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Background and purpose New remedies are required for the treatment of neuropathic pain due to insufficient efficacy of available therapies. This study provides a novel approach to develop painkillers for chronic pain treatment. Experimental approach The rat formalin pain test and spinal nerve ligation model of neuropathic pain were used to evaluate antinociception of protopanaxadiol. Primary cell cultures, immunofluorescence staining, and gene and protein expression were also performed for mechanism studies. Key results Gavage protopanaxadiol remarkably produces pain antihypersensitive effects in neuropathic pain, bone cancer pain and inflammatory pain, with efficacy comparable with gabapentin. Long-term PPD administration does not induce antihypersensitive tolerance, but prevents and reverses the development and expression of morphine analgesic tolerance. Oral protopanaxadiol specifically stimulates spinal expression of dynorphin A in microglia but not in astrocytes or neurons. Protopanaxadiol gavage-related pain antihypersensitivity is abolished by the intrathecal pretreatment with the microglial metabolic inhibitor minocycline, dynorphin antiserum or specific κ-opioid receptor antagonist GNTI. Intrathecal pretreatment with glucocorticoid receptor)antagonists RU486 and dexamethasone-21-mesylate, but not GPR-30 antagonist G15 or mineralocorticoid receptor antagonist eplerenone, completely attenuates protopanaxadiol-induced spinal dynorphin A expression and pain antihypersensitivity in neuropathic pain. Treatment with protopanaxadiol, the glucocorticoid receptor agonist dexamethasone and membrane-impermeable glucocorticoid receptor agonist dexamethasone-BSA in cultured microglia induces remarkable dynorphin A expression, which is totally blocked by pretreatment with dexamthasone-21-mesylate. Conclusion and implications All the results, for the first time, indicate that protopanaxadiol produces pain antihypersensitivity in neuropathic pain probably through spinal microglial dynorphin A expression after glucocorticoid receptor activation and hypothesize that microglial membrane glucocorticoid receptor/dynorphin A pathway is a potential target to discover and develop novel painkillers in chronic pain.

BACKGROUND: Mask wearing in the COVID-19 pandemic was previously hypothesized as a protective symbol that decreases compliance with other measures such as face touching and social distancing. However, the face mask is now central to the prevention of viral spread. AIM: In this paper, we looked at the shift of guidelines regarding mask use and the mask-wearing adherence habits of the Kittitian population at the onset of the pandemic. METHODS: In this study, we observed 468 individuals, each for 5 min, for the different types of face masks used and their adherence to the Center for Disease Control guidelines for the use of this personal protective equipment. We did the observation at three different locations at Basseterre, St. Kitts, from the 21st to April 30, 2020. RESULTS: We noted that 49.31% had medical-grade masks (N95 and surgical), 36.11% had improvised masks, and 14.74% had no facial covering. About 34% of persons with masks were not correctly covering their nose or mouth and 16.45% were touching their face with their hands. Wearing any face-covering appears to lead to more face touching than no covering at 18.25% versus 5.8%. The highest proportion of errors was seen in wearers of surgical masks, leaving the mouth/ nose uncovered at 12.08% of all errors. CONCLUSION: We recommend for public education and political efforts to increase adherence to mask use in conjunction with other protective measures such as social distancing and hand washing for curbing the COVID-19 transmission in St. Kitts and Nevis.

Background Thoracolumbar spine fractures are common injuries that can result in significant disability, deformity and neurological deficit. Controversies exist regarding the appropriate radiological investigations, the indications for surgical management and the timing, approach and type of surgery. Aim of the Work to discuss: Guidelines and controversies of short versus long posterior fixation in management of thoracolumbar spine fractures. Patients and Methods 20 articles were identified through specified electronic databases. After application of the inclusion and exclusion criteria, 9 comparative studies were finally included in this systematic review. Various other approaches were used in combination with posterior pedicle screw fixation according to the underlying pathology (e.g. Discectomy, Laminectomy, Vertebroplasty, Kyphoplasty, etc.). A total of 194 patients underwent short segment pedicle screw fixation compared to 158 patients who underwent Long segment pedicle screw fixation for various indications. The majority of the included trials were small studies with between 12 and 69 participants. The patients’ characteristics were comparable within each study group. Individual patient data were available from these articles. Results A total of 194 patients underwent short segment pedicle screw fixation compared to 158 patients who underwent Long segment pedicle screw fixation for various indications. The majority of the included trials were small studies with between 12 and 69 participants. The patients’ characteristics were comparable within each study group. Individual patients data were available from these articles; longest follow up post operative record was about 71 months; 162 male and 93 female in these studies; the mean age about 38 years; the level of thoracolumbar fracture was: 60 patients at T12,104 patients at L1 and 41 patients at L2. Conclusion This review suggest work on the guidelines with evaluating of each case according to age, angels, height, weight (BMI), comorbidities, ability to anaesthesia and types of instability in the patient before as osteoporosis and kyphosis. Degree of angels of cobb and kyphotic angel which are major factors determine if posterior long or short.

Opioid drugs are the first line of defense in severe pain but the adverse effects associated with opioids are considered as a serious issue worldwide. Acupuncture/electroacupuncture is a type of Chinese medicine therapy which is an effective analgesic therapy, well documented in animals and human studies. Electroacupuncture stimulation could release endogenous opioid peptides causing analgesia in a variety of pain models. It can be used as an alternative therapy to control the opioid crisis.

The aim of this study is to evaluate the clinical and immunological efficacy and safety of allergen immunotherapy (AIT) in patients with allergic conjunctivitis (AC) and to compare between sublingual and subcutaneous routes of administration.A prospective comparative case series study was performed on 100 patients with IgE-mediated AC. Patients were referred to allergy clinics for skin prick test (SPT) and AIT. Patients with positive SPT and high-serum IgE level were enrolled in this study. Patients were divided into two groups: sublingual immunotherapy (SLIT) group (50 patients) and subcutaneous immunotherapy (SCIT) group (50 patients). Both groups were followed for 1 year. Efficacy was assessed clinically by comparing pre- and post-treatment symptoms and medication scores and assessed immunologically by comparing pre- and post-treatment serum IgE level and wheal diameter of SPT. Safety of the therapy was assessed by the occurrence of adverse reactions and patient tolerability to the therapy.Patients were either mono- or polysensitized to different allergens. Aeroallergens were significantly more common than food allergens (P = 0.00). The most prevalent aeroallergens were pollens (40%) and house dust (30%). At 12-month follow-up, both routes SLIT and SCIT led to a statistically significant clinical and immunological improvement (P 0.05). This improvement was evident in all follow-up parameters including total ocular symptom score (TOSS), medication score, total serum IgE level, and wheal diameter of skin prick test (SPT). There was no significant difference between the two routes of administration (SLITSCIT) in any of the follow-up parameters (P 0.05). Patients were able to tolerate the allergen therapy without developing any serious adverse events.Aeroallergen polysensitization is common among patients with AC. SPT should be included in the diagnostic workup of those patients. AIT is a safe and effective treatment option for patients with AC as it has the potential to achieve significant reduction in symptom and medication scores without ocular or systemic side effects. There is no significant difference between both routes of administration either SLIT or SCIT in achieving clinical and immunologic improvement; so the patient can choose his preferred method for therapy.

