased odds of treatment adherence. Qualitative data revealed significant barriers to RHD treatment arising from health services factors at the health system level, including lack of access due to inadequate healthcare staffing, lack of faith in local healthcare systems, poor ancillary services, and patient lack of understanding of disease. Facilitators of RHD treatment included strong interpersonal support.

CONCLUSIONS

Multiple patient and system-level barriers to RHD prophylaxis adherence were identified in Khartoum, Sudan. These included patient self-efficacy and participant perception of healthcare facility quality. Strengthening local health system infrastructure, while enhancing RHD patient education, may help to improve treatment adherence in this vulnerable population.

Case of erythema multiforme/Stevens-Johnson syndrome: an unusual presentation of COVID-19

Dermatological manifestations of COVID-19 are rare, with fever ,dry cough, breathlessness, loss of taste and myalgia constituting most of the symptoms spectrum. However, these rare skin manifestations may be the only presentation of COVID-19 as in our presented patient. It is therefore prudent to be aware of such presentation in asymptomatic COVID-19 patients, as this is important for early diagnosis and hence taking appropriate preventive measures.

Targeted metabolomics as a tool for the diagnosis of kidney disease in Type II diabetes mellitus

Background: Diabetic kidney disease (DKD) is an increasing health problem and an extra burden to health services. The study of characteristic metabolic alterations of DKD is crucial for a better understanding of pathogenesis to identify new potential biomarkers and drug targets. We hypothesized that metabolic profiling of amino acids, acylcarnitines, and organic acids are useful new biomarkers for the diagnosis of the early stages of DKDMethods: The hypothesis was testing in a case-control study of 232 patients with type 2 diabetes mellitus and 150 healthy controls. Patients were classified according to urinary albumin and estimated glomerular filtration rate (eGFR) into 100 with normoalbuminuria and 132 with microalbuminuria group. Eighteen AcylCNs and 17 amino acids were measured in the blood by tandem mass spectrometry while 17 urinary organic acids were quantitatively measured by gas chromatography - mass spectrometry.Results: Regression analysis found that dodecanoylcarnitines C12 (effect size 2.03 [95%CI 1.73-2.32]), triglylcarnitine C5:1 (2.01 [1.70-2.30]), and isovalerylcarnitine C5 (1.78 [1.48-2.07]) were stronger predictors of albumin/creatinine ratio than HbA1c (1.50 [1.20-1.78]) and hence they could serve as potential biomarkers for the diagnosis of the early stages of DKD.Conclusions: Targeted metabolic profiling offers a new, non-invasive approach for detecting biomarkers for the early diagnosis of DKD suggesting new pathogenetic phases that might be new targets for treatment.

Early to medium term outcomes of osteochondral lesions of the talus treated by autologous matrix induced chondrogenesis (AMIC)

BACKGROUND

The primary aim of the study is to evaluate the functional outcome following AMIC procedure in patients with osteochondral injury of the talus. The secondary aim is to evaluate if size of the lesion and patient's age influence outcome.

MATERIALS AND METHODS

This is a retrospective study of 25 patients who underwent AMIC procedure of the talus treated by a single surgeon. Functional outcomes were evaluated using pre and post operative AOFAS and VAS scores.

RESULTS

The mean lesion size was 1.74 cms with 88% of lesions in the study more than 1.4 cms. There was a significant improvement in AOFAS score with mean improvement of 49.40 (p < 0.05) and VAS score of 5.36 (p < 0.05). We could not find any correlation between either age or lesion size with functional outcome for AMIC procedure.

CONCLUSION

AMIC procedure seems to be a reliable treatment method for larger diameter osteochondral lesions of the talus up to 2.5 cms in diameter.

Multicentric adrenocorticotropic hormone -producing steroid cell tumor of the fallopian tube & broad ligament in a 15 year old girl

Steroid cell tumors occur usually in the ovaries with very few reported cases of extra-ovarian origin. Our patient was a fifteen year old female, complaining from secondary amenorrhea and voice deepening. Values of serum cortisol, DHEA, FSH & LH were normal. Serum Testosterone was elevated while ACTH-pm was markedly elevated. MRI described bilateral solid para-ovarian masses. Exploration revealed two bilateral tubal extraluminal cysts & a right broad ligament cyst which were all excised. Pathological examination led to the diagnosis of steroid cell tumor. Serum testosterone & ACTH returned to normal levels after surgery with subsequent regression of the virilizing symptoms. We can conclude that extra-ovarian steroid cell tumors are extremely rare. They are usually presented with virilizing symptoms and hormonal abnormalities. Surgery is the main line of treatment.

