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Fibrosing mediastinitis, also known as sclerosing mediastinitis, is an uncommon condition marked by abnormal proliferation of fibrous tissue in the mediastinum. This condition may accrue either as an idiopathic condition or as a complication of an underlying disease process. Its pathogenesis remains unknown. However, most reported cases are incriminating abnormal immune-mediated hypersensitivity responses to Histoplasma infection. Other rare causes include tuberculosis, blastomycosis, and an idiopathic form that may be associated with other miscellaneous conditions. CT and MR imaging play a vital role in the diagnosis and management of this disease. We present a rare case of fibrosing mediastinitis as a late complication of tuberculosis in a 34-year-old man with a prior history of mediastinal tuberculosis, mimicking initially a neoplastic mediastinal process. We will describe this clinical case in the light of the literature and point out the contribution of radiological imaging in the diagnosis of this rare pathology.

Background: Metabolic syndrome (MetS) is a global health concern, especially for low and middle-income countries with limited resources and information. The study's objective was to assess the prevalence of MetS in Freetown, Sierra Leone, using the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III), International Diabetes Federation (IDF) and Harmonize ATP III. Additionally, we aimed to establish the concordance between these three different criteria used. Methods: This community-based health screening survey was conducted from October 2019 to October 2022. A multistage stratified random design was used to select adults aged 20 years and above. Mean, interquartile range (IQR), and logistic regression were used for statistical analysis. The kappa coefficient statistics resolved the agreement between these defined criteria. Results: The prevalence for NCEP ATP III, Harmonize ATP III and IDF criteria was 11.8 % (95 % CI: 9.0–15.15), 14.3 % (95 % CI: 11.3–18.0), and 8.5 % (95 % CI: 6.2–11.2), respectively for the 2394 selected adults. The kappa coefficient (κ) agreement between the MetS is: Harmonized ATP III and IDF criteria = [(208 (60.8 %); (κ = 0.62)]; Harmonized ATP III and NCEP ATP III = [(201 (58.7 %); (κ = 0.71)]; while IDF and NCEP ATP III was [(132 (38.6 %); (κ = 0.52)]. In the multivariable regression analysis, waist circumference correlated with all three MetS criteria: ATP III [AOR = 0.85; C.I 95 %: (0.40–1.78), p = 0.032], Harmonized ATP III [AOR = 1.14; C.I 95 %: (0.62–2.11), p = 0.024], IDF [AOR = 1.06; C.I 95 % (0.52–2.16), p = 0.018] Conclusion: We reported a high prevalence of MetS in Freetown, Sierra Leone and identified waist circumference as a major risk factor for MetS. This underscores the crucial role of health education and effective management of MetS in Sierra Leone.

Background: Head and neck cancer (HNC) encompasses malignant tumors in areas like the oral cavity, pharynx, and larynx. This analysis identifies strengths and deficiencies in HNC research, aiming to improve published papers' quality, quantity, and diversity. It also encourages more participation from oncologists, particularly in Egypt, to bridge the gap with Western healthcare standards. Methods: A systematic search was conducted in databases including PubMed, Scopus, Web of Science, and Embase. The goal was to gather research articles on HNC in Egypt published from January 1, 2000, to December 31, 2022. Results: From 2150 articles, 1329 were screened by title and abstract, leading to 193 for full-text review. Finally, 174 articles were included in the final analysis. 2020 saw the highest number of publications. The majority were primary research articles, with randomized controlled trials being prevalent. Most studies were clinical, focusing on radiotherapy, and involved adult patients, emphasizing service delivery. Publications were predominantly in non-Egyptian journals, with the Egyptian Journal of Radiology and Nuclear Medicine being the most frequent. Research was mainly conducted by Egyptian authors and at Cairo University. Conclusion: The growing prevalence of HNC in Egypt underscores the need for more comprehensive research on its various aspects, including etiology, risk factors, and prevention. There's a call for increased research outputs at different Egyptian universities, multicenter studies, and international collaborations. This approach can improve the understanding and management of HNC, contributing to global discussions and advancing treatment and prevention strategies in Egypt.

Background: We herein report the case of a patient with advanced lung adenocarcinoma who presented a heterogeneous distribution of EGFR mutation. Case report: A 74-year-old Moroccan male former smoker was diagnosed with advanced lung adenocarcinoma, harboring S768I exon 20 substitution mutation confirmed by Real Time PCR and Pyrosequencing, but not detected by direct sequencing despite 70% of tumor cells. The present report describes a case of minor histologic intratumoral heterogeneity with heterogeneous distribution of EGFR mutation. Conclusion: Both sensitivity and specificity of molecular methods can provide evidence of intratumoral heterogeneity, which may explain the mismatch between the validation of oncology biomarkers and predicting therapeutic response to targeted therapy.

Thymolipoma is a rare benign neoplasm of the thymus containing both mature adipose tissue and thymic tissue. We report a case of a 34‐year‐οld man, presenting a mass of the anterior mediastinum, the radiology investigation and operatory piece diagnosed a thymolipoma.This study highlights the clinical diagnostic and therapeutic features as well as the evolutionary characteristics of this entity.

Diclofenac (DF), a non-steroidal anti-inflammatory drug, is commonly used to relieve pain and inflammation. High doses of DF might induce acute kidney injury (AKI), particularly in elderly, a known vulnerable population., Aim: We aimed to assess the protective role of melatonin (Mel) on DF-induced AKI in aged rats and to highlight the underpinning mechanisms include, oxidative stress and inflammation focusing on microRNA-34a (miR-34a), nuclear factor erythroid-2-related factor-2/hemeoxygenase-1 (Nrf2/HO-1) and NLR family-pyrin domain containing-3 (NLRP3) inflammasome pathways, and to elucidate the possibility of epithelial sodium channel (ENaC) involvement., Materials and Methods: Thirty old male Wistar rats were allocated randomly into 3 groups: Control, DF and Mel-DF groups., Key Findings: Melatonin provided nephroprotective effects against DF-induced AKI via attenuating the expression of renal miR-34a and subsequently promoting the signaling of Nrf2/HO-1 with elevation of the antioxidant defense capacity and suppressing NLRP3 inflammasomes. Melatonin alleviated DF-induced hypernatremia via decreasing the ENaC expression. Renal histopathological examination revealed significant reduction in vascular congestion, mononuclear infiltration, glomerulo-tubular damage, fibrosis and TNF-α optical density., Significance: It can be assumed that melatonin is a promising safe therapeutic agent in controlling DF-induced AKI in elderly., Competing Interests: Declaration of competing interest The authors declare no conflict of interests., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Ticks, particularly Rhipicephalus annulatus, pose significant threats to livestock, causing economic losses and transmitting various infectious diseases. This study aimed to evaluate the potential acaricidal properties of garlic oil and its nanoemulsion against ticks infesting cattle, Rhipicephalus annulatus through the evaluation of mortality rate and morphological changes of the treated ticks. The study also included prevalence, risk factors, and molecular confirmation of tick species. Genetic characterization confirmed the identity of R. annulatus. Our results revealed a high prevalence of R. annulatus (46.9%) with a higher risk in male cattle (50%) than females (44.9%) and a nonsignificant high infection (49.1%) in animals ≤ 1 year old. The acaricidal efficiency of garlic oil and its nanoemulsion was concentration and time-dependent. The high concentration of garlic oil (20 mg/L) induced complete mortality within 48 hours. The nanoemulsion formulation enhanced efficacy, particularly at 5 mg/L, which exhibited rapid and substantial acaricidal activity. Scanning electron microscopy revealed morphological alterations induced by garlic oil and its nanoemulsion, including changes to the anterior capitulum, dorsal, and ventral cuticles. The study contributes to the exploration of effective, safe, and eco-friendly alternatives for tick control. Further research is warranted to validate their efficacy under diverse conditions and assess practical strategies., Competing Interests: Declaration of Competing Interest None, (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Goldilocks mastectomy represents a midway solution for breast reconstruction between flat chest and sophisticated reconstructive techniques. The literature lacks a standardization of the technique. In this study, we present a step-by-step approach with modifications in the original technique achieving better breast shape and contour within the context of standardization of the technique., Methods: A single arm prospective study was conducted at our center in which female patients with large ptotic breasts indicated for mastectomy were included. Patients with locally advanced skin changes, inflammatory carcinoma, stage IV disease as well as male patients were excluded. Recruited patients were subjected to the same surgical steps. Contralateral breast symmetrization was performed by reduction technique to patients who accepted this. All patients were requested to report their degree of satisfaction according to a simple 5-point Likert scale. Follow up mammogram was performed to all patients 1 year after the procedure., Results: A total of 55 patients were included with a median (IQR) age of 56.0 (50.0-62.0) years. The median (IQR) BMI was 41.20 (36.55-44.35)Kg/m 2 . The median (IQR)operative time was 115.0 (105.0-120.0) minutes. Complications were encountered in 12 patients (21.8 %). The follow up period ranged from 19 to 66 months with a median (IQR) 36.0 (28.0-45.0)months. 98.2 % of the studied patients were either satisfied or extremely satisfied., Conclusions: Goldilocks mastectomy is a valid mastectomy option for selected patients with large ptotic breasts. Standardization of the surgical steps can help in improving the aesthetic outcome., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)

