ABSTRACT
OBJECTIVE: Refractory Status Epilepticus (RSE) is a neurologic emergency that carries a high risk of mortality and morbidity. Every year, there are about 200,000 cases in the United States, affecting people of all ages. This study aimed to investigate the possible immuno-modulatory effect of tocilizumab in RSE patients receiving conventional anti-epileptic drugs. PATIENTS AND METHODS: 50 outpatients who fulfilled the inclusion requirements for RSE were recruited in this randomized, controlled, and prospective study. The patients were divided into two groups randomly (n=25); the control group received standard RSE treatment, consisting of propofol, pentobarbital, and midazolam, and the tocilizumab group received standard RSE treatment plus tocilizumab. A neurologist evaluated each patient at the beginning of the therapy and after 3 months. Before and after treatment, serum nuclear factor kappa B (NF-κB), interleukin-6 (IL-6), tumour necrosis factor-alpha (TNF-α), interleukin-1ß (IL-1ß) and serum electrolytes were assessed. RESULTS: The tocilizumab group showed a statistically significant reduction in the level of assessed parameters in comparison with the control group. CONCLUSIONS: Tocilizumab might be a novel adjuvant anti-inflammatory medication in managing RSE.
Subject(s)
Status Epilepticus , Humans , Prospective Studies , Antibodies, Monoclonal, Humanized , OutpatientsABSTRACT
PURPOSE: This study aimed to investigate the effect of single nucleotide polymorphisms (SNPs) of genes involved in ribavirin (RBV) transport (SLC28A2 gene, ABCB1 gene and ABCB11 gene) on the clinical outcome and pharmacokinetics of ribavirin in HCV- 4 Egyptian patients. METHOD: 100 patients treated with sofosbuvir/daclatasvir and ribavirin for 12 weeks. The SNP genotyping was performed by real-time PCR using high resolution melting analysis. Ribavirin plasma trough concentrations were determined at week 4 of therapy using a liquid chromatography/tandem mass spectrometry (LC-MS/MS). For clinical outcomes, sustained virological response (SVR), liver function tests (ALT and AST), total bilirubin, albumin, serum creatinine, hemoglobin, leukocyte count, and platelet count were measured. RESULTS: Concerning RBV pharmacokinetics, ABCB1 2677â¯Gâ¯>â¯T SNP and ABCB11 1331â¯Tâ¯>â¯C SNP were statistically associated with RBV Ctrough levels after 4 weeks of therapy. ABCB11 1331â¯Tâ¯>â¯C SNP revealed significant association with clinical outcomes (SVR). SLC28A2-146 Aâ¯>â¯T SNP has not showed any statistically significant association with RBV plasma levels or response. CONCLUSION: SNP genotyping for ABCB1 and ABCB11 genes can help in better personalized medicine for maximizing response for ribavirin as explored by the significant association between polymorphism in ABCB1 and ABCB11 genes and ribavirin pharmacokinetics and the significant association of ABCB11 1331â¯Tâ¯>â¯C SNP with clinical response.
Subject(s)
Genetic Variation , Hepacivirus/drug effects , Imidazoles/pharmacology , Ribavirin/pharmacology , Ribavirin/pharmacokinetics , Sofosbuvir/pharmacology , Carbamates , Drug Therapy, Combination , Egypt , Endpoint Determination , Gene Frequency/genetics , Hepatitis C, Chronic/drug therapy , Hepatitis C, Chronic/genetics , Humans , Logistic Models , Middle Aged , Polymorphism, Single Nucleotide/genetics , Pyrrolidines , Ribavirin/blood , Treatment Outcome , Valine/analogs & derivativesABSTRACT
Optimization of solid waste management systems using operational research methodologies has not yet been applied in any Egyptian governorate. In this paper, a proposed model for a municipal solid waste management system in Port Said, Egypt is presented. It includes the use of the concept of collection stations, which have not yet been used in Egypt. Mixed integer programming is used to model the proposed system and its solution is performed using MPL software V4.2. The results show that the best model would include 27 collection stations of 15-ton daily capacity and 2 collection stations of 10 ton daily capacity. Any transfer of waste between the collection station and the landfill should not occur. Moreover, the flow of the district waste should not be confined to the district collection stations. The cost of the objective function for this solution is 10,122 LE/day (equivalent to 1716 US dollars). After further calculations, the profit generated by the proposed model is 49,655.8 LE/day (equivalent to 8418.23 US dollars).
