Therapeutic potential of proteases in acute lung injury and respiratory distress syndrome via TLR4/Nrf2/NF-kB signaling modulation

The COVID-19 pandemic has drawn attention to acute lung injury and respiratory distress syndrome as major causes of death, underscoring the urgent need for effective treatments. Protease enzymes possess a wide range of beneficial effects, including antioxidant, anti-inflammatory, antifibrotic, and fibrinolytic effects. This study aimed to evaluate the potential therapeutic effects of bacterial protease and chymotrypsin in rats in mitigating acute lung injury induced by lipopolysaccharide. Molecular docking was employed to investigate the inhibitory effect of bacterial protease and chymotrypsin on TLR-4, the receptor for lipopolysaccharide. Bacterial protease restored TLR-4, Nrf2, p38 MAPK, NF-kB, and IKK-β levels to normal levels, while chymotrypsin normalized TLR-4, IKK-β, IL-6, and IL-17 levels. The expression of TGF-β, caspase-3, and VEGF in the bacterial protease- and chymotrypsin-treated groups was markedly reduced. Our results suggest that both therapies ameliorate LPS-induced acute lung injury and modulate the TLR4/Nrf2/NF-k signaling pathway. Each protease exhibited distinct mechanisms, with bacterial protease showing a better response to oxidative stress, edema, and fibrosis, whereas chymotrypsin provided a better response in the acute phase and innate immunity. These findings highlight the potential of each protease as a promising therapeutic option for acute lung injury and respiratory distress syndrome.

YIG-Based Sensor System for Millisecond Time Range Magnetorelaxometry

In the current study we propose a magneto-optical system for registration and analysis of magnetic nano- and microparticles magnetic relaxation. The core of our system is the novel compact magnetometer based on an yttrium-iron garnet film and working at room temperature. The sensor demonstrates sensitivity of 35 pT/√{Hz} at 79 Hz and recovery time less than 100 µs, which allows to register quite fast magnetic relaxations of a low amplitude. All these facts make the system feasible for usage in biological magnetorelaxometry and theranostics. Statistical processing of the relaxation curves allowed us to estimate both amplitudes and relaxation times for various biocompatible magnetic particles at the amount of 100 µg in the test tubes experiments. The system has a great potential of further development for usage in the areas of targeted drug delivery, hyperthermia, magnetic imaging. Being comparatively cheap, the system potentially is of a great interest in the fields of biomedicine and nanomedicine.

A mechanistic exploration of the metabolome of African mango seeds and its potential to alleviate cognitive impairment induced by high-fat/high-carbohydrate diets: Involvement of PI3K/AKT/GSK-3β/CREB, PERK/CHOP/Bcl-2, and AMPK/SIRT-1/mTOR Axes

ETHNOPHARMACOLOGICAL RELEVANCE

Irvingia gabonensis (Aubry-Lecomte ex O'Rorke) Baill., also known as "African mango" or "bush mango", belonging to family Irvingiaceae, has been mostly used as food and traditional medicine for weight loss and to enhance the health.

AIM OF THE STUDY

The overconsumption of high-fat and high-carbohydrate (HFHC) food induces oxidative stress, leading to neurological and cognitive dysfunction. Consequently, there is an immediate need for effective treatment. Hence, this study explored the efficacy of orlistat, metformin, and I. gabonensis seeds' total aqueous extract (IG SAE) in addressing HFHC-induced cognitive impairment by mitigating oxidative stress and their underlying mechanistic pathways.

MATERIALS AND METHODS

Initially, the secondary metabolite profile of IG SAE is determined using high-performance liquid chromatography coupled with a mass detector (UHPLC/MS). The in vivo study involves two phases: an established model phase with control (10 rats on a standard diet) and HFHC diet group (50 rats) for 3 months. In the study phase, HFHC is divided into 5 groups. The first subgroup receives HFHC diet only, while the remaining groups each receive HFHC diet with either Orlistat, metformin, or IG SAE at doses of 100 mg/kg and 200 mg/kg, respectively, for 28 days.

RESULTS

More than 150 phytoconstituents were characterized for the first holistic approach onto IG metabolome. Characterization of IG SAE revealed that tannins dominate metabolites in the plant. Total phenolics and flavonoids were estimated to standardize our extract (77.12 ± 7.09 μg Gallic acid equivalent/mg extract and 8.039 ± 0.53 μg Rutin equivalent/mg extract, respectively). Orlistat, metformin, and IG SAE successfully reduced the body weight, blood glucose level, lipid profile, oxidative stress and neurotransmitters levels leading to improved behavioral functions as well as histological alternation. Also, IG SAE halted inflammation, apoptosis, and endoplasmic reticulum stress, together with promoting autophagy, via modulation of PI3K/AKT/GSK-3β/CREB, PERK/CHOP/Bcl-2 and AMPK/SIRT-1/m-TOR pathways.

CONCLUSION

Metformin, orlistat, and IG SAE offer a promising multi-target therapy to mitigate HFHC diet-induced oxidative stress, addressing cognitive function. This involves diverse molecular mechanisms, particularly the modulation of inflammation, ER stress, and both PI3K/AKT/GSK-3β/CREB and AMPK/SIRT-1/m-TOR pathways. Furthermore, the higher dose of IG SAE demonstrated effects comparable to orlistat and metformin across most studied parameters.

