Características poblacionales y placentarias asociadas a óbito en infección asintomática por SARS-CoV-2 / Population characteristics and placental findings associated with stillbirth in asymptomatic SARS-CoV-2 infection

Resumen Objetivo: Comparar características poblacionales y hallazgos placentarios asociados a óbito, en mujeres con infección asintomática por coronavirus 2 del síndrome respiratorio agudo grave (SARS-CoV-2) al momento de la resolución del embarazo. Material y métodos: Estudio transversal analítico, mujeres con diagnóstico de óbito e infección asintomática por SARS-CoV-2. Se excluyeron pacientes con patología ginecológica y aquellas con más de una prueba RT-PCR. Resultados: No hay diferencia estadísticamente significativa entre las pacientes con infección asintomática por SARS-CoV-2 comparadas con pacientes sin infección para las características poblacionales como edad materna, antecedentes obstétricos, edad gestacional, escolaridad, estado civil, hábito tabáquico y enfermedades crónico-degenerativas. Tampoco hubo diferencia en los hallazgos placentarios de corioamnionitis, vasculitis, deciduitis, trombosis, aterosis aguda y necrosis fibrinoide. Conclusiones: No hay diferencia estadísticamente significativa en las características poblacionales y placentarias en embarazadas con diagnóstico de óbito, con y sin infección asintomática por SARS-CoV-2. Tenemos datos insuficientes para afirmar alguna característica asociada a óbito en pacientes con infección por SARS-CoV-2 asintomática.

Abstract Objective: To compare population characteristics and placental findings associated with stillbirth, in women with asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection at the time of delivery. Materials and methods: Analytical cross-sectional study women with a diagnosis of stillbirth and with asymptomatic SARS-CoV-2 infection. Patients with gynecological pathology and those with more than one RT-PCR test were excluded. Results: There is no statistically significant difference between patients with asymptomatic SARS-CoV-2 infection compared to patients without infection for population characteristics such as maternal age, obstetric history, gestational age, education, marital status, smoking habit, chronic-degenerative diseases. There was no difference in placental findings of chorioamnionitis, vasculitis, deciduitis, thrombosis, acute atherosis, and fibrinoid necrosis. Conclusions: There is no statistically significant difference in the population and placental characteristics, in pregnant women diagnosed with stillbirth with and without confirmed asymptomatic SARS-CoV-2 infection. For the moment, we have insufficient data to affirm any population characteristic associated with stillbirth in patients with asymptomatic SARS-CoV-2 infection.

The Power and Promise of Angiotensin Receptor Neprilysin Inhibitor (ARNI) in Heart Failure Management: National Consensus Statement

Heart failure (HF) is a huge global public health task due to morbidity, mortality, disturbed quality of life, and major economic burden. It is an area of active research and newer treatment strategies are evolving. Recently angiotensin receptor-neprilysin inhibitor (ARNI), a class of drugs (the first agent in this class, Sacubitril–Valsartan), reduces cardiovascular mortality and morbidity in chronic HF patients with reduced left ventricular ejection fraction (LVEF). Positive therapeutic effects have led to a decrease in cardiovascular mortality and HF hospitalizations (HFH), with a favorable safety profile, and have been documented in several clinical studies with an unquestionable survival benefit with ARNI, Sacubitril–Valsartan. This consensus statement of the Indian group of experts in cardiology, nephrology, and diabetes provides a comprehensive review of the power and promise of ARNI in HF management and an evidence-based appraisal of the use of ARNI as an essential treatment strategy for HF patients in clinical practice. Consensus in this review favors an early utility of Sacubitril–Valsartan in patients with HF with reduced EF (HFrEF), regardless of the previous therapy being given. A lower rate of hospitalizations for HF with Sacubitril–Valsartan in HF patients with preserved EF who are phenotypically heterogeneous suggests possible benefits of ARNI in patients having 40–50% of LVEF, frequent subtle systolic dysfunction, and higher hospitalization risk.

Riesgo de infección en pacientes oncológicos colonizados por bacterias productoras de p-lactamasas de espectro extendido y enterobacterias productoras de carbapenemasas / Risk of infection in cancer patients colonized by extended expectrum p-lactamases and carbapenem producing Enterobacteriaceae

INTRODUCCIÓN: La prevalencia de microorganismos multirresistentes es un problema de salud pública que continúa creciendo a lo largo del mundo. Existe una población principalmente susceptible de ser colonizada y posteriormente infectarse, son los pacientes oncológicos. OBJETIVO: Identificar las características clínicas y patológicas de los pacientes oncológicos y su relación con la infección con microorganismos productores de BLEE y EPC. PACIENTES Y MÉTODOS: Se condujo un estudio retrospectivo y de carácter analítico entre el primero de enero de 2019 y el 30 de junio de 2020 en tres unidades hemato-oncológicas. RESULTADOS: Incluyó a 3.315 pacientes, de los cuales 217 (6,5%) se encontraban colonizados por microorganismos productores de BLEE y EPC; de éstos, 106/217 (48,8%) presentaron al menos un episodio de infección. El microorganismo más frecuentemente aislado fue Klebsiella pneumoniae, en 29/106 (27,4%). De los infectados, 18/106 (17%) presentaron infección por el mismo microorganismo colonizador. La mucositis (p = 0,002), edad mayor a 65 años (p = 0,041), hipoalbuminemia (p < 0,01), neutropenia (p < 0,01) y la presencia dispositivos invasivos (p < 0,01) demostraron una relación con el desarrollo de infección. CONCLUSIÓN: La presencia de hipoalbuminemia (OR 3,3, IC 1,5-7,1, p < 0,01), dispositivos invasivos (OR 5,8, IC 3.0-11,4, p < 0,01) y neutropenia (OR 4,1, IC 1,5-11,4, p < 0,01) predicen el desarrollo de infecciones.