Background: Growth hormone (GH) is a hormone that promotes growth, cell reproduction, and cell restoration in humans and animals., Objectives: Production of recombinant human growth hormone (rhGH) in Escherichia coli (E. coli) and assessment of its characteristics and proliferation stimulatory activity., Methods: The hGH gene was cloned into a pET 3a expression vector and transformed into a competent E. coli cell. The refolded hGH was purified, Western blot and batch fermentation were performed. Cell cytotoxicity was tested on Vero cells, and MALDI-TOF and Nano-LC-ESI MS/MS were used for protein and target peptide analysis., Results: Induced rhGH was purified with a concentration of 511.9 mg/ml. Western blot confirmed the molecular identity of rhGH, showing a single 22 kDa band. The bacterial growth at OD 600 after 24 h in batch fermentation was 9.78 ± 0.26, and wet cell weight (WCWg/L) was 15.2 ± 0.32. Purified rhGH activity on Vero cells was 0.535 IU/mg. LC-MS/MS analysis revealed a score of 70.51 % and coverage of 60.37 %., Conclusion: Biologically active native rhGH protein was successfully expressed in the Prokaryotic system. Our goal is to increase its production on a pilot level in the native form at a high activity effect identical to isoform 1., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. Sami Mohamed Nasr reports financial support, administrative support, equipment, drugs, or supplies, and travel were provided by Science and Technology Development Fund. Dr. Sami Mohamed Nasr reports a relationship with Theodor Bilharz Research Institute that includes: employment. Co-author Dr. Hend Okasha and member Dr. Safia Samir are employee at Theodor Bilharz research institute., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: Copper (Cu), an essential trace mineral regulating multiple actions of inflammation and oxidative stress, has been implicated in risk for preterm birth (PTB)., Objectives: This study aimed to determine the association of maternal Cu concentration during pregnancy with PTB risk and gestational duration in a large multicohort study including diverse populations., Methods: Maternal plasma or serum samples of 10,449 singleton live births were obtained from 18 geographically diverse study cohorts. Maternal Cu concentrations were determined using inductively coupled plasma mass spectrometry. The associations of maternal Cu with PTB and gestational duration were analyzed using logistic and linear regressions for each cohort. The estimates were then combined using meta-analysis. Associations between maternal Cu and acute-phase reactants (APRs) and infection status were analyzed in 1239 samples from the Malawi cohort., Results: The maternal prenatal Cu concentration in our study samples followed normal distribution with mean of 1.92 μg/mL and standard deviation of 0.43 μg/mL, and Cu concentrations increased with gestational age up to 20 wk. The random-effect meta-analysis across 18 cohorts revealed that 1 μg/mL increase in maternal Cu concentration was associated with higher risk of PTB with odds ratio of 1.30 (95% confidence interval [CI]: 1.08, 1.57) and shorter gestational duration of 1.64 d (95% CI: 0.56, 2.73). In the Malawi cohort, higher maternal Cu concentration, concentrations of multiple APRs, and infections (malaria and HIV) were correlated and associated with greater risk of PTB and shorter gestational duration., Conclusions: Our study supports robust negative association between maternal Cu and gestational duration and positive association with risk for PTB. Cu concentration was strongly correlated with APRs and infection status suggesting its potential role in inflammation, a pathway implicated in the mechanisms of PTB. Therefore, maternal Cu could be used as potential marker of integrated inflammatory pathways during pregnancy and risk for PTB., (Copyright © 2023. Published by Elsevier Inc.)

