Anatomical, Histological, and Immunohistochemical Description of the Abomasum in One-Humped Adult Camel (Camelus dromedary) in the South of Iraq

The camel is an important mammal, especially in the Middle EAST, although it has received less attention than other mammals and ruminants. Due to the lack of studies in this field, the current research was designed to investigate the morphological, histological, and immunohistochemical of one-humped camel's stomach. In this study, the third chamber (abomasum) of the stomach in adult one-humped camels (Camelus dromedaries) were evaluated (n=12). The morphological study of the third chamber showed that it consisted of two parts, the letter J, where the front part was found to be tubular, the outer surface is smooth, swollen, and transparent, while the inner surface has longitudinal folds with a low height. The posterior part is spherical, and the inner surface is divided into two regions. Histological study showed that the abomasum consists of four layers and is lined with simple columnar epithelium. The lamina property is composed of loose connective tissue. It contains different glands that, according to their location from the abomasum, where cardiac, Fundus, and pyloric glands are found, as well as stomach cells such as neck cells, mucous cells, chief cells, and parietal cells. In contrast, the sub mucosa layer is composed of loose connective tissue. It was also observed that the muscular layer is developed and contained from two layers, a circular inner and the outer one is longitudinal. It was also noted that the fourth layer is composed of loose connective tissue. The histochemical study showed a positive response to the PAS reagent.

Therapeutic impact of purified Trichoderma viride L-asparaginase in murine model of liver cancer and in vitro Hep-G2 cell line

BACKGROUND

Hepatocellular carcinoma (HCC) is among the common cancers, but difficult to diagnose and treat. L-asparaginase has been introduced in the treatment protocol of pediatric acute lymphoblastic leukemia (ALL) since the 1960s with a good outcome and increased survival rates to nearly 90%. Moreover, it has been found to have therapeutic potential in solid tumors. Production of glutaminase-free-L-asparaginase is of interest to avoid glutaminase-related toxicity and hypersensitivity. In the current study, an extracellular L-asparaginase that is free of L-glutaminase was purified from the culture filtrate of an endophytic fungus Trichoderma viride. The cytotoxic effect of the purified enzyme was evaluated in vitro against a panel of human tumor cell lines and in vivo against male Wister albino mice intraperitoneally injected with diethyl nitrosamine (200 mg/kg bw), followed by (after 2 weeks) oral administration of carbon tetrachloride (2 mL/kg bw). This dose was repeated for 2 months, and after that, the blood samples were collected to estimate hepatic and renal injury markers, lipid profiles, and oxidative stress parameters.

RESULTS

L-asparaginase was purified from T. viride culture filtrate with 36 purification folds, 688.1 U/mg specific activity, and 38.9% yield. The highest antiproliferative activity of the purified enzyme was observed against the hepatocellular carcinoma (Hep-G2) cell line, with an IC₅₀ of 21.2 g/mL, which was higher than that observed for MCF-7 (IC₅₀ 34.2 g/mL). Comparing the DENA-intoxicated group to the negative control group, it can be demonstrated that L-asparaginase adjusted the levels of the liver function enzymes and the hepatic injury markers that had previously changed with DENA intoxication. DENA causes kidney dysfunction and altered serum albumin and creatinine levels as well. Administration of L-asparaginase was found to improve the levels of the tested biomarkers including kidney and liver function tests. L-asparaginase treatment of the DENA-intoxicated group resulted in a significant improvement in the liver and kidney tissues to near normal similar to the healthy control group.

CONCLUSION

The results suggest that this purified T. viride L-asparaginase may be able to delay the development of liver cancer and may be used as a potential candidate for future application in medicine as an anticancer medication.

Isolation of Pseudomonas aeruginosa from Persistent Bacterial Coinfection of a COVID-19 Patients with Molecular Detection of Antibiotics Resistance Genes

Pseudomonas aeruginosa (P. aeruginosa) have a considerable risk to public health in the world, due to its high ability to develop resistance to different classes of antibiotics. It has been discovered as a prevalent coinfection pathogen that causes sickness exacerbation in COVID-19 patients. This study aimed to determine the prevalence of P. aeruginosa from COVID-19 patients in Al Diwaniyah province, Iraq and to identify its genetic resistance pattern. 70 clinical samples were obtained from severe cases of patients (RT-PCR positive for SARS-COV-2 on a nasopharyngeal swab) who attended Al Diwaniyah Academic Hospital. 50 P. aeruginosa bacterial isolates were detected via microscopic examination, routine cultured and biochemical testing, then validated by the VITEK-2 compact system. VITEK reported 30 positive results, which later confirmed through molecular detection using 16s RNA specific for detection and a phylogenetic tree.20 isolates had positive PCR findings and 5 isolates submitted to GenBank with accession numbers OL314557.1, OL314556.1, OL314555.1, OL314554.1, OL314553.1.For antibiotic resistance genes, the number of the isolates containing blaOXA-1 and blaCTX-M 18 (90 percent) and 16 (80 percent) respectively. To study its adaptation in a SARS-CoV-2 infected environment, genomic sequencing investigations were undertaken with phenotypic validation. In conclusion, we demonstrate that multidrug resistant P. aeruginosa play an important role in in vivo colonization in COVID-19 patients and could be one of the causes of death of these patients which indicates the great challenge to clinicians in the facing of this serious disease.

Oxidative stress and inflammatory response of AgNPs and chitosan-coated AgNPs (25nm) via different doses in mice.. [DOI: 10.21203/rs.3.rs-1425133/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Objective The cytotoxicity of AgNPs in mice comparatively with chitosan-coated AgNPs. Silver and chitosan–coated AgNPs of average size 25 ± 5 nm, which were prepared and characterized at Nanotech Egypt for Photo-Electronics Methods Male mice were administered with different doses of 25, 50, and 100 mg/kg of both nanoparticles, oxidative stress markers; liver functions, pro-inflammatory cytokines and some tumor markers were measured Results AgNPs significantly increased malondialdehyde and nitric oxide levels. Moreover, it was found that AgNPs significantly increased the levels TNF-α and IL-6 as well as the levels of α-L-fucosidase and arginase and DNA damage measured by comet assay. On the contrary significantly decreased superoxide dismutase and reduced glutathione levels. They also led to deteriorations in serum aminotransferases, alkaline phosphatase and γ-glutamyltransferase levels, chitosan–coated AgNPs reduced the inflammatory caused in hepatic cells. Conclusion Chitosan–coated AgNPs was decreased AgNPs toxicity, by improving the biochemical parameters enrolled in this study, chitosan–coated AgNPs had less cytotoxic effects on liver function, and inflammatory biomarkers.

