Tissue Clock Beyond Time Clock: Endovascular Thrombectomy for Patients With Large Vessel Occlusion Stroke Beyond 24 Hours / 대한뇌졸중학회지

Background@#and Purpose Randomized trials proved the benefits of mechanical thrombectomy (MT) for select patients with large vessel occlusion (LVO) within 24 hours of last-known-well (LKW). Recent data suggest that LVO patients may benefit from MT beyond 24 hours. This study reports the safety and outcomes of MT beyond 24 hours of LKW compared to standard medical therapy (SMT). @*Methods@#This is a retrospective analysis of LVO patients presented to 11 comprehensive stroke centers in the United States beyond 24 hours from LKW between January 2015 and December 2021. We assessed 90-day outcomes using the modified Rankin Scale (mRS). @*Results@#Of 334 patients presented with LVO beyond 24 hours, 64% received MT and 36% received SMT only. Patients who received MT were older (67±15 vs. 64±15 years, P=0.047) and had a higher baseline National Institutes of Health Stroke Scale (NIHSS; 16±7 vs.10±9, P<0.001). Successful recanalization (modified thrombolysis in cerebral infarction score 2b-3) was achieved in 83%, and 5.6% had symptomatic intracranial hemorrhage compared to 2.5% in the SMT group (P=0.19). MT was associated with mRS 0–2 at 90 days (adjusted odds ratio [aOR] 5.73, P=0.026), less mortality (34% vs. 63%, P<0.001), and better discharge NIHSS (P<0.001) compared to SMT in patients with baseline NIHSS ≥6. This treatment benefit remained after matching both groups. Age (aOR 0.94, P<0.001), baseline NIHSS (aOR 0.91, P=0.017), Alberta Stroke Program Early Computed Tomography (ASPECTS) score ≥8 (aOR 3.06, P=0.041), and collaterals scores (aOR 1.41, P=0.027) were associated with 90-day functional independence. @*Conclusion@#In patients with salvageable brain tissue, MT for LVO beyond 24 hours appears to improve outcomes compared to SMT, especially in patients with severe strokes. Patients’ age, ASPECTS, collaterals, and baseline NIHSS score should be considered before discounting MT merely based on LKW.

Persea americana attenuates inflammatory response associated with hyperlipidemia in ovariectomized and irradiated rats by regulating MMP-3/TIMP-1 levels

Objective: To explore the effect of Persea americana supplementation on inflammation, oxidative stress, and lipid profiles in ovariectomized rats fed with a high-fat diet and exposed to radiation. Methods: The control group was sham operated, while groups 2-5 were ovariectomized and fed a high-fat diet. Groups 4 and 5 were exposed to γ-radiation (1 Gy/week for 5 weeks) after ovariectomy. Groups 3 and 5 were treated with 1 mL/250 g/day of Persea americana for one month. Serum levels of estrogen, alanine aminotransferase, aspartate aminotransferase, cholesterol, triglycerides and lipoproteins were measured. Additionally, hepatic oxidative stress, inflammatory and fibrogenic markers were evaluated. Results: Persea americana treatment reduced the oxidative stress markers as well as the levels of triglyceride, total cholesterol, and low-density lipoprotein cholesterol, which in turn lowered hepatic fat accumulation. Moreover, it suppressed hepatic inflammatory mediators (interleukin-6, tumor necrosis factor-α, and C-reactive protein) and downregulated pro-fibrogenic markers (transforming growth factor-β and tissue inhibitor of metalloproteinase-1). Conclusions: Persea americana provides protection against ovariectomy, and gamma radiation-mediated hepatic inflammation not only through its antioxidant, anti-inflammatory, lipid-lowering effect but also by modulating the fibrogenic markers.

Assessment and management of coagulopathy in neurocritical care

Coagulopathy may be defined as the loss of balance between hemostatic and fibrinolytic processes resulting in excessive bleeding, intravascular thrombosis or abnormalities in coagulation testing. It is frequently encountered across a wide range of conditions seen in the neurocritical care unit and can contribute to poor outcomes. Early recognition and appropriate management are key, with traumatic brain injury, acute ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage presenting unique challenges to the neurointensivist. We will discuss techniques to assess coagulopathies as well as treatment strategies for the brain injured patient.