Introduction: This study investigated different access cavity designs of mandibular anteriors in terms of their effect on the biomechanical behavior and longevity using finite element analysis (FEA)., Methods: A 3-dimensional model of a mandibular incisor was created for FEA. After validating the intact tooth (IT) model, 4 experimental models were developed (traditional lingual access cavity [TLA], facial access cavity [FAC], incisal access cavity [ICA], and cervical access cavity [CVA]). Cyclic loading was simulated, and the number of cycles until failure (NCF) was compared to the IT model. Stress distribution patterns, maximum von Mises stresses (vMSs), and maximum principal stresses (MPSs) were analyzed mathematically. The safety factor was also calculated and demonstrated., Results: The maximum vMS registered on the IT model was 134.16 MPa. The FCA and the CVA provided the highest NCF (193.7% compared with the IT model) followed by ICA (58.2%) and TLA (21.4%). The vM and MPS analysis revealed that the lingual surface is a primary stress channel, and the presence of an access cavity significantly weakens the tooth structure. Although the maximum vMS registered for the IT model was 134.16 MPa, the maximum vMS was 73.97 MPa for both the FCA and the CVA, 152.27 MPa for the ICA, and 173.63 MPa for the TLA., Conclusions: The facial and cervical access cavity designs provided considerable reinforcement to the endodontically treated mandibular incisors. With advancements in esthetic restorative materials and endodontic instruments, facial access design could emerge as the new standard for access cavity preparation in mandibular incisors., (Copyright © 2023 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: This study investigated the effects from the carious cavity and access from it on the fracture resistance of endodontically treated maxillary premolars using finite element analysis (FEA)., Methods: A maxillary premolar was used to compare 3 types of access cavity related to having a proximal carious defect: caries-driven access (CDA), conservative access that has a mesial component (MCA), as well as traditional access with the same mesial component (MTA). Cyclic loading was simulated on the occlusal surface, and number of cycles until failure (NCF) was compared with the intact tooth model (IT). Mathematical analysis was done to evaluate the stress distribution patterns and calculated maximum von Mises (vM) and maximum principal stresses (MPS), with emphasis on pericervical region as a specific area of interest., Results: Maximum vM registered on the IT was 6.14 MPa. CDA provided the highest NCF with 92.28% of the IT, followed by MCA (84.90%) and MTA (83.79%). The vM and MPS analysis showed that the stress values and patterns are affected more by the proximity of the occlusal load to the tooth/restoration interface. Concerning the pericervical region, maximum vM was registered for IT (4.11 MPa), followed by CDA (4.85 MPa) and then MCA (8.13 MPa) and MTA (8.61 MPa), whereas the MPS analysis revealed that CDA showed the highest magnitude of tensile stresses., Conclusions: A proximal CDA benefits the mechanical properties of maxillary premolars; however, its impact on the biological aspect should be assessed to provide a ruling for/against it., (Copyright © 2023 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Dimethylarginine dimethylaminohydrolase-1 (DDAH1) expression is frequently elevated in different cancers including prostate cancer (PCa) and enhances nitric oxide (NO) production in tumor cells by metabolising endogenous nitric oxide synthase (NOS) inhibitors. DDAH1 protects the PCa cells from cell death and promotes survival. In this study, we have investigated the cytoprotective role of DDAH1 and determined the mechanism of DDAH1 in protecting the cells in tumor microenvironment. Proteomic analysis of PCa cells with stable overexpression of DDAH1 has identified that oxidative stress-related activity is altered. Oxidative stress promotes cancer cell proliferation, survival and causes chemoresistance. A known inducer of oxidative stress, tert-Butyl Hydroperoxide (tBHP) treatment to PCa cells led to elevated DDAH1 level that is actively involved in protecting the PCa cells from oxidative stress induced cell damage. In PC3-DDAH1 - cells, tBHP treatment led to higher mROS levels indicating that the loss of DDAH1 increases the oxidative stress and eventually leads to cell death. Under oxidative stress, nuclear Nrf2 controlled by SIRT1 positively regulates DDAH1 expression in PC3 cells. In PC3-DDAH1 + cells, tBHP induced DNA damage is well tolerated compared to wild-type cells while PC3-DDAH1 - became sensitive to tBHP. In PC3 cells, tBHPexposure has increased the production of NO and GSH which may be acting as an antioxidant defence to overcome oxidative stress. Furthermore, in tBHP treated PCa cells, DDAH1 is controlling the expression of Bcl2, active PARP and caspase 3. Taken together, these results confirm that DDAH1 is involved in the antioxidant defence system and promotes cell survival., Competing Interests: Declaration of competing interest The authors declare that there are no conflicts of interest., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Aim: The current work aims to demonstrate the potential defensive function of venlafaxine (VLF) in cardiotoxicity and nephrotoxicity caused by cisplatin (CP), that could be by modulating extracellular signal-regulated kinase (ERK)1/2 and nicotinamide adenine dinucleotide phosphate (NAPDH) oxidase NOX4 pathways., Main Methods: Five groups of rats were used, as follow: three control groups (control, carboxymethyl cellulose, and VLF), CP group got CP once (7 mg/kg, intraperitoneally, i.p.), and (CP+ VLF) group got CP once then after 1 h they got VLF {50 mg/kg daily, orally for 14 days}. At the end of the study; electrocardiogram (ECG) was recorded for anaesthized rats then blood samples and tissues were taken for biochemical and histopathological investigations. Caspase 3, a marker of cellular damage and apoptosis was detected by immunohistochemistry., Key Findings: CP treatment significantly impaired cardiac functions as evidenced by changes in rats' ECG. Cardiac enzymes, renal markers and inflammatory markers were increased with decreased activities of the total antioxidant capacity, superoxide dismutase and glutathione peroxidase. Also, ERK1/2 and NOX4 were upregulated with histopathological and immunohistochemical alterations of heart and kidney. While, VLF markedly alleviated CP-induced functional cardiac abnormalities and improved ECG pattern. It reduced both cardiac and renal biomarkers, oxidative stress, proinflammatory cytokine with ERK1/2 and NOX4 downregulation, improved the histopathological and immunohistochemical changes induced by cisplatin in heart and kidney., Significance: VLF treatment impedes cardiotoxicity and nephrotoxicity caused by CP. This beneficial effect was mediated through reduction of oxidative stress, inflammation, and apoptosis by targeting the ERK1/2 and NOX4., Competing Interests: Declaration of competing interest There are no conflicts of interest to report for any of the authors., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Introduction: This study investigated the effect of shaping parameters of 2 different configurations of middle mesial canals (MMCs) on the biomechanical behavior and life span of a mandibular first molar using finite element analysis (FEA)., Methods: A mandibular molar with an independent MMC and another with a confluent MMC were scanned via micro-computed tomography, and FEA models were produced. For each tooth, an intact model and 5 experimental models were produced that differed by parameters of how the MMC was shaped: unshaped MMC, 25/.04, 25/.06, 30/.04, and 30/.06. Cyclic loading of 50 N was applied on the occlusal surface in vertical and oblique scenarios, and the number of cycles until failure (NCF) was compared with the intact models. In addition, mathematical analyses evaluated the stress distribution patterns and calculated maximum von Mises and maximum principal stresses., Results: For both the independent and confluent MMC models, shaping the MMC reduced the NCF. The lifelog percentage of models was inversely proportional with radicular shaping parameters during the vertical and oblique loading scenarios. The shaping size of 30/.06 resulted in lower lifelog percentage than the cases with shaping size of 25/.04 in both of the independent and confluent MMC models. For all models, oblique loading reduced NCF more than vertical loading., Conclusion: Shaping the MMC should be kept as conservative as 25/.04. Also, whether the MMC is independent or confluent is a deciding factor in whether to increase the apical diameter or the root canal taper when larger shaping parameters are needed., (Copyright © 2023 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

The psychoactive effects of new synthetic cannabinoids (SCs), MDMB-4en-PINACA, are being marketed as a blend of herbs and spices. This study aims to determine the behavioral, neurochemical, histopathological, and immunohistochemical alterations associated with the acute toxicity of MDMB-4en-PINACA compounds., Methods: Adult male albino rats were administered various toxic doses of the drug (1.5, 3, and 6 mg/kg), and behavioral studies were conducted 2 and 24 h later; animals were then sacrificed. Histopathological and neurochemical examinations were performed. Two hours after intraperitoneal., Results: Intraperitoneal injection of MDMB-4en-PINACA, horizontal movement, the number of stops, and mobility ratio were significantly impaired, along with coordination and balance. In addition, it led to a decline in spatial learning and memory, and neurotransmitter concentrations decreased significantly in a dose-dependent manner. Further examination of the cerebral cortex and hippocampus histopathology revealed pathological degeneration of small pyramidal cells., Conclusion: Thus, these findings revealed that MDMB-4en-PINACA interferes with hippocampal function and impairs cognitive performance, highlighting the cognitive risk associated with SC abuse., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: In chronic subjective tinnitus (CST) studies, the effect of bee-humming respiratory training (BHRT), a type of pranayama breathing technique, on autonomic cardiovascular/respiratory physiological functions (systolic pressure, rates of breathing and pulse, and diastolic pressure), tinnitus annoyance (TA), tinnitus loudness (TL), and quality of life measures as tinnitus handicap inventory (THI) did not receive significant attention., Objective: This study aimed to investigate the efficacy of BHRT on TL, THI, TA, and cardiovascular/respiratory autonomic functions in bilateral CST elderly (aged ≥65 years old)., The Design, Setting, Participants, and Intervention: The current study employs a prospective, single-blind design; it is a randomized-controlled for-tinnitus behavioral intervention. Forty-six CST elderly subjects were randomly assigned to one of two groups: the BHRT group (23 patients) or the control group (23 patients). The 4-week BHRT intervention was applied 30 min daily., Outcome Measures: TL, THI, TA, and cardiovascular/respiratory autonomic functions were evaluated., Results: Significant BHRT-induced reductions of all measures were detected in the BHRT group, whereas no significant changes were observed in the controlled elderly group., Conclusion: The complementary choice for BHRT is considered an effective method to improve TL, TA, THI, and cardiovascular/respiratory autonomic functions in CST elderly., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Objectives: Different biomarkers such as C-reactive protein (CRP), serum ferritin and D-dimer are used in prognostic assessment of patients with COVID-19 pneumonia. Presepsin (PSP) is a soluble CD14 subtype that has recently been proposed as a novel biomarker in patients with sepsis. The aim of the current study was to detect the relation of PSP to the outcome of COVID-19 as well as its relation to other inflammatory biomarkers., Methods: This multicenter retrospective observational study was conducted in Saudi Arabia and Misr International Hospital, Egypt, from January 2021 to May 2021. Hospitalised patients who had positive throat swab of SARS-CoV-2 and radiological evidence of viral pneumonia (moderate and severe forms) were included in the study. Demographics and clinical features, as well as laboratory parameters, including serum ferritin, CRP, D-dimer and PSP, of enrolled patients were retrospectively collected. Pneumonia severity index (PSI) was used to evaluate the severity of pneumonia., Results: A total of 202 hospitalised patients who were diagnosed with COVID-19 pneumonia and tested positive for SARS-CoV-2 RNA were enrolled in our study. Of 202 hospitalised patients, 67 (33.17%) required intensive care unit (ICU) admission. A total of 176 (87.1%) patients survived and were discharged, whereas 26 (12.9%) patients did not survive. PSP level was found to be significantly elevated in nonsurvivor versus survivor group (median [IQR] 978.5 [755.8-1400] vs 516.5 [343.3-720], P<0.001) as well as in ICU versus non-ICU patients (median [IQR] 800 [631-1200] and 446 [320-626], respectively) (P<0.001). Elevated levels were also found to be associated with increased length of hospital stay. Levels above 775 pg/mL were found to be associated with in-hospital mortality (specificity 80%, sensitivity 73%)., Conclusion: Elevated PSP levels indicated poor outcomes in hospitalised patients with COVID-19 pneumonia and were associated with in-hospital mortality., Competing Interests: Conflict of interests The authors declare that there are no conflicts of interests., (Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Toxoplasma gondii is a coccidian parasite known for its heavy toll on people and livestock. It can cause abortion and a variety of congenital diseases. The current study aimed to examine some seroprevalence and molecular attributes of T. gondii obtained from ruminants in the North-West of Egypt. Specimens were random selected from five different locations in Alexandria and Matrouh governorates. A total of 483 blood samples, collected from 96 mixed flocks, were screened for anti-T. gondii IgG antibodies using enzyme-linked immunosorbent assay (ELISA). The seropositive results were then confirmed using polymerase chain reaction (PCR) primers for the B1 and P30 genes. Specific PCR products were selected for sequencing and alignment against the GenBank, where phylogeny has been examined using the maximum likelihood, neighbor-joining, and maximum parsimony in MEGA6. ELISA confirmed the presence of T. gondii in 188 of the investigated samples (38.92%), indicating a higher prevalence in camels (64.51%) and sheep (43.75%) as compared to goats (27.93 %) and cattle (13.46%). PCR confirmed the presence of T. gondii-specific sequences in 159 seropositive specimens, with homology between 98.3 and 100%. The genetic distances between the investigated variants ranged from 0.1 to 0.9, and 7 single nucleotide polymorphisms (SNPs), were identified in the examined T. gondii specimens. The camel T. gondii parasite, isolated from Matrouh, showed a 100% homology with the most dangerous reference strains of T. gondii-RH in the GenBank. Our results showed that B1 and P30-specific PCR could detect T. gondii in blood samples more accurately than ELISA. In addition, the statistical analysis of our data indicated that species, age, sex, and animal location were all risk factors for toxoplasmosis. These findings are likely to boost disease control and help contain the spread of T. gondii infections., (Copyright © 2021. Published by Elsevier B.V.)