Chromosomal aberrations, DNA damage and biochemical disturbances induced by silver nanoparticles in mice: Role of particle size and natural compounds treatment

CONTEXT

Nanotechnology is widely used nowadays in several fields of industry, engineering, and medicine, the biological action mechanisms of AgNPs, which mainly involve the release of silver ions (Ag⁺), generation of reactive oxygen species (ROS).

OBJECTIVE

The potential toxicity AgNPs of damages to hepatic cells, hesperidin, and naringin role for their protective effect against the increase of ROS due to AgNPs toxicity. They can be restored, most cellular biochemical parameters, genotoxicity, mutagenicity, and histopathological analysis.

MATERIALS AND METHODS

Toxicity was induced by an oral dose of Ag NPs of (20-100 nm) for one month, after that treated with hesperidin, naringin (100 mg/kg) for three weeks, malondialdehyde (MDA) levels, nitric oxide (NO), glutathione (GSH) and catalase were estimated. Also, aminotransferases (AST and ALT), alkaline phosphatase (ALP), γ-glutamyltransferase (GGT), albumin, and total bilirubin were determined, following Chromosomal aberrations, DNA breaks and histological analyses.

RESULTS

hesperidin, and naringin treatment, recorded amelioration in most biochemical, genetic and spermatogenesis disturbances Also, histological Investigations were improved.

CONCLUSION

Their biological safety problems such as potential toxicity on cells, tissue, and organs should be paid enough attention, hesperidin and naringin amelioration fundamental alterations, as hepatic architectural and DNA damage, related to its role as antioxidant and anti-inflammatory agent.

Synthesis and hyperglycemic, biochemical and histopathological evaluation of novel sulfonylbiguanide and sulfonylurea derivatives as potent anti-diabetic agents

New sulfonylbiguanide hydrochloride salts and sulfonylurea derivatives containing two sulfonyl groups were synthesized through the reaction of arylsulfonohydrazides with cyanoguanidine and p-tolylsulfonylisocyanate, respectively. Oral treatment of hyperglycemic rats with the synthesized sulfonylbiguanide derivatives 2 and sulfonylurea derivatives 3 revealed that sulfonylurea derivatives 3a and 3c possessed significant decrease of the elevated glucose in compression with the anti-diabetic standard drugs. Effects of the synthesized sulfonylurea derivatives 3a and 3c on the diabetic properties towards α-amylase, liver function enzyme levels (AST, ALT, ALP, TB and γ-GT), kidney functions (urea and creatinine), lipids profiles (TG, TL, TC and HDL-C) were studied. Also, the effect of sulfonylurea derivatives 3a and 3c as antioxidants (reduced glutathione and lipid peroxide) was evaluated. Histopathological examination of hepatic and pancreatic tissues was investigated. The obtained results suggested that the most potent sulfonylurea derivatives 3a and 3c might be possible used as novel diabetic inhibitor agents.

Evaluation of carcinogenic activities and sperm abnormalities of Gram-negative bacterial metabolites isolated from cancer patients after subcutaneous injection in albino rats

Microbial pathogens drive tumorigenesis in 20% of cancer cases, so the present study is aimed to evaluate the carcinogenic activities, sperm abnormalities and other dangerous effects of the subcutaneous injection of extracts obtained from various clinical Gram-negative bacteria derived from cancer patients using albino rats. We isolated, identified and extracted of their secondary metabolites of carbapenem resistant Gram-negative bacteria derived from cancer patients. Various methods have been used to determine hepatotoxicity, nephrotoxicity, tumorigenesis, inflammatory and sperm abnormalities in the albino rats injected with extracts. In comparison with the normal animals group, all extracts induced hepatotoxicity which was evidenced by the significant elevation in the activity of the serum alanine aminotransferase, aspartate aminotransferase, gamma-glutamyltransferase and alkaline phosphatase; also, nephrotoxicity that was indicated through the marked increase in the serum urea and creatinine levels; tumorigenesis was achieved from the sharp elevation in serum levels of alpha fetoprotein, carcinoembryonic antigen and lactate dehydrogenase values as tumor markers; as well as severe inflammatory characteristics were monitored from the marked raise of tumor necrosis factor alpha and interleukin-1beta. Furthermore, the proportion of micronuclei in polychromatic erythrocytes and sperm abnormalities were statistically significant in all groups compared to control group. Various kinds of head abnormalities and coiled tail were noted. Histopathological examination of hepatic tissue came in line with the biochemical and cytological findings. It could conclude that the extracts of Serratia sp. Esraa 1, Stenotrophomonas sp. Esraa 2, Acinetobacter sp. Esraa 3, Escherichia sp. Esraa 4 and Pseudomonas sp. Esraa 5 were able to initiate cytotoxicity and tumorigenesis in rats.

Sequencing identifies a distinct signature of circulating microRNAs in early radiographic knee osteoarthritis

OBJECTIVE

MicroRNAs act locally and systemically to impact osteoarthritis (OA) pathophysiology, but comprehensive profiling of the circulating miRNome in early vs late stages of OA has yet to be conducted. Sequencing has emerged as the preferred method for microRNA profiling since it offers high sensitivity and specificity. Our objective was to sequence the miRNome in plasma from 91 patients with early [Kellgren-Lawrence (KL) grade 0 or 1 (n = 41)] or late [KL grade 3 or 4 (n = 50)] symptomatic radiographic knee OA to identify unique microRNA signatures in each disease state.

DESIGN

MicroRNA libraries were prepared using the QIAseq miRNA Library Kit and sequenced on the Illumina NextSeq 550. Counts were produced for microRNAs captured in miRBase and for novel microRNAs. Statistical, bioinformatics, and computational biology approaches were used to refine and interpret the final list of microRNAs.

RESULTS

From 215 differentially expressed microRNAs (FDR < 0.01), 97 microRNAs showed an increase or decrease in expression in ≥85% of samples in the early OA group as compared to the median expression in the late OA group. Increasing this threshold to ≥95%, seven microRNAs were identified: hsa-miR-335-3p, hsa-miR-199a-5p, hsa-miR-671-3p, hsa-miR-1260b, hsa-miR-191-3p, hsa-miR-335-5p, and hsa-miR-543. Four novel microRNAs were present in ≥50% of early OA samples and had 27 predicted gene targets in common with the prioritized set of predicted gene targets from the 97 microRNAs, suggesting common underlying mechanisms.