Antiviral effect of crude aqueous extracts from ten philippine medicinal plants against Zika virus

Objective@#This study aimed to determine the antiviral activity of ten Philippine medicinal plants against Zika virus (ZIKV).@*Methods@#Lyophilized aqueous plant extracts were used for cell cytotoxicity and virus inhibition assays. The therapeutic index was computed from the 50% cytotoxic concentration (CC50) and 50% effective concentration (EC50) values. Plant metabolites were also identified using mass spectroscopy. An in-silico screening of these metabolites was done using ZIKV enzymes and the Axl protein in human microglial cells as target proteins, followed by the ranking of binding energy scores to generate a hypothesis on the possible mechanism of antiviral action.@*Results@#The plants that demonstrated the highest therapeutic index were Momordica charantia, Psidium guajava, Vitex negundo, and Blumea balsamifera. The majority of the metabolites present in the aqueous extracts were saponin, terpenes and terpenoids, and anthocyanin. Further, in-silico docking results showed a higher binding affinity for viral replication proteins compared to the viral envelope protein.@*Conclusion@#The crude aqueous extracts of M. charantia, P. guajava, V. negundo, and B. balsamifera were the most potent candidate antiviral therapies against ZIKV among the ten plants tested. Meanwhile, the in-silico results suggested that the metabolites possibly employ an intracellular mechanism for the observed antiviral activity.

Medicinal and biological values of Callistemon viminalis extracts: History, current situation and prospects

Callistemon viminalis (C. viminalis) is a plant that has been reported to have various medicinal values such as antibacterial, antifungal, antioxidant activities and other pharmaceutical and insecticidal properties. This review covers the potentials, applications and properties of different extracts from different parts (branches, flowers, fruits, bark, leaves) of C. viminalis. Furthermore, the chemical structures of the bioactive compounds were reported for biological activities. All the results supported the traditional uses of C. viminalis in folk medicine. In addition, some researches supported the use of C. viminalis extracts for the preparation of metal oxide nanoparticles.

Medicinal and biological values of Callistemon viminalis extracts: History, current situation and prospects

Callistemon viminalis (C. viminalis) is a plant that has been reported to have various medicinal values such as antibacterial, antifungal, antioxidant activities and other pharmaceutical and insecticidal properties. This review covers the potentials, applications and properties of different extracts from different parts (branches, flowers, fruits, bark, leaves) of C. viminalis. Furthermore, the chemical structures of the bioactive compounds were reported for biological activities. All the results supported the traditional uses of C. viminalis in folk medicine. In addition, some researches supported the use of C. viminalis extracts for the preparation of metal oxide nanoparticles.

Enhancement of disaster management and first aid rules for primary school teachers in Egypt

Background: genuine injuries have been reported at schools. Given that schools might not have any trained healthcare providers; teachers will provide first aid to students

Objective[s]: to assess knowledge and skills regarding first aid and disaster management among primary school teachers, and evaluate the effectiveness of first aid and disaster management training program on knowledge and skills of those teachers

Methods: intervention study, in the form of a training program on 43 teachers from two primary schools in Zagazig district, was performed. Evaluation was done through comparing school teachers' first aid and disaster management knowledge and skills before and after intervention by the use of a questionnaire and an observational checklist

Results: the percent of teachers with satisfactory first aid knowledge increased from 7.0% to 46.5% while for satisfactory practice, the percent increased from 4.7% to 51.2% after intervention. For satisfactory disaster management knowledge, the percent increased from 9.3% to 58.1% while for satisfactory disaster management practice, the percent increased from 2.3% to 23.6% after intervention with a statistically significant difference

Conclusions: first-aid and disaster management training program is an effective tool for improving teachers' knowledge and practice

