Optimization, gene cloning, expression, and molecular docking insights for enhanced cellulase enzyme production by Bacillus amyloliquefaciens strain elh1.

BACKGROUND: In this study, we isolated a cellulase-producing bacterium, Bacillus amyloliquefaciens strain elh, from rice peel. We employed two optimization methods to enhance the yield of cellulase. Firstly, we utilized a one-variable-at-a-time (OVAT) approach to evaluate the impact of individual physical and chemical parameters. Subsequently, we employed response surface methodology (RSM) to investigate the interactions among these factors. We heterologously expressed the cellulase encoding gene using a cloning vectorin E. coli DH5α. Moreover, we conducted in silico molecular docking analysis to analyze the interaction between cellulase and carboxymethyl cellulose as a substrate. RESULTS: The bacterial isolate eh1 exhibited an initial cellulase activity of 0.141 ± 0.077 U/ml when cultured in a specific medium, namely Basic Liquid Media (BLM), with rice peel as a substrate. This strain was identified as Bacillus amyloliquefaciens strain elh1 through 16S rRNA sequencing, assigned the accession number OR920278 in GenBank. The optimal incubation time was found to be 72 h of fermentation. Urea was identified as the most suitable nitrogen source, and dextrose as the optimal sugar, resulting in a production increase to 5.04 ± 0.120 U/ml. The peak activity of cellulase reached 14.04 ± 0.42 U/ml utilizing statistical optimization using Response Surface Methodology (RSM). This process comprised an initial screening utilizing the Plackett-Burman design and further refinement employing the BOX -Behnken Design. The gene responsible for cellulase production, egl, was effectively cloned and expressed in E. coli DH5α. The transformed cells exhibited a cellulase activity of 22.3 ± 0.24 U/ml. The egl gene sequence was deposited in GenBank with the accession number PP194445. In silico molecular docking revealed that the two hydroxyl groups of carboxymethyl cellulose bind to the residues of Glu169 inside the binding pocket of the CMCase. This interaction forms two hydrogen bonds, with an affinity score of -5.71. CONCLUSIONS: Optimization of cultural conditions significantly enhances the yield of cellulase enzyme when compared to unoptimized culturing conditions. Additionally, heterologous expression of egl gene showed that the recombinant form of the cellulase is active and that a valid expression system can contribute to a better yield of the enzyme.

Exploring the decolorization efficiency and biodegradation mechanisms of different functional textile azo dyes by Streptomyces albidoflavus 3MGH.

Efficiently mitigating and managing environmental pollution caused by the improper disposal of dyes and effluents from the textile industry is of great importance. This study evaluated the effectiveness of Streptomyces albidoflavus 3MGH in decolorizing and degrading three different azo dyes, namely Reactive Orange 122 (RO 122), Direct Blue 15 (DB 15), and Direct Black 38 (DB 38). Various analytical techniques, such as Fourier Transform Infrared (FTIR) spectroscopy, High-Performance Liquid Chromatography (HPLC), and Gas Chromatography-Mass Spectrometry (GC-MS) were used to analyze the degraded byproducts of the dyes. S. albidoflavus 3MGH demonstrated a strong capability to decolorize RO 122, DB 15, and DB 38, achieving up to 60.74%, 61.38%, and 53.43% decolorization within 5 days at a concentration of 0.3 g/L, respectively. The optimal conditions for the maximum decolorization of these azo dyes were found to be a temperature of 35 °C, a pH of 6, sucrose as a carbon source, and beef extract as a nitrogen source. Additionally, after optimization of the decolorization process, treatment with S. albidoflavus 3MGH resulted in significant reductions of 94.4%, 86.3%, and 68.2% in the total organic carbon of RO 122, DB 15, and DB 38, respectively. After the treatment process, we found the specific activity of the laccase enzyme, one of the mediating enzymes of the degradation mechanism, to be 5.96 U/mg. FT-IR spectroscopy analysis of the degraded metabolites showed specific changes and shifts in peaks compared to the control samples. GC-MS analysis revealed the presence of metabolites such as benzene, biphenyl, and naphthalene derivatives. Overall, this study demonstrated the potential of S. albidoflavus 3MGH for the effective decolorization and degradation of different azo dyes. The findings were validated through various analytical techniques, shedding light on the biodegradation mechanism employed by this strain.

Probiotic-derived silver nanoparticles target mTOR/MMP-9/BCL-2/dependent AMPK activation for hepatic cancer treatment.