BACKGROUND: The prevalence of multi-resistant microorganisms is a public health problem that continues to grow globally. There is a population that is mainly susceptible to being colonized and subsequently infected, and these are cancer patients. AIM: To identify the clinical and pathological characteristics of cancer patients and their relationship with infection with ESBL and CPE producing microorganisms. METHODS: A retrospective and analytical study was conducted between January 1, 2019 and June 30, 2020 in three hematooncological units. RESULTS: We included 3315 patients of which 217 (6.5%) were colonized by microorganisms producing ESBL and CPE. Of these, 106/217 (48.8%) had at least one episode of infection. The most frequently isolated microorganism was Klebsiella pneumoniae 29/106 (27.4%). Of those infected, 18/106 (17%) presented infection by the same colonizing microorganism. Mucositis (p = 0.002), age over 65 years (p = 0.041), hypoalbuminemia (p < 0.01), neutropenia (p < 0.01) and the presence of invasive devices (p < 0.01) demonstrated a relationship with development of infection. The presence of hypoalbuminemia (OR 3.3, CI 1.5-7.1, P < 0.01), invasive devices (OR 5.8, CI 3.0-11.4, p < 0.01) and neutropenia (OR 4.1, CI 1.5-11.4, p < 0.01) predict the development of infections.

Rectal roflumilast improves trinitrobenzenesulfonic acid-induced chronic colitis in rats

Roflumilast, a highly selective oral phosphodiesterase IV inhibitor, exerts anti-inflammatory and anti-fibrotic effects. Oral roflumilast causes gastrointestinal side effects, especially vomiting, which could be reduced by administering roflumilast via off-label routes. Inhaled roflumilast reportedly improved inflammatory and histopathological changes in asthmatic mice. The current study investigated the effects of oral and rectal roflumilast on trinitrobenzenesulfonic acid (TNBS)-induced chronic colitis in rats, an experimental model resembling human Crohn's disease. Five groups of rats (n=8) were used: normal control, TNBS-induced colitis, and three TNBS-treated colitic groups, which received oral sulfasalazine (500 mg·kg-1·day-1), oral roflumilast (5 mg·kg-1·day-1), or rectal roflumilast (5 mg·kg-1·day-1) for 15 days after colitis induction. Then, the following were assessed: the colitis activity score, tumor necrosis factor (TNF)-α, interleukin (IL)-2, and IL-6 serum levels, colonic length, and myeloperoxidase, malonaldehyde, and glutathione levels. Histological examinations employed H&E, Masson trichrome, and PAS stains in addition to immunostaining for KI-67 and TNF-α. The TNBS-induced colitis rats showed significant increases in disease activity scores, serum TNF-α, IL-2, and IL-6 levels, and colonic myeloperoxidase and malonaldehyde content. They also showed significant decreases in colonic length and glutathione levels in addition to histopathological and immunohistochemical changes. All the treatments significantly improved all these changes. Sulfasalazine provided the greatest improvement, followed by oral roflumilast, and then rectal roflumilast. In conclusion, both oral and rectal roflumilast partially improved TNBS-induced chronic colitis, suggesting the potential of roflumilast as an additional treatment for Crohn's disease.

Polimorfismos de la metilenotetrahidrofolato reductasa C677T como factor de riesgo para el síndrome de ovario poliquístico en una muestra de mujeres jordanas / Methylenetetrahydrofolate Reductase C677T Polymorphisms as a Risk Factor for Polycystic Ovarian Syndrome in a Sample of Jordanian Women

Antecedentes: el síndrome de ovario poliquístico (SOP) es un trastorno endocrino reproductivo común, se puede identificar por hiperandrogenismo, oligomenorrea o anovulación y ovarios poliquísticos en la ecografía. Los polimorfismos de la metilentetrahidrofolato reductasa (MTHFR) C677T asociados con la hiperhomocisteinemia se encuentran entre los factores de riesgo del síndrome de ovario poliquístico. Objetivo: El presente estudio de casos y controles tiene como objetivo explorar la relación entre los polimorfismos C677T de la metilenotetrahidrofolato reductasa (MTHFR) como factor de riesgo y el síndrome de ovario poliquístico entre los pacientes jordanos que padecen esta enfermedad. Métodos: Se inscribieron en el estudio 306 sujetos (146 pacientes con SOP y 160 sujetos sanos como grupo de control). Se extrajo ADN de una muestra de sangre venosa extraída de cada participante para analizar los polimorfismos de MTHFR C677T utilizando la reacción en cadena de la polimerasa (PCR) en combinación con digestión con enzima de restricción (PCRRFLP). Posteriormente, los productos de PCR-RFLP se digirieron con la enzima HinfI, luego se sometieron a electroforesis en un gel de agarosa al 2%, se tiñeron y se examinaron bajo luz ultravioleta. Los niveles de homocisteína en plasma se analizaron utilizando el método ELISA. Resultados: Se observó una diferencia significativa en los niveles plasmáticos de homocisteína entre los pacientes con SOP frente a los sujetos de control y entre los diferentes polimorfismos de los pacientes con SOP. No se detectaron diferencias significativas en la distribución y frecuencia alélica de los polimorfismos MTHFR C677T en pacientes con SOP en comparación con los controles. El genotipo 677 / TT y el alelo T se asociaron con un aumento de 1,54 y 1,46 veces en la susceptibilidad al síndrome de ovario poliquístico. Conclusión: El estudio ha demostrado que el polimorfismo MTHFR T677T y el alelo T son posibles factores de riesgo de SOP entre las mujeres jordanas y pueden desempeñar un papel en la patogenia de la enfermedad