Recommendation: First aid and disaster management training program should be one of the preplacement and in service training programs for primary school teachers to protect the life of children

Genetic polymorphism of Toxoplasma gondii from recently infected aborted Egyptian women

Toxoplasmosis caused by Toxoplasma gondii is one of the most prevalent parasitic diseases in human beings. Human toxoplasmosis can be associated with serious clinical manifestations, particularly in developing fetus. The aim of the current study was to identify the possible lineage type of Toxoplasma gondii, molecularly detected in placental samples of women whose pregnancies were spontaneously terminated in the first trimester. Preliminary detection of Toxoplasma genomic materials was done by a SYBR green qPCR technology. Subsequent identification of Toxoplasma strain was done for the positive samples using PCR- restriction fragment length polymorphism [RFLP] at the SAG2 loci of T. gondii using restriction enzymes HhaI and Sau3AI. Out of 72 tested samples, Toxoplasma B1 gene was detected in 9 cases. Toxoplasma genotypes I and II in addition to unknown type were identified in 4, 3 and 2 cases respectively, while type III was not detected in our samples, hence excluded as a leading cause of abortion in humans in our preliminary study. Nevertheless, it remains uncertain to what extent the genotype of the parasite directly contributes to the clinical severity of human toxoplasmosis. Certainly, advanced molecular techniques targeting different Toxoplasma strains are crucial for better understanding of human toxoplasmosis. For more elucidation, additional studies are recommended intended for genetic characterization of such serious parasitic infection using larger number of samples

Preoperative Embolization of Extra-axial Hypervascular Tumors with Onyx

OBJECTIVE: Preoperative endovascular embolization of intracranial tumors is performed to mitigate anticipated intraoperative blood loss. Although the usage of a wide array of embolic agents, particularly polyvinyl alcohol (PVA), has been described for a variety of tumors, literature detailing the efficacy, safety and complication rates for the usage of Onyx is relatively sparse. MATERIALS AND METHODS: We reviewed our single institutional experience with pre-surgical Onyx embolization of extra-axial tumors to evaluate its efficacy and safety and highlight nuances of individualized cases. RESULTS: Five patients underwent pre-surgical Onyx embolization of large or giant extra-axial tumors within 24 hours of surgical resection. Four patients harbored falcine or convexity meningiomas (grade I in 2 patients, grade II in 1 patient and grade III in one patient), and one patient had a grade II hemangiopericytoma. Embolization proceeded uneventfully in all cases and there were no complications. CONCLUSION: This series augments the expanding literature confirming the safety and efficacy of Onyx in the preoperative embolization of extra-axial tumors, underscoring its advantage of being able to attain extensive devascularization via only one supplying pedicle.

[Scutumplasty with glass ionomer cement [GIC] after cholesteatoma surgery]

Objectives: To evaluate the value of glassionomer cement in repair of scutum defect after cholesteatoma surgery

Patients: Prospective study was performed on consecutive patients undergoing combined approach tympanoplasty[CAT] in 34patients with attic cholesteatoma in ENT department of Assuit University Hospital,Assuit, Egypt, from October 2012, to June 2015

Results: In this study, recurrence of cholesteatoma at the last .follow-up was found in6 % and no retraction pocket was seen. Permanent epithelialization of the bone replacement material was achieved in 30 cases[88.2 %]

Conclusion: The GIC aided scutumplasty is simple, safe and effective way of reconstruction of the attic wall in terms of cholesteatoma recurrence and further hearing restoration

Middle Meningeal Artery Arising from the Basilar Artery

Various anomalies for the origin of the middle meningeal artery (MMA) have been described in the literature. However, origin of the MMA from the basilar trunk is an extremely rare variant. We report on a 54-year-old female who presented with frequent headaches; magnetic resonance imaging showed a right parietal meningioma. The abnormal origin of the middle meningeal artery from the basilar artery was diagnosed by angiography performed for preoperative embolization of the tumor. We report on the case with a review of the embryologic basis, possible explanations for this aberrant origin, and its clinical implications.