Nerve Block for Septorhinoplasty: A Retrospective Observational Study of Postoperative Complications in 24 Hours

Septorhinoplasty is a surgical procedure that provides functional improvements and esthetic adjustments to the appearance of the nose. Pain is a common postoperative complication, and pain management is known to decrease postoperative complications and total cost. Local anesthetics can cost-effectively decrease postoperative pain scores and reduce analgesic requirements.

The primary objective of this study was to assess the effect of bilateral facial nerve blocks given with general anesthesia on pain scores and the use of postoperative analgesia. The secondary objective was to compare the vital signs stability between a group given bilateral facial nerve blocks with general anesthesia and a group given general anesthesia only.

We conducted a retrospective observational study among 40 patients who were divided into two groups, each containing 20 patients. The patients in the nerve block (NB) group received general anesthesia and bilateral facial blocks of the infraorbital and infratrochlear nerves via 5 ml of 0.25% levobupivacaine with 5 ml of diluted adrenaline 1:100,000. Patients in the Control group received general anesthesia only. Both groups received the same local injection of a mixture of 5 ml of 1% lidocaine and 5 ml of 1:100,000 epinephrine at the surgical site, along with the standard general anesthesia. A numerical rating scale, the visual analog scale (VAS), was used to evaluate postoperative pain at 15, 30, and 45 minutes postoperatively, and the stability of the vital signs was also assessed.

The results showed that using bilateral infraorbital and infratrochlear nerve block injection with 0.25% levobupivacaine for patients who underwent septorhinoplasty under general anesthesia provided greater stability of vital signs but had no effect on the pain score or analgesia need. Further assessment should be performed in a larger number of patients to either confirm or refute these results. Additional studies could be conducted in several hospitals within the Kingdom to determine how broadly applicable nerve blockade is in reducing pain sensation.

The use of Free Style Libre Continues Glucose Monitoring (FSL-CGM) to monitor the impact of Ramadan fasting on glycemic changes and kidney function in high-risk patients with diabetes and chronic kidney disease stage 3 under optimal diabetes care

AIM

To understand the risk of hypoglycaemia during Ramadan fasting by use of CGM, as well as to observe the Glycemic control and renal functions in patients with diabetes and chronic kidney disease stage 3 (CKD-3).

METHOD

A prospective interventional study conducted in the Dubai Hospital, a tertiary care centre in the United Arab Emirates, during the month of Ramadan 1437 AH (Hijri), which corresponded to June 6th till July 5th, 2016. 25 patients with type 2 diabetes and stage 3 chronic kidney disease (CKD stage 3) were included in the study, who intended to fast during Ramadan. The aim was to observe the serum glucose level through 24 h FreeStyle Libre flash continuous glucose monitor (FSL-CGM). Most patients had three sensors during the study, covering an average three weeks during Ramadan and three weeks outside Ramadan (Sha'ban and shawal). We also monitored the change in, BP, HBA1c, kidney functions and BMI before and after Ramadan.

RESULTS

This study included 25 adults with a mean age of 60 (±14 years). Fasting Ramadan did not result in any significant change in biophysical and biochemical profile of these patients. Data from FSL-CGM showed significantly longer duration (101.9 ± 119.1 Vs. 45.9 ± 47.6 min, p < 0.033) and more frequent hypoglycemic episodes (4.4 ± 4.7 Vs. 2.3 ± 3.0, p < 0.047) during Ramadan compared tonon-Ramadan respectively. The mean blood glucose readings were also significantly lower (70.7 ± 29.3 Vs.93.7 ± 57.9 mg/dl p < 0.011) during Ramadan compared to non -fasting period. The renal function mean ± SD (serum creatinine 1.48 ± 0.37, 1.44 ± 0.37 and eGFR, 49.0 ± 18.4, 48.9 ± 17.5 p 0.9) showed no significant change due to fasting.

CONCLUSION

In patients with diabetes and CKD-stage 3 Ramadan fasting under close supervision and optimal diabetes care, was not associated with worsening of HBA1c and renal function. Patients had significantly more frequent and prolonged hypoglycemic episodes during Ramadan.

Diagnostic Utility of Optic Nerve Measurements with MRI in Patients with Optic Nerve Atrophy

BACKGROUND AND PURPOSE

No MR imaging measurement criteria are available for the diagnosis of optic nerve atrophy. We determined a threshold optic nerve area on MR imaging that predicts a clinical diagnosis of optic nerve atrophy and assessed the relationship between optic nerve area and retinal nerve fiber layer thickness measured by optical coherence tomography, an ancillary test used to evaluate optic nerve disorders.