Background: Polycystic ovary syndrome (PCOS) is a common endocrine reproductive disorder, it can be identified by hyperandrogenism, oligomenorrhea or anovulation and polycystic ovaries on ultrasound. Methylenetetrahydrofolate Reductase (MTHFR) C677T polymorphisms associated with hyperhomocysteinemia are among the risk factors for PCOS. Objective: The present case control study aims to explore the relationship between Methylenetetrahydrofolate Reductase (MTHFR) C677T polymorphisms as a risk factor and PCOS among Jordanian patients suffering from this disease. Methods: 306 subjects (146 PCOS patients and 160 healthy subjects as a control group) were enrolled in the study. DNA was extracted from venous blood sample withdrawn from each participant for analyzing MTHFR C677T polymorphisms using Polymerase Chain Reaction (PCR) in combination with restriction enzyme fragment length polymorphism (PCR-RFLP). Later, PCR-RFLP products were digested with hinfI enzyme, then, electrophoresed on a 2% agarose gel, stained and examined under UV light. Plasma homocysteine levels were assayed using ELISA method. Results: A significant difference was observed in plasma homocysteine levels among PCOS patients versus the control subjects and in between the different polymorphisms of PCOS patients. No significant difference was detected in the distribution and allelic frequency of MTHFR C677T polymorphisms in PCOS patients compared to the controls. 677/TT genotype and T allele were associated with 1.54 and 1.46 folds increase in the susceptibility for PCOS. Conclusion: The study has shown that MTHFR T677T polymorphism and T allele are possible risk factors for PCOS among Jordanian women and may play a role in the pathogenesis of the disease.

¿Existe una asociación entre polimorfismos de inserción/supresión - 2549 en la región promotora del gen que codifica la vegfa como factor de riesgo y el descargo espontáneo idiopático recurrente en una muestra de mujeres jordanas? / Is there an association between - 2549 Insertion/ Deletion Polymorphisms in the Promotor Region of the Gene Encoding for VEGFA as a Risk Factor and the Idiopathic Recurrent Spontaneous Miscarriage in a sample of Jordanian Women?

Antecedentes: al menos el 50% de los casos de aborto espontáneo recurrente son etiológicamente idiopáticos. Recientemente se han propuesto varios polimorfismos genéticos como factores de riesgo de susceptibilidad a la pérdida del embarazo. Objetivo: El objetivo del presente estudio de casos y controles es establecer la asociación entre los polimorfismos funcionales −2549 I / D en la región promotora del gen del factor de crecimiento endotelial vascular A (VEGFA) y el aborto espontáneo recurrente idiopático (IRSM) en una muestra de las mujeres jordanas. Sujetos y métodos: Se reclutaron 328 sujetos, 103 y 98 mujeres con IRSM primario y secundario, respectivamente, se seleccionaron 127 mujeres normales como grupo de control. Se aisló ADN genómico de una muestra de sangre extraída de cada participante, luego, se genotipificaron los polimorfismos I / D -2549 del gen VEGFA mediante la reacción en cadena de la polimerasa (PCR). Resultados: Los resultados obtenidos revelaron que el polimorfismo ID y el alelo D de VEGFA -2549 polimorfismos I / D tienen las frecuencias más altas en pacientes IRSM tanto primario como secundario, sin diferencia significativa entre los tres grupos en cuanto a polimorfismos y frecuencias alélicas, pacientes con DD + ID Los modelos genéticos tienen una asociación positiva con un alto riesgo de IRSM versus el modelo II, y los pacientes con alelo D son más propensos a tener IRSM que los que tienen el alelo I, no hay diferencia significativa en la asociación de polimorfismos VEGFA -2549 I / D con IRSM en los tres modelos genéticos de los pacientes con IRSM primario y secundario. Conclusión: los pacientes con modelo genético ID de polimorfismos I / D -2549 en la región promotora del gen VEGFA y el alelo D tienen mayor riesgo de IRSM

Background: At least 50% of the cases of recurrent spontaneous miscarriage are aetiologically idiopathic. Recently various genetic polymorphisms have been proposed as susceptibility risk factors for pregnancy loss. Objective: The aim of the present case control study is to establish the association between the functional −2549 I/D polymorphisms in the promoter region of the vascular endothelial growth factor A (VEGFA) gene and idiopathic recurrent spontaneous miscarriage (IRSM) in a sample of Jordanian women. Subjects and methods: 328 subjects were recruited, 103 and 98 women with primary and secondary IRSM, respectively, 127 normal women were selected as a control group. Genomic DNA was isolated from a blood sample withdrawn from each participant, then, -2549 I/D polymorphisms of VEGFA gene were genotyped by Polymerase Chain Reaction (PCR). Results: The obtained results revealed that ID polymorphism and D allele of VEGFA -2549 I/D polymorphisms have the highest frequencies in both primary and secondary IRSM patients, no significant difference between the three groups regarding polymorphisms and allele frequencies, patients with DD+ID genetic models have positive association with high risk of IRSM versus II model, and patients with D allele are more liable to have IRSM than those having I allele, no significant difference in the association of VEGFA -2549 I/D polymorphisms with IRSM in the three genetic models of the primary and secondary IRSM patients. Conclusion: patients with ID genetic model of -2549 I/D polymorphisms in the VEGFA gene's promotor region and D allele have higher risk for IRSM.