Recent advances in nanotechnology have offered novel ways to combat cancer. By utilizing the reducing capabilities of Lactobacillus acidophilus, silver nanoparticles (AgNPs) are synthesized. The anti-cancer properties of AgNPs have been demonstrated in previous studies against several cancer cell lines; it has been hypothesized that these compounds might inhibit AMPK/mTOR signalling and BCL-2 expression. Consequently, the current research used both in vitro and in silico approaches to study whether Lactobacillus acidophilus AgNPs could inhibit cell proliferation autophagy and promote apoptosis in HepG2 cells. The isolated strain was identified as Lactobacillus acidophilus strain RBIM based on 16 s rRNA gene analysis. Based on our research findings, it has been observed that this particular strain can generate increased quantities of AgNPs when subjected to optimal growing conditions. The presence of silanols, carboxylates, phosphonates, and siloxanes on the surface of AgNPs was confirmed using FTIR analysis. AgNPs were configured using UV-visible spectroscopy at 425 nm. In contrast, it was observed that apoptotic cells exhibited orange-coloured bodies due to cellular shrinkage and blebbing initiated by AgNP treatment, compared to non-apoptotic cells. It is worth mentioning that AgNPs exhibited remarkable selectivity in inducing cell death, specifically in HepG2 cells, unlike normal WI-38 cells. The half-maximum inhibitory concentration (IC50) values for HepG2 and WI-38 cells were 4.217 µg/ml and 154.1 µg/ml, respectively. AgNPs induce an upregulation in the synthesis of inflammation-associated cytokines, including (TNF-α and IL-33), within HepG2 cells. AgNPs co-treatment led to higher glutathione levels and activating pro-autophagic genes such as AMPK.Additionally, it resulted in the suppression of mTOR, MMP-9, BCL-2, and α-SMA gene expression. The docking experiments suggest that the binding of AgNPs to the active site of the AMPK enzyme leads to inhibiting its activity. The inhibition of AMPK ultimately results in the suppression of the mechanistic mTOR and triggers apoptosis in HepG2 cells. In conclusion, the results of our study indicate that the utilization of AgNPs may represent a viable strategy for the eradication of liver cancerous cells through the activation of apoptosis and the enhancement of immune system reactions.

Fully Characterized Effective Bacteriophages Specific against Antibiotic-Resistant Enterococcus faecalis, the Causative Agent of Dental Abscess.

Background and Objectives: Enterococcus faecalis (E. faecalis) is a primary pathogen responsible for dental abscesses, which cause inflammation and pain when trapped between the crown and soft tissues of an erupted tooth. Therefore, this study aims to use specific phages as an alternative method instead of classical treatments based on antibiotics to destroy multidrug-resistant E. faecalis bacteria for treating dental issues. Materials and Methods: In the current study, twenty-five bacterial isolates were obtained from infected dental specimens; only five had the ability to grow on bile esculin agar, and among these five, only two were described to be extensive multidrug-resistant isolates. Results: Two bacterial isolates, Enterococcus faecalis A.R.A.01 [ON797462.1] and Enterococcus faecalis A.R.A.02, were identified biochemically and through 16S rDNA, which were used as hosts for isolating specific phages. Two isolated phages were characterized through TEM imaging, which indicated that E. faecalis_phage-01 had a long and flexible tail, belonging to the family Siphoviridae, while E. faecalis_phage-02 had a contractile tail, belonging to the family Myoviridae. Genetically, two phages were identified through the PCR amplification and sequencing of the RNA ligase of Enterococcus phage vB_EfaS_HEf13, through which our phages shared 97.2% similarity with Enterococcus phage vB-EfaS-HEf13 based on BLAST analysis. Furthermore, through in silico analysis and annotations of the two phages' genomes, it was determined that a total of 69 open reading frames (ORFs) were found to be involved in various functions related to integration excision, replication recombination, repair, stability, and defense. In phage optimization, the two isolated phages exhibited a high specific host range with Enterococcus faecalis among six different bacterial hosts, where E. faecalis_phage-01 had a latent period of 30 min with 115.76 PFU/mL, while E. faecalis_phage-02 had a latent period of 25 min with 80.6 PFU/mL. They were also characterized with stability at wide ranges of pH (4-11) and temperature (10-60 °C), with a low cytotoxic effect on the oral epithelial cell line at different concentrations (1000-31.25 PFU/mL). Conclusions: The findings highlight the promise of phage therapy in dental medicine, offering a novel approach to combating antibiotic resistance and enhancing patient outcomes. Further research and clinical trials will be essential to fully understand the therapeutic potential and safety profile of these bacteriophages in human populations.