Background and study aim: Cirrhotic cardiomyopathy of cirrhotic patients without heart diseases is a chronic cardiac ‎disorder with impaired cardiac contractility, responding to stress as well as altered diastolic ‎relaxation. More studies are required to address unanswered questions, including consensus ‎definition, particular diagnostic tests, exact prevalence of such syndrome in addition to ‎proper management approaches. Herein, we aimed at determining prevalence regarding ‎cirrhotic cardiomyopathy in our patients and improving early diagnosis of this syndrome‎. Patients and methods: ‎72 chronic liver disease (CLD) patients were recruited from gastroenterology department of ‎Suez Canal University Hospital, Ismailia, Egypt. The patients were then divided into three ‎main groups according to Child-Pugh criteria, and each group included 24 patients. All ‎patients underwent a medical history assessment and clinical examination, laboratory ‎investigations involving BNP levels, ECG in addition to echocardiography ‎‎‎.‎ Results: QTc interval prolongation was present in 56% of our decompensated cirrhotic patients. ‎Diastolic dysfunction exhibiting different grades (grade I- II) was found in most cirrhotic ‎patients (82%) in this study, while LT atrial dilatation with different grades (mild to severe) ‎was found in 69% of patients. Increased Child-Pugh class was significantly associated (p-‎value

Bulleyaconitine A (BAA), a C19-diterpenoid alkaloid, has been prescribed as a nonnarcotic analgesic to treat chronic pain over four decades in China. The present study investigated its inhibition in morphine-induced withdrawal symptoms, conditioned place preference (CPP) and locomotor sensitization, and then explored the underlying mechanisms of actions. Multiple daily injections of morphine but not BAA up to 300 μg/kg/day into mice evoked naloxone-induced withdrawal symptoms (i.e., shakes, jumps, genital licks, fecal excretion and body weight loss), CPP expression, and locomotor sensitization. Single subcutaneous BAA injection (30–300 μg/kg) dose-dependently and completely attenuated morphine-induced withdrawal symptoms, with ED50 values of 74.4 and 105.8 μg/kg in shakes and body weight loss, respectively. Subcutaneous BAA (300 μg/kg) also totally alleviated morphine-induced CPP acquisition and expression and locomotor sensitization. Furthermore, subcutaneous BAA injection also specifically stimulated dynorphin A expression in microglia but not astrocytes or neurons in nucleus accumbens (NAc) and hippocampal, measured for gene and protein expression and double immunofluorescence staining. In addition, subcutaneous BAA-inhibited morphine-induced withdrawal symptoms and CPP expression were totally blocked by the microglial metabolic inhibitor minocycline, dynorphin A antiserum, or specific KOR antagonist GNTI, given intracerebroventricularly. These results, for the first time, illustrate that BAA attenuates morphine-induced withdrawal symptoms, CPP expression, and locomotor sensitization by stimulation of microglial dynorphin A expression in the brain, suggesting that BAA may be a potential candidate for treatment of opioids-induced physical dependence and addiction.

Background. Neuropathic pain is a common chronic pain, which is related to hypersensitivity to stimulus and greatly affects the quality of life of patients. Maladaptive gene changes and molecular signaling underlie the sensitization of nociceptive pathways. We previously found that the activation of microglial glucagon-like peptide 1 receptor (GLP-1R) could potently relieve formalin-, bone cancer-, peripheral nerve injury-, and diabetes-induced pain hypersensitivity. So far, little is known about how the gene profile changes upon the activation of GLP-1R signaling in the pathophysiology of neuropathic pain. Methods. Spinal nerve ligation (SNL) was performed to induce neuropathic pain in rats. Mechanical allodynia was assessed using von Frey filaments. The expression of IL-10, β-endorphin, and μ-opioid receptor (MOR) was examined by real-time quantitative polymerase chain reaction (qPCR) and whole-cell recording. Measurements of cellular excitability of the substantia gelatinosa (SG) neurons by whole-cell recording were carried out. R packages of differential gene expression analysis based on the negative binomial distribution (DESeq2) and weighted correlation network analysis (WGCNA) were used to analyze differential gene expression and the correlated modules among GLP-1R clusters in neuropathic pain. Results. The GLP-1R agonist, exenatide, has an antiallodynic effect on neuropathic pain, which could be reversed by intrathecal injections of the microglial inhibitor minocycline. Furthermore, differential gene expression analysis (WGCNA) indicated that intrathecal injections of exenatide could reverse the abnormal expression of 591 genes in the spinal dorsal horn induced by nerve injury. WGCNA revealed 58 modules with a close relationship between the microglial GLP-1R pathway and features of nerve injuries, including pain, ligation, paw withdrawal latency (PWL), and anxiety. The brown module was identified as the highest correlated module, and the Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis indicated that inflammatory responses were most correlated with PWL. To further unravel the changes of hyperalgesia-related neuronal electrophysiological activity mediated by microglia GLP-1 receptors, whole-cell recording identified that MOR agonism stimulated a robust outward current in the sham groups compared with the spinal nerve ligation (SNL) groups. This inhibitory effect on the SNL group was more sensitive than that of the sham group after bath application of β-endorphin. Conclusions. Our results further confirmed that the GLP-1R pathway is involved in alleviating pain hypersensitivity mediated by spinal microglia activation, and inflammatory responses were the most correlated pathway associated with PWL changes in response to exenatide treatment. We found that the identification of gene regulation in response to GLP-1R activation is an effective strategy for identifying new therapeutic targets for neuropathic pain. Investigation for the activation of spinal microglial GLP-1R which might ameliorate inflammatory responses through gene expression and structural changes is providing a potential biomarker in pain management.

Gabapentinoids are recommended first-line treatments for neuropathic pain. They are neuronal voltage-dependent calcium channel α2δ-1 subunit ligands and have been suggested to attenuate neuropathic pain via interaction with neuronal α2δ-1 subunit. However, the current study revealed their microglial mechanisms underlying antineuropathic pain. Intrathecal injection of gabapentin, pregabalin and mirogabalin rapidly inhibited mechanical allodynia and thermal hyperalgesia, with projected ED50 values of 30.3, 6.2 and 1.5 µg (or 176.9, 38.9 and 7.2 nmol) and Emax values of 66%, 61% and 65% MPE respectively for mechanical allodynia. Intrathecal gabapentinoids stimulated spinal mRNA and protein expression of IL-10 and β-endorphin (but not dynorphin A) in neuropathic rats with the time point parallel to their inhibition of allodynia, which was observed in microglia but not astrocytes or neurons in spinal dorsal horns by using double immunofluorescence staining. Intrathecal gabapentin alleviated pain hypersensitivity in male/female neuropathic but not male sham rats, whereas it increased expression of spinal IL-10 and β-endorphin in male/female neuropathic and male sham rats. Treatment with gabapentin, pregabalin and mirogabalin specifically upregulated IL-10 and β-endorphin mRNA and protein expression in primary spinal microglial but not astrocytic or neuronal cells, with EC50 values of 41.3, 11.5 and 2.5 µM and 34.7, 13.3 and 2.8 µM respectively. Pretreatment with intrathecal microglial metabolic inhibitor minocycline, IL-10 antibody, β-endorphin antiserum or μ-opioid receptor antagonist CTAP (but not κ- or δ-opioid receptor antagonists) suppressed spinal gabapentinoids-inhibited mechanical allodynia. Immunofluorescence staining exhibited specific α2δ-1 expression in neurons but not microglia or astrocytes in the spinal dorsal horns or cultured primary spinal cells. Thus the results illustrate that gabapentinoids alleviate neuropathic pain through stimulating expression of spinal microglial IL-10 and consequent β-endorphin.