Role of elastography strain ratio and TIRADS score in predicting malignant thyroid nodule

ABSTRACT Objective: Ultrasonography (US) is the most accurate and cost-effective imaging method in diagnosis of thyroid nodules. A practical thyroid imaging reporting and data system (TIRADS) for thyroid nodules has been proposed to classify nodules of the thyroid gland to solve the problem of nodule selection for fine needle aspiration cytology (FNAC). Real-time elastography and strain ratio (SR) is a method used to assess the stiffness and predict the malignancy of thyroid nodules. The objective of this study was to assess the role of elastography and SR and the TIRADS scoring system in discriminating malignant from benign thyroid nodules. Materials and methods: From 2015 to 2018 at Cairo University Hospital, a series of 409 patients with thyroid nodules was referred to undergo thyroid ultrasound. Categorization of each nodule according to the TIRADS ranged from 1 to 5. The qualitative elastography score and semiquantitative SR of the nodules were evaluated. Final diagnosis was done by either post-thyroidectomy histopathological examination or US-guided FNAC. Results: Our study included 409 patients with thyroid nodules. Their mean age was 39 ± 10 SD; 36 were males and 373 were females. There were 22 malignant nodules and 387 benign nodules. There were statistical differences between benign and malignant nodules regarding TIRADS classification, SR, anteroposterior/transverse ratio, degree of echogenicity, border, presence of calcification, and absence of halo sign (P < 0.001). The elastic properties of thyroid nodules proved to be a good discriminator between malignant and benign nodules (P- < 0.001) at a cut off value of > 2.32 with 95.2% sensitivity and 86.5% specificity. For every unit increase in SR, the risk of malignancy increased by nearly 2 times. Patients with irregular borders had nearly 17 times increased risk of malignancy than those with regular borders. Conclusion: Elastography and SR proved to be of high significant value in discriminating benign from malignant nodules, so we recommend adding it to the TIRADS classification.

Relationship between pulmonary function tests, sputum eosinophilia and total serum IgE levels among asthmatic patients in Duhok, Iraq

Background: Bronchial asthma is a disease characterized by reversible airway obstruction, airway inflammation; and hyper-responsiveness. The prevalence of asthma is high, and both its prevalence and burden have increased over the last several decades. The study of inflammatory markers has implications for the appropriate management of this disease. Inflammatory markers has implications for the appropriate management of this disease. Objective of the study is to determine the correlation between asthma severity using pulmonary function tests with sputum eosinophilia and total serum IgE levels.Methods: This case-control study was conducted from March 2017 to September 2018 in the respiratory unit of Azadi general teaching hospital. It included 42 asthmatic patients and 18 healthy subjects. They underwent pulmonary function tests and measurement of total serum IgE levels. Induced sputum was done for asthmatic patients.Results: The age of asthmatic patients ranged from 16-70 years (mean 42±19 years). The asthmatic patient’s female: male ratio was 1.8. Mild asthma was the most common severity group (N=18, 43%) followed by moderate asthma (N=14, 33%) then severe asthma (N=10, 24%). Abnormal sputum eosinophilia (≥3%) was detected in 90% of severe asthma (N=9) compared to 36% in moderate asthma (N=5) and 5.6% in mild asthma (N=1). There was significant statistical association between asthma severity and sputum eosinophilia (p=0.00004). The association between asthma severity and total serum IgE levels was highly significant (p<0.0000) with levels of total serum IgE increasing as the severity of asthma increases.Conclusions: Severe asthma is the least common severity group in this study. Both abnormal sputum eosinophilia and total serum IgE levels are associated with the severity of asthma.

Analysis of >100. 000 Cardiovascular Surgeries Performed at the Heart Institute and a New Era of Outcomes / Análise de >100. 000 Cirurgias Cardiovasculares Realizadas no Instituto do Coração e a Nova Era com Foco nos Resultados

