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Inflammation is a major pathophysiological factor in development of type-2 diabetes mellitus (T2DM). Vitamin D (VITD) plays an imperative role in modulation of several inflammatory responses. The current study aimed to investigate the possible beneficial effects of coadministration of VITD with pioglitazone (PIO), a PPAR-γ agonist, in fructose/streptozotocin (F/STZ) T2DM model in male Wistar rats. T2DM was induced by maintaining rats on 10% (w/v) fructose in drinking water for 9 weeks with an intraperitoneal injection of sub-diabetogenic dose of STZ (35 mg/kg) by the end of the fourth week. One week after STZ injection, PIO (10 mg/kg/day) alone or with VITD (500 IU/kg/day) was administered orally to diabetic rats till the end of the experiment. Blood samples were collected, livers were homogenized to determine biochemical parameters, and samples of livers were fixed in 10% formalin in saline for histological examination. Administration of PIO alone improved diabetes-induced inflammatory and oxidative states besides controlling hyperglycemia and decreasing apoptosis. Coadministration of VIT D with PIO promoted additional improvement in glycemic and lipid profiles, provided further control on diabetic-induced hepatic inflammation evident by downregulating TLR2, TLR4, and IKK-β while upregulating IκB-α expression and reducing inflammatory cytokines namely; NF-κB, TNF-α, IL-6, and IL-1β, decreasing apoptosis and oxidative stress by hampering caspase-3 and MDA contents, respectively, and improved liver histology than PIO alone. These beneficial effects of VIT D may expand its use by diabetics combined with antidiabetic drugs due to its anti-inflammatory, antioxidant, and antiapoptotic properties.

The aim of this work was to investigate the effect of an acute bout of different exercise intensities on modifying the inflammatory markers in overweight and obese subjects. Sixty adult males divided into: a control group (n=30) included normal weight subjects (BMI < 25 kg/m2) and an overweight (OW) and obese group (n=30) included subjects with BMI ≥ 25 kg/m2. Each group was randomly subdivided into three groups (n=10 each): low, moderate and high intensity exercise groups. Anthropometric measurements obtained and plasma C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α) levels were measured before and thirty minutes after twenty minutes incremental exercise, at 45%, 60% or 80% of predicted maximum heart rate, on a motor driven treadmill. Following an acute bout of moderate or high intensity exercise, OW and obese subjects showed significant increase in CRP and IL-6 levels; however, TNF-α levels significantly decreased. Nevertheless, an acute low intensity exercise induced no significant changes in any of the measured markers in the OW and obese subjects. In conclusion, an acute bout of moderate or high intensity exercise, but not low intensity exercise, induces an inflammatory response, characterized by a rise in levels of CRP and IL-6, and a decrease in TNF-α level in overweight and obese subjects.

Background: Central venous stenosis or occlusion (CVSO) is a major complication in hemodialysis patients that significantly affects morbidity and failure of the peripheral arteriovenous fistula (AVF). However, the best treatment is still unknown (surgical or endovascular). Endovascular treatment is a widely accepted option that includes percutaneous transluminal angioplasty (PTA) with or without stenting. The optimal endovascular treatment is still undetermined. Aim: To study the success rate and effect of endovascular intervention as angioplasty alone or with stenting, in patients with CVSO as optimal endovascular treatment still undetermined. Patients and Methods: this is uncontrolled clinical trial was conducted in Suez Canal University Hospital in the period between July 2017 to July 2019 and follow-up for 12 months. Thirty-four patients with compromised upper limb arteriovenous fistula due to CVSO were included to assess the patency rate of primary angioplasty with or without stenting. Any patients with (mediastinal lesion invading central veins, ipsilateral peripheral vein stenosis, or infected AVF) were excluded. Results: The mean age of studied patients was 53.06±8.49 with a slightly larger number (19) of females (56%). Pre-intervention, the innominate vein was the highest affected with lesion by 41%. Occlusion was in 9 patients (26%), while; 25patients (74%) had stenotic lesion. The success rate of primary patency was 55%, follow-up of the successful cases at 3, 6, and 12 months with patency rate 91%,77%, and 59% respectively. There was no significant difference in the patency rate during one-year follow-up regarding the use of angioplasty alone or with stenting. Conclusion: percutaneous transluminal angioplasty with or without stenting according to our results is successful, safe, and effective in managing central venous lesions in compromised AVF in hemodialysis patients.

Background: Contrary to traditional long saphenous vein (LSV) surgeries, stripping and endovenous laser ablation, using heat coagulation, ambulatory conservative hemodynamic correction of venous insufficiency (CHIVA) is LSV sparing technique. Aim: Based on the lack of studies discussing success and recurrence rate, this study was designed to assess the immediate and one-year follow-up of this technique, as well as its efficacy and safety. Patients and Methods: Thirty-three patients with primary LSV varicosities were included in this uncontrolled clinical trial. Patients with LSV diameter of ≥ 9.5mm or pregnancy were excluded. Results: The mean age of our patients was 33.36±8.865 years, and 54.5% of them were males. According to Hobb's score, 25 patients (75.7%) were completely cured, 6 patients (18.1%) were improved, while 2 patients (6.2%) were considered as failure. Most (87.9%) of the patients showed absent or no visible recurrence. The rest showed visible recurrence by duplex ultrasound. All patients had significant improvement of their symptoms (no pain, or edema) at the immediate follow-up after operation. No complication including hematomas, ecchymosis, hemorrhage, saphenous nerve neuralgia, phlebitis, infection, deep or LSV thrombosis was detected. Conclusion: CHIVA is a successful and effective option in managing patients with primary long Saphenous varicosities, with minimal recurrence rate, after one-year of follow-up.

Valproic acid is a commonly used drug for many psychiatric disorders, particularly for epilepsy. However, it has been reported that its use is associated with possible side effects including hepatotoxicity.The present study investigated the hepatoprotective effect of ellagic acid against valproic acid-induced hepatotoxicity in rats.Ellagic acid (60 mg/kg/day; p.o) was treated for one week, followed by concomitant injection of valproic acid (250 mg/kg/day; i.p.) for another 14 consecutive days to induce hepatocellular damage in adult Sprague–Dawley rats.Valproic acid showed a marked increase in serum enzyme activities, AST, ALT, ALP and GGT. In addition, it significantly increased MDA and NO along with a marked decline in reduced GSH content. At the same time, valproic acid administration resulted in marked elevation in hydroxyproline, TNF-α production and NF-kB expression. These results were confirmed by histopathological examination.Treatment with ellagic acid markedly attenuated valproic acid-induced hepatic injury in rats. Keywords: Valproic acid, Hepatotoxicity, Oxidative stress, Ellagic acid, Hepatocellular damage

Purpose Systemic lupus erythematosus (SLE) is an autoimmune disease with multi-organ involvement. Hyponatremia is common in inflammatory diseases such as meningitis. Also, it has been found to be strongly associated with the degree of inflammation. However, it has not been fully evaluated in lupus. This study aimed to assess the inflammatory impact of hyponatremia in SLE patients and investigate its relationship with SLE disease activity. Patients and methods A total of 101 patients with SLE were enrolled in this study and divided into two groups according to Na level; a normo-natremic group and a hyponatremic group. Demographic and clinical data were collected. SLE activity was assessed by the systemic lupus erythematosus disease activity index (SLEDAI). The estimated sedimentation rate (ESR) as well as levels of C-reactive protein (CRP) and complements (C3 and C4) were measured. Results The majority of patients were females (98 subjects) (97%) with a mean age of 33±8 years. Out of 101 participants, 40 patients (39.6%) were hyponatremic with a mean Na level of 131.58±3.11 mmol/L. There was a statistically negative correlation between both ESR and SLEADI score and Na level (r=-0.436 and -0.436, respectively) with p=0.002, whereas Na level was positively correlated with complements, Cl, and albumin levels (r=0.653, 0.314, and 0.460, respectively) (p=0.000, 0.027, and >0.001, respectively). CRP was not correlated with Na level. ESR was independently correlated with hyponatremia at the 95% CI for Exp B (0.997-0.058) with a p-value of 0.048. Conclusion Hyponatremia could be used as an indicator of SLE activity. Also, it might be an easily and rapidly detected as well as a prognostically useful marker of inflammation.