CONCLUSION

Sequencing of well-characterized patient cohorts produced unbiased profiling of the circulating miRNome and identified a unique panel of 11 microRNAs in early radiographic knee OA.

C-reactive Protein Signaling and Chromosomal Abnormalities in Nanotoxicity Induced via Different Doses of TiO2 (80 nm) Boost Liver Function

The wide application of nanotechnology merits the need to clarify their nanotoxicity. In vivo studies have raised concerns about the toxicity of titanium dioxide nanoparticles (TiO₂ NPs), but there are limited data on chromosomal abnormalities induced in hepatic tissue. In this article, the toxicity of three IP doses of TiO₂ NPs (80 nm) (50, 250, and 500 mg/kg) through three time intervals (up to 7, 15, and 45 days) on liver tissue was assessed. Hepatic catalase (CAT), glutathione (GSH), nitric oxide (NOx), and malondialdehyde (MDA) levels varied with the administered dose and exposure time of TiO₂ NPs. As a result, TiO₂ NPs caused a statistically significant decrease in hepatic CAT and GSH activities and a significant alleviation in MDA and NOx levels (p < 0.05), suggesting that the liver exposed to these various doses of TiO₂ NPs suffered from severe oxidative stress. The extent of depletion of antioxidant enzymes and the elevation of MDA and NOx in the liver exposed to the highest dose and duration of TiO₂ NPs 500 mg for 45 days was the greatest, suggesting that the toxicity might be dose and time dependent. Further, C-reactive protein (CRP) as an inflammatory marker was also alleviated, in addition to the apparent chromosomal aberration and liver pathologies including necrotic and fibrotic hepatocytes after exposure to 250 and 500 mg/kg of TiO₂ NPs for 14 and 45 days that were deduced. Hence, nanotechnology-based industries are growing rapidly leading to large-scale production of engineered nanoparticles. They contribute to increased chances of human NPs exposure and health risk.

Therapeutic effects of mesenchymal stem cells on cutaneous leishmaniasis lesions caused by Leishmania major

OBJECTIVES

Leishmania major (L. major) is a cutaneous leishmaniasis causative agent. Current chemotherapeutic methods are not totally effective in treatment of this disease. The immunomodulation and tissue repairing capability of mesenchymal stem cells (MSCs), ease of isolation, detection and in vitro culture, have encouraged biologists to use MSCs for cell therapy in different infections such as cutaneous leishmaniasis.

METHODS

BALB/c mice (6-8 weeks old) were infected with L. major then divided into four groups and treated with MSCs, Glucantime, Glucantime + MSCs, or PBS. Regression of lesions, potency of macrophages for phagocytosis, proliferation of immune cells against Leishmania soluble antigen, reduction of spleen parasite burden and healing of the lesions were evaluated on days 10, 20 and 30 of treatment.

RESULTS

The results indicated that the mice intralesionally injected with MSCs showed significant regression in the lesions produced by L. major by day 30. Proliferation of splenocytes stimulated with SLA (soluble leishmania antigen) in vitro in MSC-treated mice on day 20 was significantly higher than in the other groups. The potency of phagocytosis in macrophages of mice treated with MSCs was significantly higher by day 30 and healing of the lesions in this group of mice showed more progress on histopathological examinations. Spleen parasite burden showed significant reduction in the mice treated with Glucantime + MSCs by day 30.

CONCLUSIONS

The results showed that including MSCs in treatment of cutaneous leishmaniasis caused by L. major is a promising approach.

DNA damage and genetic aberration induced via different sized silver nanoparticles: Therapeutic approaches of Casimiroa edulis and Glycosmis pentaphylla leaves extracts

Potential of Casimiroa edulis and Glycosmis pentaphylla leaves extracts were investigated against the effect of two different particle sizes of silver nanoparticles induced toxicity in mice. Mice received silver nanoparticles (AgNPs) (100 mg/kg) with 20 and 100 nm for four weeks followed by daily oral dose of extracts (500 mg/kg) for three weeks. C. edulis leaves identified fourteen phenolic compounds while, G. pentaphylla leaves identified, twelve phenolic compounds. Additionally, biochemical, genotoxicity, mutagenicity, and histopathological investigations were carried out, revealed that liver function activities, lipid profile, hydrogen peroxide, and C-reactive protein were significantly elevate post AgNPs exposure. While, superoxide dismutase, glutathione-S-transferases, and glutathione peroxidase significantly reduce. A marked amelioration in all detected biomarkers, improved histopathological changes and repair DNA damage after treated with C. edulis and G. pentaphylla leaves extracts. These extracts are used for the first time as promising candidate therapeutic agents against toxicity induced by AgNPs. PRACTICAL APPLICATIONS: The potential applications of AgNPs make it necessary to investigate the possible toxicity associated with release of free silver ions in the biological system. AgNPs of varying particle sizes had toxic effects as evidenced by alterations in some cellular biochemical parameters, genotoxicity, mutagenicity, and histopathological indices on mice. Casimiroa edulis and Glycosmis pentaphylla leaves extracts are used for the first time as promising candidate therapeutic, where they are able to ameliorate the toxicity induced via AgNPs and record vacillate percentage of improvement in the selected biomarkers, as a result of the bioactive secondary metabolites especially flavonoids and other polyphenolic compounds.

Aerosolised Mesenchymal Stem Cells Expressing Angiopoietin-1 Enhances Airway Repair

BACKGROUND

The aim of this study was to investigate the effects of MSCs and MSC-expressing ANGPT1 (MSC-pANGPT1) treatment via aerosolisation in alleviating the asthma-related airway inflammation in the rabbit model.

METHODS

Rabbits were sensitised and challenged with both intraperitoneal injection and inhalation of ovalbumin (Ova). MSCs and MSC-pANGPT1 cells were aerosolised into rabbit lungs using the MicroSprayer® Aerosolizer Model IA-1B 48 h after injury. The post mortem was performed 3 days following cell delivery. Histopathological assessments of the lung tissues and inflammatory response were quantitatively scored following treatments.