Abstract Background: The current challenge of cardiovascular surgery (CVS) is to improve the outcomes in increasingly severe patients. In this respect, continuous quality improvement (CQI) programs have had an impact on outcomes. Objective: To assess the evolution of the incidence and mortality due to CVS, as well as the current outcomes of the Hospital das Clínicas Heart Institute of the University of São Paulo Medical School (InCor-HCFMUSP). Methods: An outcome analysis of CVSs performed at the InCor, between January 1984 and June 2019. We observed the surgical volume and mortality rates in 5 time periods: 1st (1984-1989), 2nd (1990-1999), 3rd (2000-2007), 4th (2008-2015) and 5th (2016-2019). The CQI program was implemented between 2015 and 2016. The analysis included the total number of surgeries and the evolution of the most frequent procedures. Results: A total of 105,599 CCVs were performed, with an annual mean of 2,964 procedures and mortality of 5,63%. When comparing the 4th and the 5th periods, the average global volume of surgeries was increased from 2,943 to 3,139 (p = 0.368), bypass graft (CABG), from 638 to 597 (p = 0.214), heart valve surgery, from 372 to 465 (p = 0.201), and congenital heart disease surgery, from 530 to 615 (p = 0.125). The average global mortality went from 7.8% to 5% (p < 0.0001); in CABG surgery, from 5.8% to 3.1% (p < 0.0001); in heart valve surgery, from 14% to 7.5% (p < 0.0001) and in congenital heart disease surgery, from 12.1% to 9.6% (p < 0.0001). Conclusion: In spite of a recent trend towards increased surgical volume, there was a significant decrease in operative mortality in the groups studied. After the implementation of the CQI program, the mortality rates were closer to international standards.

Resumo Fundamento: O desafio atual da cirurgia cardiovascular (CCV) é melhorar resultados em pacientes cada vez mais graves. Nesse sentido, Programas de Melhoria Contínua da Qualidade (PMCQ) tem impactado os resultados. Objetivo: Avaliar a evolução da incidência e mortalidade das CCV, assim como os resultados atuais do Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor). Métodos: Análise dos resultados das CCV realizadas no InCor entre jan-1984 e jun-2019. Foram observadas as tendências dos volumes cirúrgicos e da mortalidade em 5 períodos 1º (1984-1989), 2º (1990-1999), 3º (2000-2007), 4º (2008-2015) e 5º (2016-2019). O PMCQ foi estabelecido entre 2015-2016. A análise incluiu o total de cirurgias e a evolução dos procedimentos mais frequentes. Resultados: Foram realizadas 105.599 CCV, com uma média anual de 2.964 procedimentos e mortalidade de 5,63%. Comparando o 4º com o 5º período, o volume global médio de cirurgias foi de 2.943 para 3.139 (p = 0,368), cirurgias de revascularização miocárdica (CRM) de 638 para 597 (p = 0,214), valvas cardíacas de 372 para 465 (p = 0,201) e cardiopatias congênitas de 530 para 615 (p = 0,125). A mortalidade média global passou de 7,8% para 5% (p < 0,0001), nas cirurgias de revascularização miocárdica de 5,8% para 3,1% (p < 0,0001), nas cirurgias valvares de 14% para 7,5% (p < 0,0001) e nas cirurgias de cardiopatias congênitas de 12,1% para 9,6% (p < 0,0001). Conclusão: Embora haja uma tendência recente ao aumento dos volumes cirúrgicos, houve uma diminuição significativa da mortalidade cirúrgica nos grupos analisados. Após o estabelecimento do PMCQ, as taxas de mortalidade se aproximaram a dos padrões internacionais.

Correlation between brain neurotransmitters and insulin sensitivity: Neuro-preservative role of resveratrol against high fat, high fructose-induced insulin resistance

Insulin resistance (IR) is a major public health problem that can lead to many dangerous medical disorders and earlymortality. This study aimed to explore the effectiveness of resveratrol (RSV) to counteract the neuro-complicationsaccompanying high fat, high fructose (HFHF) diet experimentally induced-IR in rats. IR was induced by the ingestion ofHFHF diet for 70 days, 80 juvenile rats were used, and the treatments were given orally for the diet latest 10 days. Rats’general behavior was assessed by open field test (OFT) and forced swimming test (FST). On biochemical level; neurocomplications were assessed by measuring brain levels of monoamines and their metabolites as well as the levels of8-hydroxyguanosine (8-OHDG), tumor necrosis factor-α (TNF-α), malondialdehyde (MDA), reduced and oxidizedglutathione (GSH and GSSG) and nitric oxide (NOx). Oral RSV (20 and 40 mg/kg p.o) increased the activity ofthe rats in the OFT and decreased the immobility period in the FST in a dose-dependent manner. Moreover, RSVreduced monoamines turnover, elevated GSH, and reduced GSSG, NOx, MDA, 8-OHDG, and TNF-α (p < 0.05).RSV exhibited neuro-protective activities against HFHF-induced IR, thus it can be recommended as a favorable dailydietary supplement for treating the neuronal side effects related to IR.

Saudi Parents' Knowledge, Attitudes, and Practices Regarding Antibiotic use for Upper Respiratory Tract Infections in Children

A lot of experiments have been carried out in Saudi Arabia concerning the misuse of antibiotics and buying themwithout being prescribed by a doctor. However, despite all these studies, a few or none of them have appraisedthe parental awareness, practices and attitude toward the use of antibiotics in the treatment of URTIs in theirchildren. As such, the objective of this experiment was to document and analyze the parental levels of knowledge,attitudes, and practices (KAP) regarding the use for upper respiratory tract infections in children. This is a crosssectional study that was conducted across 8 cities: Riyadh, Jeddah, Taif, Makkah, Dammam, Al Ahsa, Albahaand Asir Saudi Arabia from 01/09/2019 to 26/09/2019, according to which a total of 714 parents took part in thestudy. Convenience sampling was the method that was used to select the participants of the experiment. Thefindings of the current research were found to be the same as those of the studies that were conducted before inPalestine. The researcher found out that the parents in Saudi Arabia lack adequate knowledge regarding the useof antibiotics in the treatment of URTIs and this led to their wrong practices and attitudes toward the same.Despite all these, the study established a relationship of trust between the subjects and the doctors, meaning thatthere is a trust in the information and recommendations that the doctors give them concerning the medications.