Effect of thermocycling on surface topography and fracture toughness of milled and additively manufactured denture base materials: an in-vitro study.

BACKGROUND: Studies investigating thermocycling effect on surface topography and fracture toughness of resins used in digitally manufactured denture bases are few. The study aimed to assess the impact of thermocycling on surface topography and fracture toughness of materials used for digitally manufactured denture bases. METHODS: Water sorption, solubility, hardness, surface roughness, and fracture toughness of both three-dimensional (3D)-printed and computer-aided design, computer-aided manufacturing (CAD-CAM) milled specimens (n = 50) were assessed both prior to and following 2000 thermocycles, simulating 2 years of clinical aging. Surface hardness (n = 10) was measured using a Vickers hardness testing machine, surface roughness (n = 10) was determined by a contact profilometer, and fracture toughness (n = 20) was measured using the 3-point bend test, then studying the fractured surfaces was done via a scanning electron microscope (SEM). Prior to and following thermocycling, water sorption and solubility (n = 10) were assessed. Normally distributed data was tested using two-way repeated ANOVA and two-way ANOVA, while Mann Whitney U test and the Wilcoxon signed ranks test were used to analyze data that was not normally distributed (α < 0.05). RESULTS: Following thermocycling, Vickers hardness and fracture toughness of both groups declined, with a significant reduction in values of the 3D-printed resin (P < .001). The 3D-printed denture base resins had a rougher surface following thermocycling with a significant difference (P < .001). The sorption and solubility of water of both materials were not affected by thermocycling. CONCLUSIONS: Before and after thermocycling, milled specimens had lower surface roughness and a greater degree of hardness and fracture toughness than 3D-printed specimens. Thermocycling lowered hardness and fracture toughness, and increased surface roughness in both groups, but had no effect on water sorption and solubility.

Effect of denture cleansers on the physical and mechanical properties of CAD-CAM milled and 3D printed denture base materials: An in vitro study.

STATEMENT OF PROBLEM: Studies on the impact of denture cleansers on the physical and mechanical properties of denture bases designed and constructed by using computer software programs are lacking. PURPOSE: The purpose of this in vitro study was to test the effect of a peroxide denture cleanser on the hardness, fracture toughness, water sorption, and solubility of denture base materials manufactured by 3D printing and computer-aided design and computer-aided manufacturing (CAD-CAM) milling. MATERIAL AND METHODS: The hardness, fracture toughness, water solubility, and sorption of CAD-CAM milled and 3D printed groups (n=40) were evaluated before and after exposure to a denture cleanser. Hardness (n=10) was analyzed with a Vickers hardness testing machine, and fracture toughness (n=20) with the 3-point bend test. After the fracture of specimens, a scanning electron microscope at ×300 was used for fractographic analysis. Water sorption and solubility (n=10) were evaluated before and after immersion in denture cleanser for 6 days to simulate 180 days of immersion. Two-way repeated ANOVA and 2-way ANOVA were used to test normally distributed data, whereas the Mann Whitney U test and Wilcoxon signed ranks test were used for data that were not normally distributed (α<.05). RESULTS: The Vickers hardness and fracture toughness of both materials decreased after immersion in denture cleansers, with a higher decrease in values for the 3D printed group (P<.001). The denture cleanser had no effect on the water sorption and solubility of either group. CONCLUSIONS: Milled specimens had higher hardness values and fracture toughness before and after immersion in the denture cleanser. Denture cleansers resulted in the reduced hardness and fracture toughness of both groups, but the percentage change in the milled group was lower. Denture cleansers had no effect on water sorption or solubility.

Bioactive Metabolite from Endophytic Aspergillus versicolor SB5 with Anti-Acetylcholinesterase, Anti-Inflammatory and Antioxidant Activities: In Vitro and In Silico Studies.