Background: Recent studies have reported the epidemiological link between Metabolic Syndrome (MS) and asthma, but it has rarely been studied in Egypt. The study aimed to investigate the prevalence of MS and its predictors among asthma patients in Egypt. Methods: In total, 320 patients with bronchial asthma were included. The following were assessed: spirometric evaluation, anthropometric indices, blood pressure, fasting blood sugar and serum lipid profile. We analyzed the correlation between metabolic scores and patient characteristics. Predictors of MS were identified using logistic regression analysis. Results: The prevalence of MS was 57.5% in asthma patients. For asthma patients, low High-Density Lipoprotein (HDL) and abdominal obesity were the commonest metabolic abnormality. Waist circumference, Fasting Blood Sugar (FBS) and triglyceride correlated significantly with asthma (P ‹ 0.05). FBS and DBP were the best predictors of MS. Conclusion: MS is frequent in asthma patients in Egypt. Obesity and lipid abnormalities were the commonest metabolic abnormality. Screening of these patients for components of metabolic syndrome should be a part of routine workup.

Highlights • Evaluation of TB meningitis. • Pathophysiology of TBM. • Safe assessment of headaches in patients with TBM. • Rare complications of TB meningitis., Tuberculosis is an ancient infectious disease with global distribution and a multitude of multisystem presentations. Infection of the central nervous system (CNS) is the most serious presentation manifested as tuberculous meningitis (TBM), intracranial tuberculoma, and tuberculous arachnoiditis all associated with significant morbidity and mortality. TBM is the commonest form of CNS manifestations capable of causing secondary arteritis leading to vascular complications. We report a case of a 22-year-old Indian patient diagnosed with TBM who subsequently presented with sudden onset severe headache, which was eventually diagnosed as subarachnoid hemorrhage. Radiological assessment confirmed secondary complications with cerebral aneurysmal dilatation attributed to TBM. The patient was safely managed with combined radiological and surgical interventions with uneventful outcomes. Review of the literature revealed that such complication of TBM is rare usually with serious implications. We aim to highlight to infection specialists to be aware of such association.

Cerebral venous sinus thrombosis (CVT) is an uncommon yet serious condition. While CVT has many known precipitants and etiologies, hyperthyroidism as a precipitant of CVT is not well understood. This study reported a case of a 41-year-old male with a 4-year history of hyperthyroidism presented with seizure. Consequently, a diagnosis of superior sagittal sinus thrombosis was confirmed by computed tomography and magnetic resonance (MR) venograms. Extensive investigations yielded no apparent underlying cause, but laboratory findings were consistent with uncontrolled hyperthyroidism. The patient improved rapidly following anticoagulation. Follow-up MR and MRV scans 2 months after treatment revealed full recanalization of the superior sagittal sinus. This case report highlighted hyperthyroidism, as a procoagulant condition, resulting specifically in superior sagittal sinus thrombosis.

Background and purpose: Drug addiction is a chronic and recurrent brain disease, which has become a social problem in recent years. Our study investigated Bulleyaconitine A (BAA) inhibition in physical and psychological dependence and explored underlying mechanisms of action. Experiment approach: Naloxone-induces withdrawal signs in morphine mice and conditioned place preference (CPP) paradigm were used. Prodynorphin gene expression and dynorphin A level were measured in nucleus accumbens (NAc) and hippocampal CA1. Double immunofluorescence staining of dynorphin A with glia and neuronal cellular biomarkers was detected in NAc and hippocampal CA1. Key results: 1 Multiple daily injections of morphine in mice induced withdrawal signs and conditioned place preference (CPP) acquisition. 2 Single subcutaneous injection of BAA (30-300 μg/kg) dose-dependently and attenuated morphine withdrawal signs, and BAA (300 μg/kg) also totally alleviated morphine CPP acquisition. 3 BAA specifically stimulated the expression of dynorphin A in microglia in NAc and hippocampal CA1, measured by gene and protein expression and double immunofluorescence staining. 4 BAA-inhibited naloxone-induced withdrawal signs and CPP acquisition were totally blocked by the microglial activation inhibitor minocycline, dynorphin A antiserum and specific κ-opioid receptor antagonist GNTI. Conclusions & implications: Our results, for the first time, illustrate that BAA attenuates morphine-induced physical and psychological dependence by stimulation of microglial dynorphin A expression in brain and suggest that BBA may be a potential candidate for the treatment of opioid drug addiction. Keywords: BAA, dynorphin A, κ-opioid receptor, nucleus accumbens (NAc), hippocampal CA1, microglia

Background Cinobufagin is the major bufadienolide of Bufonis venenum (Chansu), which has been traditionally used for the treatment of chronic pain especially cancer pain. The current study aimed to evaluate its antinociceptive effects in bone cancer pain and explore the underlying mechanisms. Methods Rat bone cancer model was used in this study. The withdrawal threshold evoked by stimulation of the hindpaw was determined using a 2290 CE electrical von Frey hair. The β-endorphin and IL-10 levels were measured in the spinal cord and cultured primary microglia, astrocytes, and neurons. Results Cinobufagin, given intrathecally, dose-dependently attenuated mechanical allodynia in bone cancer pain rats, with the projected Emax of 90% MPE and ED50 of 6.4 μg. Intrathecal cinobufagin also stimulated the gene and protein expression of IL-10 and β-endorphin (but not dynorphin A) in the spinal cords of bone cancer pain rats. In addition, treatment with cinobufagin in cultured primary spinal microglia but not astrocytes or neurons stimulated the mRNA and protein expression of IL-10 and β-endorphin, which was prevented by the pretreatment with the IL-10 antibody but not β-endorphin antiserum. Furthermore, spinal cinobufagin-induced mechanical antiallodynia was inhibited by the pretreatment with intrathecal injection of the microglial inhibitor minocycline, IL-10 antibody, β-endorphin antiserum and specific μ-opioid receptor antagonist CTAP. Lastly, cinobufagin- and the specific α-7 nicotinic acetylcholine receptor (α7-nAChR) agonist PHA-543613-induced microglial gene expression of IL-10/β-endorphin and mechanical antiallodynia in bone cancer pain were blocked by the pretreatment with the specific α7-nAChR antagonist methyllycaconitine. Conclusions Our results illustrate that cinobufagin produces mechanical antiallodynia in bone cancer pain through spinal microglial expression of IL-10 and subsequent β-endorphin following activation of α7-nAChRs. Our results also highlight the broad significance of the recently uncovered spinal microglial IL-10/β-endorphin pathway in antinociception.