Reconstrucción endovascular de aneurisma intracraneal mediante dispositivo diversor de flujo Pipeline®. Reporte de 2 casos y revisión de la literatura / Endovascular reconstruction of intracranial aneurysm using a Pipeline® flow diversifier device

Resumen Introducción: Los aneurismas intracraneales son anomalías vasculares cerebrales con una prevalencia aproximada a nivel mundial del 2-3%. Son la principal causa de hemorragia subaracnoidea no traumática, el diagnóstico y tratamiento preventivo de esta entidad puede reducir considerablemente la morbimortalidad que de ella deviene. Con la aparición de nuevos dispositivos de terapia endovascular cerebral como los diversores de flujo se ha logrado ofrecer al paciente un procedimiento menos invasivo que no requiere cirugía convencional, y una importante reducción en el número de días de estancia intrahospitalaria y de recuperación, con alto grado de seguridad. El tratamiento endovascular para aneurismas intracraneales ha evolucionado sustancialmente en las últimas dos décadas, convirtiéndose en el tratamiento de elección en diversas situaciones clínicas. Reporte de caso: Caso 1: Varón de 62 años edad que ingresa a unidad hospitalaria después de sufrir un traumatismo craneoencefálico moderado con pérdida transitoria del estado de alerta y cefalea holocraneana. Se realizó una tomografía de cráneo simple y con contraste ante la sospecha de hemorragia subaracnoidea. Se evidenció la presencia de un aneurisma intracraneal en la arteria carótida interna izquierda, segmento comunicante posterior de 4 x 3 mm con cuello de 3 mm. Se realizó tratamiento mediante la colocación de dispositivo diversor de flujo Pipeline®, así como control angiográfico a los 3 meses post-tratamiento con una evolución satisfactoria. Caso 2: Mujer de 59 años de edad que acudió por presentar hemiparesia facial y brazo ipsilateral, con incremento gradual de la intensidad y duración. Se inició protocolo de estudio con resonancia magnética. Se evidenció la presencia de aneurisma intracraneal de 15 mm de diámetro en el segmento comunicante de la arteria carótida interna derecha y otro de 8 mm contralateral. Fue programada para colocación de dispositivo diversor de flujo Pipeline® con adecuada evolución. Conclusión: El uso de dispositivos diversores de flujo es una excelente alternativa para el tratamiento de aneurismas intracraneales incidentales, con importantes ventajas de costo-efectividad, reduciendo tiempos quirúrgicos, de estancia hospitalaria y de recuperación. Además de tener un porcentaje de curación superior al 95% a 5 años.

Abstract Introduction: Intracranial aneurysms are cerebral vascular anomalies with an approximate global prevalence of 2 to 3% and are the main cause of non-traumatic subarachnoid hemorrhage. Diagnosis and preventive treatment of this entity can considerably reduce morbidity and mortality. With the advent of new devices for cerebral endovascular therapy such as flow diverters, the patient now has the option of choosing a less invasive procedure, which does not require conventional surgery. This represents a significant reduction in the number of days of in hospital stay and recovery. The procedure has showed a high degree of security. The endovascular treatment for intracranial aneurysms has evolved substantially in the last two decades, and has become the treatment of choice. Case report: Case 1: A 62-year-old male was admitted in the hospital after a moderate cranioencephalic trauma with transient loss of conscious and a holocranial headache. A cerebral angiography was performed to rule out subarachnoid hemorrhage. The angiography showed an intracranial aneurysm. It was localized in left internal carotid-posterior communicating artery. The measures were of 4mm X 3mm with a 3mm neck. The treatment was performed with a pipeline flow-diverting device, as well as an angiographic control 3 months after the treatment with a satisfactory evolution. Case 2: A 59-year-old female patient with facial hemiparesis and ipsilateral arm, that showed a gradual increase in intensity and duration. A magnetic resonance study protocol was initiated and an intracranial aneurysm was observed in the communicating segment of the right internal carotid artery. The diameter of the aneurysmal sac was of 15 mm and also, a contralateral of 8 mm. Placement of a flow-diverting device was programmed. Conclusion: The use of flow-diverting devices is an excellent alternative for the treatment of incidental intracranial aneurysms, with important cost-effectiveness advantages, surgical time, hospital stay and recovery reduction. In addition to having a recovery percentage of 95% in 5 years.