Endophytic fungi are a highly unpredictable group of microorganisms that can create a diverse range of secondary metabolites with biological activity. These metabolites enhance the host's ability to tolerate stress caused by various factors, such as disease, insects, pathogens, and herbivores. The secondary metabolites produced by endophytic fungi may have potential applications in agriculture, pharmacy, and medicine. The purpose of this study was to examine the anti-acetylcholinesterase activity of secondary metabolites extracted from endophytic fungi. Aspergillus versicolor SB5 was one of the many endophytic fungi isolated from Juncus rigidus and identified genetically with accession number ON872302. Our study utilized fermentation and microbial cultivation techniques to obtain secondary metabolites. During the course of our investigation, we isolated a compound called Physcion (C1) from the endophytic fungus Aspergillus versicolor SB5. We subsequently identified that C1 possesses inhibitory activity against COX-2 and LOX-1, with IC50 values of 43.10 and 17.54 µg/mL, respectively, making it an effective anti-inflammatory agent. Moreover, we found that C1 also exhibited potent anticholinesterase activity (86.9 ± 1.21%). In addition to these promising therapeutic properties, our experiments demonstrated that C1 possesses strong antioxidant capacity, as evidenced by its ability to scavenge DPPH, ABTS, O2 radicals, and NO and inhibit lipid peroxidation. To further investigate the molecular mechanisms underlying C1 pharmacological properties, we employed SwissADME web tools to predict the compound's ADME-related physicochemical properties and used Molecular Operating Environment and PyMOL for molecular docking studies.

An immobilized biosorbent from Paenibacillus dendritiformis dead cells and polyethersulfone for the sustainable bioremediation of lead from wastewater.

Heavy metals, including lead, cause serious damage to human health and the surrounding environment. Natural biosorbents arise as environmentally friendly alternatives. In this study, two of the 41 isolates (8EF and 17OS) were the most efficient bacteria for growing on media supplemented with Pb2+ (1000 mg/L). At high concentrations up to 2000 mg/L, the pioneer isolate 17OS exhibited remarkable resistance to multiheavy metals. This isolate was identified as Paenibacillus dendritiformis 17OS and deposited in GenBank under accession number ON705726.1. Design-Expert was used to optimize Pb2+ metal removal by the tested bacteria. Results indicated that four of six variables were selected using a minimum-run resolution IV experimental design, with a significant affecting Pb2+ removal. Temperature and Pb2+ concentration were significant positive influences, whereas incubation period and agitation speed were significant negative ones. The tested strain modulated the four significant variables for maximum Pb2+ removal using Box-Behnken design. The sequential optimization method was beneficial in increasing biosorption by 4.29%. Dead biomass of P. dendritiformis 17OS was embedded with polyethersulfone to get a hydrophilic adsorptive membrane that can separate Pb2+ easily from aqueous solutions. SEM images and FT-IR analysis proved that the new biosorbent possesses a great structure and a lot of surface functional groups with a negative surface charge of - 9.1 mV. The removal rate of 200 mg/L Pb2+ from water reached 98% using 1.5 g/L of the immobilized biosorbent. The adsorption isotherm studies were displayed to determine the nature of the reaction. The adsorption process was related to Freundlich isotherm which describes the multilayer and heterogeneous adsorption of molecules to the adsorbent surface. In conclusion, dead bacterial cells were immobilized on a polyether sulfone giving it the characteristics of a novel adsorptive membrane for the bioremediation of lead from wastewater. Thus this study proposed a new generation of adsorptive membranes based on polyethersulfone and dead bacterial cells.

Evaluation of retention and wear of a titanium-formed stud overdenture attachment with different interimplant angulations after simulated clinical use: An in vitro study.

STATEMENT OF PROBLEM: How implant alignment impacts stud attachment retention and wear-induced alterations, notably when the attachment exhibits metal-to-metal frictional interlocking, is unclear. PURPOSE: The purpose of this in vitro study was to evaluate the effect of the interimplant angulation on retention forces and wear changes before and after 2 years of simulated clinical use of implant overdentures retained by titanium stud overdenture attachments. MATERIAL AND METHODS: The canine regions of 3 identical edentulous mandibular models were used to receive 2 dental implants analogs with TiTach attachments (Dental Evolutions, Inc) at interimplant angulations of 0, 30, and 60 degrees. Six identical overdentures were constructed over each model (n=6). A universal testing machine was used to determine overdenture retention forces at 0, after 1440, and after 2880 insertion and removal cycles to simulate the average insertion and removal cycles in 12 and 24 months. A stereomicroscope, a laser microscope, and a scanning electron microscope were used to evaluate the wear in the attachments. A linear regression model, ANOVA, and the Kruskal-Wallis tests were used to analyze the data (α=.05). RESULTS: All groups demonstrated reduced retention over the study duration (P<.001). The retention forces of the 0- and 30-degree groups were not significantly different after 2880 insertion and removal cycles, but both were significantly higher than those of the 60-degree group (P=.002). Within each group, the wear pattern of the matrix cap was more noticeable than that of the patrix abutment, with increased wear changes as interimplant angulation increased (P<.001). CONCLUSIONS: TiTach attachments could retain overdentures on parallel and divergent implants with a 30-degree angle of interimplant angulation. However, at a 60-degree angle of interimplant angulation, considerable reduction in retention forces and increased wear changes were observed after 2 years of simulated clinical use.