Background: Finding new efficacious regimens for H Pylori eradication remains the goal of many studies especially after the increased resistance to standard therapy, which includes clarithromycin as the main antibiotic. In the current study, the aim is to evaluate the efficacy of concomitant or non-bismuth quadruple therapy in eradication of H Pylori. Methods: 50 patients from Al-Zahraa Hospital University Medical Center (ZHUMC) receiving concomitant therapy were included in the study from August 2015 to December 2016. Patients were presented with symptoms of gastritis, peptic ulcer diseases (epigastric pain, heartburn, halitosis, nausea…) and found to have H. pylori infection through Rapid Urease Test (RUT) following endoscopy, were included in this study. Patients were assigned into the 14 days’ concomitant non-bismuth quadruple therapy, which is consisted of Lansoprazole (30mg), amoxicillin (1g), clarithromycin (500mg) and metronidazole (500mg).Our primary endpoint was H. Pylori eradication as established by a negative urease breath test at least 2 weeks after the end of treatment. Results: All were evaluated at the end of the study. The H. pylori eradication rate was 94% (47/50). The treatment was well tolerated by the participants to the study with a 96% compliance. Conclusions: A total 14-day concomitant therapy is a highly effective treatment for H. pylori infection as showed by the high tolerance, mild and non-serious side effects in our sample of patients.

Antioxidant therapy is considered as promising strategy for treating oxidative stress-induced cardiovascular disease. Bis (β-elemene-13-yl) glutarate (BEG) is a novel β-elemene derivative. Herein, we examined the antioxidant activity of BEG on human umbilical vein endothelial cells (HUVECs) after injury with hydrogen peroxide (H2O2) and investigated the mechanism involved. HUVECs were divided into the following groups: control group (untreated cells); treated groups (cells treated with 0.1, 1, 10 μmol/L of BEG); positive control group (cells treated with 0.1 mM Vitamin E); model group (cells treated with 0.5 mM H2O2 alone). Cells were pre-incubated with or without BEG for 24 h and then incubated for a further 2 h with 0.5 mM H2O2. Our results showed that BEG significantly reduced H2O2 induced loss in endothelial cell viability, reactive oxygen species (ROS) production, reduced lactate dehydrogenase (LDH) release, and malonyldialdehyde (MDA) level in a concentration-dependent manner. Also, BEG increased the cellular the superoxide dismutase (SOD) activity. Moreover, we found that H2O2 decreased Akt and eNOS phosphorylation, which perhaps, indirectly reduced nitric oxide (NO) production. These effects induced by H2O2, however, were reduced by pre-treatment with BEG. BEG effects were inhibited by a PI3K inhibitor (wortmannin) and eNOS inhibitor (L-NAME). In conclusion, the present study demonstrated that BEG has antioxidant activity. Furthermore, BEG reduced H2O2-induced endothelial cells injury by the involvement of antioxidation and PI3K/Akt/eNOS/NO signaling pathways.

Cardiovascular diseases (CVDs) are considered as the major reason for mortality and morbidity worldwide. Substantial evidence suggests that increased oxidative stress plays a significant role in the pathogenesis of CVDs, including atherosclerosis, hypertension, vascular endothelial dysfunction and ischemic heart disease. Cellular oxidative stress results in the release of toxic free radicals by endothelial cells and vascular smooth muscle cells that interact with cell components such as protein, DNA or lipid resulting in cardiovascular pathology. Silymarin has antioxidant activities against CVDs and offers protection against oxidative stress-induced hypertension, atherosclerosis and cardiac toxicity. We present a comprehensive review regarding the oxidative stress and protective effects of silymarin in CVDs management. We also aim to provide mechanistic insight of the mechanisms of silymarin action in oxidative stress-induced CVDs.

Purpose: To evaluate the efficacy and safety of Tranexamic acid in reducing blood loss during PCNL. Materials and Methods: A total of 50 patients who underwent unilateral Percutaneous Nephrolithotomy from March 2017 to November 2017 were randomized into 2 equal groups; group (A) who received 1 gm (10 cc) of tranexamic acid ampule on call to surgery and group (B) who received (10 cc) normal saline. The Patients clinical data were collected and recorded in Microsoft Excel 2016 and analyzed using Statistical Package for the Social Science (SPSS) version 20 software program. Results: Fifty patients were included in the study: (33 males and 17 female). The mean age in group A patients was (48.12 ± 13.58) years, and in group B was (48.88 ± 16.17) with P value = 0.858. In group A the number of males was 16 (64%), and female was 9 (36%), and in group B male was 17 (68%) and female was 8 (34%). Mean body mass index (BMI) in group A was (28.58 ± 4.51) and in group B was (26.72 ± 3.71), with P value = 0.119 which is statistically not significant. The mean total blood loss in milliliters in group A was (73.80 ± 60.1), while in group B it was (117.24 ± 87.9) which is statistically significant with P-Value = 0.047. The mean hemoglobin drop in group A was (0.45 ± 0.35 g/dl) while in group B was (1.00 ± 0.46 g/dl), which is statistically significant with P value = 0.0001. The mean operative time was (48.4 ± 17) minute in group A, while it was (62.4 ± 15) in group B, with P-Value = 0.005, which is statistically was significant. Post-operative hematuria in group A; 20 (80%) patients had mild hematuria, 3 (12%) patients had moderate hematuria and 2 patients (8%) had no hematuria. In group B; 18 (72%) patients had mild hematuria, 6 (24%) patients had moderate hematuria and one patient (4%) had no hematuria, which is statistically not significant with P-Value = 0.487 (Table 2). One patient (4%) had intra operative bleeding in group A, in group B two patients (8%) had bleeding with P value of 0.79 which statistically not significant. Conclusion: Tranexamic acid is safe and effective drug in reducing blood loss and the rate of blood transfusion in percutaneous nephrolithotomy. It is associated with fewer intraoperative, postoperative complications and shorter operative time.

Thalidomide is an antiinflammatory, antiangiogenic and immunomodulatory agent which has been used for the treatment of erythema nodosum leprosum and multiple myeloma. It has also been employed in treating complex regional pain syndromes. The current study aimed to reveal the molecular mechanisms underlying thalidomide-induced pain antihypersensitive effects in neuropathic pain. Thalidomide gavage, but not its more potent analogs lenalidomide and pomalidomide, inhibited mechanical allodynia and thermal hyperalgesia in neuropathic pain rats induced by tight ligation of spinal nerves, with ED50 values of 44.9 and 23.5 mg/kg, and Emax values of 74% and 84% MPE respectively. Intrathecal injection of thalidomide also inhibited mechanical allodynia and thermal hyperalgesia in neuropathic pain. Treatment with thalidomide, lenalidomide and pomalidomide reduced peripheral nerve injury-induced proinflammatory cytokines (TNFα, IL-1β and IL-6) in the ipsilateral spinal cords of neuropathic rats and LPS-treated primary microglial cells. In contrast, treatment with thalidomide, but not lenalidomide or pomalidomide, stimulated spinal expressions of IL-10 and β-endorphin in neuropathic rats. Particularly, thalidomide specifically stimulated IL-10 and β-endorphin expressions in microglia but not astrocytes or neurons. Furthermore, pretreatment with the IL-10 antibody blocked upregulation of β-endorphin in neuropathic rats and cultured microglial cells, whereas it did not restore thalidomide-induced downregulation of proinflammatory cytokine expression. Importantly, pretreatment with intrathecal injection of the microglial metabolic inhibitor minocycline, IL-10 antibody, β-endorphin antiserum, and preferred or selective μ-opioid receptor antagonist naloxone or CTAP entirely blocked thalidomide gavage-induced mechanical antiallodynia. Our results demonstrate that thalidomide, but not lenalidomide or pomalidomide, alleviates neuropathic pain, which is mediated by upregulation of spinal microglial IL-10/β-endorphin expression, rather than downregulation of TNFα expression.