The diagnostic utility of FIB-4 as a non-invasive tool for liver fibrosis scoring among NAFLD patients: a retrospective cross-sectional study

OBJECTIVE

Liver biopsy is the gold standard method to evaluate patients with non-alcoholic fatty liver disease (NAFLD). However, due to its several limitations and complications, a reliable and non-invasive marker is required to assess liver fibrosis. In this study, we compared the performance of the FIB-4 index [based on age, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) levels and platelets count] with the Scheuer scoring system of liver biopsies to evaluate the diagnostic utility of FIB-4 among NAFLD patients with different liver fibrosis severities.

PATIENTS AND METHODS

A cross-sectional study was conducted at An-Najah National University Hospital (NNUH) in Palestine. The FIB-4 index was calculated using laboratory data for 128 NAFLD patients who underwent liver biopsies between November 2014 and July 2022. The results of FIB-4 were compared with the Scheuer scoring system of liver biopsies (using F0, F1+F2, F3+F4) to determine the sensitivity and specificity of FIB-4 in detecting and staging liver fibrosis.

RESULTS

Out of 128 patients involved in our study, 49 of them had advanced fibrosis according to liver biopsy (F3+F4), where their FIB-4 indices showed 87% sensitivity at 1.45 cut off point and 87% specificity at 3.25 cut off point.

CONCLUSIONS

The FIB-4 index may be used as a screening tool in the primary care setting. To raise awareness of liver diseases, this non-invasive, inexpensive, simple, and quick marker could identify people in need of further liver fibrosis evaluation and diagnosis.

Parental occupational and environmental risk factors for childhood bone cancer in Mansoura oncology center: a case control study

Cancer is the most frequently diagnosed disease-related cause of death among children and adolescents. This study was conducted to test association of occupational, environmental risk factors such as exposure to pesticides, radiations, hazardous chemicals and smoking among children with bone cancer. A retrospective case control study was conducted in Oncology center Mansoura University (OCMU). Study groups included bone cancer cases (n = 51) and an age and sex matched control group (n = 67). An interview-based questionnaire included demographic data, occupational and environmental risk factors for both children and parents. Exposure to n nitrose compounds from burning incense among children, paternal smoking and consanguinity are significantly different between cases and control. (p < 0.05). Paternal smoking and consanguinity are significant predictors for childhood bone cancer. It is recommended to add surveillance for environmental and occupational exposures to childhood bone cancer patients.

Yttrium-Iron Garnet Film Magnetometer for Registration of Magnetic Nano- and Submicron Particles: In Vitro and In Vivo Studies

In the current article, we present a new kind of magnetometer for quantitative detection of magnetic objects (magnetic nano- and submicron particles) in biological fluids and tissues. The sensor is based on yttrium-iron garnet film with optical signal registration system. Inheriting the working principle of a fluxgate magnetometers, the sensor works at a room-temperature, its wide dynamic range allows the measurements in an unshielded environment. A small size of sensitive element combined with a short recovery time after the excitation coils are off provide us with a potentially high spatial and temporal resolution of measurements. We show the feasibility of the developed devices by sensing the remanent magnetization of magnetic nanoparticles (MNPs) both in vitro (test tubes, dry MNPs) and in vivo (local injection of the MNPs into mice).

In silico and in vivo analysis of the relationship between ADHD and social isolation in pups rat model: Implication of redox mechanisms, and the neuroprotective impact of Punicalagin

Attention deficit hyperactivity disorder (ADHD) has high incidence rate among children which may be due to excessive monosodium glutamate (MSG) consumption and social isolation (SI).

AIM

We aimed to explore the relationships between MSG, SI, and ADHD development and to evaluate the neuroprotective potential of Punicalagin (PUN).

METHODS

Eighty male rat pups randomly distributed into eight groups. Group I is the control, and Group II is socially engaged rats treated with PUN. Groups III to VII were exposed to ADHD-inducing factors: Group III to SI, Group IV to MSG, and Group V to both SI and MSG. Furthermore, Groups VI to VIII were the same Groups III to V but additionally received PUN treatment.

KEY FINDINGS

Exposure to MSG and/or SI led to pronounced behavioral anomalies, histological changes and indicative of ADHD-like symptoms in rat pups which is accompanied by inhibition of the nuclear factor erythroid 2-related factor 2 (Nrf2)/Heme-oxygenase 1 (HO-1)/Glutathione (GSH) pathway, decline of the brain-derived neurotrophic factor (BDNF) expression and activation of the Toll-like receptor 4 (TLR4)/Nuclear factor kappa B (NF-kB)/NLR Family Pyrin Domain Containing 3 (NLRP3) pathway. This resulted in elevated inflammatory biomarker levels, neuronal apoptosis, and disrupted neurotransmitter equilibrium. Meanwhile, pretreatment with PUN protected against all the previous alterations.

SIGNIFICANCE

We established compelling associations between MSG consumption, SI, and ADHD progression. Moreover, we proved that PUN is a promising neuroprotective agent against all risk factors of ADHD.

Canagliflozin alleviates experimentally induced benign prostate hyperplasia in a rat model: exploring potential mechanisms involving mir-128b/EGFR/EGF and JAK2/STAT3 signaling pathways through in silico and in vivo investigations