RESULT(S)

Administration of aerosolised MSCs and MSC-pANGPT1 were significantly reduced inflammation of the airways (p < 0.001), as reflected by improved of structural changes such as thickness of the basement membrane, epithelium, mucosa and sub-mucosa regions. The airway inflammation score of both treatment groups revealed a significant reduction of inflammation and granulocyte infiltration at the peribronchiale and perivascular regions (p < 0.05). Administration of aerosolised MSCs alone was resulted in significant reduction in the levels of pro-inflammatory genes (IL-4 and TGF-β) while treatment with aerosolised MSC-pANGPT1 led to further reduction of various pro-inflammatory genes to the base-line values (IL4, TNF, MMP9 and TGF-β). Treatment with both aerosolised MSCs and MSC-pANGPT1 cells was also alleviated the number of airway inflammatory cells in the bronchoalveolar lavage (BAL) fluid and goblet cell hyperplasia.

CONCLUSION(S)

Our findings suggest that treatment with MSCs alone attenuated airway inflammation and structural changes of the airway. Treatment with MSC-pANGPT1 provided an additional effect in reducing the expression levels of various pro-inflammatory genes. Both of these treatment enhancing airway repair and therefore may provide a basis for the development of an innovative approach for the treatment and prevention of airway inflammatory diseases.

The role of age and mode of delivery in the STEPS intervention: a longitudinal pilot-study in treatment of posttraumatic stress symptoms in Danish survivors of sexual assault

Background: The STEPS programme has been succesfully implemented as a group-based treatment of trauma symptoms after rape for adolescents. The STEPS intervention was translated from Dutch to Danish and offered to adults in addition to adolescents as well as an individual intervention in addition to a group-based intervention at a Danish Centre for Rape Victims through 2011 to 2014. The programme was translated from Dutch to Danish and expanded to adults in addition to adolescents as well as to an individual intervention in addition to a group-based intervention at a Danish Centre for Rape Victims through 2011 to 2014. Objective: The present study observes  development in trauma symptoms and ICD-11 diagnostic status during an adapted version of the intervention programme 'STEPS' for survivors of sexual assault. Methods: A prospective uncontrolled study was conducted, monitoring symptoms of posttraumatic stress and other trauma-related symptomatology before treatment, after treatment and at 6 and 12 months' follow up for 103 referrals receiving individual or group-based STEPS. Tentative diagnoses of posttraumatic stress disorder (PTSD) and complex PTSD were assigned to participants according to the ICD-11 to observe the development in diagnostic status across time, and multilevel modelling was used to assess the development of symptom severity and to assess the moderating effect of age-group and mode of delivery. Results: A loglinear function representing large and statistically significant decline in symptomatology over time provided the best fit for all measures of trauma-related symptomatology. The decline was not moderated by age-group or mode of intervention. Dropout rates were independent of mode of intervention and age. Conclusion: The adaption of the STEPS programme to adults and as an individual intervention is feasible and maintains effect sizes comparable to those observed in the original intervention. Further research using randomized controlled trials is needed to ascribe the observed effect to the STEPS programme.

Prospective evaluation of the diagnostic potential of LipL32 based latex agglutination test for Bovine leptospirosis

The Livestock Sector of India plays an important role in livelihood security and socioeconomic development of rural households. Leptospirosis is an important zoonotic disease responsible for septicaemia, interstitial nephritis, jaundice, abortion, reproductive problem in most of the animal species. Reproductive disturbances in bovine population is most often restricted to investigation of brucellosis, however apart from brucellosis, there are many undiagnosed diseases like leptospirosis that takes a toll in the reproductive anomalies of cattle and buffalo. Hence, the present study was elucidated to screen the seroprevalence of Leptospira in cattle and buffalo in various hamlets of North India using a user friendly screening test i.e. LipL32 latex agglutination test. The overall seropositivity was found to be 26.01% (230/884) in case of bovine in this study and the LipL32 LAT showed a profound sensitivity and specificity with level of 94.97% and 99.53% respectively.

The potential chemo preventive effect of ursolic acid isolated from Paulownia tomentosa, against N-diethylnitrosamine: initiated and promoted hepatocarcinogenesis

The present study discusses the isolation of ursolic acid from the chloroform extract of Paulownia tomentosa (Thunb) Steud fruits and its cytotoxic effect has been assessed in-vitro was performed in different cells lines (A-549, MCF-7, HepG2) and in-vivo using N-diethylnitrosamine. The obtained results revealed that ursolic acid showed significant cytotoxic activity on MCF-7 and HepG2 cell lines in comparison to Doxorubicin as a reference drug. Moreover, we have assessed the inhibitory effects of Paulownia tomentosa fruit chloroform extract and the isolated ursolic acid on hepatocarcinogenesis was carried out for the first time using N-diethylnitrosamine, where the group treated with ursolic acid given orally after 8 weeks of cancer induction showed the most significant results in comparison to the chloroform extract. The effect of ursolic acid on intoxicated rats caused significant restoration of most of the normal hepatocytes architecture with regular dark nuclei and the group treated with Paulownia tomentosa fruits showed remarkable results with improvement in biochemical analysis.

Maternal anaemia and maternal, fetal, and neonatal outcomes in a prospective cohort study in India and Pakistan

OBJECTIVE

To describe the association of maternal anaemia with maternal, fetal, and neonatal outcomes.

DESIGN

Prospective cohort study.

SETTING

Rural India and Pakistan.

POPULATION

Pregnant women residing in the study catchment area.

METHODS

We performed an analysis of a prospective pregnancy registry in which haemoglobin is commonly obtained as well as maternal, fetal, and neonatal outcomes for 42 days post-delivery. Women 40 years or older who delivered before 20 weeks or had a haemoglobin level of <3.0 g/dl were excluded. Our primary exposure was maternal anaemia, which was categorised in keeping with World Health Organization criteria based on a normal (≥11 g/dl), mild (>10-10.9 g/dl), moderate (7-9.9 g/dl) or severe (<7 g/dl). haemoglobin level. The primary maternal outcome was maternal death, the primary fetal outcome was stillbirth, and the primary neonatal outcome was neonatal mortality <28 days.

RESULTS

A total of 92 247 deliveries and 93 107 infants were included, of which 87.8% were born to mothers who were anaemic (mild 37.9%, moderate 49.1%, and severe 0.7%). Maternal mortality (number per 100 000) was not associated with anaemia: normal 124, mild 106, moderate 135, and severe 325 (P = 0.64). Fetal and neonatal mortality was associated with severe anaemia: stillbirth rate (n/1000)-normal 27.7, mild 25.8, moderate 30.1, and severe 90.9; P < 0.0001; 28-day neonatal mortality (n/1000)-normal 24.7, mild 22.9, moderate 28.1, and severe 72.6 (P < 0.0001). Severe maternal anaemia was also associated with low birthweight (<2500 and <1500 g), preterm birth, and postpartum haemorrhage.