Hypertension is considered as the most common risk factor for cardiovascular diseases, also is regarded as a leading cause of the mortality and morbidity worldwide. The mechanisms underlying the pathological process of hypertension are not completely explained. However, there is growing evidence that increased oxidative stress plays an important role in the pathophysiology of hypertension. Several preclinical studies and clinical trials have indicated that antioxidant therapy is important for management of hypertension, using antioxidants compounds such as alpha tocopherol (Vit E) and ascorbic acid (Vit C), polyphenols with others and some antihypertensive drugs that are now in clinical use (e.g. ACEIs, ARBs, novel B-blockers, dihydropyridine CCBs) which have antioxidative pleiotropic effects. The purpose of this review is to highlight the importance of antioxidant therapy for management of oxidative stress induced hypertension. Furthermore, we review the current knowledge in the oxidative stress and its significance in hypertension.

Objectives: To detect the prevalence of carbapenem resistant Enterobacteriaceae (CRE) species and determine their antimicrobial susceptibility profile using the Vitek 2 system and the presence of carbapenemases genes using Multiplex PCR. Methodology: Various clinical samples were collected from 469 patients from Sohag University Hospitals, CRE isolates were identified by conventional methods and antimicrobial susceptibility testing using disc diffusion method and also performed by Vitek 2 automated system, Multiplex PCR was used for detection of carbapenemases genes as blaKPC, blaVIM, blaIMP, blaNDM-1 and blaOXA-48. Results: The prevalence of carbapenem resistant Enterobacteriaceae (CRE) species was 19.9%, Klebsiella pneumoniae was the most common species (51.4%), Escherichia coli (28.6%), Enterobacter aerogenes(8.6%) and Acinetobacter baumannii (5.7%). Vitek 2 system identified CRE isolates with 82.7% sensitivity, 98.6 % specificity and 90.6% diagnostic accuracy 25.7% of CRE strains were isolated from the internal ICU and 20 % from Chest Department, and mostly isolated from urine(40%) and from endotracheal tubes swabs(28.6 %) 77.1 % of CRE isolates contained carbapenemases genes, 62.1 % were blaKPC positive, 20.7 % were blaVIM-positive, 3.4 % were blaNDM-positive, 13.8 % were blaOXA-48-positive and none was blaIMP-positive. Conclusion: Conventional methods supported by Vitek 2 system is a valuable method for identification of CRE species, the detected carbapenemases genes in this study indicate that carbapenem resistance is spreading in Egypt and support the use of molecular methods for the rapid detection of CRE for successful implementation of infection control measures.

The exact etiology and pathogenesis of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) are still unknown, as a result, available therapeutic options for patients are far from satisfactory. Therefore, there is a need to develop a valid therapeutic approach that can ameliorate the manifestations of CP/CPPS. Fifty male C57BL/6 mice were randomly divided into five groups of ten mice each. All groups except naive were subcutaneously injected with 0.2 ml of T2 plus complete Freund adjuvant (CFA) on day 0 and 14 to generate valid CP/CPPS model. After successful CP/CPPS induction, model group was injected with 0.2 ml of normal saline while PLGA, PLGA-OVA, and PLGA-T2 groups were administered intravenously with 0.2 ml mixture of PLGA, PLGA-OVA, and PLGA-T2, respectively. Voiding behavior, pain threshold, and hematoxylin and eosin staining were used to assess micturition habits, pain intensity as well as prostate inflammation. Additionally, TNF-α, CRP, and IL-10 levels in plasma were measured by using ELISA kits. Mice administered with PLGA-T2 showed higher pain threshold, lower urine frequencies, mild edema, and inflammation in prostate tissue in comparison to other groups. Moreover, the expression of TNF-α and CRP levels was markedly decreased while IL-10 expression was increased in the PLGA-T2 treatment group as compared to the other groups. Our results showed that nanoparticles conjugated with autoantigen novel peptide T2 could successfully alleviate or even heal CP/CPPS to some extent in mice. This study provides an easy, useful, and economic tool for ameliorating the manifestations of CP/CPPS that will improve the therapeutic approaches.

Doxorubicin (DOX) is one of the most effective chemotherapeutic drugs; however, the incidence of cardiotoxicity compromises its therapeutic index. Oxidative stress and apoptosis are believed to be involved in DOX-induced cardiotoxicity. Chitosan oligosaccharides (COS), the enzymatic hydrolysates of chitosan, have been reported to possess diverse biological activities including antioxidant and anti-apoptotic properties. The objective of the present study was to investigate the potential role of COS against DOX-induced cardiotoxicity, and the effects of COS on apoptosis and oxidative stress in rats and H9C2 cells. Furthermore, we also shed light on the involved pathways during the whole process. For this purpose, first, we demonstrated that COS exhibited a significant protective effect on cardiac tissue by not only inducing a decrease in body and heart growth but also ameliorated oxidative damage and ECG alterations in DOX-treated rats. Second, we found that COS reversed the decrease of cell viability induced by DOX, reduced the intracellular reactive oxygen species (ROS), increased the mitochondrial membrane potential (MMP) and Bcl-2/Bax ratio. COS treatment also results in reduced caspase-3 and caspase-9 expressions, and an increase in the phosphorylation of MAPKs (mitogen-activated protein kinases) in DOX-exposed H9C2 cells. Additionally, cellular homeostasis was re-established via stabilization of MAPK mediated nuclear factor erythroid 2-related factor 2/antioxidant-response element (Nrf2/ARE) signaling and transcription of downstream cytoprotective genes. In summary, these findings suggest that COS could be a potential candidate for the prevention and treatment of DOX-induced cardiotoxicity.

Western values influence cognitive behavioural therapy (CBT) as it was primarily developed and practised in the West. As understanding the cultural context has been linked to better therapy outcomes, it has been suggested that CBT might need modification to non-Western clients’ cultural backgrounds. Previously we developed a cost-effective approach to adapt CBT for clients in China and Pakistan. In this study, we applied the same methodology for local clients suffering from depression and anxiety in the Kingdom of Saudi Arabia and Bahrain. This study aimed to understand the views of patients with depression and anxiety, caregivers and mental health professionals about CBT to develop guidelines for culturally adapting CBT for depression and anxiety. We conducted semi-structured interviews with the patients (n= 42), caregivers (n= 11), and psychiatrists and psychologists (n= 16). The data were analysed using a thematic framework analysis by identifying emerging themes and categories. The themes emerging from the analyses of interviews by each interviewer were compared and contrasted with those of other interviewers. The results highlighted barriers of access to and strengths of CBT while working with these patient groups. Patients and their caregivers in both countries use a bio-psycho-spiritual-social model of illness and seek help from multiple sources. Therapists emphasized the need for using local idioms, culturally appropriate translation and minor adjustments in therapy. There were no thematic differences between the two sites. These findings will be used to culturally adapt a CBT manual, which will be tested in a randomized controlled trial.Key learning aimsAfter reading this article, readers will be able to:(1)Understand the need for cultural adaptation of CBT.(2)Identify the necessary steps to adapt CBT for the Muslim Arab population.(3)Understand the modifications required to deliver culturally adapted CBT for the Muslim Arab population.

An amendment to this paper has been published and can be accessed via the original article.