Adipose Tissue and Bone Marrow-Derived Mesenchymal Stem Cells Role in Regeneration of Cleft Alveolus in Dogs

Aim: This study was designed to evaluate the therapeutic potential of adipose tissue-derived mesenchymal stem cells (ATMSCs) compared to bone marrow-derived mesenchymal stem cells (BM-MSCs) on the regeneration of surgically createdcleft alveolus in dogs. Methods: Split mouth experimental study was performed on twelve healthy mongrel dogs. The dogswere divided into two groups (A and B): Ingroup A, the surgically created alveolus was transplanted with AT-MSCs,scaffold and growth factors at the experimental side (right side of the maxilla). Ingroup B, the surgically created alveoluswas transplanted with BM-MSCs, scaffold and growth factors at the experimental side (right side of the maxilla). In thecontrol side (left side of the maxilla), the surgically created alveolus was transplanted with scaffold and growth factors only.The flaps were replaced and sutured with resorbable sutures. Bone regeneration was evaluated clinically andradiographically after 1.5 and 3 months following dogs’ scarification. The data were evaluated with descriptive and t-testmethods (p=0.05). Results: Stem cells whether AT-MSCs or BM-MSCs accelerate the healing and regeneration of thedefected area by increasing the bone width and surface area; providing the bone quantity and quality as early as 1.5 and 3months. Conclusions: AT-MSCs and BM-MSCs are attractive tools in bone regeneration. AT-MSCs in experimental studiesshowed that their effectiveness is comparable to BM-MSCs, in addition to its low cost, ease of harvesting and saferprocedure to obtain stem cells as well as less risk of infection.

Evaluación de formulaciones de ketoconazol para uso tópico en leishmaniasis cutánea por Leishmania(Viannia) / Evaluation of ketoconazole formulations for topical use in cutaneous leishmaniasis caused by Leishmania (Viannia)

RESUMEN Se evaluó la efectividad de diversas formulaciones farmacéuticas de ketoconazol en modelos experimentales de leishmaniasis cutánea (LC) en ratones BALB C. Fueron preparadas formulaciones tópicas tipo gel, lipogel y crema conteniendo potenciadores de la permeación y diferentes concentraciones de ketoconazol. Se determinó la estabilidad, la toxicidad y la actividad anti-Leishmania in vitro. Además, se evaluó in vivo la efectividad de las formulaciones aplicadas tópicamente en ratones con LC infectados con Leishmania (Viannia) braziliensis. Las formulaciones tipo crema fueron evaluadas adicionalmente en ratones infectados con L. (V.) panamensis. Los sistemas evaluados mantuvieron in vitro la actividad del ketoconazol contra los parásitos; sin embargo, ninguna de las formulaciones fue efectiva en curar las lesiones de LC en los ratones. El tratamiento tópico con miltefosina (utilizado como control) curó las lesiones. Se concluye que las formulaciones que contienen ketoconazol diseñados en este estudio, no fueron efectivos contra la LC en los ratones infectados.

ABSTRACT The effectiveness of various pharmaceutical formulations of ketoconazole was evaluated in experimental models of cutaneous leishmaniasis (LC) in BALB C mice. Topical gel, lipogel, and cream formulations containing permeation enhancers and different concentrations of ketoconazole were prepared. Stability, toxicity and anti-Leishmania activity were determined in vitro. In addition, the effectiveness of topically applied formulations in LC-infected mice infected with Leishmania (Viannia) braziliensis was evaluated in vivo. Cream formulations were additionally evaluated in mice infected with L. (V.) panamensis. The systems evaluated maintained in vitro the activity of ketoconazole against parasites; however, none of the formulations were effective in curing LC lesions in mice. Topical treatment with miltefosine (used as a control) cured the lesions. It is concluded that the ketoconazole-containing formulations designed in this study were not effective against LC in infected mice.

Unilateral maxillary distomolar with multiple abnormalities in a young patient: A rare case report with mini systemic review

Supernumerary teeth are those teeth present in addition to the normal number of teeth and are mostfrequently seen in the maxillary incisors and molar regions. In the molar regions, supernumerary teethare divided into two types depending on their location: distomolars and paramolars. Distomolarsusually occur in the form of a fourth molar distal to the third molar. Distomolars are a developmentalanomaly and have been argued to arise from a combination of genetic and environmental factors.Therefore, distomolar management should be part of a comprehensive treatment plan. This articlepresents a case report of an unusual occurrence of a rare unilateral distomolar in the right of themaxilla with multiple abnormalities in a 21-year old healthy subject. In addition, a mini literaturereview includes the definition, types, prevalence, classification, etiology, complications, diagnosis,and therapeutic strategies, which may be adopted in the occurrence of distomolars.

Evaluation of undergraduate dental students in typodont preparation for all-ceramic crowns

Background: All-ceramic crown (ACC) preparations are widely used in day-to-day dentalclinical practice. Objectives: This study aimed to evaluate all-ceramic crown preparationsperformed by pre-clinical dental students at the College of Dentistry, Jazan University inSaudi Arabia and to compare the quality of the preparations between male and female groups.Materials and Methods: A total of 95 ivory teeth were prepared by fourth-year dentalstudents (44 males, 51 females). The students prepared a maxillary right central incisor forACC after mounting in the Frasaco typodont arches. Two silicone putty indexes for maxillaryanterior were obtained that extended to cover one or two teeth on either side. The facial indexwas used to provide information about the facial reduction mesio-distally. Another index wasprepared by cutting the silicone in half along the faciolingual midline of the prepared tooth,providing us with incisal, buccal, palatal, and axial reductions, in addition to biplanereduction. The data were encoded into a Statistical Package for Social Sciences program andanalyzed accordingly using Chi-square test. Results: The preparations of ACC for maxillaryanterior teeth were acceptable, ranging within 60%-85% in all criteria, which includedstructural durability, retention, and resistance. The male group was more excellent in incisalreduction (41.0%), whereas the female group was more excellent in axial taper preparations(59.1%), resulting in significant differences between genders in this preparation criteria. Allgender groups showed acceptable tooth preparations in shoulder reductions and location offinish lines, ranging within 57%-89%. Conclusion: The preparations for ACC achieved bythese dental students were considered clinically acceptable. The students clearly understoodthe principles of crown preparation. However, they still require more practice in order tomaster the art of crown preparation.