Benign prostatic hyperplasia (BPH) poses a significant health concern amongst elderly males. Canagliflozin (Cana), a selective sodium-glucose co-transporter 2 (SGLT2) inhibitor, has a powerful anti-inflammatory influence. Nevertheless, its role in treating BPH has not been clarified. Therefore, the study aimed to investigate the potential ameliorative effect of Cana on experimentally induced BPH in rats and explore the underlying mechanisms compared to the standard finasteride (Fin). The study employed histological analysis, biochemical assays using ELISA, and western blotting. Animals were categorized into four groups: Control (2.5 ml/kg CMC, orally + 3 ml/kg olive oil, subcutaneous), BPH (3 mg/kg testosterone, subcutaneous + CMC orally), Fin-treated BPH (5 mg/kg, orally), and Cana-treated BPH (5 mg/kg, orally), for 28 days. The BPH group showed obvious BPH manifestations including an increase in prostate weight (PW), prostate index (PI), dihydrotestosterone (DHT) level, and histological aberrations compared to control. Fin and Cana therapy had a comparable impact. Cana treatment significantly reduced PW and PI, besides it improved prostatic biochemical, and histopathological features compared to BPH, consistent with in silico study findings. Cana was associated with downregulation of the androgen axis, increased miR-128b expression, with a lowered expression of epidermal growth factor (EGF) and its receptor. Phosphorylation of STAT3 and its downstream proliferative markers were significantly reduced suggesting apoptotic activity. Cana markedly rescued the BPH-induced upregulation of IL-1β, and iNOS levels. Altogether, the current study demonstrates that Cana could impede BPH progression, possibly by modulating miR-128b/EGFR/EGF and JAK2/STAT3 pathways and downregulating AR, cyclin D1, and PCNA immunoreactivity.

Punicalagin's Protective Effects on Parkinson's Progression in Socially Isolated and Socialized Rats: Insights into Multifaceted Pathway

Parkinson's disease (PD) is a gradual deterioration of dopaminergic neurons, leading to motor impairments. Social isolation (SI), a recognized stressor, has recently gained attention as a potential influencing factor in the progress of neurodegenerative illnesses. We aimed to investigate the intricate relationship between SI and PD progression, both independently and in the presence of manganese chloride (MnCl2), while evaluating the punicalagin (PUN) therapeutic effects, a natural compound established for its cytoprotective, anti-inflammatory, and anti-apoptotic activities. In this five-week experiment, seven groups of male albino rats were organized: G1 (normal control), G2 (SI), G3 (MnCl2), G4 (SI + MnCl2), G5 (SI + PUN), G6 (MnCl2 + PUN), and G7 (SI + PUN + MnCl2). The results revealed significant changes in behavior, biochemistry, and histopathology in rats exposed to SI and/or MnCl2, with the most pronounced effects detected in the SI rats concurrently exposed to MnCl2. These effects were associated with augmented oxidative stress biomarkers and reduced antioxidant activity of the Nrf2/HO-1 pathway. Additionally, inflammatory pathways (HMGB1/RAGE/TLR4/NF-ᴋB/NLRP3/Caspase-1 and JAK-2/STAT-3) were upregulated, while dysregulation of signaling pathways (PI3K/AKT/GSK-3β/CREB), sustained endoplasmic reticulum stress by activation PERK/CHOP/Bcl-2, and impaired autophagy (AMPK/SIRT-1/Beclin-1 axis) were observed. Apoptosis induction and a decrease in monoamine levels were also noted. Remarkably, treatment with PUN effectively alleviated behaviour, histopathological changes, and biochemical alterations induced by SI and/or MnCl2. These findings emphasize the role of SI in PD progress and propose PUN as a potential therapeutic intervention to mitigate PD. PUN's mechanisms of action involve modulation of pathways such as HMGB1/RAGE/TLR4/NF-ᴋB/NLRP3/Caspase-1, JAK-2/STAT-3, PI3K/AKT/GSK-3β/CREB, AMPK/SIRT-1, Nrf2/HO-1, and PERK/CHOP/Bcl-2.

Revealing how phenytoin triggers liver damage and the potential protective effects of Balanites Aegyptiaca fruit extracts: Exploring Nrf2/MAPK/ Beclin-1 signaling pathways

Phenytoin-induced liver injury (PHT ILII) is a serious condition that may necessitate discontinuation of the drug. This study investigates the mechanisms of PHT ILII and evaluates the protective effects of Balanites Aegyptiaca (BA) fruit extracts on the liver. We focus on the Nrf2/MAPK/NF-κB/Beclin-1 signaling pathways involved in oxidative stress and inflammation from drug-induced liver injury. Phytochemical analyses of BA fruit extracts (Bu-F and EA-F) are conducted. Molecular docking techniques explore the interaction between phenytoin (PHT) and the Nrf2/MAPK/NF-κB/Beclin-1 pathways. Thirty-six male rats are divided into Control, Bu-F, EA-F, PHT, Bu-F/PHT, and EA-F/PHT groups, and they are observed for 45 days. EA-F extract is rich in phenolics/flavonoids, while Bu-F extract mainly contains saponins.PHT ILII causes histological damage in liver tissues and affects Nrf-2, MAPK, TNF-α, IL-1β, Mcp-1, Beclin-1, iNOS expression, and liver function markers (ALT, AST, ALP). However, EA-F/Bu-F extracts effectively improve the histological structure and significantly reduce biochemical/immunohistochemical parameters, restoring them to near-normal levels. EA-F extract is particularly effective.In conclusion, the Nrf2/MAPK /Beclin-1 pathways play a critical role in the development of PHT ILII. BA fruit extracts show promise as hepato-protective agents, with the EA-F extract demonstrating superior efficacy. These results lay the groundwork for new treatments for PHT ILII and drug-induced liver injuries.