Human Chromogranin A N46 (CGA-N46) is a weak cationic α-helical peptide with wide-spectrum antibacterial, fungal, and anticancer activities. In this study, the recombinant human CGA-N46 peptide was expressed successfully in Escherichia coli. The gene of CGA-N46 was cloned into the expression vector pET-15b without a fusion tag at the N terminus and the peptide was expressed using Isopropyl-β-d-thiogalactoside (IPTG) as an inducer. Using 8 M guanidinium HCl, inclusion bodies containing the peptide were purified and solubilized. The rhCGA-N46 peptide was purified using Q-FF anion exchange column. The cytotoxicity of the purified rhCGA-N46 peptide was investigated on WI-38 human lung normal cell line. The anticancer activity was studied on human colon cancer cell line; HCT-116 cell line. Besides, the possible involvement of rhCGA-N46 peptide in regulating apoptotic signal pathways was analyzed by detecting the expression levels of BCL2, BID, and CAS-8 in the treated cells. The results concluded that the active peptide recovery was up to 41.98%. The purified rhCGA-N46 was safe on normal cells with IC 50  = 227.74 µg/ml (40.67 µM) and had an obvious anticancer effect on colon cancer cells with IC 50 = 1.997 µg/ml (356.6 nM). The expression level of BCL2 was down-regulated and BID and CAS-8 were up-regulated significantly in treated HCT-116 cells compared to untreated. In conclusion, the rhCGA-N46 peptide was produced successfully in the native form with promising anti-colon cancer activity., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Introduction: This study investigated the impact of different canal tapers and access cavity designs on the life span of endodontically treated mandibular first molars using the finite element method., Methods: Finite element analysis was performed on simulated models with 3 access cavity designs (traditional, conservative, and truss). The mesial canals were prepared to either constant tapers of 25/.04 and 25/.06 or a variable taper corresponding to the cumulative canal preparation shapes of TruNatomy Prime (Dentsply Sirona, Charlotte, NC) and ProTaper Gold F2 (Dentsply Sirona). The distal canals in all models had a 40/.04 preparation. Using occlusal fingerprint analysis, all models were subjected to cyclic occlusal loading until model failure. The number of cycles until failure, the location of failure, stress distribution patterns, and the maximum von Mises stresses were assessed., Results: The traditional access models showed a lower life span than the conservative and truss models regardless of the canal taper, whereas there was not a notable difference in the conservative and truss models. The stresses migrated apically along the root surface and remarkably on the mesial aspect of the mesial root and the furcation area's outer surface. After root canal preparation with different tapers, there were no evident changes in the pattern and magnitude of the stresses distributed along the root surface., Conclusions: The life span of the tooth is affected more significantly by the access cavity design than the root canal preparation taper. Because stress patterns migrate apically rather than concentrate in the pericervical area, crack initiation and propagation might occur anywhere on the root surface., (Copyright © 2021 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Background: Surgical conditions account for as much as one third of the global burden of disease, yet 5 billion people worldwide do not have access to timely, affordable surgical care. These disparities in access to timely surgical care are most pronounced in low- and middle-income countries, where the availability of specialty surgical services such as neurosurgery are severely limited or completely absent. The African autonomous region of Somaliland, in the Horn of Africa, is one such region., Methods: Discussions were conducted with key individuals in Somaliland to ascertain the current state of neurosurgery in Somaliland., Results: The current state of neurosurgery in Somaliland was characterized. First, a background on the recent history of the republic and the surrounding region was furnished, which provides context for the challenging socioeconomic conditions in Somaliland. Brief biographical sketches were presented of local leaders and general surgeons who are actively working to improve economic and health conditions and who welcome opportunities to improve all health services, including neurosurgery. In addition, an overview was presented of new initiatives in capacity building in neurosurgery and sources of directed training and care in neurosurgery., Conclusions: This article provides the first-ever assessment of current neurosurgery-related activity in Somaliland. The article provides recommendations to guide the international neurosurgery community in future contributions., (Copyright © 2021 Elsevier Inc. All rights reserved.)

In the current study, a structure-based virtual screening paradigm was used to screen a small molecular database against the Non-structural protein 15 (Nsp15) endoribonuclease of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). The SARS-CoV-2 is the causative agent of the recent outbreak of coronavirus disease 2019 (COVID-19) which left the entire world locked down inside the home. A multi-step molecular docking study was performed against antiviral specific compounds (~8722) collected from the Asinex antiviral database. The less or non-interacting molecules were wiped out sequentially in the molecular docking. Further, MM-GBSA based binding free energy was estimated for 26 compounds which shows a high affinity towards the Nsp15. The drug-likeness and pharmacokinetic parameters of all 26 compounds were explored, and five molecules were found to have an acceptable pharmacokinetic profile. Overall, the Glide-XP docking score and Prime-MM-GBSA binding free energy of the selected molecules were explained strong interaction potentiality towards the Nsp15 endoribonuclease. The dynamic behavior of each molecule with Nsp15 was assessed using conventional molecular dynamics (MD) simulation. The MD simulation information was strongly favors the Nsp15 and each identified ligand stability in dynamic condition. Finally, from the MD simulation trajectories, the binding free energy was estimated using the MM-PBSA method. Hence, the proposed final five molecules might be considered as potential Nsp15 modulators for SARS-CoV-2 inhibition., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Case Presentation: A 72-year-old Chinese man presented with a 5-month history of chronic dry cough, weight loss, and progressive dyspnea. There was no associated hemoptysis, hoarseness, epistaxis, or fever on systemic review. He was a nonsmoker and had no family history of malignancy. He was treated for pulmonary TB 40 years ago. A chest radiograph (Fig 1) showed mass-like consolidation in the right midzone with loss of the right hilar border, a small right pleural effusion, and bi-apical scarring. On physical examination, he was afebrile and normotensive, and he had pulse oxygen saturation of 97%. Examination of the chest was remarkable only for reduced breath sounds over the right chest. He did not have digital clubbing, distended neck veins, or cervical lymphadenopathy., (Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