Subchronic toxicity of propyl paraben in adult male rats

In the current study, daily per os administration of propyl paraben [n-propyl-p-hydroxybenzoate] to adult male rats for four consecutive weeks induced severe hepatotoxicity as revealed by the significant elevation in serum marker enzymes along with a significant decrease in serum protein and its fractions. Furthermore, propyl paraben administration disturbed steroid hormones balance by suppressing serum testosterone level, with a concomitant increase in serum estradiol and an ultimate decrease in testosterone/estradiol ratio. Hepatic and testicular toxicity was furtherly attributed to oxidative stress induction, since propyl paraben altered the oxidant/antioxidant balance in both tissues. Signs of toxicity and histopathological changes in the liver and testes were observed by light microscopy of haematoxylin and eosin-stained sections. In conclusion, our data demonstrate the potency of propyl paraben as an endocrine disruptor to induce disturbances in normal steroid balance in adult male rats. In addition, the induced oxidative stress represents a common mechanism of propyl paraben toxicity in hepatic and testicular tissues

Evaluation of extracts and essential oil from Callistemon viminalis leaves: antibacterial and antioxidant activities, total phenolic and flavonoid contents

OBJECTIVE@#To investigate antioxidant and antibacterial activities of Callistemon viminalis (C. viminalis) leaves.@*METHODS@#The essential oil of C. viminalis leaves obtained by hydro-distillation was analyzed by GC/MS. Different extracts were tested for total phenolic and flavonoid contents and in vitro antioxidant (DPPH assay) and antibacterial (agar disc diffusion and 96-well micro-plates methods) actives.@*RESULTS@#Fourteen components were identified in the essential oil, representing 98.94% of the total oil. The major components were 1,8-cineole (64.53%) and α-pinene (9.69%). Leaf essential oil exhibited the highest antioxidant activity of (88.60±1.51)% comparable to gallic acid, a standard compound [(80.00±2.12)%]. Additionally, the biggest zone of inhibitions against the studied bacterial strains was observed by the essential oil when compared to the standard antibiotic (tetracycline). The crude methanol extract and ethyl acetate fraction had a significant antibacterial activity against the tested bacterial strains.@*CONCLUSIONS@#It can be suggested that C. viminalis is a great potential source of antibacterial and antioxidant compounds useful for new antimicrobial drugs from the natural basis. The present study revealed that the essential oil as well as the methanol extracts and ethyl acetate fraction of C. viminalis leaves exhibited highly significant antibacterial activity against the tested bacterial strains.

Protective efficacy of immunoglobulins Y prepared against Cerastes cerastes snake venom in the Kingdom of Saudi Arabia

To prepare and evaluate the protective efficacy of immunoglobulin Y [IgY] prepared against local Saudi Cerastes cerastes snake venom. The study was conducted between October 2009 and October 2011 at the Center of Excellence in Biotechnology Research, King Saud University, Riyadh, Kingdom of Saudi Arabia. The study designed as follow; 4 groups of 8 chickens were immunized intramuscularly with Cerastes cerastes snake venoms mixed with Freund's complete adjuvant. Three weeks later, the injections were repeated with the venoms with incomplete Freund's adjuvant. Three boosters were given with the venoms at 3 weeks intervals. The IgY was extracted by ammonium sulphate-caprylic acid method, the antibody titer were tested by enzyme linked immunosorbant assay, and the protective efficacies of the extracted immunoglobulins were performed. Immunoglobulin Y preparation extracted by ammonium sulphate-caprylic acid method showed lack of low molecular weight bands. The bands representing IgY-antibodies, which have molecular weights ranged from 180-200 KD, appeared sharp and clear. Furthermore, evaluation of the prepared protective value of IgY-antibodies revealed one ml of extracted IgY-antibodies containing 15 mg/ml anti Cerastes cerastes; specific IgY could produce 100% protection against 50 LD50. Laying hens could be used as an alternative source of polyclonal antibodies against Cerastes cerastes snake venoms due to several advantages as compared with mammals