Anti-Alzheimer Activity of Combinations of Cocoa with Vinpocetine or Other Nutraceuticals in Rat Model: Modulation of Wnt3/β-Catenin/GSK-3β/Nrf2/HO-1 and PERK/CHOP/Bcl-2 Pathways

Alzheimer's disease (AD) is a devastating illness with limited therapeutic interventions. The aim of this study is to investigate the pathophysiological mechanisms underlying AD and explore the potential neuroprotective effects of cocoa, either alone or in combination with other nutraceuticals, in an animal model of aluminum-induced AD. Rats were divided into nine groups: control, aluminum chloride (AlCl3) alone, AlCl3 with cocoa alone, AlCl3 with vinpocetine (VIN), AlCl3 with epigallocatechin-3-gallate (EGCG), AlCl3 with coenzyme Q10 (CoQ10), AlCl3 with wheatgrass (WG), AlCl3 with vitamin (Vit) B complex, and AlCl3 with a combination of Vit C, Vit E, and selenium (Se). The animals were treated for five weeks, and we assessed behavioral, histopathological, and biochemical changes, focusing on oxidative stress, inflammation, Wnt/GSK-3β/β-catenin signaling, ER stress, autophagy, and apoptosis. AlCl3 administration induced oxidative stress, as evidenced by elevated levels of malondialdehyde (MDA) and downregulation of cellular antioxidants (Nrf2, HO-1, SOD, and TAC). AlCl3 also upregulated inflammatory biomarkers (TNF-α and IL-1β) and GSK-3β, leading to increased tau phosphorylation, decreased brain-derived neurotrophic factor (BDNF) expression, and downregulation of the Wnt/β-catenin pathway. Furthermore, AlCl3 intensified C/EBP, p-PERK, GRP-78, and CHOP, indicating sustained ER stress, and decreased Beclin-1 and anti-apoptotic B-cell lymphoma 2 (Bcl-2) expressions. These alterations contributed to the observed behavioral and histological changes in the AlCl3-induced AD model. Administration of cocoa, either alone or in combination with other nutraceuticals, particularly VIN or EGCG, demonstrated remarkable amelioration of all assessed parameters. The combination of cocoa with nutraceuticals attenuated the AD-mediated deterioration by modulating interrelated pathophysiological pathways, including inflammation, antioxidant responses, GSK-3β-Wnt/β-catenin signaling, ER stress, and apoptosis. These findings provide insights into the intricate pathogenesis of AD and highlight the neuroprotective effects of nutraceuticals through multiple signaling pathways.

Severe MAC increases shear stresses on particles traversing the mitral valve: an in vitro study

Funding Acknowledgements

Type of funding sources: None.

Background

  Mitral annular calcification (MAC) is a strong predictor of stroke but mechanism(s) are poorly defined.  Severe MAC can produce a gradient across the mitral valve (MV) and, when studied in vitro, disturbs normal flow across the valve resulting in increased viscous energy dissipation.

Purpose

  We hypothesized that severe MAC would increase shear stress on particles traveling across the MV into the left ventricle (LV).  Given that shear stresses cause platelet activation this might represent a mechanism by which MAC could increase stroke risk.

Methods

  A silicone model MV was created using a 3D TEE dataset. 3D printed calcium phantoms were incorporated into the valve simulate severe MAC. The valve was tested in a left heart duplicator under rest and exercise conditions and compared with a duplicate valve without the calcium phantoms. Fine particles suspended in a water/glycerol blood analogue allowed for measurement of vortex formation and shear stresses using particle image velocimetry (PIV).  Particle residence time (PRT) maps were created to assess how long blood particles would remain in the LV.  Particle residence index (PRI - ratio of remaining particles in LV/initial number of particles) is a more quantitative measure of how fast particles leave the LV.  These calculations were used to approximate viscous shear stresses on blood particles.  For each particle the induced viscous shear stress was evaluated for the entire duration of residence in the LV.

Results

  For the normal MV all released particles left the LV by the 3rd cycle; with severe MAC particles completely left the LV shortly after the 7th cycle.  PRI measurements confirmed that particles remained longer in the LV in the presence of severe MAC (figure 1).  MAC also induced a shift in the accumulated shear stress levels from the high range &gt; 0.4 Pa.s and the low range &lt; 0.1 towards the middle region (0.16-0.32 Pa.s, figure 2). As shear stress is reported for one cycle, one may expect MAC to lead to higher accumulated higher viscous stresses as particles reside in the LV for a longer time.

Conclusions

  In the presence of severe MAC blood particles remain longer in the LV and are exposed to greater cumulative shear stresses vs the normal situation.  Given that shear stress is known to cause platelet activation this may be a mechanism by which MAC increases risk of ischemic stroke. Abstract Figure 1  Abstract Figure 2

Clearing the air about airborne transmission of SARS-CoV-2

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that has created the current pandemic, has caused a worldwide worry. Different countries have since enforced varying levels of lockdowns and guidelines for their populations to follow in a serious effort to mitigate the spread. Up until recently, the majority of these regulations and policies were established on the assumption that the dominant routes of transmission of this virus are through droplets and fomite contact. However, there is now a substantial amount of research pointing towards the strong possibility that SARS-CoV-2 can spread through airborne means. The World Health Organization (WHO) and the Center for Disease Control and Prevention (CDC) have recently recognized this, which poses the question of whether our collective methods of lessening transmission risk and keeping people safe have been sufficient. This paper is a comprehensive review of the evidence on SARS-CoV-2 being an airborne disease, through different epidemiological, experimental, and animal-model based published research. Studies opposing this evidence have also been discussed. The majority of these studies are favoring the high plausibility of SARS-CoV-2 aerosol transmission, and therefore the many implications of aerosol transmission have been discussed in this paper to suggest effective mitigation and control strategies.

Optimal method for collection of umbilical cord blood: an Egyptian trial for a public cord blood bank

BACKGROUND

Umbilical cord blood (UCB) contains stem cells and can be used as an alternative to bone marrow transplantation. Engraftment is dependent on the total nucleated cell (TNC) and CD34+ cell counts of the cord blood units. This study was designed to evaluate the effect of the method of collection of the UCB on the yield of the cord blood units.