Ischemic stroke is a major cause of death and motor disabilities all over the world. It is a muti-factorial disorder associated with inflammatory, apoptotic, and oxidative responses. Nateglinide (NAT), an insulinotropic agent used for the treatment of type 2 diabetes mellitus, recently showed potential anti-inflammatory and anti-apoptotic effects. The aim of our study was to elucidate the unique neuroprotective role of NAT in the middle cerebral artery occlusion (MCAO)-induced stroke in rats. Fifty-six male rats were divided to 4 groups (n = 14 in each group): the sham-operated group, sham receiving NAT (50 mg/kg/day, p.o) group, ischemia/reperfusion (IR) group, and IR receiving NAT group (50 mg/kg/day, p.o). MCAO caused potent deficits in motor and behavioral functions of the rats. Significant increase in inflammatory and apoptotic biomarkers has been observed in rats' hippocampi. Janus kinase 2 (JAK2)/signal transducer and activator of transcription 3 (STAT3) pathway was significantly stimulated causing activation of series inflammatory biomarkers ending up neuro-inflammatory milieu. Pretreatment with NAT preserved rats' normal behavioral and motor functions. Moreover, NAT opposed the expression of hypoxia-inducible factor-1α (HIF-1α) resulting in downregulation of more inflammatory mediators namely, NF-κB, tumor necrosis factor-β (TNF-β), and the anti-survival gene PMAIP-1. NAT stimulated caveolin-1 (Cav-1) which prevented expression of oxidative biomarkers, nitric oxide (NO), and myeloperoxidase (MPO) and hamper the activation of apoptotic biomarker caspase-3. In conclusion, our work postulated that NAT exhibited its neuroprotective effects in rats with ischemic stroke via attenuation of different unique oxidative, apoptotic, and inflammatory pathways.

Inflammation is an important biological event in host defenses against bacterial or viral infections. However, excessive inflammatory responses by aberrantly activated macrophages, producing excess amounts of inflammatory mediators, which disrupt immune homeostasis and result in immunopathological conditions such as sepsis. Sepsis was recognized as a systemic inflammatory response syndrome after serious infections, most commonly with bacteria, which have a high mortality rate. Propolis (Prop) could be used as adjuvant therapy in the management of sepsis. The present study aimed to investigate the protective effect of Prop against sepsis-induced in rats. Evaluation of complete blood count, activity of liver function enzymes in serum; alanine and aspartate aminotransferases were recorded. Oxidant/antioxidant markers in liver tissue namely; malonaldehyde, nitrites/nitrates, glutathione disulfide, glutathione levels, catalase and superoxide dismutase activities. Also, tumor necrosis factor-alpha and prostaglandin E-2 levels in both serum and liver tissue were estimated. Furthermore, interleukin-8, cyclooxygenase-2 and inducible nitric oxide synthase genes expression were determined. Histopathological examination of liver tissue was investigated. Brain neurotransmitters; Dopamine, Norepinephrine and 5-hydroxytryptamine were also determined against sepsis-induced inflammation. The present study indicated that Prop could be an efficient protector that resets sepsis-induced severe oxidative stress, inflammation and improve the immune response of the liver as well as septic neurotoxic problems.

Chlorpyrifos (CPF) is a widely used organophosphate insecticide with several harmful effects. N-acetylcysteine (NAC) represents an ideal antixenobiotic; it can directly enter endogenous biochemical processes and is used as adjunctive treatment for psychiatric disorders. We aimed to evaluate the neuroprotective effect of NAC as an antioxidant drug against CPF-induced neurotoxicity in adult male albino rat brains. Twenty-eight male Wister rats were allocated into four groups (n = 7) and were administered the following for 28 days: group I (control group), physiological saline (0.9% NaCl); group II (CPF group), 10 mg/kg body weight (BW) CPF; group III (NAC group), 100 mg/kg BW NAC; and group VI (CPF+NAC group), NAC 1 h before CPF. CPF intoxication resulted in acetylcholinesterase inhibition, reduced glutathione content, and elevated levels of malondialdehyde and nitric oxide, which are oxidative stress biomarkers. CPF also depleted the activity of antioxidant enzymes, superoxide dismutase and catalase, and levels of inflammatory mediators, tumor necrosis factor-α, interleukin (IL)-6, and IL-1β. Levels of vascular endothelial growth factor, Bax, and the proapoptotic caspases-3 also increased, while brain-derived neurotrophic factor level decreased. Additionally, CPF significantly diminished Bcl-2 (an antiapoptotic protein) in rat brain cortical tissue. NAC treatment was found to protect brain tissue by reversing the CPF-induced neurotoxicity. Our results show the antioxidant, antiinflammatory, and antiapoptotic effects of NAC on CPF-induced neurotoxicity in rat brain tissue.

Background: Several trials have reported that dipeptidyl peptidase-4 (DPP-4) inhibitors are used to improve endothelial function in addition to treating type 2 diabetes (T2DM). The current study investigated the effects of vildagliptin, DPP-4 inhibitor, compared to metformin on endothelial function and blood pressure through vascular endothelial growth factor (VEGF) modulation in patients with T2DM and hypertension. Methods: This study was designed as a randomized controlled parallel study. A total of 120 volunteers were recruited and allocated into 4 groups: healthy volunteers, patients recently diagnosed with hypertension and diabetes, patients treated with captopril for hypertension in addition to metformin, and patients treated with captopril in addition to vildagliptin. The percentage change in body weight was calculated in addition to serum VEGF levels, blood pressure, glycated hemoglobin (HbA1c), total lipid profile, and insulin resistance. Results: At the end of the therapeutic period, the results showed that vildagliptin significantly decreased blood pressure and increased serum VEGF levels, while metformin was more effective at lowering body weight. In comparison with metformin, vildagliptin showed a promising action through its antihypertensive effect via elevating VEGF levels and improving physiological angiogenesis and vasculature. What is new and conclusion: Vildagliptin showed a promising action through its blood pressure-regulating effect via modulating VEGF levels and improving physiological angiogenesis and vasculature, in addition to improving the lipid profile of patients, while metformin was better in reducing body weight.

Early detection and clinical interference are major challenges for the prevention of diabetic nephropathy (DN) progression. This study investigated the effects of dapagliflozin, a sodium glucose co-transporter 2 inhibitor, on some early markers for DN in fructose-streptozotocin (Fr-STZ)-induced diabetes in rats. Fr-STZ rats were treated with either dapagliflozin (1 mg/kg p.o. daily), metformin (350 mg/kg p.o. daily), or their combination for 6 weeks. Fr-STZ rats displayed marked early tubular renal damage and glomerular podocyte injury as evidenced by renal KIM-1, NGAL, cystatin C, and vanin-1 mRNA, as well as urinary NAG elevation and nephrin mRNA suppression, associated with the development of marked renal interstitial fibrosis and glomerulosclerosis despite the presence of normoalbuminuria. Propagation of oxidative, inflammatory, fibrotic, and apoptotic reactions was obvious in the setting of renal glucose overload. Dapagliflozin significantly attenuated the renal tubular injury makers namely KIM-1, NGAL, vanin-1 and urinary NAG. In addition, it restored glomerular nephrin expression and reversed renal histopathological changes. Oxidative, inflammatory, and fibrotic processes were also alleviated. This study suggests that dapagliflozin exerts a renoprotective effect against early features of DN in rats presumably by inhibition of diabetes-induced renal tubular and glomerular injury thereby modulating oxidative, inflammatory, and fibrotic as well as apoptotic mechanisms elicited during hyperglycemia.