Biochemical study on some adipocyto-kines in chronic renal failure: their relationship to endothelial dysfunction and inflammation

Chronic renal failure has been associated with impaired immunity and subclinical inflammation involving cytokines derived from adipose tissue - adipocytokines. Deteriorating renal function may increase overall inflammatory responses because of the decreased renal clearance of factors that are directly or indirectly involved in inflammation. Declining renal function may also affect the levels of additional inflammatory molecules such as C-reactive protein [CRP] and interleukin-6.The aim of the study was to assess visfatin and apelin in correlation with markers of endothelial cell injury and inflammation in 20 patients with CRF and 20 age- and sex-matched healthy controls.We assessed visfatin and apelin, markers of: coagulation: TAT [thrombin-antithrombin complexes]; fibrinolysis: tPA [tissue plasminogen activator] and PAI-1 [plasminogen activator inhibitor-1]; endothelial function/injury: 1CAM [intracellular adhesion molecule], VCAM [vascular cell adhesion molecule], CD40L and E-selectin and inflammation: hsCRP andIL-lbeta. Visfatin, apelin, TAT, ICAM, VCAM, CD40L, PAI-1, E-selectin, hsCRP, IL-lbeta and triglycerides were elevated while serum albumin and t-PA were decreased in CRF patients when compared with the control group.Significant positive correlations were found between visfatin on one hand and each of apelin, t-PA, PAI-1, E-selectin, ICAM, VCAM, hsCRP, LL-lbeta, CD40L and triglycerides on the other hand in patients with CRF.Also, Significant positive correlations were found between Apelin and each of EL-lbeta, E-selectin, ICAM, VCAM, creatinine and triglycerides in CRF

Prevalence and risk factors of erectile dysfunction among patients attending primary health care centres in Qatar

Erectile dysfunction is a common health problem affecting the quality of life of men of all ages. The aim of this study was to find the prevalence of and significant risk factors for erectile dysfunction among men of all nationalities attending primary health care centres in Qatar for any reason. Respondents aged > 30 years [N = 1139] completed the sexual health inventory for men plus a questionnaire about their demographic characteristics, lifestyle habits and presence of chronic diseases. The total prevalence of erectile dysfunction was 56.9% [32.7% mild and 2.3% severe cases]. All studied sociodemographic variables showed a significant association with erectile dysfunction. A lower prevalence of erectile dysfunction was found in smokers and those who exercised. More than 1 sexual partner, obesity and having a chronic disease [hypertension, coronary heart disease, hypercholesterolaemia or diabetes mellitus] were significantly positively associated with erectile dysfunction

Biochemical markers in blood can predict the cirrhotic evolution of chronic hepatitis

Approximately one-fifth of chronically infected patients develop significant chronic liver inflammation that progressively can lead to cirrhosis and HCC. The course and outcome of chronic liver disease may be difficult to predict. There is an urgent need to develop and validate noninvasive tests that can accurately reflect the full spectrum of hepatic inflammation and fibrosis. Serum fibronectin can differentiate HCV infected patients with liver fibrosis from patients with non fibrosis. Serum pseudocholinesterase activity might be a more specific indicator of liver dysfunction than the traditional liver function tests while prothrombin time is a measurement of synthetic liver function. To study the ability of three serum biochemical markers when combined in specific equation can differentiate between chronic active hepatitis and cirrhotic patients. Patients were 29 with chronic active hepatitis [CAR] and 28 with liver cirrhosis. These were compared with 10 healthy controls. Liver function tests were done to all subjects. Three biochemical parameters were also measured and combined in a certain equation. Fibronectin was measured using ELISA, pseudocholinesterase using colorimetric method while prothrombin activity was done using calcium thromboplastin. It was found that the equation significantly discriminated between fibrosis and cirrhosis at cut off value of 243.28, with sensitivity 100% and specificity 60% and area under the curve 80%, p=0.000. The three biochemical inexpensive parameters when combined can contribute to the differentiation between liver cirrhosis and chronic hepatitis