MATERIALS AND METHODS

We evaluated 26 patients with suspected optic nerve atrophy (8 with unilateral, 13 with bilateral and 5 with suspected but not demonstrable optic nerve atrophy) who had both orbital MR imaging and optical coherence tomography examinations. Forty-five patients without optic nerve atrophy served as controls. Coronal inversion recovery images were used to measure optic nerve area on MR imaging. Retinal nerve fiber layer thickness was determined by optical coherence tomography. Individual eyes were treated separately; however, bootstrapping was used to account for clustering when appropriate. Correlation coefficients were used to evaluate relationships; receiver operating characteristic curves, to investigate predictive accuracy.

RESULTS

There was a significant difference in optic nerve area between patients' affected eyes with optic nerve atrophy (mean, 3.09 ± 1.09 mm²), patients' unaffected eyes (mean, 5.27 ± 1.39 mm²; P = .008), and control eyes (mean, 6.27 ± 2.64 mm²; P < .001). Optic nerve area ≤ 4.0 mm² had a sensitivity of 0.85 and a specificity of 0.83 in predicting the diagnosis of optic nerve atrophy. A significant relationship was found between optic nerve area and retinal nerve fiber layer thickness (r = 0.68, P < .001).

CONCLUSIONS

MR imaging-measured optic nerve area ≤ 4.0 mm² has moderately high sensitivity and specificity for predicting optic nerve atrophy, making it a potential diagnostic tool for radiologists.

Peripheral administration of lactate produces antidepressant-like effects

In addition to its role as metabolic substrate that can sustain neuronal function and viability, emerging evidence supports a role for l-lactate as an intercellular signaling molecule involved in synaptic plasticity. Clinical and basic research studies have shown that major depression and chronic stress are associated with alterations in structural and functional plasticity. These findings led us to investigate the role of l-lactate as a potential novel antidepressant. Here we show that peripheral administration of l-lactate produces antidepressant-like effects in different animal models of depression that respond to acute and chronic antidepressant treatment. The antidepressant-like effects of l-lactate are associated with increases in hippocampal lactate levels and with changes in the expression of target genes involved in serotonin receptor trafficking, astrocyte functions, neurogenesis, nitric oxide synthesis and cAMP signaling. Further elucidation of the mechanisms underlying the antidepressant effects of l-lactate may help to identify novel therapeutic targets for the treatment of depression.

Assessment of hysteroscopic role in management of women with recurrent pregnancy loss

OBJECTIVES

To assess the hysteroscopic value in the management of intrauterine lesion in women with recurrent pregnancy loss.

METHODS

This study was done in Ain Shams Maternity Hospital after the approval of the research Ethics Committee, during the period between August 2014 and December 2015 where 200 nonpregnant women with a history of three or more consecutive unexplained first and second trimester miscarriages before 20 weeks were recruited from recurrent miscarriage clinic. A written informed consent was obtained from all women before participation.

RESULTS

This current study was conducted in Ain Shams University Maternity Hospital during the period between August 2014 to May 2015 a total of 200 women with history of recurrent miscarriage were included in the study. Regarding the results of this study the mean age was 30.5(5.7), the mean number of previous abortion 3(3-5) the mean number of the first trimesteric abortion was 2 with range (2-2) the mean number of second trimesteric abortion was 2 with range (1-2). In this study, 88% of patients were nullipara. It was also found that hysteroscopic findings were found in 58.5%. Uterine anomalies was present in 21%, including septate uterus and intrauterine adhesion (IUAs) were present in 12.5%. Endometrial polyps were present in 8.5%, bicornute uterus in 4.5%, unicornuate uterus in 4.5% while submucous myomas were present in 7.5%. It was found that 48.5% need hysteroscopic intervention including 21% need septectomy 12.5% need adhesiolysis, 6.5% need myomectomy while 8.5% need polypectomy. The study found that no statistically significant difference between patients with normal hysteroscopic finding and patients with abnormal hysteroscopic finding as regard age, time of previous abortion and number of previous abortion. But there was statistically significant difference as regard number of previous delivery and abnormal HSG.

CONCLUSIONS

It appears that hysteroscopy is a useful tool in the diagnosis and treatment of the causes of recurrent miscarriage that can be performed safely without anesthesia in most cases. The prevalence of uterine anomalies in patients with recurrent miscarriages is 54.5%, septate uterus is the most common anomaly and for this reason uterine anomalies should be systematically assessed in patients with recurrent miscarriage.