Background: Early prediction and clinical intervention are extremely important in order to delay or hinder diabetic nephropathy (DN) progression. Objectives: This study aimed to detect early signs of DN and study the potential ameliorating effect of the dipeptidyl peptidase-4 inhibitor, linagliptin, on some early markers for DN in fructose-streptozotocin (Fr-STZ)-induced diabetic rats. Method: Fr-STZ rats were treated with either linagliptin (3 mg/kg p.o. daily), metformin (350 mg/kg p.o. daily), or their combination for 6 weeks. Results: Fr-STZ DN rats exhibited obvious tubular renal damage and glomerular podocyte injury as confirmed by renal kidney ­injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), and vanin-1 mRNA, as well as urinary N-acetyl-β-D-glucosaminidase elevation and nephrin mRNA suppression, associated with the appearance of marked renal interstitial fibrosis and glomerulosclerosis despite the absence of microalbuminuria. Initiation of oxidative, inflammatory, fibrotic, and apoptotic reactions was evident in the settings of renal hyperglycemia. Linagliptin significantly modulated the aforementioned renal tubular injury makers and restored glomerular nephrin expression as well as reversed renal histopathological alterations. Oxidative, inflammatory, fibrotic and apoptotic processes were also alleviated. Conclusions: This study suggests that linagliptin exerts renoprotection against early features of DN in rats probably by inhibition of high glucose-induced renal tubular and glomerular injury thereby hampering KIM-1 and NGAL as well as vanin-1 associated with renal inflammation, fibrosis and oxidative stress.

Aims Hepatic encephalopathy (HE) is a complex neuropsychiatric syndrome. Paracetamol (APAP) causes, in high doses, a hepatic injury. Alogliptin (ALO), with its 100% oral bioavailability, may be able to reverse the acute hepatic injury and memory impairments. Materials and methods Forty rats were divided into four groups as follows; Normal Control Group, APAP intoxicated group, ALO and SIL groups. Behavioral tests (Morris water maze, Y-maze spontaneous alteration, and novel object recognition test) were performed together with evaluating HE score. Neurotransmitters (gamma-aminobutyric acid, glutamate, dopamine, serotonin, norepinephrine and acetylcholine), as well as acetylcholinesterase activity, were determined in the hippocampus. Also, hepatotoxicity markers (alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and ammonia) were measured in blood. Additionally, transforming growth factor beta 1, tumor necrosis factor alpha, cytochrome c, granzyme B and caspase-3, coiled-coil Moesin-like BCL-interacting protein 1 “beclin-1”, cellular FLICE-like inhibitory protein, protein 53, TNF-α related apoptosis-inducing ligand, Fas-ligand and alpha-smooth muscle actin were measured in liver homogenate. Moreover, the histopathological investigation was performed. Key findings APAP was able to disturb neurotransmitters which were mirrored in the performance of rats in the behavioral test. Most hepatotoxicity, apoptosis and inflammation indicators were elevated after APAP administration, while beclin-1 (autophagy marker) was declined. The tested drugs, both, reversed most of the last mentioned parameters but ALO was more efficient in reducing TGF-β1, α-SMA, TNF-α and ALP as well as increasing % alteration. Significance ALO and SIL elicited anti-apoptotic, anti-inflammatory and autophagic effects on paracetamol-damaged liver cells and improved memory impairments of HE.

Eprosartan (EPRO), an angiotensin receptor type-1 (AT-1) blocker, exhibited neuroprotective activities in ischemic stroke resulting from focal cerebral ischemia in rats. The current study aimed to clarify the neuroprotective role of EPRO in middle carotid artery occlusion (MCAO)-induced ischemic stroke in rats. Fifty-six male Wistar rats were divided into four groups (n = 14 per group): sham-operated group, sham receiving EPRO (60 mg/kg/day, po) group, ischemia-reperfusion (IR) group, and IR receiving EPRO (60 mg/kg/day, po) group. MCAO led to a remarkable impairment in motor function together with stimulation of inflammatory and apoptotic pathways in the hippocampus of rats. After MCAO, the AT1 receptor in the brain was stimulated, resulting in activation of Janus kinase 2/signal transducers and activators of transcription 3 signaling generating more neuroinflammatory milieu and destructive actions on the hippocampus. Augmentation of caspase-3 level by MCAO enhanced neuronal apoptosis synchronized with neurodegenerative effects of oxidative stress biomarkers. Pretreatment with EPRO opposed motor impairment and decreased oxidative and apoptotic mediators in the hippocampus of rats. The anti-inflammatory activity of EPRO was revealed by downregulation of nuclear factor-kappa B and tumor necrosis factor-β levels and (C-X-C motif) ligand 1 messenger RNA (mRNA) expression. Moreover, the study confirmed the role of EPRO against a unique pathway of hypoxia-inducible factor-1α and its subsequent inflammatory mediators. Furthermore, upregulation of caveolin-1 mRNA level was also observed along with decreased oxidative stress marker levels and brain edema. Therefore, EPRO showed neuroprotective effects in MCAO-induced cerebral ischemia in rats via attenuation of oxidative, apoptotic, and inflammatory pathways.

BACKGROUND Digital subtraction angiography (DSA) is still considered the gold standard test to evaluate arteriovenous malformation's (AVM) residual after microsurgical resection. OBJECTIVE To evaluate the safety and reliability of intraoperative computed tomography angiography (iCTA) as an immediate method of evaluating the surgical results of AVM resection. METHODS We performed a retrospective review for all cases of cerebral AVMs at our institute from January 2015 to April 2020 who underwent surgical resection of cerebral AVM and had iCTA. All included patients underwent a postoperative DSA, and the results were compared with iCTA. RESULTS Twenty-eight cases were included. All cases showed complete resection (100%) in the iCTA, and the results were consistent with the postoperative DSA results. The sensitivity of iCTA was 100%. The added operative time ranged from 25 to 30 min. There were no complications related to the use of iCTA. CONCLUSION Intraoperative assessment of AVMs surgical results with an iCTA is safe and reliable. The sensitivity of iCTA following AVM resection merits further investigations.

Public health issues have been raised regarding fructose toxicity and its serious metabolic disorders. Deleterious effects of high fructose intake on insulin sensitivity, body weight, lipid homeostasis have been identified. The new millennium has witnessed the emergence of a modern epidemic, the metabolic syndrome (MS), in approximately 25% of the world’s adult population. The current study aimed to investigate the effect of the TNF-α antagonist infliximab on fructose-induced MS in rats. Rats were administered fructose (10%) in drinking water for 12 weeks to induce the experimental MS model. infliximab (5 mg/kg) was injected once weekly intraperitoneally starting on the 13th week for 4 weeks. Increase in body weight, blood glucose level, serum triglycerides (TGs), adiponectin level and blood pressure were present in MS rats. They also prompted increases in serum of leptin, TNF-α, and malondialdehyde (MDA) levels. Treatment with infliximab did not affect body weight, hyperglycemia or hypertension, but decreased serum TGs and increased serum HDL-c levels. Infliximab also decreased adiponectin levels. Surprisingly, infliximab increased MDA above its value in the MS group. These results reflect the fact that infliximab affects the manifestations of MS in rats. Though infliximab reduced TGs, increased HDL-c levels, reversed adiponectin resistance occurred by fructose, the drug failed to combat MS-mediated hyperglycemia, hypertension, and elevated MDA above the insult.