Oxidative stress (OS) is a result of the imbalance between reactive oxygen species (ROS) and antioxidants in the body that can cause tissue damage. Oxidative stress has a significant involvement in the pathogenesis of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and male infertility. CP/CPPS is a major risk factor for male infertility due to generation of excessive ROS that damage sperm DNA, lipids, and proteins, resulting in compromised vitality and decreased sperm motility. Here we present a comprehensive review of oxidative stress relevance in CP/CPPS and male infertility, and embody the protective effects of antioxidants against ROS. An online literature was searched using the following keywords/terms: oxidative stress, ROS, Oxidative stress and chronic prostatitis, oxidative stress and male infertility and antioxidants. Original and review articles, clinical trials, and case reports of human and animal studies published till 2017 were searched using the PubMed and MEDLINE.

Introduction: Measuring the patient mortality rate is the most important indicator for the evaluation of healthcare capabilities in intensive care units in hospitals and health systems. This study aims to investigate the impact of the socio economic status of households on premature infant mortality in hospitals affiliated to the Tehran University of Medical Sciences. Methods: This descriptive and analytic study was conducted in hospitals, having neonatal intensive care units (NICU), affiliated to the Tehran University of Medical Sciences in the spring of 2013. Using the census sampling method, 114 premature infants constituted the sample of the current study. Data was gathered using a questionnaire and analyzed using chi square and Fisher methods. Results: The results of the study showed that there is a significant statistical relationship (PConclusion: According to the results of this study and the relationship between the mentioned variables, increasing health awareness among parents and their education level can be considered as a significant factor in reducing infant mortality and also focusing on promoting healthy behavior can have a desirable impact on the reduction of premature infant mortality.

Background and Aims The changes of autonomic nervous activity during bronchoscopic procedures are closely related to the development of cardiovascular complications. We aimed to evaluate the changes of autonomic nervous activity during bronchoscopic procedures using R-R interval variability from electrocardiograms (ECGs) obtained during diagnostic bronchoscopy. Methods Twenty-four patients who underwent bronchoscopy were included. Continuous ECG was recorded prior to, during and after the bronchoscopic procedure. Time and frequency domain analyses of heart rate variability were performed. Results Heart rate increased significantly after pre-medication compared with that before pre-medication and increased further during bronchoscopy. The coefficient of variation (CVRR) values after pre-medication and during bronchoscopy were significantly higher than those before pre-medication (P = 0.031 and P = 0.041, respectively). The low frequency (LF) power decreased during bronchoscopy. LF powers obtained after bronchoscopy were significantly lower than those obtained before bronchoscopy (P

Background: Vitamin D is a potent immunomodulator of innate immune responses, and its deficiency was implicated in the activation of tuberculosis (TB). The effects of vitamin D are exerted by the interaction with the vitamin D receptor (VDR) and may be influenced by polymorphisms in the VDR gene. Methods: We conducted a case–control study to identify 25(OH) D levels and FOK1 polymorphism of the VDR gene in a group of newly diagnosed pulmonary TB patients and compared to the findings in a group of healthy controls. Results: Obtained results revealed that 25(OH) D levels were significantly lower in the patients than in the controls (P 0.05). Also, no association between VDR genotype and 25(OH) D levels was found. Conclusion: FokI polymorphisms in the VDR gene do not appear to be responsible for host susceptibility to human tuberculosis in the Egyptian population. However, vitamin D deficiency may be a cause of the susceptibility to tuberculosis.

Background: Medical tourism is one of the most influential factors in industrial growth and development. To increase medical tourism, it is crucial to promote the quality of medical care and facilities to the level of international standards. This study aimed at identifying service quality as perceived by medical tourists admitted to the children’s Medical center of Tehran. Methods: All patients admitted to the children’s Medical center between years 2014 and 2015, in all hospital wards, were included. For data collection, a 24-item questionnaire and the Likert scale for scoring were used. The reliability of the questionnaire was assessed with Cronbach’s Alpha coefficient, which was 0.87. The data was presented as descriptive measures. Results: The findings revealed that therapeutic care and facilities were rated as “good”, by 56.67% and 65% of the patients, respectively. The clarity of medical costs was rated as “very poor” by 50% of the patients. Furthermore, payment system was clearly causing problems for a large percentage of patients (48.33%), mainly due to the weak currency exchange capability. Conclusions: The findings of this study suggest that the center has satisfactory medical services and therapeutic care, however, it fails to provide a good payment service and enough currency exchange counters for the patients, which need proper planning and monitoring.

Objective The objective of the present study was to assess the safety and feasibility of computed tomography lymphography by transbronchial injection of a water-soluble extracellular computed tomography contrast agent. Methods From April 2010 to May 2011, patients with clinical stage I non–small cell lung cancer who were candidates for lobectomy were enrolled in the present study. An ultrathin bronchoscope was inserted to the target bronchus under the guidance of virtual bronchoscopic navigation images. Computed tomography images of the chest were obtained 0.5 and 5 minutes after 2 or 3 mL of iopamidol was injected through a microcatheter. Sentinel nodes were identified when the maximum computed tomography attenuation value of the lymph nodes on the postcontrast computed tomography images increased by 30 Hounsfield units or more compared with the precontrast images. Patients underwent lobectomy with standard lymph node dissection. Results The ultrathin bronchoscope could access the targeted bronchus, and iopamidol was delivered into the peritumoral area in all 13 patients without any complications. Sentinel nodes were identified in 12 (92.3%) of the 13 patients. The average number of sentinel nodes was 1.5 (range, 1–2). Pathologic examination revealed metastatic lymph nodes in 2 patients. Metastatic nodes were included with the sentinel nodes. Conclusions Computed tomography lymphography by transbronchial injection of iopamidol was a safe and feasible method to identify the sentinel nodes in patients with clinical stage I non–small cell lung cancer.

Background It is known that endogenously synthesized protoporphyrin IX (PpIX) following the administration of 5-aminolevulinic acid (5-ALA) is an effective photosensitizer for photodynamic diagnosis (PDD). We tested in vivo and in vitro susceptibility of human lung cancer and mesothelioma cells to photodynamic diagnosis (PDD) using 5-aminolevulinic acid (5-ALA) as a photosensitizer. Methods Human lung cancer cell lines A549, Ma44-3, FT821 and human mesothelioma cell lines MSTO-211H, NCI-H290, Y-MESO-14 were incubated with 0.03% 5-ALA for 4 h. After incubation, protoporphyrin IX (PpIX) fluorescence was detected using a fluorescence microscope. Pleural carcinosis was induced in severe combined immunodeficiency disease mice using the previous cell lines to test the efficacy of PDD in vivo. The mice were sacrificed 4 h after oral administration of 400 mg/kg of 5-ALA. We counted the visible tumors under white light then fluorescence light. Results In vitro, clear red fluorescence was observed in all cell lines. The mean fluorescence intensity was stronger in A549 and FT821 cells than Ma44-3 cells (165.59 ± 26.49, 157.62 ± 18.93 vs. 104.01 ± 17.58). Also, MSTO-211H and NCI-H290 cells had stronger fluorescence intensity than Y-MESO-14 cells (142.51 ± 26.85, 165.16 ± 12.91 vs. 92.31 ± 8.69). In vivo, the tumor detection rate of fluorescence diagnosis was 1.1–4.5 times higher than that of white light. The mean number of metastases detected by the PDD was significantly higher than that of white light for FT821 (p = 0.004), Ma44-3 (p = 0.006) and Y-MESO-14 cell lines (p = 0.005), but not for A549, NCI-H290 and MSTO-211H cell lines. Small lesions were detected by fluorescence diagnosis even though the lesions were invisible macroscopically under white light. Conclusion Our results suggest the possibility of clinical application of fluorescence diagnosis with intrapleural malignant tumors.