STUDY DESIGN AND METHODS

Informed consent was obtained from 100 eligible mothers for donation of cord blood. Both in utero and ex utero methods were used for collection. The cord blood volume was measured. The TNC and the CD34+ cell counts were enumerated.

RESULTS

We have found that in utero collection gave significantly larger volumes of cord blood and higher TNC counts than ex utero collection. There was no significant difference between both methods regarding the CD34+ cell counts. This study revealed a significant correlation between the volume of the collected cord blood and both TNC and CD34+ cell counts.

CONCLUSION

It is better to collect cord blood in utero before placental delivery to optimize the quality of the cord blood unit.

Gestational trophoblastic neoplasia: treatment outcomes from a single institutional experience

PURPOSE

To report the outcomes of gestational trophoblastic neoplasia (GTN) at a single institution and to determine the factors affecting response to chemotherapy and survival.

METHODS/PATIENTS

From 1979-2010, we retrospectively reviewed the data of 221 patients treated at our center. GTN Patients were assigned to low-risk (score ≤6) or high-risk (score ≥7) based on the WHO risk factor scoring system. Overall survival (OS) probabilities were estimated using Kaplan-Meier method. Logistic regression was applied to study the impact of different factors on the response to initial therapy.

RESULTS

Patients' OS rate was 97 %. Median age at diagnosis was 37 year. 131 (59 %) patients had low-risk and 88 (40 %) cases had high-risk GTN. Complete remission rates to initial chemotherapy in low-risk group were 53 % and 87 % for single-agent methotrexate or dactinomycin, respectively. In high-risk group, 94 % achieved complete remission to initial chemotherapy with etoposide, methotrexate, dactinomycin, cyclophosphamide, and vincristine (EMA-CO). Etoposide, cisplatin, and dactinomycin as primary therapy in high-risk patients was successful in 70 %, while bleomycin, etoposide, and cisplatin (BEP) was successful in 53 % of cases. Salvage chemotherapy, surgical intervention or radiation therapy resulted in overall complete remission of 90 % in low-risk and 73 % in high-risk groups. Factors associated with resistance to initial chemotherapy were advanced-stage III/IV (p = 0.005), metastatic site other than lung or vagina (p = 0.005) and high-risk prognostic score (p = 0.05). OS was significantly influenced by the type of antecedent pregnancy (molar 98 % vs. others 93 %; p = 0.04), FIGO stage (I, II 100 % vs. III, IV 94 %; p = 0.02), score (low-risk 100 % vs. high-risk 92 %; p = 0.01), and site of metastasis (lung/vagina 98 % vs. others 85 %; p = 0.002).

CONCLUSIONS

GTNs have excellent prognosis if properly treated at experienced centers. Single-agent dactinomycin seems more effective for low-risk GTN. EMA-CO remains the preferred primary treatment regimen for high-risk group. The excellent outcome reflects the success of salvage therapy.

Epidemiological characteristics and survival studies of rhabdomyosarcoma in East egypt: a five-year multicenter study

Background. Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in children, it represents 5–8% of childhood malignancies. Aim of the Work. To evaluate the epidemiological characteristics and treatment outcome in two pediatric oncology centers. Patients and Method. A retrospective analysis was performed on 41 medical records of children with RMS during 6 years period. Results. The median age of patients was 6 years with 80.4% below 10 years. Head and neck was the most common primary site. Embryonal RMS was the most frequent histopathologic subtype. Stage IV was the most frequent stage. According to IRS postsurgical grouping classification, group 4 was the most frequent group. There was a significant relationship between histopathologic subtypes of tumor and metastasis, primary site of tumor and histopathologic subtype, age, metastasis, IRS presurgical stage and IRS postsurgical group and outcome. The overall survival rate was 56.9% ± 8.4 and the failure free survival rate was 68.3% ± 7.6. Conclusion. The epidemiological characteristics of our patients are quite near to the worldwide data, apart from the higher prevalence of stage IV and group 4 with most of the primary tumor site in the extremities. CWS2002 protocol of therapy had led to improvement in the curability of the disease.

Intralobar Pulmonary Sequestration in 22 year-old Male: Case report and review of literature

Pulmonary sequestration is a rare congenital malformation of the lower respiratory tract characterized by a non-functioning mass of lung tissue that is not communicating with the normal tracheo-bronchial tree and receives its vascular supply from a systemic artery. We report the first case of intrapulmonary sequestration in Qatar, of a 22 year-old Qatari male who presented with recurrent chest infection. This case study includes a literature review.

Optimized culture conditions for tissue explants of uterine leiomyoma

BACKGROUND

Uterine leiomyomas are the most common benign tumours in women, which arise from smooth muscle cells of the uterine myometrium and usually are multicentric. In spite of their frequency pathogenesis is widely unknown, mainly due to the absence of a suitable model system. We describe the systematic optimization of culturing leiomyoma tissue explants in an economical and effective ex vivo system.

METHODS

Different concentrations of oxygen, different media, sera, hormones, and growth factor supplements were tested. Immunohistochemical stainings with antibodies against hormone receptors as well as specifying proliferation and apoptotic indices and real-time PCR were performed.

RESULTS

Main parameters for culturing myoma tissue explants were tested for finding an optimal protocol. Standard medium D-MEM-F12 in combination with the use of horse serum in a reduced concentration of 1% turned out to be optimal for these tissue cultures as well as the addition of estradiol and epidermal growth factor EGF to media. Reduced oxygen content in the incubator air showed no positive effect.