Introduction: This study aimed to compare the biomechanical properties of a mandibular first molar with different endodontic cavity designs and increasing sizes of root canal preparations using finite element analysis (FEA)., Methods: The experimental finite element models were designed with 3 different endodontic access cavities and 2 sizes of canal preparations: traditional access cavity, conservative access cavity, and truss access cavity and #30/.04 and #40/.04 of root canal preparations. Vertical and oblique loads were applied with a 250-N static force to simulate masticatory forces. Mathematical analysis was performed to evaluate the stress distribution patterns. Maximum von Mises (VM) stresses were assessed at the occlusal surface; cervical line; and 1 , 3, 5, and 7 mm from the root apices., Results: Decreasing the size of the access cavity was associated with a higher magnitude of cervical stresses. The magnitude of VM stresses was maximum at the 7-mm level and was minimum at the 1-mm level from the root apex. Increasing the size of the access cavity was associated with the transmission of stresses to a further apical direction regardless of the extent of root canal enlargement. The root canal enlargement from #30 to #40 increased radicular VM stresses within all models., Conclusions: Within the limitations of this study, conservative and truss access designs preserved a significant volume of tooth structure. The extent of root canal enlargement should be as small as practical without jeopardizing the biologic objectives of root canal treatment., (Copyright © 2020 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Phytochemical investigation of the ethanolic extract of Glandularia x hybrida roots resulted in the isolation and identification of five previously undescribed saponins, 3-O-β-ᴅ-xylopyranosyl-hederagenin-28-O-β-ᴅ-glucopyranosyl (1→2)-O-β-ᴅ-glucopyranosyl ester, 3-O-β-ᴅ-xylopyranosyl-hederagenin-28-O-β-ᴅ-glucopyranosyl (1→2)-[β-ᴅ-glucopyranosyl (1→6)]-β-ᴅ-glucopyranosyl ester, hederagenin-28-O-β-ᴅ-glucopyranosyl (1→2)-[β-ᴅ-glucopyranosyl (1→6)]-β-ᴅ-glucopyranosyl ester, 23-O-acetyl-3-O-β-ᴅ-xylopyranosyl-pomolic acid-28-O-β-ᴅ-glucopyranosyl ester, and 23-O-acetyl-pomolic acid-3-O-β-ᴅ-xylopyranoside, along with eleven structurally diverse compounds. The structural characterizations of the isolated compounds were determined using physical data, comprehensive 1D and 2D NMR spectral analysis, and HRESIMS. All isolated saponins are hederagenin or pomolic acid glycosides conjugated with differentiable sugar units bound to C-3 and/or C-28 of the aglycone through ether and/or ester glycosidic linkages, respectively. Structural diversity of these isolated secondary metabolites would have a great impact on the future chemosystematic studies of this plant. Four saponins, obtained in good yield were evaluated for their anti-inflammatory activities in a rat model using the carrageenan-induced paw edema protocol. Two of these exhibited significant anti-inflammatory activities demonstrated through inhibition of the paw edema by 64 and 60%., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: The component (C3) of the complement system constitutes a central element in liver transplantation. C3 is produced mainly by the liver and comprises both slow (C3-S), and fast (C3-F) components., Methods: The effect of a single nucleotide variation in the C3 gene on the first-year outcome examined by ARMS PCR in 30 recipients of living donor allograft., Results: Frequencies of C3-S and C3-F in the Egyptian recipients' population were 67% and 33%. C3-F allele frequency was prevalent than the C3-S allele in recipients who developed acute rejection. The C3-SF and C3-FF genotypes significantly associated with acute rejection with 6.25 times increase in the risk of rejection than C3-SS (OR: 6.25; CI:1.05-37.07, p < .05). C3-SS increases the survival 2.5 times more than C3-SF or C3-FF but without significant association (OR: 0.40, CI: 0.07-2.44, p = .3). C3 genotypes or allotypes had no significant association with the recipient's survival, death, graft loss, infection, or serum levels of tacrolimus (all p > .05). C3-FF and C3-SF genotypes had the highest HCV recurrence rate but without significant association (p > .05)., Conclusion: In liver allograft recipients, C3-SF and C3-FF genotypes significantly associated with acute rejection with the C3-F allele more prevalent than the C3-S. C3-SS genotype increases survival without significant association., Competing Interests: Declaration of Competing Interest Authors declare there is no conflict of interest., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Objective: To evaluate the effects of the patient-dentist relationship on dental anxiety among young adult Sudanese patients., Materials and Methods: In this cross-sectional study, 864 patients attending outpatient dental clinics of the governmental dental hospitals in Khartoum, Sudan were recruited; 51.2% were males and 48.8% were females, with an age range of 18-24 years. The questionnaire used evaluated the socio-demographics, education levels, economic status, patient experience, and also included the Dental Anxiety Scale, Corah (J Dent Res 1969 48: 596)., Results: High dental anxiety was reported by 22.2%, 29.5% reported moderate dental anxiety, and 48.3% reported low or no dental anxiety. There were statistically significant associations between dental anxiety and gender, time lapse since the previous dental visit (P < 0.004) and the reason for the previous visit (P < 0.001). In addition, the dental clinic environment (P < 0.002), the time waiting before seeing the dentist (P < 0.001) and the overhearing of pain expressed by other patients (P < 0.001) were also statistically significant. Negative comments by the treating dentist also had a statistically significant impact (P < 0.032). In contrast, a clear explanation of related dental care (P < 0.008), as well as the allowance of adequate time to discuss oral health (P < 0.006), had significantly positive effects., Conclusion: The study showed that the patient-dentist relationship had a significant association with dental anxiety, and may be an important target for improving the delivery and standards of oral health in dentally anxious patients in this region., (© 2018 FDI World Dental Federation.)

Although lactic acid bacteria (LAB) are used widely as starter cultures in the production of fermented foods, they are also responsible for food decay and deterioration. The undesirable growth of LAB in food causes spoilage, discoloration, and slime formation. Because of these adverse effects, food companies test for the presence of LAB in production areas and processed foods and consistently monitor the behavior of these bacteria. The 3M Petrifilm LAB Count Plates have recently been launched as a time-saving and simple-to-use plate designed for detecting and quantifying LAB. This study compares the abilities of Petrifilm LAB Count Plates and the de Man Rogosa Sharpe (MRS) agar medium to determine the LAB count in a variety of foods and swab samples collected from a food production area. Bacterial strains isolated from Petrifilm LAB Count Plates were identified by 16S rDNA sequence analysis to confirm the specificity of these plates for LAB. The results showed no significant difference in bacterial counts measured by using Petrifilm LAB Count Plates and MRS medium. Furthermore, all colonies growing on Petrifilm LAB Count Plates were confirmed to be LAB, while yeast colonies also formed in MRS medium. Petrifilm LAB Count Plates eliminated the plate preparation and plate inoculation steps, and the cultures could be started as soon as a diluted food sample was available. Food companies are required to establish quality controls and perform tests to check the quality of food products; the use of Petrifilm LAB Count Plates can simplify this testing process for food companies.

Background: A critical thinker may not necessarily be a good decision-maker, but critical care nurses are expected to utilise outstanding critical thinking skills in making complex clinical judgements. Studies have shown that critical care nurses' decisions focus mainly on doing rather than reflecting. To date, the link between critical care nurses' critical thinking and decision-making has not been examined closely in Malaysia., Aim: To understand whether critical care nurses' critical thinking disposition affects their clinical decision-making skills., Method: This was a cross-sectional study in which Malay and English translations of the Short Form-Critical Thinking Disposition Inventory-Chinese Version (SF-CTDI-CV) and the Clinical Decision-making Nursing Scale (CDMNS) were used to collect data from 113 nurses working in seven critical care units of a tertiary hospital on the east coast of Malaysia. Participants were recruited through purposive sampling in October 2015., Results: Critical care nurses perceived both their critical thinking disposition and decision-making skills to be high, with a total score of 71.5 and a mean of 48.55 for the SF-CTDI-CV, and a total score of 161 and a mean of 119.77 for the CDMNS. One-way ANOVA test results showed that while age, gender, ethnicity, education level and working experience factors significantly impacted critical thinking (p<0.05), only age and working experience significantly impacted clinical decision-making (p<0.05). Pearson's correlation analysis showed a strong and positive relationship between critical care nurses' critical thinking and clinical decision-making (r=0.637, p=0.001)., Conclusion: While this small-scale study has shown a relationship exists between critical care nurses' critical thinking disposition and clinical decision-making in one hospital, further investigation using the same measurement tools is needed into this relationship in diverse clinical contexts and with greater numbers of participants. Critical care nurses' perceived high level of critical thinking and decision-making also needs further investigation., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