Porous Polymeric Films from Microbubbles Generated Using a T-Junction Microfluidic Device

In this work, a simple microfluidic junction with a T geometry and coarse (200 μm diameter) capillaries was used to generate monodisperse microbubbles with an alginate polymer shell. Subsequently, these bubbles were used to prepare porous alginate films with good control over the pore structure. The lack of pore size, shape, and surface control in scalable forming of polymeric films is a major application-limiting drawback at present. Controlling the thinning process of the shell of the bubbles to tune the surface of the resulting structures was also explored. Films were prepared with nanopatterned surfaces by controlling the thinning of the bubble shell, with the aid of surfactants, to induce efficient bursting (fragmentation) of bubbles to generate nanodroplets, which become embedded within the film surface. This novel feature greatly expands and enhances the use of hydrophilic polymers in a wide range of biomedical applications, particularly in drug delivery and tissue engineering, such as studying cellular responses to different morphological surfaces.

Gulf Cooperation Council-dialysis outcomes and practice patterns study: An overview of anemia management trends at the regional and country specific levels in the Gulf Cooperation Council countries

The Gulf Cooperation Council-Dialysis Outcomes and Practice Patterns Study (GCC-DOPPS) marks the joining of the six Gulf region countries including Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates to the main DOPPS study in 2012. The current review is a descriptive reporting on results related to the management of anemia from these countries. Our data demonstrate consistent anemia management patterns across the GCC countries allowing the achievement of international treatment levels. Overall, the majority of hemodialysis patients were prescribed appropriate erythropoiesis-stimulating agents (ESAs) and supplemental iron, enabling the attainment of mean hemoglobin (Hb) level of 10.9 g/dL. Comparisons of the individual country profiles reveal individual differences in the choice and mode of ESA and iron administration. However, all countries displayed good compliance with guideline recommendations. The same challenges as elsewhere are faced in the GCC, with respect to optimizing Hb levels and judiciously using ESA and iron supplements. Some opportunities exist for focused efforts to fine tune inter-facility variability in anemia management based on continued data tracking. The latter is vital in enabling adopting new trends to further improve not only anemia management but also the wholesome care of dialysis patients.

Effects of exposing ostrich eggs to doses of gamma radiation on hatchability, growth performance, and some blood biochemicals of hatched chicks

Effects of radiating ostrich eggs before incubation on hatchability, growth performance, and some blood components of ostrich chicks were studied. 72 ostrich eggs were randomly distributed into four groups. The first group was kept without exposure to gamma radiation (control). The 2nd, 3rd, and 4th groups were exposed to 0.8, 1.6, and 3.2 Gy, respectively, of ⁶⁰Co gamma rays just before incubation. Total bacterial counts (×10³ CFU) were significantly increased with the increase in gamma radiation levels before incubation. Feed conversion was lower (P ≤ 0.01) in the control group than those irradiated. Embryonic mortality rate (%), hatchability (%) and chick weight at hatch, body weight, daily body weight gain, feed consumption, and all of hematology parameters studied were insignificantly fluctuated with the doses of gamma rays used. Serum concentrations of total protein, albumen, globulin, glucose, and triiodothyronin of the chicks from eggs of the control and the 1st group were significantly the highest. Chicks of the control group had significantly the lowest values of serum concentrations of uric acid, creatinine, triglyceride, total cholesterol, ALT, and AST when compared with the other groups. In conclusion, radiation of ostrich eggs before incubation with a dose of 0.8 Gy gamma has a stimulative effect upon the metabolism of hatched chicks.

Population-based cohort study of variation in the use of emergency cholecystectomy for benign gallbladder diseases

Background

The aims of this prospective population-based cohort study were to identify the patient and hospital characteristics associated with emergency cholecystectomy, and the influences of these in determining variations between hospitals.

Methods

Data were collected for consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing the performance of emergency cholecystectomy were analysed by means of multilevel, multivariable logistic regression modelling using a two-level hierarchical structure with patients (level 1) nested within hospitals (level 2).

Results

Data were collected on 4744 cholecystectomies from 165 hospitals. Increasing age, lower ASA fitness grade, biliary colic, the need for further imaging (magnetic retrograde cholangiopancreatography), endoscopic interventions (endoscopic retrograde cholangiopancreatography) and admission to a non-biliary centre significantly reduced the likelihood of an emergency cholecystectomy being performed. The multilevel model was used to calculate the probability of receiving an emergency cholecystectomy for a woman aged 40 years or over with an ASA grade of I or II and a BMI of at least 25·0 kg/m2, who presented with acute cholecystitis with an ultrasound scan showing a thick-walled gallbladder and a normal common bile duct. The mean predicted probability of receiving an emergency cholecystectomy was 0·52 (95 per cent c.i. 0·45 to 0·57). The predicted probabilities ranged from 0·02 to 0·95 across the 165 hospitals, demonstrating significant variation between hospitals.

Conclusion

Patients with similar characteristics presenting to different hospitals with acute gallbladder pathology do not receive comparable care.