CONCLUSIONS

For culturing tissue explants of uterine leiomyoma several conditions were optimized. The established tissue culture model allows examining the effects of known and potential therapeutic substances and the influence of immune competent cells in the process of tumour formation to find new targets for medical treatment.

Pakistan's fight against poliomyelitis: introducing innovative strategies to address challenges and attain the goal of eradication

Pakistan, with Nigeria, India and Afghanistan, is one of the four remaining polio endemic countries in the world. Since the start of polio eradication initiative in 1994, the country has succeeded in reducing the number of polio cases from an estimated 20,000 annually to 89 in 2009. Furthermore, persistent transmission is largely localized to three transmission zones in which ten of the fifteen highest risk areas are situated. Insecurity, operational issues, governance lapses, low routineimmunization coverage, inadequate trickle-down of the political commitment existing at the national level to sub-national level and extensive population movement are the main barriers to the process. A robust strategic plan was developed for 2010-2012 encompassing district-specific plans and focused strategy on securitycompromised areas, performance-based payment, independent monitoring, attention to migratory populations, social mobilization, and strategic cooperation with Afghanistan. This will provide Pakistan a strong and imminent opportunity to interrupt polio virus circulation.

Hook wire localization procedure in biopsy and diagnosis of early breast cancers: Oman experience

INTRODUCTION

Between January 2000 and December 2005, a total of 30 cases of impalpable suspicious breast lesions (microcalcifications or impalpable lumps classified as BRADS IV and above) were biopsied after hook wire localization. This is a retrospective review of these cases.

RESULTS

One third of the suspicious lesions were malignant or pre-malignant. All these had further oncological treatment and follow up.

CONCLUSIONS

Hook wire localization biopsy remains an important tool for the diagnosis of impalpable lesions of the breast. The incidence of malignancy in our series was similar to the published international levels. Our series is small, so there is a need to review the data with bigger number.

Living-related versus deceased donor pediatric liver transplantation: a multivariate analysis of technical and immunological complications in 235 recipients

Timely access to a living donor (LD) reduced pretransplant mortality in pediatric liver transplantation (LT). We hypothesized that this strategy may provide better posttransplant outcome. Between July 1993 and April 2002, 235 children received a primary LT from a LD (n = 100) or a deceased donor (DD) (n = 135). Demographic, surgical and immunological variables were compared, and respective impact on posttransplant complications was studied using a multivariate analysis. Five-year patient survival rates were 92% and 85% for groups LD and DD, respectively (p = 0.181), the corresponding graft survival rates being 89% and 77% (p = 0.033). At multivariate analysis: (1) type of donor (DD) was correlated with higher rate of artery thrombosis (p < 0.012); (2) biliary complication rate at 5 years was 29% and 23% for groups LD and DD, respectively (p = 0.451); (3) lower acute rejection incidence could be correlated with type of donor (DD) (p = 0.001), and immunosuppressive therapy (tacrolimus) (p < 0.001). We conclude that (1) according to the multivariate analysis, LT with LD provided similar patient and graft outcome, when compared to DD; (2) a higher rate of artery thrombosis and a lower rate of rejection were observed in group DD; (3) this study confirms the efficacy of tacrolimus for immunoprophylaxis, whatever the type of organ donor is.

Rhinoscleroma: a clinicopathological study from the Gulf region

INTRODUCTION

Rhinoscleroma is a chronic progressive inflammatory disease of the upper respiratory tract. We report a clinicopathological series from the Gulf region.

METHODS

The clinical and pathological features of patients diagnosed with rhinoscleroma at three main hospitals in Saudi Arabia and Bahrain over a 20-year period are presented. Archived glass slides and paraffin blocks from these patients were retrieved from the pathology files for review. Special stains were performed whenever indicated. Biopsy material and clinical data from 25 patients formed the basis of this study.

RESULTS

Most of the patients were young females with a median age of 24 years. The nose was involved in all cases with frequent extension to other parts of the upper respiratory tract. The provisional clinical diagnoses included syphilis, midline granuloma and malignancy. The histological differential diagnoses included leprosy, malakoplakia and metastatic renal cell carcinoma.

CONCLUSION

Rhinoscleroma is rare in Saudi Arabia and Bahrain. Awareness of possible clinical presentations and early diagnosis will significantly reduce the morbidity caused by this disease.

‘Extension Technique’: A Modified Technique for Brachio-Cephalic Fistula to Prevent Dialysis Access-Associated Steal Syndrome

OBJECTIVES

To describe a modification in brachio-cephalic fistula formation for prevention of dialysis access-associated steal syndrome (DASS).

DESIGN

Short report.

MATERIALS

From September 2001 to December 2003, 32 upper arm autogenous fistulae were formed using the 'extension technique' in patients at high-risk for developing DASS i.e. diabetics.

METHODS

In this technique, the fistula is formed by anastomosing the median vein to the radial or ulnar artery just below the brachial bifurcation, thus preserving part of the blood supply to the hand, to prevent steal syndrome. All patients were evaluated for patency, adequacy of needling and the absence of steal symptoms.

RESULTS

Only 1 patient (3.1%) developed DASS. On investigation, he was found to have the fistula formed distal to the origin of a posterior branch with the bifurcation further distally. Symptoms improved with revision of the fistula. Thrombosis of the cephalic vein (6.2%), difficulty in needling (3.1%) and deep cephalic vein in upper arm that required superficialization (15.6%) were the other complications noted.

CONCLUSIONS

The 'extension technique' has been found to be a safe and effective procedure for prevention of DASS, with a good patency rate. Additional advantage of this technique is maturation of both cephalic and basilic veins.