APRIL (A Proliferation Inducing Ligand) is a member of the tumor necrosis factor (TNF) family. It is essential for the survival of normal and malignant B lymphocytes. Increased expression of APRIL is noted in most of hematological malignancies and auto immune diseases. We investigated the expression level of APRIL mRNA in 50 de novo acute myeloid leukemia (AML) patients, together with 20 healthy controls using a Real-Time Quantitative Reverse-Transcriptase Polymerase Chain Reaction (RTQ-PCR) with a specific aim of determining its relation to clinical features and laboratory findings at diagnosis and its impact on the response to therapy. APRIL mRNA expression level was significantly higher in AML patients than in controls (p = < 0.001). APRIL expression level was significantly higher in patients who didn't achieve CR compared to those who achieved CR (p < 0.001). Patients who did not achieve CR also had higher TLC, lower platelets and older age than CR patients. The difference was statistically significant (p < 0.001, p = 0.047, p = 0.019) respectively. APRIL levels showed significant positive correlation with TLC (r = 0.743.p < 0.001), with age (r = 0.296,p = 0.037) and a negative correlation with platelets count (r = -0.443,p = 0.001) and no correlation with gender, Hb level, BM blast, HSM or LNs enlargement. Our study has shown that APRIL is overexpressed in AML patients, its level might serve as an indicator for disease progression. APRIL might be an indicator for poor prognosis and treatment resistance in AML patient; therefore, APRIL antagonists may represent a novel therapeutic approach for the treatment of AML., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: A limited number of studies have examined the vaccine-specific antibody status of children with cancer. There are disagreements over the guidelines for postcancer immunization strategy., Methods: Our study was an observational, cross-sectional retrospective review of data collected on children who were seen in the outpatient clinic at King Abdullah Medical City, Oncology Center, Jeddah, the Kingdom of Saudi Arabia. Our aim was to evaluate the seropositive status to vaccine-preventable diseases: measles, mumps, rubella, diphtheria, tetanus, polio, and Haemophilus influenzae type B (HIB) in childhood cancer survivors at our center in order to plan future vaccination for these children and establish a simple revaccination schedule., Results: Forty-seven patients (21 boys and 26 girls) were included in the study. Age at the time of cancer diagnosis (mean±standard deviation) was 5.68±3.79 years and age at test sampling was 10.68±3.79 years. Acute leukemia was the most common cancer (49% of patients), followed by lymphoma (28%), brain tumors (13%), and solid tumors (10%). Treatment intensities (according to the Treatment Intensity Rating Scale, version 3.0; ITR-3) were 2, 3, and 4 for 26 patients (55%), 20 patients (43%), and one patient (2.1%), respectively. We found that 93% of our patients were considered seronegative (unprotected) for at least one vaccine-preventable disease. The seronegative rates for measles, mumps, rubella, diphtheria, tetanus, polio, and HIB were 46.8%, 36.2%, 36.2%, 46.8%, 61.7%, 17.1%, and 42.6%, respectively. Criteria including age at diagnosis, age at sampling, type of malignancy, and treatment intensity were not significantly different between seropositive and seronegative patients., Conclusion: Seronegative rates for vaccine-preventable diseases were very high in childhood cancer survivors, which represented a subpopulation of high-risk patients who could benefit from revaccination. We suggest a universal revaccination approach for all childhood cancer survivors, which is easily applicable and of low cost., (Copyright © 2016. Published by Elsevier B.V.)

Phyllanthus debilis Klein ex Willd. is wild medicinal plant used in the traditional system of medicine. This plant has been actively used for hepatoprotection and to cure many diseases including jaundice and so on; which leads to complete extinction of this particular species. Therefore, the chitosan mediated cost effective cell suspension method has been developed for the production of hydrolysable tannin. The hydrolysable tannins are the main therapeutically active constituents with antioxidant, anticancer, and antimicrobial properties. An in vitro cell suspension culture was optimized by adding chitosan for production of hydrolysable tannin. According to the growth kinetics, a maximum biomass of 4.46±0.06g fresh cell weight and 1.33±0.04g dry cell weight were obtained from the optimal suspension medium consisted of MS medium+0.5mgL -1 BAP+1.5mgL -1 NAA. Chitosan was treated at the stationary phase which leads to the highest accumulation of hydrolysable tannin compared to the untreated control. Hydrolysable tannin was observed and compared using HPLC at the Rt of 4.91 in both chitosan treated and untreated cells. This is the first ever report where use of chitosan has been done to enhance the production of the hydrolysable tannin in P. debilis using cell suspension culture technique., (Copyright © 2017 Elsevier B.V. All rights reserved.)

This study aimed to explore the potential of tailoring the liquid crystalline structure for augmenting the oral absorption and biopharmaceutical performance of rosuvastatin. Rosuvastatin (ROS)-loaded liquid crystalline nanodispersions (LCNDs) were prepared via emulsification technique. The effect of incorporating oleic acid (OA) in various proportions in the lipid domain of the LCNDs was studied. The formulations were characterized for particle size, zeta potential, in vitro release, ex vivo intestinal permeation, in vivo oral bioavailability, and stability. All the prepared LCNDs possessed uniform nanometric size and negative zeta potential. Employing OA in the lipid domain enhanced ROS entrapment efficiency, and resulted in structural transition from cubic to hexagonal phase as proved by transmission electron microscopy. Increasing OA proportion up to a certain ratio prolonged the in vitro drug release rate, after which further increase in OA had no significant effect. The OA bearing hexagonal LCNDs provided a significant enhancement in the intestinal permeation compared to glyceryl monooleate cubical nanodispersion and demonstrated an outstanding in vivo performance by maintaining higher ROS plasma levels up to 8 h and enhancing oral bioavailability compared to commercial tablet. They proved to be promising carriers for improved oral delivery of ROS with substantial bioavailability enhancing effects, and superiority compared to cubosomes and OA emulsion., (Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

Background: Antipsychotics (APs) are widely prescribed drugs, which are well known to cause reproductive adverse effects through mechanisms yet to be determined. The purpose of this study was to investigate the effect of antipsychotics on mitochondrial bioenergetics of rat ovarian theca cells as a possible mechanism of reproductive toxicity., Methods: Isolated rat theca interstitial cells (TICs) were treated with two typical (chlorpromazine [CPZ] and haloperidol [HAL]) and two atypical APs (risperidone [RIS] and clozapine [CLZ]). The effects of these APs on TICs bioenergetics (ATP content, mitochondrial complexes I and III activities, oxygen consumption rates (OCRs), mitochondrial membrane potential (MPP) and lactate production) and on steroidogenesis (androstenedione and progesterone synthesis) were investigated., Results: All APs resulted in a concentration-dependent decrease in the ATP content of TICs. All APs at their estimated IC 50 s (6μM, 21μM, 35μM and 37μM for CPZ, HAL, CLZ and RIS respectively) significantly decreased TICs OCRs (p<0.0001), MPP (p<0.0001) and significantly (p=0.0003) inhibited mitochondrial complex I activity. Only typical APs inhibited complex III (p=0.005). Also, APs at IC 50 s increased TICs lactate production to varying degrees. All APs used at their IC 50 s significantly inhibited progesterone (p=0.0022) and androstenedione (p=0.0027) production. Only CPZ was found to inhibit these hormones at the low concentration (1μM)., Conclusion: All four antipsychotics seem to inhibit mitochondrial bioenergetics and steroidogenesis in rat's ovarian theca cells. These findings support the hypothesis that APs-induced reproductive toxicity may be through mechanisms involving mitochondrial insult>. Further research is required to establish the link between APs-induced mitochondrial dysfunction and disordered steroidogenesis., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Objective: To determine the effects of vitamin D (VD) supplementation and isokinetic training on muscle strength, explosive strength (counter movement jump) (ES), lean body mass (LBM) and gait parameters in severe pediatric burn., Methods: Forty-eight burned children with circumferential lower extremity burns covering 40-55% of the total body surface area (TBSA), aged 10-16 years (Mean±SD 13.01±1.75), were randomized into the standard of care (n=16), isokinetic (n=17) and VD (n=15) groups. Unburned children (n=20) served as matched controls. All burned children received 12 weeks of routine physical therapy program (RPTP). In addition, the isokinetic group received isokinetic training for the quadriceps dominant limb 3 times per week at angular velocity 150°/s, and the VD group received the isokinetic training plus an oral daily dose of vitamin D 3 1000 IU (Cholecalciferol). The primary measures, assessed at baseline and 12 weeks, included quadriceps strength by isokinetic dynamometer, ES, LBM by dual-energy X-ray absorptiometry (DEXA) and gait parameters by GAITRite system., Results: The VD and isokinetic groups showed significant improvement in quadriceps strength, ES, LBM and gait parameters compared with the standard of care, and VD group show significant improvement in the VD level as compared with the other groups. The outcome measures (and percent of improvement where applicable) for the VD, isokinetic and standard of care are as follows: quadriceps strength, 85.25±0.93Nm (85%), 64.25±0.93 (36%) and 51.88±1.31Nm (12%); stride length, 94.00±2.69 (7%), 110.60±2.87 (25%) and 139.56±2.57 (60%); step length, 67.26±2.45 (72%), 55.25±2.49 (43%) and 43.76±1.34 (18%); velocity, 133.94±1.65 (82%), 99.94±1.65 (35%) and 80.11±1.91 (9%); and cadence, 140.63±1.36 (68%), 132.63±1.36 (58%) and 90.35±1.32 (9%), VD level 43.33±7.48 (75%), 24.77±7.38 (5%) and 25.63±8.39 (4%) respectively., Conclusions: VD supplementation combined with exercise training significantly increased muscle strength, ES, LBM, gait and VD level in severely burned children., (Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.)