Background and objective Infertility in couples is rated one in every eight couple worldwide which affects 15% of couples and a male factor is found to be solely responsible or in conjunction with a female factor in 50% of cases. The natural chemicals found in rocca and red cabbage leaves breakdown into compounds like indole-3-carbinol, which has anti-cancer property. Flavonoids of the crop have good therapeutic potential in inflammation and pain. Meanwhile, this investigation aimed to evaluate the effect of rocca leaves and red cabbage leaves on male infertility rats. Materials and methods Thirty-six adult male Sprague Dawley rats were divided into six groups. Group 1: Normal rats fed on basal diet as control negative (C-), Group 2: Control positive C+, in which infertility rats were fed on basal diet. Group 3: Infertility rats fed on basal diet and 5% rocca leaves. Group 4: Infertility rats fed on basal diet and 10% rocca leaves. Group 5: Infertility rats fed on basal diet and 5% red cabbage leaves. Group 6: Infertility rats fed on basal diet and 10% red cabbage leaves. At the end of experiment, after 28 days of feeding, all serum samples were analyzed for biochemical parameters. Results Injection with cadmium chloride caused a significant increase in the level of glucose, urea, creatinine, uric acid, AST, ALT, ALP, total cholesterol, triglycerides, LDLc, VLDLc, AI, Glob, TB, IB, DB and LH hormone while a significant decrease was recorded in HDLc, testosterone, FSH hormones, TP and Alb. Meanwhile, in infertility rats then treated with rocca leaves 5 and 10% and red cabbage leaves at the same doses 5 and 10% caused significant improvement in all tested parameters. Conclusion The obtained results demonstrated that rocca leaves and red cabbage leaves had significant improvement in testosterone, Follicle-stimulating hormone, luteinizing hormone, total protein, albumin and lipids profile in cadmium chloride induced infertility in rats.

Objectives As one of the most frequent worldwide neurological disorders, epilepsy is an alteration of the central nervous system (CNS) characterized by abnormal increases in neuronal electrical activity. The mammalian target of rapamycin (mTOR) signalling pathway has been investigated as an interesting objective in epilepsy research. Vinpocetine (VNP), a synthesized derivative of the apovincamine alkaloid, has been used in different cerebrovascular disorders. This study aimed to examine the modulatory effects of VNP on neurobehavioral comorbidities via the mTOR signalling pathway in a lithium-pilocarpine (Li-Pil) rat model of seizures. Methods In male Wistar rats, seizures were induced with a single administration of pilocarpine (60 mg/kg; i.p.) 20 hours after the delivery of a single dose of lithium (3 mEq/kg; i.p.). VNP (10 mg/kg; i.p.) was administered daily for 14 consecutive days before Li-Pil administration. Key findings VNP had a protective effect against Li-Pil-induced seizures. VNP improved both the locomotor and cognitive abilities, moreover, VNP exerted a neuroprotective action, as verified histologically and by its inhibitory effects on hippocampal glutamate excitotoxicity, mTOR pathway, and inflammatory and apoptotic parameters. Conclusions VNP is a valuable candidate for epilepsy therapy via its modulation of the mechanisms underlying epileptogenesis with emphasis on its modulatory effect on mTOR signalling pathway.

In the present investigation, we tested the hypothesis that suppression of the phospho-extracellular signal regulated kinase (pERK1/2)-nuclear factor kappa (NFκ)-B signaling, subsequent to tumor necrosis factor-α (TNF-α) inhibition, underlies thalidomide (TLM) mediated neuroprotection. Male Wistar rats (250–280 g) were divided into five groups: (1) sham; (2) negative control receiving TLM (5μg/1μl/site) and 3 groups of ischemia-reperfusion (IR) injury rats pretreated with: (3) vehicle (DMSO 100%); (4) TLM (5μg/1μl/site) or (5) PD98059 (0.16μg/1μl/site). IR rats were subjected to occlusion of both common carotid arteries for 45 min followed by reperfusion for 24 h. Drugs and/or vehicles were administered by unilateral intrahippocampal injection after removal of the carotid occlusion and at the beginning of the reperfusion period. IR rats exhibited significant infarct size, histopathological damage, memory impairment, motor incoordination and hyperactivity. Unilateral intra-hippocampal TLM ameliorated these behavioral deficits along with the following ex vivo hippocampal effects: (i) abrogation of the IR-evoked elevations in hippocampal TNF-α, pERK1/2, NFκB, BDNF, iNOS contents and (ii) partial restoration of the reduced anti-inflammatory cytokine IL-10 and p-nNOS S852. These neurochemical effects, which were replicated by the pERK1/2 inhibitor PD98059, likely underlie the reductions in c-Fos and caspase-3 levels as well as the anti-apoptotic effect of TLM in the IR model. These results suggest a crucial anti-inflammatory role for pERK1/2 inhibition in the salutary neuronal and behavioral effects of TLM in a model of brain IR injury.

Metabolic syndrome is a cluster of cardiovascular and metabolic risk factors that include impaired glucose metabolism and obesity. The use of nutraceuticals is an ideal choice for controlling this disorder. The aim of the present study is to investigate the effect (-) hydroxycitric acid present in garcinia fruit rind and (+) hydroxycitric acid present in hibiscus calyx on metabolic syndrome and compare it to that of metformin. Metabolic syndrome was induced in rats by ingestion of high fat high fructose (HFHF) diet for 90 days. Metformin (500 mg/Kg animal b.wt.), garcinia (1000 mg/Kg animal b.wt.) and hibiscus (250 mg/Kg animal b.wt) were orally administered throughout the last 30 days of the HFHF diet regimen. Both garcinia and hibiscus were effective in reducing serum blood glucose and insulin levels. The effect of garcinia on blood glucose was comparable to that of metformin, while the effect of hibiscus on insulin and HOMA-IR was comparable to that of metformin. Both were able to reduce serum leptin level. All treated groups showed a significant decrease in total cholesterol level. Only hibiscus was able to normalize liver function while garcinia failed to reduce the elevated liver function. As a conclusion we would recommend the use of hibiscus over garcinia to overcome the adverse effects of metabolic syndrome.

Gleason grade (GG) on prostate biopsy is important for risk stratification and clinical decision making. Multiparametric MRI (mpMRI) improved detection of clinically significant disease and some studies suggest that MRI-fusion biopsy combined with systematic biopsy results in fewer upgrades on final surgical pathology. However, the downgrade rate is unclear and there is controversy in the literature. The objectives of this study are to assess the concordance of combination biopsy with final surgical pathology, and furthermore, to specifically determine downgrade rates.In our institutional mpMRI-ultrasound fusion biopsy database, 173 underwent targeted and systematic biopsy followed by radical prostatectomy (RP). GG on targeted, systematic and combination (targeted and systematic) biopsy were compared with GG on RP. Concordance rates between biopsy types were compared with the McNemar test. Proportion of GG upgrade or downgrade at the time of RP was also evaluated.Surgical pathology was concordant with 44.5% of systematic biopsies, 46.8% of targeted biopsies, and 56.7% of combination biopsies. Combination biopsy significantly overestimated the final GG on RP compared to systematic biopsy (16.8% vs. 8.7% RR 1.93, 95% CI 1.36-2.75, P0.001). Downgrade rate from unfavorable to favorable intermediate-risk disease was 46.2%, and from high-risk to intermediate-risk disease was 45.1%.Combination (targeted and systematic) biopsy is associated with the highest concordance rate between biopsy and RP pathology when compared with systematic or targeted biopsy alone. However, targeting MRI lesions and therefore the higher risk components, may at times overestimate the final surgical pathology which can result in overtreatment of what may truly be less aggressive disease.