CONCLUSION

Severe maternal anaemia is associated with higher risks of poor maternal, fetal, and neonatal outcomes but other degrees of anaemia are not. Interventions directed at preventing severe anaemia in pregnant women should be considered.

TWEETABLE ABSTRACT

Severe maternal anaemia is associated with adverse fetal and neonatal outcomes in low/middle-income countries.

Intestinal parasitic infections frequency in referred patients to a large teaching hospital, Khuzestan, Southwest, Iran, 2017

Intestinal parasitic infections (IPIs) are among the most important infectious diseases in Iran. A cross sectional study was designed to determine frequency of intestinal parasites among referrals to a large teaching hospital in Khuzestan, Southwest of Iran, 2017. A total number of 5613 stool samples were examined through direct smear and formalin-ether concentration methods to detect possible parasitic infections. Samples consisted of 2643 (47.09%) male and 2970 (52.91%) female. A total of 1468 (26.15%) samples were positive (13.11% male and 13.4% female) and 4145 (73.85%) were negative. The results also showed that 255 of samples had more than one type of parasite (mix infections). Counting single and mix parasite infections, the total number of positive cases reached to 1723. Helminthes parasites were present in 12 (0.7%) cases, while intestinal protozoan parasites were in 1711 (99.3%) cases. Almost equally, pathogenic and nonpathogenic parasites infected 860 (49.91%) and 863 (50.09%) of patients, respectively. The frequency for helminthes was determined at 0.52% with Hymenolepis nana and Enterobius vermicularis however, Giardia lamblia in 38.54% and Entamoeba histolytica/dispar at 10.68% were concluded as protozoa elements. The IPIs frequency was recorded in female and male patients at 49.16% and 50.14%, respectively. According to the current results the infection rate of intestinal parasites has been significantly reduced especially for helminths infections in this region possibly due to public attention to health issues such as; increased awareness of people, improvement of sanitation, seasonal variations, health education and personal hygiene.

Subcutaneous veins depth measurement using diffuse reflectance images

Intravenous (IV) procedures are often difficult due to the poor visualization of subcutaneous veins. Because existing vein locators lack the ability to assess depth, and also because mis-punctures and poor vascular access remain problematic, we propose an imaging system that employs diffuse reflectance images at three isosbestic wavelengths to measure both the depth and thickness of subcutaneous veins. This paper describes the proposed system as well as proof-of-principle experimental demonstrations. We initially introduce the working principle and structure of the system. All measurements were based on the Monte Carlo (MC) method and accomplished by referring an optical density (OD) ratio to a multi-layer diffuse reflectance model. Results were all validated by comparative ultrasound measurements. Experimental trials included 11 volunteers who were subjected to both ultrasound measurements and the proposed optical process to validate the system's applicability. However, the unreliability of the "thickness" measurement of the vein may be due to the fact that the veins have collapsible walls - so excess pressure by the transducer will give a false thickness.

Device-associated infections in a paediatric intensive care unit in Pakistan

This study assessed the effect of implementation of active infection control and surveillance on the occurrence of device-associated infections (DAIs) in a paediatric intensive care unit (PICU) from 2012 to 2015. There were 1378 patients, equating to 4632 patient-days, on the PICU, and 29 DAI episodes, giving an incidence rate of 2.1% and an incidence density rate of 6.26 per 1000 patient-days. The rates of central-line-associated bloodstream infections, ventilator-associated pneumonia and catheter-related urinary tract infections were 7/1000 central-line-days, 1.17/1000 ventilator-days and 0.24/1000 urinary-catheter-days, respectively. Despite the overall low rate of DAIs in the PICU, there was a relatively high rate of central-line-associated bloodstream infections.

Antischistosomal Activity of Two Active Constituents Isolated from the Leaves of Egyptian Medicinal Plants

In this paper, we investigate the role of two active constituents isolated from the leaves of Egyptian medicinal plants. D-mannitol a naturally occurring sugar isolated from the leaves Ixora undulata Roxb., and the pectin a linear chain homogalacturonan (HG) polysaccharide isolated from the leaves of Linum grandiflorum Desf. (scarlet flax). Both are evaluated for their therapeutic effect against schistosomiasis with biochemical and histochemical evaluations and compared with praziquantel, a reference drug. Biochemical studies of hepatic glucose, the glycogen content, and total serum protein were carried out, and histochemical evaluations through serum protein fractions separated by polyacrylamide gel electrophoresis with different molecular weights (260-10 kDa) were made in all groups, in addition to liver and body weight. D-mannitol and pectin show a remarkable effect in enhancing liver and kidney functions through enhancing most protein fractions in the serum of mice infected with Schistosoma mansoni. Also, the glucose and glycogen content in injured liver tissues improved, in addition liver and body weight in the infected groups. Thus they may be of therapeutic potential in the treatment hepatoxicity and nephrotoxicity.

Potential antifibrotic and angiostatic impact of idebenone, carnosine and vitamin E in nano-sized titanium dioxide-induced liver injury

BACKGROUND/AIM

The present study investigated the in vitro and in vivo effects of individual and combined doses of idebenone, carnosine and vitamin E on ameliorating some of the biochemical indices of nano-sized titanium dioxide (n-TiO2) in mice liver.

METHODS

The in vitro cytotoxic effect of nano-sized anatase TiO2 (21 nm) on hepatic cell lines (HepG 2) was investigated. Additionally, n-TiO2 was orally administered (150 mg/kg/day) for 2 weeks, followed by a daily intragastric gavage of the aforementioned antioxidants for 1 month.

RESULTS

n-TiO2 induced significant cytotoxicity in hepatic cell lines and elevated the levels of serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), hepatic total antioxidant capacity (TAC) and nitrite/nitrate (NOx) levels. Meanwhile, glutathione-S-transferase (GST) activity was significantly reduced. Moreover, RT-PCR and western blot analysis showed that n-TiO2 significantly altered the mRNA and protein expressions of transforming growth factor-beta (TGF-β1) and Smad-2, as well as vascular endothelium growth factor (VEGF). Histopathological examination of hepatic tissue reinforced these results.