Background and Study Aims: There is a lack of studies on erectile dysfunction (ED) in patients diagnosed with nonalcoholic fatty liver disease (NAFLD). The present study aimed to estimate the prevalence of ED in patients with NAFLD and to determine the independent predictors of ED in these patients., Patients and Methods: We conducted a prospective, hospital-based study of 192 consecutive male patients with NAFLD. All patients underwent clinical evaluation; abdominal ultrasonography; test for viral hepatitis markers; and estimation of liver chemistry panel, complete blood count, prothrombin time, serum lipids panel, serum testosterone, and fasting serum levels of glucose, insulin, and C-peptide., Results: The mean age of the study population was 42.4±7.7years (79.1%≥40years). Of the 192 patients with NAFLD, 88 (45.8%) had ED, 28 (14.6%) had metabolic syndrome, 25 (13%) had type-2 diabetes mellitus (DM), and 131 (68.2%) had insulin resistance (IR). The mean level of serum testosterone was 3.17±2.94ng/mL, while the mean insulin resistance index was 2.9±1.7. Mild ED (38.6%) was the most frequent grade of ED. Age≥40years (odds ratio [OR] 6.4; 95% confidence interval [CI] 1.7-24.1; p- 0.006), IR (OR 5.9; 95% CI 1.7-20.6; p- 0.005), and low serum testosterone (OR 5.1; 95% CI 1.5-17.1; p- 0.009) were the predictors of ED., Conclusions: ED is a common disorder in male patients with NAFLD; both IR and low serum testosterone contribute to its development. Treatment of IR may carry a dual benefit of improving erectile function and decreasing the grade of hepatic steatosis., (Copyright © 2017 Pan-Arab Association of Gastroenterology. Published by Elsevier B.V. All rights reserved.)

Objectives: To describe the incidence, mortality, cost, and length of stay (LOS) of hospitalized community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP) in three Southeast Asian countries: Malaysia, Indonesia, and the Philippines., Methods: Using Casemix system data from contributing hospitals, patients with International Classification of Diseases 10(th) revision (ICD-10) codes identifying pneumonia were categorized into CAP or HAP using a logical algorithm. The incidence among hospitalized patients, case fatality rates (CFR), mean LOS, and cost of admission were calculated. The population incidence was calculated based on Malaysian data., Results: For every 100000 discharges, CAP and HAP incidences were 14245 and 5615 cases, respectively, in the Philippines, 4205 and 2187, respectively, in Malaysia, and 988 and 538, respectively, in Indonesia. The impact was greatest in the young and the elderly. The CFR varied from 1.4% to 4.2% for CAP and from 9.1% and 25.5% for HAP. The mean LOS was 6.1-8.6 days for CAP and 6.9-10.2 days for HAP. The cost of hospitalization was between USD 254 and USD 1208 for CAP and between USD 275 and USD 1482 for HAP., Conclusions: The burden of CAP and HAP is high. Results varied between the three countries, likely due to differences in socio-economic conditions, health system differences, and ICD-coding practices., (Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.)

A new cycloartane-type saponin with unusual hydroxylation at C-17 and a unique side chain, 9 (R), 19, 22 (S), 24 (R) bicyclolanost-3β, 12α, 16β, 17α tetrol-25-one 3-O-β-d-glucopyranosyl-(1→2)-β-d-glucopyranoside (1) and two new monoterpenoid glucoindole alkaloids, 10-methoxy pumiloside (2) and the previously chemically synthesized, 10-methoxy strictosidine (3) along with other five known compounds, 7α-morroniside (4), 7-epi-loganin (5), (7β)-7-O-methylmorroniside (6), 5(S)-5-carboxystrictisidine (7) and apigenin-7-O-neohesperidoside (8) were isolated from the aerial parts of Mussaenda luteola (Rubiaceae). The structural elucidation of the isolates was accomplished by extensive (1D and 2D NMR) spectroscopic data analysis and HR-ESI-MS. Compounds 4-8 were reported for the first time from the genus Mussaenda. Interestingly, this is the first report for the occurrence of the monoterpenoid glucoindole-type alkaloids in the genus which might be useful for the chemotaxonomic evaluation of the genus Mussaenda. All isolates were evaluated for their antiprotozoal activities. Compound 7 showed good antitrypanosomal activity with IC50 and IC90 values of 13.7 and 16.6 μM compared to IC50 and IC90 values of 13.06 and 28.99 μM for the positive control DFMO, difluoromethylornithine., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Five new triterpenoid saponins, heinsiagenin A 3-O-[α-l-rhamnopyranosyl-(1→2)-β-d-glucopyranosyl-(1→2)]-β-d-glucopyranoside (1), heinsiagenin A 3-O-[α-l-rhamnopyranosyl-(1→2)-β-d-glucopyranosyl-(1→2)]-[β-d-glucopyranosyl-(1→4)]-β-d-glucopyranoside (2), 2α-hydroxyheinsiagenin A 3-O-[α-l-rhamnopyranosyl-(1→2)-β-d-glucopyranosyl-(1→2)]-β-d-glucopyranoside (3), 2α-hydroxyheinsiagenin A 3-O-[β-d-glucopyranosyl-(1→2)]-[β-d-glucopyranosyl-(1→4)]-β-d-glucopyranoside (4) and N-(2S, 3R, 4R-3-methyl-4-pentanolid-2-yl)-18-hydroxylanosta-8 (9), 22E, 24E-trien-27-amide-3-O-[α-l-rhamnopyranosyl-(1→2)-β-d-glucopyranosyl-(1→2)]-[β-d-glucopyranosyl-(1→4)]-β-d-glucopyranoside (5) were isolated from the aerial parts of Mussaenda luteola Delile (Rubiaceae). Structural elucidation was based on the analysis of spectroscopic data (1D and 2D NMR) and HR-ESI-MS. Compound 1 showed potent antitrypanosomal activity with an IC50 value of 8.80μM. Compounds 2-4 showed highly potent antitrypanosomal activity with IC50 values ranging between (2.57-2.84μM) and IC90 values ranging between (3.36-4.35μM), which are 5 fold greater than the positive control DFMO (IC50 and IC90 values of 13.06 and 28.99μM, respectively). Compounds 1 and 2 showed moderate affinity to μ-opioid receptors with Ki values of 9.936μM and 0.872μM, respectively compared to a Ki value of 1.958nM for the positive control, naloxone HCl., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Background: Euphorbia hirta has been reported to possess anti-inflammatory activity. This study was carried out to determine the prostaglandin E 2 (PGE 2 ) inhibition activity of the fractions of the E. hirta aqueous extract on rabbit synovial fibroblast cells (HIG-82)., Methods: E. hirta aqueous extract was fractionated into five fractions (fractions A, B, C, D, and E) by reversed phase flash chromatography. Rabbit synovial fibroblast cells (HIG-82) were activated with phorbol myristate acetate and treated with the fractions. The amount of PGE 2 released into the medium was measured by enzyme-linked immunosorbent assay., Results: Fraction A (0.1, 1, and 10 μg/ml) had the greatest PGE 2 inhibitory effect among the five fractions, and showed a greater extent of PGE 2 inhibition compared to the aqueous extract. In contrast, Fraction E had the greatest stimulatory effect on PGE 2 release., Conclusions: Fraction A of the aqueous extract inhibited the production of PGE 2 from activated HIG-82 cells to a greater extent than the crude aqueous extract. Bioactive compounds with anti-inflammatory activity are likely to be concentrated in Fraction A of E. hirta aqueous extract.