Systematic Review of Cost-Effectiveness Analyses Comparing Open and Minimally Invasive Lumbar Spinal Surgery.

BACKGROUND: Minimally invasive surgery (MIS) has benefits over open surgery for lumbar decompression and/or fusion. Published literature on its cost-effectiveness vs open techniques is mixed. OBJECTIVE: Systematically review the cost-effectiveness of minimally invasive vs open lumbar spinal surgical decompression, fusion, or discectomy using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. METHODS: A systematic electronic search of databases (MEDLINE, Embase, and Cochrane Library) and a manual search from the cost-effectiveness analysis (CEA) database and National Health Service economic evaluation database was conducted. Studies that included adult populations undergoing surgery for degenerative changes in the lumbar spine (stenosis, radiculopathy, and spondylolisthesis) and reported outcomes of costing analysis, CEA, or incremental cost-effectiveness ratio were included. RESULTS: A total of 17 studies were included. Three studies assessed outcomes of MIS vs open discectomy. All 3 reported statistically significant lower total costs in the MIS, compared with the open group, with similar reported gains in quality-adjusted life years (QALYs). Two studies reported cost differences in MIS vs open laminectomy, with significantly lower total costs attributed to the MIS group. Twelve studies reported findings on the relative direct costs of MIS vs open lumbar fusion. Among those, 3 of the 4 studies comparing single-level MIS-transforaminal lumbar interbody fusion (TLIF) and open TLIF reported lower total costs associated with MIS procedures. Six studies reported cost evaluation of single- and 2-level TLIF procedures. Lower total costs were found in the MIS group compared with the open fusion group in all studies except for the subgroup analysis of 2-level fusions in a single study. Three of these 6 studies reported cost-effectiveness (cost/QALY). MIS fusion was found to be more cost-effective than open fusion in all 3 studies. CONCLUSION: The studies reviewed were of poor to moderate methodological quality. Generally, studies reported a reduced cost associated with MIS vs open surgery and suggested better cost-effectiveness, particularly in MIS vs open single- and 2-level TLIF procedure. Most studies had a high risk of bias. Therefore, this review was unable to conclusively recommend MIS over open surgery from a cost-effectiveness perspective. CLINICAL RELEVANCE: The incidence of spinal decompressive and fusion surgey and financial constraints on healthcare services continue to increase. This study aims to identify the cost and clinical effectiveness of common approaches to spinal surgery. LEVEL OF EVIDENCE: 3a.

Concepts behind epilepsy among Egyptian patients. Is it a disease or a possession?!

BACKGROUND: Many epileptic patients visit traditional healers secondary to unaffordability, inaccessibility of medical service and being refractory. This may lead to delay in seeking medical advice and may influence prognosis. OBJECTIVES: Studying concepts behind epilepsy among Egyptian epilepsy sufferers including beliefs behind epilepsy and whether there is difference in these beliefs as regards gender, education and urban to rural socioeconomic status. METHODS: A semi structured questionnaire designed according to the guidelines of the 9th edition of research methods in psychology and applied to 393 cases presenting to epilepsy clinics at three hospitals representing rural delta, capital, and upper rural Egypt between November 2019 and April 2020. Inclusion criteria included a fulfillment of the international league against epilepsy operational definition and availability of an electroencephalogram supporting the diagnosis of epilepsy. RESULTS: 30 % of patients visited traditional healers within the course of their illness with males accounting for 55.9 %, and relatives' impact was more obvious in this decision (83.9 % visited traditional healers secondary to a relative influence). 43.2 % of traditional healers' visitors had a basic education. Low education level was significantly correlated with visiting traditional healers (rho=-0.126, p = 0.012). 43 patients (36.4 %) received traditional therapy and only 3 patients (2.5 %) out of them improved. More males (55.9 %) than females (29.5 %) were found to seek non-medical help with no significant difference (p = 0.852). Additionally, it was noticed that males who lived in rural areas visited traditional healers significantly more than those who lived in urban (72.2 % vs 27.3 %, p = 0.011) while in females, it seems that residency did not affect traditional healers seeking behavior (50 % urban vs 50 % rural). Rural residents were seeking non-medical advice more than urban (28.3 % vs 22 %, p < 0.001) as well as receiving traditional treatments (19.7 % vs 11 %, p = 0.017). CONCLUSIONS: Seeking traditional healers in epilepsy sufferers is not uncommon in Egypt. Education, gender, and residency may affect concepts and beliefs regarding epilepsy. Although awareness of epilepsy as a medical condition is also questionable, yet it is needed.