CONCLUSION

Idebenone, carnosine and vitamin E ameliorated the deviated parameters with the combination regimen demonstrating the most pronounced effect. Oxidative stress, liver fibrosis and angiogenesis may be implicated in n-TiO2-induced liver toxicity.

Amelioration of titanium dioxide nanoparticles-induced liver injury in mice: possible role of some antioxidants

This study investigates the efficacy of idebenone, carnosine and vitamin E in ameliorating some of the biochemical indices induced in the liver of titanium dioxide nanoparticles (TiO2 NPs) intoxicated mice. Nano-anatase TiO2 (21 nm) was administered (150 mg/kg/day) for 2 weeks followed by the aforementioned antioxidants either alone or in combination for 1 month. TiO2 NPs significantly increased serum liver function enzyme activities, liver coefficient and malondialdehyde levels in hepatic tissue. They also suppressed hepatic glutathione level and triggered an inflammatory response via the activation of macrophages and the enhancement of tumor necrosis factor-α and interleukin-6 levels. Moreover, the mRNA expression of nuclear factor-erythroid-2-related factor 2, nuclear factor kappa B and Bax was up-regulated whereas that of Bcl-2 was down-regulated following TiO2 NPs. Additionally, these NPs effectively activated caspase-3 and caused liver DNA damage. Oral administration of idebenone (200mg/kg), carnosine (200mg/kg) and vitamin E (100mg/kg) alleviated the hazards of TiO2 NPs with the combination regimen showing a relatively higher effect. The histopathological examination reinforced these findings. In conclusion, oxidative stress could be regarded as a key player in TiO2 NPs-induced liver injury. The study also highlights the anti-inflammatory and the anti-apoptotic potentials of these antioxidants against the detrimental effects of TiO2 NPs.

Virulence loss and amastigote transformation failure determine host cell responses to Leishmania mexicana

The effect of alterations in virulence and transformation by long-term in vitro culture of Leishmania mexicana promastigotes on infectivity and immune responses was investigated. Fresh parasite cultures harvested from Balb/c mice were passaged 20 times in vitro. Infectivity was decreased and was completely avirulent after 20 passages. The qPCR results showed a down-regulation of GP63, LPG2, CPC, CPB2, CPB2.8, CHT1, LACK and LDCEN3 genes after passage seven concomitant with a reduced and absence of infectivity by passages seven and 20, respectively. Parasites at passages one and 20 are referred to as virulent and avirulent, respectively. The growth of avirulent and virulent parasite was affected by conditioned media derived from macrophages or monocytes infected with parasites for 2 h. Giemsa staining showed the failure of avirulent but not virulent parasites to transform to the amastigote stage in infected host cells with both virulent and avirulent modulating the expression of CCL-22, Tgad51, Cox2, IL-1, IL-10, TGF-β, TNF-α, Rab7, Rab9 and A2 genes; virulent but not avirulent L. mexicana significantly up-regulated Th2-associated cytokines, but down-regulated Rab7 and Rab9 gene expression. In conclusion, a model for L. mexicana is reported, which is of potential value in studying host-parasite interaction.

Monitoring polio supplementary immunization activities using an automated short text messaging system in Karachi, Pakistan

PROBLEM

Polio remains endemic in many areas of Pakistan, including large urban centres such as Karachi.

APPROACH

During each of seven supplementary immunization activities against polio in Karachi, mobile phone numbers of the caregivers of a random sample of eligible children were obtained. A computer-based system was developed to send two questions--as short message service (SMS) texts--automatically to each number after the immunization activity: "Did the vaccinator visit your house?" and "Did the enrolled child in your household receive oral polio vaccine?" Persistent non-responders were phoned directly by an investigator.

LOCAL SETTING

A cluster sampling technique was used to select representative samples of the caregivers of young children in Karachi in general and of such caregivers in three of the six "high-risk" districts of the city where polio cases were detected in 2011.

RELEVANT CHANGES

In most of the supplementary immunization activities investigated, vaccine coverages estimated using the SMS system were very similar to those estimated by interviewing by phone those caregivers who never responded to the SMS messages. In the high-risk districts investigated, coverages estimated using the SMS system were also similar to those recorded--using lot quality assurance sampling--by the World Health Organization.

LESSONS LEARNT

For the monitoring of coverage in supplementary immunization activities, automated SMS-based systems appear to be an attractive and relatively inexpensive option. Further research is needed to determine if coverage data collected by SMS-based systems provide estimates that are sufficiently accurate. Such systems may be useful in other large-scale immunization campaigns.

Non-viral factors contributing to hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is a major cause of cancer death worldwide, accounting for over half a million deaths per year. The geographic pattern of HCC incidence is parallel to exposure to viral etiologic factors. Its incidence is increasing, ranging between 3% and 9% annually depending on the geographical location, and variability in the incidence rates correspond closely to the prevalence and pattern of the primary etiologic factors. Chronic infections with hepatitis B viruses or hepatitis C viruses have both been recognized as human liver carcinogens with a combined attributable fraction of at least 75% of all HCC cases. Multiple non-viral factors have been implicated in the development of HCC. Increased body mass index and diabetes with subsequent development of non-alcoholic steatohepatitis represent significant risk factors for HCC. Other non-viral causes of HCC include iron overload syndromes, alcohol use, tobacco, oral contraceptive, aflatoxin, pesticides exposure and betel quid chewing, a prevalent habit in the developing world. Wilson disease, α-₁ antitrypsin deficiency, Porphyrias, autoimmune hepatitis, Schistosoma japonicum associated with positive hepatitis B surface antigen, and thorotrast-ray are also contributing hepatocellualar carcinoma. In addition, primary biliary cirrhosis, congestive liver disease and family history of liver cancer increase the risk of HCC incident. In conclusion, clarification of relevant non-viral causes of HCC will help to focus clinicians on those risk factors that are modifiable. The multilevel preventative approach will hopefully lead to a reduction in incidence of non-viral HCC, and a decrease in the patient morbidity and mortality as well as the societal economic burden associated with HCC.