Background: Preparation of critically ill patients throughout their transition experiences in Critical Intensive Care Units (CICU) and following discharge can impact upon their recovery. However, there is little research addressing critical care nurses' awareness of patients' transition experiences., Aim: This study aimed to examine CICU nurses' awareness of patients' transition experiences and transitional care practice in Malaysia., Method: A descriptive questionnaire was used to survey Registered Nurses in seven CICUs in four hospitals in Malaysia. Data were analysed using descriptive statistics and correlation analysis., Results: The survey had a response rate of 65.2% (178 of 273 eligible nurses). The respondents' mean age was 29.6 years. Most of the respondents were from public hospitals and the majority had one to five years' experience working as Registered Nurses, and in CICU. Public teaching hospital nurses had greater awareness of patients' transition experience (PE) (p<0.05), and of transitional care practice (TCP) (p<0.05) than public hospital nurses. Nurses with >10 years Critical Intensive Care Unit experience (p<0.05) had greater awareness of both PE and TCP (p<0.05). Attending a course of any kind did not affect nurses' awareness in both PE and TCP (p>0.05). There was a positive correlation between nurses' awareness of patients' transition experience and its impact, and their awareness of transitional care practice performance (rs=0.42, p<0.05)., Conclusion: CICU nurses need targeted transition education to enable them to anticipate patients' transitional experiences and to provide appropriate transitional care, particularly for public hospital nurses. Nursing schools need to integrate more content about critically ill patients' transition experiences into the curriculum, to ensure graduate nurses will be able to anticipate the patient's experience and provide appropriate transitional care., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Objectives: The aim of this study was to evaluate the cost-effectiveness of the national public sector specialist periodontal program in the management of periodontal disease., Methods: This was a multicenter, time motion, prospective, economic evaluation study involving a total of 165 patients with periodontitis recruited from five selected specialist periodontal clinics. Treatment costs were measured in 2012 Malaysian ringgit (MYR) and estimated from the societal perspective using step-down and activity-based costing methods, and substantiated by clinical pathways. A cost-effectiveness analysis was done to compare the specialist periodontal program with a hypothetical scenario in which patients attend biannual dental visits only for regular dental check-up and scaling. The incremental cost-effectiveness ratio was defined as the difference in cost per gain in quality-adjusted life-years (QALYs) and clinical attachment levels (CALs). One-way scenario-based sensitivity analyses were carried out to assess the uncertainty of inputs., Results: The average cost for managing patients with periodontitis was MYR 376 per outpatient visit and MYR 2820 per annum. Clinically, a gain of an average of 0.3 mm of CAL was attained at post-treatment (paired t test, P < .001). Patients gained an average of 3.8 QALY post-treatment (paired t test, P < .001). For cost-effectiveness analysis, the specialist periodontal program was more cost-effective than the hypothesized biannual dental visits, with incremental cost-effectiveness ratios of MYR 451 and MYR 5713 per additional QALY and millimeter CAL gained, respectively., Conclusions: It is very cost-effective for the public sector to provide specialist periodontal treatment for patients with periodontitis according to the World Health Organization criteria and when compared with conventional biannual dental treatment., (Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.)

Background: To reduce the morbidity and mortality related to bacterial meningitis, it is important to discriminate bacterial meningitis from aseptic meningitis during the acute phase of the disease, when the clinical symptoms are often similar., Objectives: To test the reliability of serum procalcitonin (PCT) to discriminate bacterial meningitis from aseptic meningitis in patients who have a negative direct cerebrospinal fluid (CSF) examination, and to evaluate the role of serum PCT to assess treatment efficacy compared with the total leukocyte count (TLC), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)., Materials and Methods: Forty patients with suspected acute meningitis and negative gram stains were included, and ten healthy persons were included as controls. According to the clinical examination and the CSF cytochemical analysis and cultures, the patients were divided into bacterial and aseptic groups. The measurements of serum PCT, ESR, CRP and TLC were performed., Results: Patients in the bacterial group had a higher value of serum PCT at admission and at 3 days post-treatment than those in the aseptic group, with a highly significant difference between them., Conclusion: Serum PCT and, to a lesser extent, TLC had prognostic value in patients with acute meningitis, and PCT is more useful because it can be frequently measured for the diagnosis and follow-up of bacterial meningitis., (Copyright © 2013 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.)

Objective: The aim of this study was to investigate the effects of isokinetic training program on muscle strength, muscle size and gait parameters after healed pediatric burn., Design: Randomized controlled trial., Subjects: Thirty three pediatric burned patients with circumferential lower extremity burn with total body surface area (TBSA) ranging from 36 to 45%, and ages from 10 to 15 years participated in the study and were randomized into isokinetic group and a control group. Non-burned healthy pediatric subjects were assessed similarly to burned subjects and served as matched healthy controls., Methods: Patients in the isokinetic group (n=16) participated in the isokinetic training program for 12 weeks for quadriceps dominant limb, 3 times per week, at angular velocity 150°/s, concentric mode of contraction, time rest between each set for 3 min, 3 sets/day and control group (n=17) participated in home based physical therapy exercise program without isokinetic., Main Measures: Assessment of quadriceps strength by isokinetic dynamometer, quadriceps size and gait parameters were performed at baseline and at the end of the training period for both groups., Results: Patients in isokinetic group showed a significant improvement in quadriceps strength, quadriceps size and gait parameters as compared with those in the control group. Quadriceps strength and percentage of improvement was 79.25 ± 0.93 Nm (68.40%) for isokinetic group and 51.88 ± 1.31 Nm (9.84%) for the control group. Quadriceps size and percentage of improvement was 31.50 ± 0.89 cm (7.47%) for isokinetic group and 29.26 ± 1.02 cm (1.02%) for the control group. Stride length, step length, velocity and cadence and percentage of improvement for isokinetic group was 135.50 ± 2.82 (53.97%), 63.25 ± 2.97 (63.77%), 135.94 ± 1.65 (81.42%), 137.63 ± 1.36 (66.96%) and for the control group was 94.00 ± 2.69 (6.68%), 43.76 ± 1.34 (15.15%), 81.11 ± 1.91 (8.6%), 90.35 ± 1.32 (9.01%) respectively., Conclusions: Participation in the isokinetic training program resulted in a greater improvement in quadriceps muscle strength, size and gait parameters in pediatric burn., (Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.)

Background: Urine neutrophil gelatinase-associated lipocalin (uNGAL) has been proposed as a potential biomarker for lupus nephritis (LN) activity. We determined the association between uNGAL with LN activity in systemic lupus erythematosus (SLE) patients compared to the current standard markers of SLE., Methods: A total of 100 SLE patients with biopsy-proven LN were recruited-47 with active and 53 inactive LN. uNGAL levels were measured. Renal function test, urinary parameters, lupus serology and calculated renal SLE Disease Activity Index-2K (renal SLEDAI-2K) were analyzed to determine their associations with uNGAL., Results: Normalized uNGAL levels (ng/mg creatinine) were significantly higher in patients with active LN compared to those with inactive disease (p=0.01). uNGAL and renal SLEDAI-2K were associated (r=0.32, p=0.001). Multiple logistic regression showed that only serum creatinine and renal SLEDAI-2K were independent predictors of uNGAL levels (p=0.03 and 0.02 respectively). Analysis of the receiver operating characteristic (ROC) curve showed that uNGAL was a potential biomarker for LN., Conclusions: uNGAL was increased in active LN especially in LN flares. Serial measurements of uNGAL levels may be of value in monitoring response of LN to treatment and for predicting LN flares., (© 2013 Elsevier B.V. All rights reserved.)