Our previous studies revealed a variety of genetic changes in lung cancers from chromate-exposed workers (chromate lung cancer). In the present study, we examined epigenetic changes in chromate lung cancers. Nested-methylation-specific PCR was employed in studying the methylation of CpG islands in the APC, MGMT, hMLH1 genes in 36 chromate lung cancers and 25 nonchromate lung cancers. Methylation in chromate lung cancers was detected at 86% for APC, 20% for MGMT, and 28% for hMLH1. Whereas, it occurred at lower frequencies in nonchromate lung cancers, particularly in APC (44%) and hMLH1 (0%) genes. Our previous study showed that methylation of p16 gene in chromate lung cancer and nonchromate lung cancer was 33% and 26%, respectively. The mean methylation index (MI), a reflection of the overall methylation status, was significantly higher in chromate lung cancers than nonchromate lung cancers (0.41 vs. 0.21, P = 0.001). Methylation of multiple genes (particularly hMLH1, p16, and APC genes) had experienced more than 15 yr of chromate exposure in chromate lung cancer (MI

Tuberculosis treatment failure remains a major health problem in many parts of the Islamic Republic of Iran. This study was conducted to identify the risk factors associated with failure of tuberculosis treatment under the DOTS strategy in two cities of Golestan province. A retrospective cohort study in 2012-2013 was conducted on 167 smearpositive tuberculosis patients monitored under DOTS. Demographic, clinical and treatment outcome factors and social determinants of health were recorded for each patient. Multivariate regression analysis found that the strongest predictors of tuberculosis treatment failure were: being infected with other diseases (OR 9.35; 95% CI: 3.01-29.1), male sex (OR 5.03; 95% CI: 1.58-16.1), Turkoman ethnicity (OR 11.0; 95% CI: 2.00-60.1), family history of tuberculosis (OR 0.21; 95% CI: 0.05-0.96) and household size (OR 1.21; 95% CI: 0.99-1.48). Recommendations include better follow-up for patients with other diseases and facilitating access to treatment, especially for Turkoman patients.تقييم العوامل المرتبطة بفشل عاج السل في إطار "اسراتيجية العاج قصر الأمد تحت الإشراف المباشر" في شال جمهورية إيران الإسامية.خليل علي محمد زادة، عباس علي قيومي، ردسا مقصودلو.لا يزال فشل معالجة السل يمثل مشكلة صحية كبرة في أنحاء كثرة من جمهورية إيران الإسامية. وقد أجريت هذه الدراسة للتعرف عى عوامل الخطر المرتبطة بفشل عاج السل في إطار "اسراتيجية العاج قصر الأمد تحت الإشراف المباشر" في مدينتن من محافظة جوليستان. فأجريت دراسة أترابية استعادية في عامي 2012-2013 عى 167 مريضاً من مرضى السل إيجابيي مسحة البصاق روقبوا في إطار اسراتيجية العاج المذكورة. حيث سُجلت العوامل السكانية والسريرية والعوامل المتعلقة بنتائج العاج والمحدِّداتُ الاجتماعية للصحة لكل مريض. فوُجد بتحليل التحوف متعدد المتغرات أن أقوى المنبئات بفشل معالجة السل كانت: وجود عدوى بأمراض أخرى (CI=3.01-29.1 ؛%95 OR=9.35) ، والذكورة (CI=16.1-1.58 ؛%95 OR=5.03) ، والانتاء للأثنية التركمانية (CI=60.1-2.00 ؛%95 OR=11.0) ، ووجود تاريخ عائي للإصابة بالسل (CI=0.96-0.05 ؛%95 OR=0.21) ، وحجم الأسرة .(CI=1.48-0.99 ؛%95 OR=1.21) وتشمل التوصيات متابعةً أفضل للمرضى المصابن بأمراض أخرى، وتيسر الحصول عى العاج؛ خصوصاً بالنسبة للمرضى التركان.Évaluation des facteurs associés à l’échec du traitement antituberculeux dans le cadre du DOTS (traitement de brève durée sous surveillance directe) dans le nord de la République islamique d’Iran.L’échec du traitement antituberculeux demeure un problème de santé majeur dans de nombreuses régions de la République islamique d’Iran. La présente étude a été réalisée dans le but d’identifier les facteurs de risque associés à l’échec du traitement antituberculeux dans le cadre de la stratégie DOTS dans deux villes de la province de Golestan. En 2012 et 2013, une étude de cohorte rétrospective a été menée auprès de 167 patients à frottis positifs qui étaient sous surveillance DOTS. Les facteurs démographiques, cliniques ainsi que ceux qui concernent les issues thérapeutiques et les déterminants sociaux de la santé ont été enregistrés pour chaque patient. L'analyse de régression multivariée a révélé que les prédicteurs de l'échec du traitement antituberculeux les plus importants étaient les suivants : le fait d'être porteur d’infections concomitantes (OR 9,35 ; IC à 95 % : 3,01 – 29,1), être de sexe masculin (OR 5,03 ; IC à 95 % : 1,58 – 16,1), d'appartenir à l’ethnie turkmène (OR 11,0 ; IC à 95 % : 2,00 – 60,1), d'avoir des antécédents familiaux de tuberculose (OR 0,21 ; IC à 95 % : 0,05 – 0,96) et la taille du ménage (OR 1,21 ; IC à 95 % : 0,99 – 1,48). Les recommandations comprennent l'amélioration du suivi des patients atteints d’autres maladies ainsi que le fait de faciliter de l'accès au traitement, en particulier pour les patients turkmènes.

Introduction: Hepatocellular carcinoma (HCC) is the fourth most common cancer worldwide with a high morbidity and mortality. Alpha-fetoprotein (AFP) is considered the main tumor marker for HCC diagnosis, but the variation in its diagnostic validity among studies justifies further investigation of the underlying contributing factors. Ethnic difference could be one of the factors that has not been well studied. We aimed at investigating the ethnic difference in AFP validity between Egyptian (representing Arabic North African) and Japanese (representing Asian) for HCC diagnosis. Methods: Four cohorts with chronic liver diseases (CLD) were studied: 171 Egyptian (65 HCC/106 non-HCC), and 173 Japanese (45 HCC/128 non-HCC). Laboratory tests including serum AFP, protein-induced vitamin K deficiency or absence (PIVKA-II), alanine aminotransferase (ALT), total bilirubin, platelet count, HBsAg, anti-HCV, and HCV core antigen were conducted using standard commercially available assays. Results: A significantly higher sensitivity of AFP in Egyptian in comparison with Japanese for HCC diagnosis (99 vs 67%, P 20.5 ng/mL (P = 0.007), older age (>50 years) with an AFP level >26 ng/mL (P = 0.010), and cirrhosis with an AFP level >10.5 ng/mL (P = 0.014) were the independent risk factors for HCC. Conclusion: There is an ethnic variation in AFP validity between Egyptian and Japanese patients with a significantly lower sensitivity in the latter. Alpha-fetoprotein should not be the only marker used for screening HCC among Asian Japanese and younger age groups (