Comparative study of Nigella sativa and triple therapy in eradication of helicobacter pylori in patients with non-ulcer dyspepsia

A large number of diseases are ascribed to Helicobacter pylori [H. pylori], particularly chronic active gastritis, peptic ulcer disease and gastric cancer. Successful treatment of H. pylori infection with antimicrobial agents can lead to regression of H. pylori-associated disorders. Antibiotic resistance against used herb, possesses in vitro anti-helicobacter activity. The present study was undertaken to evaluate the efficacy of NS in eradication of H. pylori infection in non-ulcer dyspeptic patients. The study was conducted on 88 adult patients attending King Fahd Hospital of the University, Al-Khobar, Saudi Arabia, from 2007 to 2008, with dyspeptic symptoms and found positive for H. pylori infection by histopathology and urease test. Patients were randomly assigned to four groups, receiving i] triple therapy [TT] comprising of clarithromycin, amoxicillin, omeprazole [n=23], ii] 1 g NS + 40 mg omeprazole [OM] [n=21, iii] 2 g NS+ OM [n=21] or iv] 3 g NS + OM [n=23]. Negative H. pylori stool antigen test four weeks after end of treatment was considered as eradication. H. pylori eradication was 82.6, 47.6, 66.7 and 47.8% with TT, 1 g NS, 2 g NS and 3 g NS, respectively. Eradication rates with 2 g NS and TT were statistically not different from each other, whereas H. pylori eradication with other doses was significantly less than that with TT [P <0.05]. Dyspepsia symptoms improved in all groups to a similar extent. N. sativa seeds possess clinically useful anti-H. pylori activity, comparable to triple therapy. Further clinical studies combining N. sativa with antibiotics are suggested

Surgical outcome of canal wall up procedures with reconstruction versus without reconstruction

To compare the surgical outcome of canal wall up procedure with reconstruction versus without reconstruction, considering recidivism, otorrhea and hearing level. Fifty two patients with middle ear cholesteatoma were involved in this study. 26 patients were submitted to canal wall up with reconstruction and 26 patients, to canal wail up without reconstruction. cholesteatoma was attic in 32.7%, atticoantral in 36.5% and extensive in 30.8%. cholesteatoma residual or recurrence was found in 10 patients [19.2%] during the three years period of follow up. seven out of them were children, [2 in attic region with reconstruction, 2 in atticoantral with reconstruction and 3 in atticoantral without reconstruction, one in extensive with reconstruction and 3 in extensive without reconstruction. Otorrhea in attic was 45.5% in canal wall up with recons/ruction and 50% after without reconstruction, in atticoantral was 50% and 54.4% in canal wall up with and without reconstruction respectively and in extensive cholesteatoma was 42.9% after canal up with reconstruction and 44.4% after without reconstruction. There was statistically significant hearing improvement [8. 91dB] after canal wall up with reconstruction in attic cholesteatoma while decreased by [2dB.] after canal up without reconstruction, in atticoantral and extensive cholesteatoma the hearing gain was insignificant. surgery should be planned according to the site, size of cholesteatoma and age of the patient. One stage tympanoplasty is not recommended for childhood or for extensive adult cholesteatoma but only for attic cholesteatoma in adult

thermal analysis study of the tenoxicam

This study focuses on the decomposition of tenoxicam alone. The raw material's purity, kinetic parameters, thermal behavior and melting characteristics were determined by differential scanning calorimetry and thermogravimetric analysis. TG.DTA and DSC unit using in an inert atmosphere of flowing nitrogen. The compound was subject to temperature ramp after heating rates, 5, 10, 15, 20, 25 from ambient to 800 C. Mass spectrometry was used as adjunctary technique to identify the products of the decomposition reaction. It was observed that tenoxicam decomposed via multistage reaction following melting. The purity was 99.01 +/- 0.16. The thermal decomposition followed first order kinetic, activation energy 87.31 kJ mol and frequency factor of 3.941.I0[7] min[-1]