Non-traumatic lower limb vascular complications in endurance athletes. Review of literature

OBJECTIVES

To review the importance, clinical features, investigations, management and prognosis of non-traumatic vascular injuries, affecting the lower limbs of endurance athletes.

DESIGN

Review of literature.

MATERIALS AND METHODS

A literature search was conducted from Medline, Pubmed, the National Electronic Library for Health, Google and Yahoo search engines for related articles and case reports regarding non-traumatic vascular complications involving the lower limb of endurance athletes.

CONCLUSIONS

Non-traumatic vascular complications affecting the lower limbs include endofibrosis, stenosis/kinking of iliac arteries, dissection of external iliac artery, adductor canal syndrome, popliteal entrapment syndrome, chronic exertional compartment syndrome and effort-induced venous thrombosis. These are important as they affect athletes at the peak of their career and can be confusing to diagnose. The management is relatively well documented and produces good results in short term but the long term results are not known.

Cervical changes associated with progestagen-only contraceptives: a team approach

OBJECTIVES

To report clinical, cytologic and colposcopic findings among women using progestagen-only contraceptives for more than 3 years as compared to nonhormonal contraceptives; and to assess the role of nursing in increasing the women's knowledge about Pap test and risk factors for cervical cancer in a developing country set-up.

DESIGN

A prospective cross-sectional comparative study.

SETTING

Family-planning clinic of a tertiary care university hospital.

SUBJECTS

A total of 325 current users of contraceptive methods for more than 3 years.

INTERVENTIONS

Patients were divided into two groups. Group A included 200 patients using progestagen-only contraceptives. While group B comprised 125 patients wearing intrauterine devices. In both groups, the patient was asked about the risk factors and her knowledge about cancer cervix. Clinical and cytologic evaluations of the cervix were done. For each patient, two cervical smears were taken using Ayre's spatula and the endocervical brush.

MAIN OUTCOME MEASURES

Clinical, cytologic and histopathologic cervical abnormalities after prolonged use, and the effect of health education or counseling on the patient's knowledge about preinvasive or invasive cervical cancer.

RESULTS

Initial naked eye assessment of the cervix revealed statistically significant difference between both groups (p < 0.000). However, cytologic examinations revealed positive cases of low- and high-grade squamous intraepithelial lesions (SIL) in 38 (19%) and 22 (17.6%) in the study and control groups, respectively, without any statistically significant difference. There were no statistically significant differences in both groups regarding the frequency of positive cases whether using Ayre's spatula or the endocervical brush. Women's knowledge was compared in the first and last interviews by the nursing staff involved in health education or counseling. It increased in the counseling group; however, the difference was statistically insignificant.

CONCLUSIONS

Prolonged use of progestagen-only contraceptives is not associated with increased risk of abnormal cytologic findings. There was a marked lack of women's knowledge as regards Pap test and cervical cancer with some statistically insignificant improvement after interview and counseling. Extended training of the nursing staff on the procedure of Pap smear would help establish screening programs in the developing countries.

Use of low-dose ketamine and/or midazolam for pediatric cardiac catheterization

Ketamine and midazolam are commonly used in children undergoing cardiac catheterization. However, there is controversy regarding the safety of administering these agents in the absence of an anesthesiologist. We retrospectively reviewed pediatric cardiac catheterization procedures at our institution between 1996 and 1997. A total of 154 patients (0.3-192 months) underwent a total of 205 procedures. They received ketamine (n = 79, 1.05 +/- 0.88 mg/kg/hr), midazolam (n = 35, 0.14 +/- 0.09 mg/kg/hr), or both (n = 91; ketamine, 1.13 +/- 0.84 mg/kg/hr; midazolam, 1.57 +/- 1.03 mg/kg//hr). In 18.5% of patients there were complex cardiac lesions. Mean procedure time was 79 +/- 36.2 minutes. Pre- and postprocedure systolic and diastolic mean blood procedure 72 +/- 14 and 68 +/- 12 mmHg, respectively. Pre- and postprocedure O2 saturation was 93.19 +/- 8.72 and 93.63 +/- 8.3, respectively. One patient required intubation, and 15% required oxygen therapy. The mortality rate was zero. The anesthesiologist's assistance was requested by the cardiologist in 21 procedures (group A) and not requested in 184 procedures (group B). The two groups were not different in relation to the drug used (p = 0.283) or the complexity of the cardiac lesions (p = 0.051). However, there was significant difference between the two regarding the need for supporting drugs (3/21 vs 3/184, p = 0.02) or oxygen treatment (7/21 vs 26/184, p = 0.014). No patients in group B required intubation, whereas 14% and 1.6% required oxygen therapy and supporting drugs, respectively. We conclude that low-dose ketamine and midazolam can be administered safely to most pediatric patients by the cardiologist, who can safely predict the need for an anesthesiologist.

Investigation into a cluster of infant deaths following immunization: evidence for methanol intoxication

A cluster of infant deaths due to severe metabolic acidosis following immunization was reported in a prosperous farming village in Egypt. Fears that more deaths might occur, and of a deleterious effect on national immunization programs prompted an urgent investigation by national and international partners. The deaths, and other previously unrecognized illness following immunization, were associated with excessive topical application of methanol. Methanol was employed as an anti-pyretic and anti-inflammatory agent following injections. Fear of adverse reactions to vaccine had encouraged increasing use of methanol for these purposes. Local physicians and nurses were unaware of the toxicity of methanol and did not consider it in the differential diagnosis, and thus did not offer appropriate life-saving therapy. The interaction of traditional practices and modern medical interventions can have clinically important consequences, and should be considered when programs are introduced and as they are monitored.