Background: Ischemia refers to diminished blood supply, causing a lack of oxygen and when blood supply is re-established this is reperfusion. The Ischemia-Reperfusion (I/R) process is a common event after living donor liver transplantation, trauma, and hemorrhagic shock. Renalase, a ubiquitous flavoprotein, is highly expressed in kidney, liver, heart, skeletal muscles and adipose tissues. Renalase has been verified that it is the only enzyme involved in the catecholamine metabolism that can be secreted into the blood cycle hitherto.Considering renalase close relationship with oxidative stress, renalase is thought to play a role, or at least responsive, in the process of hepatic ischemia reperfusion injury.Aim of Study: To demonstrate whether serum Renalase can be used as a potential biomarkers of hepatic ischemia reperfusion injury following living donor liver transplantation especially when combined with the standard LFT panel.Patients and Methods: The present study was conducted on 50 patients with End Stage Liver Disease (ESLD) under-going Living Donor Liver Transplantation (LDLT). Patients were evaluated pre-operatively laboratory by using the Child-Pugh score and Model for End-Stage Liver Disease (MELD) Score and radiological by abdominal Doppler ultrasonography. Intra-operative evaluation of patients included: Operative details including ischemia time, intraoperative bleeding and amount of blood transfused. Post-operative workup included daily examinations as regards vital signs, drains and fluid balance. Daily measurement of CBC, LFT and KFT was done for seven days.Results: By comparing different laboratory data day seven to laboratory data on day one post-living donor liver trans-plantation, there was a statistically significant decline regarding AST, ALT, INR reflecting graft function, our study demon-strated no statistically significant correlation between serum Renalase levels and operative ischemia time predisposing to ischemia reperfusion injury.Conclusion: Clinical treatment decisions based on the serial detection of renalase activities in the blood did not help in early detection and possible prevention of hepatic ischemia reperfusion injury post-living donor liver transplantation to improve the clinical outcomes of liver transplantation.

Background: Periapical periodontitis is caused by extension of necrotic pulp tissue into the periodontal ligament area. cone-beam computed tomography (CBCT) facilitates better diagnosis for periapical periodontitis, especially in the absence of clinical symptoms. This study aims to use cone-beam computed tomography-endodontic radiolucency index (CBCT-ERI) to determine the extension of periapical periodontitis in post-graduate clinics of Riyadh Elm university (REU) and to record the extension of periapical periodontitis in the coronal direction along the root surface and evaluate the degree of cortical bone involvement associated with periapical radiolucency.Methods: CBCT images for patients treated at the endodontic clinics of REU were selected for this retrospective observational study. Images were examined after inter-examiner calibrations under the same magnification, slice thickness, and resolution and the measurements were analyzed statistically.Results: The first permanent molars were the most frequently affected by periapical periodontitis, followed by the second molars. The majority of lesions were graded with a score of 6 in length and width according to CBCT-ERI.Conclusions: The use of CBCT-ERI revealed extensive involvement of periodontal tissues around the apices of the roots of the examined teeth. Coronal extension of periapical periodontitis was observed along the root surface. The axial view accurately detected cortical bone involvement, including thinning of the cortical bone, which was the most common manifestation (11.76%). Apical radiolucency was observed most commonly in the first molars.

Background and aim Chronic kidney disease is a major public health problem with increased global incidence and prevalence, especially in Egypt, poor quality of life, and high risk of morbidity and mortality. The aim of the work was to determine the prevalence and the risk factors of incidental kidney diseases among apparently healthy adults. Patients and methods A total of 300 healthy normotensive and normoglycemic individuals were assessed for creatinine, proteinuria, and glomerular filtration rate, with correlation to their BMI and systolic and diastolic blood pressures. Results Microalbuminuria was positively correlated to age, BMI, and systolic blood pressure, with a significant P-value of less than 0.001. Conclusion The prevalence estimates and risk factors for those with microalbuminuria as a marker of occult renal disease include age, BMI, high systolic blood pressure, and family history of renal problems.

Rationale: Gaucher disease (GD) is the most common amongst the lysosomal storage disorders. Prevalence of GD in Saudi Arabia is not available in published literature and it is expected to be high and remains undiagnosed. In 2004, a Saudi study reported that GD accounts for 6% of all genetic metabolic disorders. While acid sphingomyelinase deficiency (ASMD) is a rare progressive genetic disorder with no clear data about its incidence in Saudi Arabia. Consequently, this study proposes to determine the prevalence of GD and ASMD in outpatient settings in Saudi Arabia by screening patients with unknown causes of splenomegaly and/or thrombocytopenia. These data will change the local practice and increase the awareness towards GD and ASMD in Saudi Arabia. Objectives: To determine the prevalence of GD in high risk group (defined as patients with splenomegaly and/or thrombocytopenia of unknown cause) and describe their characteristics. We also aim to determine the prevalence of ASMD in high risk group. Methods: A multi-center, observational, study will be conducted in 25 specialty care centres across Saudi Arabia, these centres are mainly focusing on pediatric hematology, adult hematology and hemato-pathology. Female or male patients (aged 2-75 years) will deemed eligible if they have clinical, instrumental or laboratory signs of splenomegaly or thrombocytopenia over a period of 12 months without definitive cause. These patients will be tested for acid β-glucosidase and acid sphingomyelinase enzymes activity on dried blood spot (DBS) samples. Patients with hematological malignancies, hemolytic anemia, and/or thalassemia (except sickle cell disease) will be excluded. A total of 400 patients from Saudi Arabia who fulfill the eligibility criteria will be enrolled in the study. All patient data will be collected in a single visit. Each enrolled patient will visit the investigator for a baseline visit. The investigator will contact them later for sharing the investigation blood test results. During the baseline visit, data and blood sample for enzyme tests and genotyping will be collected by the investigator/designated person at the site. Discussion: Arab world represents one of the leading regions in terms of the incidence of congenital and genetic disorders; a growing body of published literature reported a notable trends towards higher incidence of congenital and genetic diseases, compared to other parts of the world(1). High consanguinity rates which reach up to 60% in some regions, high prevalence of haemoglobinopathies and metabolic disorders, relatively high maternal and parental age, and lack of proper genetic screening were reported as contributing factors for this high prevalence of genetic disorders in the Arab world(1-3). In Saudi Arabia, the situation appears to be no different as previous retrospective studies showed a relatively high incidence of genetic diseases such as inborn error of metabolism. The data of the present study will change the local practice and increase the awareness towards GD and ASMD in Saudi Arabia. References: Al-Gazali L, Hamamy H, Al-Arrayad S. Genetic disorders in the Arab world. BMJ [Internet]. 2006 Oct 21 [cited 2019 Jun 29];333(7573):831-4. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17053236 Al-Gazali LI, Alwash R, Abdulrazzaq YM. United Arab Emirates: Communities and Community Genetics. Public Health Genomics [Internet]. 2005 [cited 2019 Jun 29];8(3):186-96. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16113536 Wahab AA, Bener A, Teebi AS. The incidence patterns of Down syndrome in Qatar. Clin Genet [Internet]. 2006 Mar 30 [cited 2019 Jun 29];69(4):360-2. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16630172 Disclosures No relevant conflicts of interest to declare.