Non-viral factors contributing to hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is a major cause of cancer death worldwide, accounting for over half a million deaths per year. The geographic pattern of HCC incidence is parallel to exposure to viral etiologic factors. Its incidence is increasing, ranging between 3% and 9% annually depending on the geographical location, and variability in the incidence rates correspond closely to the prevalence and pattern of the primary etiologic factors. Chronic infections with hepatitis B viruses or hepatitis C viruses have both been recognized as human liver carcinogens with a combined attributable fraction of at least 75% of all HCC cases. Multiple non-viral factors have been implicated in the development of HCC. Increased body mass index and diabetes with subsequent development of non-alcoholic steatohepatitis represent significant risk factors for HCC. Other non-viral causes of HCC include iron overload syndromes, alcohol use, tobacco, oral contraceptive, aflatoxin, pesticides exposure and betel quid chewing, a prevalent habit in the developing world. Wilson disease, α-1 antitrypsin deficiency, Porphyrias, autoimmune hepatitis, Schistosoma japonicum associated with positive hepatitis B surface antigen, and thorotrast-ray are also contributing hepatocellualar carcinoma. In addition, primary biliary cirrhosis, congestive liver disease and family history of liver cancer increase the risk of HCC incident. In conclusion, clarification of relevant non-viral causes of HCC will help to focus clinicians on those risk factors that are modifiable. The multilevel preventative approach will hopefully lead to a reduction in incidence of non-viral HCC, and a decrease in the patient morbidity and mortality as well as the societal economic burden associated with HCC.

Effects of black seed oil on resolution of hepato-renal toxicity induced bybromobenzene in rats

OBJECTIVE

Volatile halocarbon, bromobenzene (BB), is frequently encountered in table-ready foods as contaminants residues. The objective of this study was to investigate whether black seed oil could attenuate hepato-renal injury induced by BB exposure.

MATERIALS AND METHODS

The evaluation was done through measuring liver oxidative stress markers: reduced glutathione (GSH), superoxide dismutase (SOD) and malondialdehyde (MDA). Hepatic succinate dehydrogenase (SDH), lactate dehydrogenases (LDH) and glucose-6-phosphatase (G-6-Pase) were estimated. Serum aspartate and alanine aminotransferases (AST, ALT) and alkaline phosphatase were also evaluated. Kidney function indices; blood urea nitrogen (BUN), creatinine, serum protein, nitric oxide (NO), Na-K-adenosine triphosphatase (Na+-K+-ATPase) and phospholipids were done. Liver and kidney histopathological analysis and collagen content were analyzed for results confirmation.

RESULTS

Treatment with black seed oil (BSO) alleviated the elevation of GSH, SDH, LDH, G-6-Pase, serum protein, NO, Na+-K+-ATPase, phospholipids levels and attenuated MDA, SOD, AST, ALT and ALP. Diminution of collagen content and improvement in liver and kidney architectures were observed.

CONCLUSIONS

BSO enhanced the hepato-renal protection mechanism, reduced disease complications and delayed its progression. Further studies are needed to identify the molecules responsible for its pharmacological effect.  

Malachite green induces genotoxic effect and biochemical disturbances in mice

BACKGROUND AND OBJECTIVES

Malachite green (MG) is a triarylaminmethane dye used in the fish industry as an anti-fungal agent. Concern over MG is due to the potential for consumer exposure, suggestive evidence of tumor promotion in rodent liver, and suspicion of carcinogenicity based on structure-activity relationships. In order to evaluate the risks associated with exposure to MG, we examined the mutagenicity and biochemical effect of MG.

MATERIALS AND METHODS

For genotoxic effect we use the doses 27, 91, 272 and 543 mg/kg b.wt. for different period of time (7, 14, 21 and 28 days) to evaluate chromosomal aberrations in mouse somatic and germ cells as well as sister chromatid exchanges in bone marrow cells. For DNA fragmentation assay from mouse liver the same doses of MG were used for 28 days. For measuring biochemical parameters such as glycolysis and gluconeogenesis enzyme pathways, antioxidant indices, hepatic marker enzymes, total protein, glucose, glycogen levels and liver function enzyme activities were evaluated. Mice were treated orally up to 28 days with the two high doses of MG 272 and 543 mg/kg b.wt.

RESULTS AND CONCLUSIONS

Our results show that MG induce elevation in the percentage of SCE's and chromosomal aberrations (p < 0.01) after treatment with the high doses for long period of time. MG also induces DNA damage in mice liver in a dose dependent manner. Beside, MG treatment either in low or high doses causes biochemical disturbances in the major glucolytic-gluconeogenic pathways, hepatic marker enzymes, depleted glutathione and increased free radical as determined by increasing lipid peroxide. Histopathological observations revealed that MG induced sinusoidal, congestion, focal necrosis and degenerating in hepatic cells, hypertrophy and vacuolization followed by necrosis and cirrhosis.

Therapeutic potential of ginger against renal injury induced by carbon tetrachloride in rats

The objective of this study was to evaluate the potential of successive ginger extracts (petroleum ether, chloroform, and ethanol) against nephrotoxicity induced by CCl(4) in rats. The evaluation was done through measuring kidney antioxidant parameters: glutathione (GSH), lipid peroxides (LPO), and superoxide dismutase (SOD). Renal function test: urea, creatinine and serum protein values, were also evaluated. The work was extended to examine tissue inflammatory mediators, prostaglandin-E(2) (PGE(2)), collagen content and the kidney histopathology. Severe alterations in all biomarkers were observed after injury with CCl(4). Treatment with ginger extracts resulted in markedly decreased levels of LPO, PGE(2), collagen and kidney function tests, while increased levels of GSH, SOD and serum protein were observed. In conclusion, extracts of ginger, particularly the ethanol, resulted in an attractive candidate for the treatment of nephropathy induced by CCl(4) through scavenging free radicals, improved kidney functions, inhibition of inflammatory mediators, and normalizing the kidney histopathological architecture. Further studies are required in order to identify the molecules responsible of the pharmacological activity.

Fragility fractures in the elderly: Evolving approaches in the NHS

Fragility fractures account for a significant proportion of trauma admissions and clinic attendances in the UK. Hip fractures constitute a major part of these fractures followed by wrist, spine and humerus. With the increasing elderly population and increasing life expectancy, incidences of these fractures have increased proportionately. Hip fractures cause significant morbidity and mortality because of existing medical co-morbidities or perioperative complications. In order to decrease the overall incidence of osteoporotic fractures and improve outcome of surgical treatment, different approaches to prevention and treatment are currently evolving throughout the NHS. These include primary prevention through management of osteoporosis and secondary prevention aimed at treating osteoporosis and reducing further fractures. In this article, we highlight the different care pathways that could effectively decrease the incidence of fragility fractures as well as the morbidity and mortality in these patients.