Primera descripción de Sclerotium coffeicola en caoba africana en México / First description of Sclerotium coffeicola on African mahogany in Mexico

Una enfermedad foliar fue detectada en la plantación comercial de Khaya senegalensis con 3 anos de edad, en la localidad de Huimanguillo (Tabasco, México). Mediante la caracterización morfológica y molecular, y por el cumplimiento de los postulados de Koch, se determinó que el agente causal corresponde al hongo Sclerotium coffeicola. Este es el primer reporte de S. coffeicola causando mancha foliar en caoba africana en México.

A foliar disease was detected in the commercial plantation of Khaya senegalen with three years of age in Huimanguillo, Tabasco, Mexico. Through the morphological and molecular characterization and the compliance of the Koch's postulates, it was concluded that the causal agent corresponds to the fungus Sclerotium coffeicola. This is the first report of S. coffeicola causing leaf spot on African mahogany in Mexico.

Synergistic renoprotective effect of a compiled branched-chain amino acids and Cymbopogon schoenanthus extract against experimentally induced oxido-nitrosative renal insult

Objective:To better investigate the protective role of branched-chain amino acids (BCAAs) and Cymbopogon schoenanthus (CS) extract against the potassium dichromate (PDC)-induced oxido-nitrosative nephrotoxic insult in the experimental rat model.Methods:Thirty male rats were randomly divided into five equal groups: The 1st group served as control; the 2Results:The PDC-induced nephrotoxic effect caused a depletion of renal oxidative scavengers glutathione, superoxide dismutase with consequent lipo-oxidative cellular membrane deterioration manifested by a rise in malonaldehyde, oxidized glutathione, myeloperoxidase and the concomitant increase in inflammatory response elements tumor necrosis factor α, nitric oxide, and interleukin 1 β. Moreover, the comet assay and increased 8-hydroxy-2-deoxyguanosine proved an accelerated apoptotic DNA fragmentation. These local renal changes were met with global altered blood biochemistry. The BCAAs and CS or their compiled administration showed an ameliorative effect against PDC-induced nephrotoxic in a synergistic pattern.Conclusions:Both BCAAs and CS or their combined administration afford potential competitors against renal insult induced by polyvalent anion pollutants in experimentally studied animals model. As a route for novel drug discovery, further investigation should be attempted to optimize their augmenting reno-protecting potential.

Prevalence of rheumatic heart disease and its risk factors among cardiac patients in taif city, ksa

Background: exposure of the body's connective tissue to group A â-hemolytic streptococci, after an infection, causes an inflammatory response called Rheumatic fever [RF]. When the heart's connective tissue is affected, the condition is called Rheumatic heart disease [RDH]

Aim of the Work: we aimed at discovering the prevalence of RDH among cardiac patients and to determine factors that played a role in its development. Also, the study was conducted to find out the causal relationship between early treatment of RF and the occurrence of RHD

Patients and Methods: faisal Hospital's cardiac outpatient clinics, in Taif, KSA, who filled a designed questionnaire after training. To screen the population for the prevalence of RDH among cardiac patients and to determine factors that played a role in its development. Also, it was conducted to find the causal relationship between early treatment of RF and the occurrence of RHD. The ages were from 18 to 70 years old

Results: the overall prevalence of RHD among cardiac patients was 8%. The difference in prevalence of RHD was statistically significant [p=0.021] between patients whose family sizes exceeded 10 individuals [37.5%] compared to those whose family sizes was 10 individuals or less [62.5%]. Also, the difference in prevalence of RHD was statistically significant [p=0.044] between patients who had little [37.5%] or no knowledge [37.5%] about symptoms of RHD compared to those who had moderate [25%] or good knowledge [0%] about symptoms of RHD. The effect of RF management on RHD was studies and it was found that irregular and incomplete antibiotic therapy in case of tonsillitis [p=0.006] and irregular oral hygiene [p=0.027] were associated with higher prevalence rates of the disease

Conclusion: The that efficient management of rheumatic fever and acute tonsillitis in terms of adequate antibiotic therapy, good oral hygiene and awareness about the symptoms of RHD are very import aspects to protect against RHD

Risk factors associated with glaucoma disease progression

Background: Glaucoma is a disease which damage the eye's optic nerve. That so many instances of glaucoma can be undiscovered ways that research studies based in hospitals or specialist clinics, as an example, can be biased to specific classes of referred patients and so not representative of the Glaucoma associate

Objective: In this review we discuss risk factors that lead to onset of glaucoma and focus on risk factors affecting the progression of this disease, to give information to prevent and start early treatment

Method: PubMed and Embase database were searched up to July, 2018 for relevant studies that discussing the risk factors of glaucoma

Conclusion: The most consistent factors are older age and also higher baseline IOP. Currently, there is very little we can do about age, due to the fact that it is probably a surrogate threat factor for various other potentially more important elements, for example, mitochondrial performance. Because IOP can be lowered either medically or operatively, it is a flexible threat or prognostic element for open-angle glaucoma