BACKGROUND: Examine the ability of a dynamic scapular recognition exercise to improve scapular upward rotation and decrease shoulder pain and disability in patients with adhesive capsulitis of the shoulder. METHODS: A test-retest randomized controlled study design was used. A total of sixty-six patients with unilateral adhesive capsulitis were equally divided into two groups. The study group received a dynamic scapular recognition exercise using a wireless biofeedback system, while the control group received placebo treatment in the form of active range-of-motion (ROM) exercises of the sound upper limb. A digital inclinometer was used to measure the scapular upward rotation and ROM of the shoulder joint, and the Shoulder Pain and Disability Index (SPADI) was used to measure the shoulder pain and disability. RESULTS: Study results showed that after two weeks, there were statistically significant differences between the study and control groups in scapular upward rotation and shoulder flexion and abduction (P < .05) and nonsignificant differences in shoulder external rotation and SPADI (P > .05). After two and six months, there were statistically significant differences between study and control groups in scapular upward rotation; shoulder flexion, abduction and external rotation; and SPADI scores (P < .05). CONCLUSION: This study showed that a dynamic scapular recognition exercise significantly improves scapular upward rotation and the ROM of shoulder flexion and abduction after two weeks. At two and six months, this exercise improves scapular upward rotation; ROM of shoulder flexion, abduction, and external rotation; and SPADI scores. These improvements persisted for six months after the performance of this exercise

Background Premature atherosclerosis is clearly described in systemic lupus erythematosus as a main cause of poor outcomes and mortality(1).Pleiotropic adipokines including adiponectin and visfatin are implicated in the inflammatory process of lupus disease that promote cytokines signaling leading accelerated endothelial disruption(2) Objectives To evaluate the endothelial dysfunction by measuring serum visfatin,adiponectin,leptin and HOMA-insulin Index as reliable biomarkers of atherosclerosis &estimating the FMD of brachial artery among lupus patients and correlating these parameters with clinical characteristics Methods A case-control study in which 150 systemic lupus patients who were fulfilling American College of Rheumatology revised classification were recruited consecutively from Internal Medicine department at Cairo University.They were compared to 90 age & sex matched healthy controls. Patients who were pregnant,smoker,diabetic,those with hepatic and renal dysfunction, hypothyroidism,and familial dyslipidemia were excluded.Adiponectin,leptin,visfatin and HOMAIR were evaluated.Flow mediated dilatation of brachial artery was calculated as the maximum percent increase in artery diameter after cuff release compared to baseline Results Data revealed elevated levels of adiponectin,leptin,visfatin and HOMAIR in lupus cases compared to controls with reduced FMD percent.Clinical and laboratory background are summarized in table(1) Table(1) None of adipokines is correlated to age,BMI,Disease duration or activity.An inverse correlation between FMD of the brachial artery and total cholesterol, visfatin, adiponectin, leptin and HOMAIR (r-value=-0.523,- 0.35,-0.27,-0.45,-0.56 respectively)with P Conclusion Endothelial dysfunction is evident in SLE.Reduced FMD of brachial artery and increased adipokines &HOMAIR are noted.Adiponectin and visfatin could be predictors of atherosclerosis in lupus References [1] Nassef S, Essam M, Abdelfattah D, et al. Evaluation of Impact of Interferon-Induced Helicase C Domain-Containing Protein 1 Gene in Egyptian Systemic Lupus Erythematosus Patients and its Relationship With Vascular Manifestations of the Disease. Arch Rheumatol 2018;33(2):181–9. [2] Li H, Zhang T, Leng R, Li X. Emerging role of adipokines in systemic lupus erythematosus. Immunol Res. 2016;64(4):820–30. Acknowledgement to all participants in this work Disclosure of Interests None declared

Background/Aims. Unplanned hospitalisation is a marker of poor prognosis and a major financial burden in patients with cirrhosis. Frailty-screening tools could determine the risk for unplanned hospital admissions and death. The study aims to evaluate the bedside frailty-screening tool (Short Physical Performance Battery (SPPB)) in prediction of mortality in patients with liver cirrhosis. Methods. One hundred forty-five patients with liver cirrhosis were recruited from Cairo University Hospital. Clinical assessment and routine laboratory tests were performed, and the SPPB frailty index, Child score, and model for end-stage liver disease (MELD) score were calculated on admission. These metrics were compared to assess mortality outcomes over the course of 90 days. Results. The mean age of the patients was 60 ± 7 years, and frailty index score (SD) was 6 ± 3. The overall 90-day readmission rate was 43.4%, while the overall 90-day mortality rate was 18.6%. SPPB scores differed significantly between survivors (4.1 ± 1.4) and nonsurvivors (6.47 ± 2.8) (P value ≤ 0.001) as well as between readmitted patients (7.5 ± 2.9) and patients who were not readmitted (4.5 ± 1.9) (P value ≤ 0.001), while the Child and MELD scores showed no associations with patient outcomes. SPPB performed better with a specificity of 72.3% and a sensitivity of 72.2% for predicting mortality. Conclusions. SPPB could be a screening tool used to detect frailty and excelled over traditional scores as a predictor of death. A low SPPB frailty score among hospitalised patients with cirrhosis is associated with poor outcomes.

Background: Critical limb ischemia (CLI) is the final consequence of peripheral arterial disease (PAD). The management of this complex patient population often warrants a multidisciplinary approach with collaboration between endovascular interventionist, vascular surgeons, podiatrist, infectious disease, and wound care specialist. Objective of the study was to evaluate the impact of endovascular pedal arteries revascularization on wound healing in patients with critical limb ischemia.Methods: This was an interventional study conducted on 30 consecutive CLI patients underwent infra-genicular endovascular revascularization who attended to the outpatient department and emergency, Suez Canal university hospital complaining of symptoms of critical lower limb ischemia involving the foot (rest pain, ulcer and gangrene), during the period study from June 2017 till January 2019. Full detailed history, full examination, lab investigation, radiological imaging was done.Results: The pain intensity decreased from 7 to 4 post-procedural at 2nd day post-op, then to 3 at one week follow up and then it totally disappeared at one month follow up visit. The remaining patients who had incomplete PAA reported faster relieve of pain and more dramatic improve over time as it was totally relieved post procedural by time of discharge. The overall mean time required to achieve wound healing was 15±8 weeks.Conclusion: Successful pedal artery revascularization significantly improved wound healing in patients with CLI. Endovascular revascularization is effective to facilitate healing of wounds in CLI and can be performed without significant complications.

Background and study aims pancreatic cysts are commonly found lesions and proper diagnosis is very important for planning further management. The study aims to evaluate the role of cyst fluid amylase and tumour markers as cancer antigen (CA 19-9) and carcinoembryonic antigen (CEA) in addition to mucin stain in diagnosing pancreatic cysts and differentiating malignant from benign lesions. Patients and methods This prospective study was conducted on 184 patients diagnosed to have pancreatic cystic lesions from January 2013 to January 2018. Fluid analysis for CA 19-9, CEA, amylase, mucin stain and cytopathology were done. We compared these data with the final diagnosis based on histopathology after surgical resection, positive cytopathology and long period of follow up of the patients for at least 18 months. Results The highest AUC was that of cystic CEA with cut-off value of 160 ng/ml; it had a sensitivity of 60.4% and a specificity of 85%. The best cut-off value for cystic CA 19-9 was 1318 U/ml with a sensitivity of 64.1% and a specificity of 68.1%. The cut-off value of cyst amylase level was 5500 U/L, with 84.2% sensitivity and 37.1% specificity. The sensitivity of mucin stain in detecting mucinous cystic neoplasm was 85.45%, specificity was 86.05% with accuracy 85.87%. Conclusion Cyst fluid analysis by investigating amylase, mucin, CA 19-9, CEA and EUS examination improves the diagnosis of different pancreatic cysts.