Immunogenicity of MHC Class I Peptides Derived from Leishmania mexicana Gp63 in HLA-A2.1 Transgenic (HHDII) and BALB/C Mouse Models

BACKGROUND

Leishmania is an intracellular parasite infecting humans and many wild and domestic animals. Recent studies have suggested an important role for cytotoxic T cells against Leishmania. Peptide-based vaccines targeting short sequences derived from known immunogenic proteins have been shown to elicit cellular immune responses against disparate pathogens.

METHODS

We predicted four HLA-A2 peptides derived from L. mexican/major gp63 and tested these in HHD II mice, as well as four peptides for mouse MHC class I from the same proteins tested in BALB/ mice.

RESULTS

The results revealed immunogenicity for three of the four peptides predicted for HLA-A2. Immunisation with these peptides, along with IFA, induced CTL responses detected by standard 4-hour cytotoxicity assay and significantly upregulated the production of IFN-γ. When HHDII mice were injected IM with L. mexicana gp63 cDNA and splenocytes were restimulated with blasts loaded with the immunogenic peptides, two of the peptides were able to induce significant level of IFN-γ detected by ELISA. None of the peptides predicted for Balb/c mouse MHC class I elicited CTL activity or significantly upregulated the IFN-γ.

CONCLUSION

The results may help in developing a peptide-based vaccine, which can be applied alone or in combination with drugs against Leishmania.

Leishmania mexicana Gp63 cDNA Using Gene Gun Induced Higher Immunity to L. mexicana Infection Compared to Soluble Leishmania Antigen in BALB/C

BACKGROUND

Leishmaniasis is a worldwide disease prevalent in tropical and sub tropical countries. Many attempts have been made and different strategies have been approached to develop a potent vaccine against Leishmania. DNA immunisation is a method, which is shown to be effective in Leishmania vaccination. Leishmania Soluble Antigen (SLA) has also recently been used Leishmania vaccination.

METHODS

The immunity generated by SLA and L. mexicana gp63 cDNA was compared in groups of 6 mice, which were statistically analysed by student t- test with the P-value of 0.05. SLA was administered by two different methods; intramuscular injection and injection of dendritic cells (DCs) loaded with SLA. L. mexicana gp63 cDNA was administered by the gene gun.

RESULTS

Immunisation of BALB/c mice with L. mexicana gp63 resulted in high levels of Th1-type immune response and cytotoxic T lymphocytes (CTL) activity, which were accompanied with protection induced by the immunisation against L. mexicana infection. In contrast, administration of SLA, produced a mixed Th1/Th2-type immune responses as well as a high level of CTL activity but did not protect mice from the infection.

CONCLUSION

The results indicate higher protection by DNA immunisation using L. mexicana gp63 cDNA compared to SLA, which is accompanied by a high level of Th1 immune response. However, the CTL activity does not necessarily correlate with the protection induced by the vaccine. Also, gene gun immunisation is a potential approach in Leishmania vaccination. These findings would be helpful in opening new windows in Leishmania vaccine research.

Levels of certain tumor markers as differential factors between bilharzial and non-biharzial bladder cancer among Egyptian patients

BACKGROUND/OBJECTIVE

Bladder cancer is the commonest type of malignant tumors as a result of schistosomaisis which is a major healthy problem in many subtropical developing countries. The aim of this study is to comparatively elucidate the underlying biochemical tumor markers in schistosomal bladder cancer versus non-schistosomal bladder cancer when compared to normal healthy ones.

METHODS

This work was performed on tissue specimens from total 25 patients and serum samples from total 30 patients versus ten healthy individuals served as control. The investigated parameters in serum are: xanthine oxidase (XO), fructosamine, lactate dehydrogense (LDH), aspartate aminotransferase (AST), alanine aminotransferase (ALT), total proteins, essential and non- essential amino acids profile, hydroxyproline, total immunoglobulin E (IgE) and tumor necrosis factor alpha (TNF-α). In addition, the current investigation also extended to study some markers in tumor bladder tissues including, pyruvate kinase enzyme (PK), lactate dehydrogenase (LDH), aspartate aminotransferase (AST) and alanine aminotransferase (ALT).

RESULTS

Results showed that biharzial bladder cancer patients recored more significant elevation in serum XO, fructosamine, LDH, AST, ALT, hydroxyproline, IgE and TNF-α than in bladder cancer patients when compared to control ones. While, in tissues there were significant increase in PK, LDH, AST & ALT activities of schistosomal bladder cancer than in bladder cancer as compared to control healthy patients.

CONCLUSIONS

It could be concluded that, bilharzial and non-bilharzial bladder cancer showed distinct biochemical profile of tumor development and progression which can be taken into consideration in diagnosis of bladder cancer.

Evaluation of the syndesmotic-only fixation for Weber-C ankle fractures with syndesmotic injury

BACKGROUND

With the length of the fibula restored and the syndesmosis reduced anatomically, internal fixation using a plating device may not be necessary for supra-syndesmotic fibular fractures combined with diastasis of inferior tibio-fibular joint. A retrospective observational study was performed in patients who had this injury pattern treated with syndesmosis-only fixation.

MATERIALS AND METHODS

12 patients who had Weber type-C injury pattern were treated with syndesmosis only fixation. The treatment plan was followed only if the fibular length could be restored and if the syndesmosis could be anatomically reduced. Through a percutaneous or mini-open reduction and clamp stabilization of the syndesmosis, all but one patient had a single tricortical screw fixation across the syndesmosis. Patients were kept non-weight-bearing for 6 weeks, followed by screw removal at an average of 8 weeks. Outcomes were assessed using an objective ankle scoring system (Olerud and Molander scale) and by radiographic assessment of the ankle mortise.

RESULTS

At a mean follow-up of 13 months, the functional outcome score was 75. Excellent to good outcomes were noted in 83% of the patients. Ankle mortise was reduced in all cases, and all but one fibular fracture united without loss of fixation. Six patients had more than one malleolar injury, needing either screw or anchor fixations. One patient had late diastasis after removal of the syndesmotic screw and underwent revision surgery with bone grafting of the fibula. This was probably due to early screw removal, before union of the fibular fracture had occurred.

CONCLUSION

We recommend syndesmosis-only fixation as an effective treatment option for a combination of syndesmosis disruption and Weber type-C lateral malleolar fractures.