The association between cryoglobulinemia and hepatitis C virus (HCV) infection has been reported. However, the factors underlying its wide variation of occurrence have not yet been well identified. To investigate this, cryoglobulinemia was studied in four cohorts of Egyptian and Japanese patients. Fifty Egyptian patients with chronic hepatitis C, infected with genotype 4 (the predominant HCV genotype in Egypt), were compared with 50 age- and sex-matched Japanese patients, infected with HCV genotype 1b (the predominant HCV genotype in Japan). Thirty-two Egyptian and 30 age- and sex-matched Japanese patients with chronic hepatitis B were included as controls. All patients were noncirrhotic. Antinuclear antibody (ANA), immunoglobulins (Ig), and cryoglubulins were assessed. Results showed a significantly higher prevalence of cryoglobulinemia in chronic hepatitis C Japanese genotype 1b (40%) as compared with Egyptian genotype 4 (14%), P = 0.003, while no difference was found between Japanese (17%) and Egyptian chronic hepatitis B controls (13%). Symptomatic cryoglobulinemia was more prevalent in the Japanese than in the Egyptian chronic hepatitis C group (10% vs. 4%), but the difference was not statistically significant. Univariate analysis showed no association between cryoglobulinemia and either age, sex, alanine aminotransferase level, or HCV viral load in Japanese or Egyptian patients, while the mean IgM level was significantly higher in the cryoglobulin-positive than in the cryoglobulin-negative chronic hepatitis C patients in each group (P = 0.003 and 0.017, respectively). Cryoglobulinemia was found to be significantly associated with both high IgG level (P = 0.020), and positive ANA (P0.001) in Japanese patients with chronic hepatitis C, genotype 1b but not in Egyptians with genotype 4. Multivariate analysis showed that the only factors predisposing to cryoglobulinemia were Japanese ethnicity with HCV genotype1b (P = 0.002, OR = 2.56), high IgM level of245 mg/dl (P = 0.018, OR = 2.05) and female gender (P = 0.040, OR = 1/0.66). In conclusion, cryoglobulinemia is prevalent in Japanese patients with chronic hepatitis C infected with genotype 1b, but cryoglobulinemia is not common in Egyptians with HCV genotype 4. Although it was not possible to evaluate ethnicity and HCV genotype separately in this study, HCV genotype 1b appears to predispose more to cryoglobulinemia than does genotype 4. Female gender and high serum IgM level were also related.

Variceal bleeding is one of the major complications of portal hypertension. Gastro-esophageal varices are present 40-60% of patients with cirrhosis; bleeding occurs in 25-35% of patients and account for 80-90% of bleeding episodes in these patients. Hepatic venous pressure gradient (HVPG) > 20 mmHg is associated with early re-bleed and failure to control bleeding (83%) with high mortality (64%) In the last two decades variceal re-bleeding has decreased from 47% to 13% with the use of pharmacological, endoscopic, and radiological intervention.DM co-existing with cirrhosis is considered to be one of the factors in the genesis of variceal bleeding. This may be due to an increase in portal blood flow. is to determine the correlation between DM as a risk factor and failure to control variceal bleeding and re-bleeding in cirrhotic patients. This study is a case-control study, sixty cirrhotic patients with variceal bleeding with or without DM were included in the study. The patients were divided into two groups: Group 1 (diabetic group): this group included 30 cirrhotic patients with variceal bleeding and had a history of DM. Group 2 (control group): this group included 30 cirrhotic patients with variceal bleeding and had no history of DM. All Patients were subjected to the following:-Complete clinical evaluation (history and physical examination) with Laboratory and imaging investigations. Tthere were significantly higher frequency of unstable course and mean times of previous admission in diabetic patients than control patients (73.3% and 1.6 times versus 36.6% and 1.3 times, respectively). Other variables showed insignificant differences between both groups (p>0.05). There were significantly higher mean numbers of attacks of hematemesis and melena and times of previous admission with these attacks in diabetic patients than control patients. [Med-Science 2017; 6(2.000): 338-46]

A key challenge in diagnosis and treatment of thymic epithelial tumors (TET) is in improving our understanding of the genetic and epigenetic changes of these relatively rare tumors.Methylation specific PCR (MSP) and immunohistochemistry were applied to 66 TET to profile the methylation status of DNA repair gene O6-methylguanine DNA methyltransferase (MGMT) and its protein expression in TET to clarify the association between MGMT status and clinicopathological features, response to chemotherapy and overall survival.MGMT methylation was significantly more frequent in thymic carcinoma than in thymoma (17/23, 74% versus 13/44, 29%; P0.001). Loss of expression of MGMT protein was significantly more frequent in thymic carcinoma than in thymoma (20/23, 87% versus 10/44, 23%; P0.0001). There is a significant correlation between of MGMT methylation and loss of its protein expression (P0.0003). MGMT methylation and loss of expression were significantly more frequent in advanced thymic epithelial tumors (III/IV) than in early tumors (I/II).MGMT methylation plays a soul role in development of TET, especially in thymic carcinoma. Therefore, translation of our results from basic molecular research to clinical practice may have important implication for considering MGMT methylation as a marker and a target of future therapies in TET.

OBJECTIVE: Carbon monoxide (CO) is expelled mainly via the lungs, so that exhaled carbon monoxide (Ex-CO) concentration reflects endogenous production. Recent reports have shown that Ex-CO levels are increased in critically ill patients and after anaesthesia and surgery. However, there has been no investigation of the changes in Ex-CO level during a lung operation. We continuously monitored Ex-CO and exhaled carbon dioxide (Ex-CO2) concentrations during surgery for lung cancer. METHODS: Eighteen lung cancer patients who underwent elective lung cancer lobectomy were enrolled in this study. All patients were endotracheally intubated and ventilated under general anaesthesia. Ex-CO and Ex-CO2 concentrations were separately monitored and recorded continuously using two sets of Carbolyzer® breath analysers (Taiyo Inc., Osaka, Japan). RESULTS: Ex-CO concentration increased rapidly in response to changes in body position from supine to decubitus and was significantly decreased when patients were once again lying back (supine 2). Upon restarting bilateral ventilation, Ex-CO concentration in the operated lung was significantly higher than that in the breathing lung. In the lateral decubitus position, Ex-CO2 concentration showed the same pattern of increase as seen for Ex-CO. In the operated lung, the Ex-CO2 concentrations changed significantly at clamping, declamping and supine 2. In the re-ventilated, operated lung, the Ex-CO2 concentration was significantly lower than in the breathing lung. In the breathing lung, the Ex-CO2 concentration did not exhibit any significant changes over the course of the operation. CONCLUSIONS: When breathing was restarted, the Ex-CO level of the target lung was significantly higher than that of the breathing lung. The Ex-CO concentration was also affected by the surgical body position and this change was marked and transient.

The authors report this case of a 48-year-old male patient sustaining a complete tear of the biceps tendon and associated radial head subluxation. A restriction of supination-pronation of the forearm was noted as a result of the radial head subluxation. The complete tear of the biceps tendon was treated conservatively and the radial head subluxation corrected itself.