Objective To determine the ability of ureterorenoscopy (URS) to identify the precise number and location of all lesions as compared with pathologic review of nephroureterectomy specimens, which have not been previously determined. Upper tract urothelial carcinoma (UTUC) comprises 5% of all urothelial malignancies in the United States. With advances in endoscopic equipment, there has been a move toward using flexible ureteroscopes to perform URS as part of the diagnostic evaluation and management. Methods We identified patients who had undergone URS with biopsy before radical nephroureterectomy for UTUC. Operative reports for each procedure were reviewed and compared with the surgical pathology reports. Results URS correctly identified the number and location of lesions in 57 of 76 patients (75%). The most common locations for missed lesions were in the ureter (9 patients) and renal pelvis (8 patients). Carcinoma in situ was missed on the initial biopsy for 9 patients. Three of 11 patients (27%) with a solitary lesion in the distal ureter visualized by URS had a missed lesion in the renal pelvis. URS with biopsy accurately predicted the grade of UTUC lesions in 79% of cases, whereas 65% of patients were upstaged on final pathology. Conclusion URS with biopsy can accurately map UTUC in the majority of patients. However, up to 25% of patients will have missed lesions, and nearly 50% of these patients will have a missed carcinoma in situ lesion. Undergrading and understaging of UTUC lesions remain shortcomings with potentially severe consequences.

Backg round: Acute myocardial infarction (AMI) remains a leading cause of morbidity and mortality worldwide A well - characterized IL8 gene single - nucleotide polymorphism (SNP) at position −251 A/T is the only one known to influence its expression and was associated with several diseases. Aim: To investigate the possible correlation of the − 251 A/T polymorphism of IL - 8 gene with susceptibility to Acute Myocardial infarction and its correlation with Plasma IL - 8 levels in two case control populations , the Saudi and Egyptian populations. Methods : 20 AMI patients and 20 asymptomatic controls from Saudi population in addition to 20 AMI patients and 20 asymptomatic controls from Egyptian population were included in the current study. The IL - 8 plasma level was assayed using the human IL - 8 Quantikine ELISA Kit . The IL - 8

Aims: To describe the influence of the seasonal variations on the development of blow fly Ch. albiceps (Wiedemann) stages as regards to the fluctuated temperature, Study Design: Eggs and larvae of the Ch. albiceps were collected from rabbit carcasses, the development period for immature and adult stages under naturally circulating room conditions were observed. Place and Duration of Study: Observations were carried out for a year (June, 2012 – May, 2013) at Zoology Dept., Zagazig University, Zagazig, Egypt. Methodology: Groups of newly formed pupae were kept in rearing jars for adult emergence. The development time (in days) from emergence to egg laying and immature growth was determined. Original Research Article Rashed et al.; BJMMR, 5(11): 1413-1421, 2015; Article no.BJMMR.2015.159 1414 Results: The overall development time of the Ch. albiceps exhibited significant seasonal variations corresponding to temperature changes. High temperatures accelerate the overall development, whereas low temperatures slow it down. The average period between emerging of Ch. albiceps adults, mating, spawning, larval and pupal development at low temperatures in winter was sustained the record average of 25-51 days when reared at 11°C. This period, was decreased gradually to reach average of 19-27 days at 15°C in autumn, 16-23 days at 18°C in spring and 1719 days, in summer months when temperature average was 23°C. Adult emergence of the Ch. albiceps fly was positively affected by temperature, it ranged from 96.12±0.24%, in summer (23°C), to 81.79±0.77 in winter (11°C). Generally female emergence was in high rates more than males and the higher female ratio was during winter (1.62). Also changes in temperatures due seasonal variations showed significant effect on the pre-oviposition and incubation periods, female fecundity, percentage of egg hatching and time of larval development. Conclusion: Changes in temperature according to seasonal variation considered an important factor for the development time for the forensically important Ch. albiceps

Objectives This study aimed to determine the immune status of Taibah University medical students against HBV, and the possible host factors related to the poor response to a previously-administered hepatitis-B vaccine. Methods A cross-sectional study was conducted which included all 3rd year medical students of Taibah University. One hundred and five responded to a self-administered questionnaire. At the same time, a blood sample analysis was performed for hepatitis B markers (HBs Ag, HBcAb, and HBs Ab) of the participants. Results Of the total number of respondents, only 36.2% were aware that they received a hepatitis-B vaccine, 52.4% were not sure they received it, and 11.4% were not aware of receiving it. Of all, the hepatitis B markers showed that only 16 students (15.2%) had protective levels against the disease, while the rest showed negative markers, and only one student was immune due to past infection. Students with protective titers often had a family history for hepatitis B or a positive history of contact with a known case. Conclusion The low prevalence of HBV protective levels in Taibah University medical students needs further research and mandates implementation of a screening program and vaccination for all non-immune health care students.

Introduction: Understanding the changes in bone density of patients affected by aggressive periodontitis could be useful in early disease detection and proper treatment planning. Aim: The aim of this study was to compare alveolar bone density in patients affected with aggressive periodontitis and periodontally healthy individuals using Cone Beam Computed Tomography (CBCT). Materials and Methods: This cross-sectional study was conducted on 20 patients with a confirmed diagnosis of aggressive periodontitis. Twenty periodontally healthy patients attending the dental clinics for implant placement or extraction of impacted third molars served as controls. Alveolar bone density was measured using CBCT scanning. Comparisons between aggressive periodontitis group and controls for age and alveolar bone density of the anterior and posterior regions were performed using an independent sample t-test. Multivariable linear regression models were also performed. Results: The differences between groups in regard to age, anterior and posterior alveolar bone density was not statistically significant (p

Infectious eczematoid dermatitis (IED) is characterized by an acute eczematous eruption triggered by purulent discharge from a primary infected site. Alcohol consumption, cigarette smoking and occupations with higher incidences of contact dermatitis portend increased risk for IED. Staphylococcus aureus is the most commonly cultured microbe from affected skin, with Streptococcus species the second most. Patients are first evident with peripherally spreading vesicles and pustules radiating from an infected site. Older areas of involvement become crusty, scaly and erythematous. Diagnosis is clinical. Other eczematous rashes, including autoeczemitization and contact dermatitis, should be on the differential diagnosis list. The treatment centres on topical antibiotics and soaks. Prognosis has improved since the advent of antibiotics. However, cases with multiple relapses and poor response to therapy are still observed.

The effect of larval and adult nutrition on survival and fecundity of the dengue vector Aedes albopictus Skuse (Diptera: Culicidae) were studied under laboratory conditions, the energy for the physiological activities for both male and female mosquitoes is provided largely by their reserves during larval stage and affected by adult diets. Two groups of larvae (A, B) were reared at 27 ± 3 degrees C, 70-80% R.H. and DL. 12: 12. Group (A) with 200 larvae (high larval diet) and Group (B) with 600 larvae (low larval diet). Ae. albopictus exhibited increased fecundity and egg hatch success. Immature development was quick. Immature survival was high, with lowest rate in the pupal stage. Highest longevity was observed in large females fed water + 10% sucrose solution (29.571 ± 0.415 days) while the lowest one was (1.3 ± 0.132 days) in starved small females. Large females have significantly (P < 0.001) higher fecundity than smaller females, regardless of whether the females were provided 10% sucrose solution or not (524 ± 0.203 eggs/group 159.714 ± 0.1997 eggs/group), respectively. The addition of 10% sucrose solution significantly (P < 0.001) increase the fecundity regardless of whether large or small females (657.9 ± 0.2198 eggs/group, 242.429 ± 0.119 eggs/group), respectively.