Increased control of the sheep biting louse Bovicola (Damalinia) ovis with deltamethrin formulated in a fractionated wool grease carrier

The synthetic pyrethroid deltamethrin (DM) containing a trace of [(14)C]-DM was formulated with non-oxidised sterol and wax ester fractions (F1) of wool grease and as the commercial preparation 'Clout-S'. These were applied as a 'backline' strip to sheep immediately after shearing and the concentration of [(14)C]-DM at meridians adjacent to the application strip and at 1/4 and 3/4 of the dorsal-ventral distance was determined. The F1 formulation resulted in significantly greater lateral spread of DM with less remaining at the application site (66+/-8% of dose) 98 days after treatment compared to 'Clout-S' (94+/-3% dose). Autoradiographic examination of treated wool demonstrated that there was more DM in the lower half of the wool staple when formulated in F1 compared to 'Clout-S'. Greater mortality occurred when sheep biting lice Bovicola (Damalinia) ovis were exposed in vitro to wool containing DM from F1 compared to 'Clout-S' treated sheep. In field trials there was increased efficacy against synthetic pyrethroid resistant B. ovis with F1 formulation than with 'Clout-S'. The study has demonstrated that synthetic pyrethroid availability, and therefore efficacy, can be significantly increased when the insecticide is formulated in a 'carrier' with the physicochemical characteristics of wool grease.

Double-chambered right ventricle in 73 patients: spectrum of the disease and surgical results of transatrial repair

OBJECTIVE

To review the spectrum of double-chambered right ventricle (DCRV) and the outcome of surgical repair in patients diagnosed between February 1988 and March 1999.

DESIGN

The charts of patients with DCRV were studied.

SETTING

Tertiary care hospital.

PATIENTS AND METHODS

A total of 73 patients were identified. Sixty-nine underwent surgical repair, while four are awaiting surgery. The repair was through a transatrial approach in 61 patients, while in eight an additional ventriculotomy was performed.

MAIN RESULTS

An associated ventricular septal defect (VSD) was present in 56 of 73 patients (77%). These patients were significantly younger (P<0.05) than the 17 patients without a VSD. Among patients with a VSD, the 31 requiring patch closure were significantly younger than the 25 patients having direct closure. Five older patients among those with intact septum had impaired right ventricular (RV) function as well as higher intraventricular gradients. At surgery the intraventricular obstruction was relieved by myomectomy. There was no hospital or late mortality. Following surgery, at a mean follow-up of 13.6 months, no increase in the intraventricular gradient was detected by Doppler echocardiography.

CONCLUSIONS

The development of DCRV is associated with VSD in early life. The probability of the presence of a VSD decreases with age. The disease is progressive, resulting in increased intracavitary gradient within the RV and in RV impairment if it is not treated in a timely fashion. Transatrial repair is safe with excellent midterm results. In the presence of high gradients within the RV, a ventriculotomy may be necessary to obtain acceptable results.

Production and oxidation of wool grease after shearing

OBJECTIVE

To measure the production and amount of oxidation of wool grease secreted immediately after shearing. To identify components of wool grease that might act as a carrier to facilitate lateral diffusion of topically applied insecticides.

DESIGN

Fine-wool Merino sheep were shorn and residual greasy wool was collected from the sheep's flank. The quantity of grease produced, and the amount of oxidation was measured during 18 days after shearing. Wool grease was fractionated into five component groups based on their polarity and the degree of oxidation in these fractions determined.

RESULTS

There was a 24% increase in grease production within 2 days after shearing but secretions returned to pre-shearing amounts after 4 days. During this period wool grease oxidized rapidly. Of the grease fractions examined, sterol and wax esters remained essentially unoxidized whereas free sterols such as cholesterol and lanosterol, fatty acids and polar lipids, aldehydes and alcohols were extensively oxidized within 7 days after shearing.

CONCLUSION

The transient increase in grease production after shearing may facilitate diffusion of topically applied synthetic pyrethroid insecticides. Oxidation of grease components may then contain the insecticide and limit further diffusion. Incorporating the insecticide in non-oxidising fractions of wool grease may make insecticide dispersion more efficient.

Infantile fibromatosis

A case of infantile fibromatosis involving the cheek of a three-year-old Sudanese girl is described. The tumour was resected through a sublabial approach.

Cluster survey evaluation of coverage and risk factors for failure to be immunized during the 1995 National Immunization Days in Egypt

BACKGROUND

In 1995, Egypt continued to experience endemic wild poliovirus transmission despite achieving high routine immunization coverage with at least three doses of oral poliovirus vaccine (OPV3) and implementing National Immunization Days (NIDs) annually for several years.

METHODS

Parents of 4188 children in 3216 households throughout Egypt were surveyed after the second round of the 1995 NIDs.

RESULTS

Nationwide, 74% of children are estimated to have received both NID doses, 17% one NID dose, and 9% neither NID dose. Previously unimmunized (47%) or partially immunized (64%) children were less likely to receive two NID doses of OPV than were fully immunized children (76%) (P < 0.001). Other risk factors nationwide for failure to receive NID OPV included distance from residence to nearest NID site >10 minute walk (P < 0.001), not being informed about the NID at least one day in advance (P < 0.001), and residing in a household which does not watch television (P < 0.001). Based on these findings, subsequent NIDs in Egypt were modified to improve coverage, which has resulted in a marked decrease in the incidence of paralytic poliomyelitis in Egypt.

CONCLUSIONS

In selected situations, surveys can provide important information that is useful for planning future NIDs.