93 Background: Multiparametric MRI is increasingly used in prostate cancer detection. Previous studies have shown that detection rate of clinically significant cancer is higher in MRI targeted biopsy than systematic biopsy. However, the concordance between the Gleason score on fusion biopsy and radical prostatectomy is less well known. The objective of this study is to look for predictors of histopathologic concordance between biopsy (fusion and systematic) and radical prostatectomy. Methods: We used an institutional database of men who underwent mpMRI-ultrasound fusion targeted and systematic biopsy followed by radical prostatectomy. Gleason score on targeted, systematic and combination (targeted + systematic) biopsy were compared with Gleason score on radical prostatectomy, and concordance was recorded. The McNemar test was used to compare concordance and upgrade rates. Predictors of concordance and upgrade such as age, prostate volume, PSA, PSA density, Gleason score on biopsy, number of targets reported on mpMRI, and PI-RADS score were evaluated with Fisher’s exact test and logistic regression. Results: Surgical pathology was concordant with 47.4% of systematic biopsies, 52.0% of targeted biopsies and 58.4% of combination biopsies. There was no significant difference in concordance rates between systematic and targeted biopsy (P = 0.37). However, combination biopsy was superior to both systematic (RR 1.23, 95% CI 1.08-1.40, P = 0.03) and targeted biopsy (RR 1.12, 95% CI 1.02 – 1.24, P = 0.03) in predicting concordance with surgical pathology. Risk of upgrade to a higher Gleason score on surgical pathology was significantly lower with combination biopsy compared to systematic (RR 0.57, 95% CI 0.46-0.69, P < 0.001) or targeted biopsy alone (RR 0.72, 95% CI 0.61-0.84, P = 0.001). Upgrade rates were 43.9% for systematic biopsy, 34.7% for targeted, and 24.9% for combination. Lastly, we found no significant predictors of concordance or upgrade. Conclusions: Combination biopsy is associated with the highest concordance rate between biopsy and radical prostatectomy when compared with systematic or targeted biopsy alone. Performing targeted biopsy alone will underestimate tumour aggressiveness on surgical pathology.

Obesity affects a disproportionate proportion of total knee arthroplasty (TKA) patients. Our study explores pre-operative characteristics between obese and non-obese patients undergoing TKA surgery. A cohort of 4718 osteoarthritic patients, undergoing primary TKA, was studied. Patients were stratified according to BMI classes. Each class was compared in terms of age, race, gender, level of education, insurance status, pre-operative WOMAC, SF-36, and Elixhauser comorbidities. There was a positive relationship between BMI and female gender, non-white race, Medicaid, private insurance, and self-pay. A negative relationship was observed between BMI and age, Medicare, WOMAC and SF-36. Obese TKA candidates differ from their non-obese counterparts in a number of demographic, socioeconomic, and clinical characteristics.

AimThe aim of this study was to evaluate the diagnostic accuracy of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) in comparison to procalcitonin (PCT) and C-reactive protein (CRP) in early diagnosis of septic meningitis and its usefulness to distinguish between septic and aseptic meningitis.Patients and methodsThis study included 26 patients with septic meningitis, 32 patients with aseptic meningitis and 15 controls. Besides Gram staining, cultures of blood and CSF and latex agglutination test of CSF, CRP, serum PCT and sTREM-1 measurement were done on admission and after 48–72h of treatment.ResultsSeptic meningitis was diagnosed in 26 (44.82%) of the studied cases. Patients with septic meningitis had a significant increase in serum sTREM-1 and PCT levels at the time of admission (mean 32.99±19.7ng/ml and 97.9±86.35ng/ml, respectively), while patients with aseptic meningitis showed (6.8±5.67ng/ml and 1.88±1.6ng/ml, respectively). Control group showed sTREM-1 and PCT levels (6.6±4.6ng/ml and 0.58±0.36ng/ml, respectively) (P

Background Asthma is a chronic inflammatory condition of the airways. Pain and anxiety triggered by dental treatment can induce the secretion of endogenous catecholamines. When the situation is combined with the use of local anesthetics with vasoconstrictors, it may increase its undesirable effects on the cardiovascular system and respiratory systems. Aim of the work To evaluate the effects of dental procedures with and without local anesthesia on pulmonary function and arterial oxygen saturation in healthy volunteers and asthmatic patients. Patients and methods Our study included 30 asthmatic patients, and 20 healthy volunteers. Careful history taking, clinical examination, spirometry and pulse oximetry to measure O 2 saturation before and 10 min after dental procedures were obtained. Results Pulmonary function showed a statistically significant decrease in PEF and O 2 saturation in asthmatic patients and a statistically significant decrease in O 2 saturation in the healthy group after dental procedures compared to pre-procedure results. Asthmatic patients receiving local anesthesia had a statistically significant decrease in PEF and O 2 saturation after dental procedures compared to pre-procedure results. In the healthy group, there was a statistically significant decrease in O 2 saturation after dental filling and dental prosthesis and in asthmatic patients after dental filling, extraction, prosthesis, and scaling compared to that before. Conclusion Asthmatic patients may be at a higher risk of developing oxygen desaturation after dental procedures regardless of their type with and without local anesthesia and a decrease in PEF after dental procedures with local anesthesia.

Introduction: Diabetic neuropathy patients are at very high risk for developing foot ulcer that may lead to lower extremity amputation and threaten the patient’s life. Objective: To evaluate the effects of scanning 850 nm He-Ne infrared laser on nerve conduction, pain intensity, and foot planter pressure distribution of painful diabetic polyneuropathy patients. Methods: Thirty diabetic neuropathy patients with pain and reduced nerve conduction velocity were randomly divided into two groups; an experimental group (active laser group, n=15) and a control group (placebo laser group, n=15). Peak static and dynamic planter pressure were measured under heel, big toe and little toe. Sural and Peroneal nerves conduction velocity and amplitude and pain level were measured before and after treatment in both groups. The active laser group had got scanning 850 nm He–Ne infrared laser on foot planter surface and lumbosacral area with 5.7 J/cm2 for 15 min/site/session, 3 session /week for four weeks. Results: All measured parameters improved significantly in the active laser group, while no significant changes obtained in the control group. Comparison of post treatment measurements between groups showed that sural nerve conduction velocity and amplitude, pain level, and peak static and dynamic planter pressure were significantly higher in the experimental group compared with the control group. On the other hand there was no significant difference between groups for peroneal nerve conduction velocity and amplitude. Conclusion: 850 nm He–Ne therapy with the applied parameter and technique was an effective modality for improving nerve conduction, redistributing foot plantar pressures and relieving pain of painful diabetic polyneuropathy patients.

Introduction Taurine is an amino acid whose protective effects were shown in certain inflammatory conditions. Aim of the work The present work aimed to explore the possible anti-arthritic effects of taurine in comparison with diclofenac. Materials and methods Rats were allocated into five groups ( n = 10). The normal and control groups received normal saline. The remaining three groups were treated with diclofenac (2 mg/kg), taurine (5 mg/kg), or taurine (50 mg/kg), respectively. Drugs were i.p. injected for 26 successive days starting from the onset of adjuvant induction. Arthritis was induced by s.c. injection of 0.4 ml of Freund’s complete adjuvant (FCA) into the subplantar region of the right hind paws of rats in all groups except the normal one. Paw volume was measured before and at different time intervals after adjuvant inoculation. After the last measurement, blood samples were collected and were used for estimation of serum levels of lipid peroxides, nitrite, total antioxidants, tumor necrosis factor-alpha, and interleukin-1beta as well as lactate dehydrogenase activity. Histopathological examination of knee tissues of all rats was also performed. Results Injection of FCA induced marked arthritis manifested by paw edema during the 26-day experiment period. Treatment with diclofenac or taurine (50 mg/kg) markedly inhibited adjuvant arthritis as well as its associated biochemical and histological changes. Taurine (5 mg/kg) did not affect FCA-induced paw edema but it attenuated some of the induced biochemical changes. Conclusions Taurine effects could be explained by inhibition of pro-inflammatory cytokines production as well as its antioxidant effects.