Light-cured hyaluronic acid composite hydrogels using riboflavin as a photoinitiator for bone regeneration applications.

OBJECTIVE: Self-healing of bone from damage caused by infection, trauma, or surgical removal of cysts is limited. Generally, external intervention is needed to increase bone repair and regeneration. In this study, biocompatible light-cured hyaluronic acid hydrogels loaded with nano-hydroxyapatite and chitosan were prepared using a new photoinitiating system based on riboflavin for bone regeneration applications. METHOD: Four light-cured hydrogel groups were prepared as follows: Group I, a control group with no additions; Group II, loaded with nano-hydroxyapatite; Group III, loaded with chitosan; and Group IV, loaded with both nano-hydroxyapatite and chitosan. The new photoinitiating system consisted of riboflavin as a photoinitiator, dimethylaminoethyl methacrylate (DMAEMA) as a coinitiator (being used with riboflavin for the first time), and diphenyliodonium chloride as an accelerator. For each group, X-ray-diffraction, surface morphology by scanning electron microscope, mechanical properties, water uptake (%), and cell viability (%) were tested. The osteogenic potential was then tested in a rabbit model, and histomorphometric assessment was conducted. RESULTS: In the four groups, the light-cured hydrogels were obtained after a short irradiation time of 10 s using a dental light-curing unit. The prepared hydrogels were biocompatible. Simultaneous addition of nano-hydroxyapatite and chitosan increased the mechanical properties threefold and the osteogenic potential, twofold, with a statistically significant difference compared with the control group. CONCLUSIONS: Light-cured hyaluronic acid composite hydrogels loaded with nano-hydroxyapatite and chitosan-prepared by using the new photoinitiating system-are promising materials that can be used in bone regeneration applications.

Better outcome of COVID-19 positive kidney transplant recipients during the unremitting stage with optimized anticoagulation and immunosuppression.

INTRODUCTION: COVID-19 is an ongoing pandemic with high morbidity and mortality and with a reported high risk of severe disease in kidney transplant recipients (KTR). AIM: We aimed to report the largest number of COVID-19-positive cases in KTR in a single center and to discuss their demographics, management, and evolution. METHODS: We enrolled all the two thousand KTR followed up in our center in Kuwait and collected the data of all COVID-19-positive KTR (104) from the start of the outbreak till the end of July 2020 and have reported the clinical features, management details, and both patient and graft outcomes. RESULTS: Out of the one hundred and four cases reported, most of them were males aged 49.3 ± 14.7 years. Eighty-two of them needed hospitalization, of which thirty-one were managed in the intensive care unit (ICU). Main comorbidities among these patients were hypertension in 64.4%, diabetes in 51%, and ischemic heart disease in 20.2%. Management strategies included anticoagulation in 56.7%, withdrawal of antimetabolites in 54.8%, calcineurin inhibitor (CNI) withdrawal in 33.7%, the addition of antibiotics in 57.7%, Tocilizumab in 8.7%, and antivirals in 16.3%. During a follow-up of 30 days, the reported number of acute kidney injury (AKI) was 28.7%, respiratory failure requiring oxygen therapy 46.2%, and overall mortality rate was 10.6% with hospital mortality of 13.4% including an ICU mortality rate of 35.5%. CONCLUSION: Better outcome of COVID-19-positive KTR in our cohort during this unremitting stage could be due to the younger age of patients and early optimized management of anticoagulation, modification of immunosuppression, and prompt treatment of secondary bacterial infections. Mild cases can successfully be managed at home without any change in immunosuppression.

Pretransplant donor-specific anti-human leukocyte antigen antibodies despite a negative complement-dependent lymphocytotoxicity crossmatch: Is it wise to desensitize before kidney transplant?

The significance of pretransplant donor-specific antibodies (DSAs) despite negative complement-dependent lymphocytotoxicity crossmatch (CDC-XM) would be useful for clinical decision-making. Hence, we aimed to determine the impact of pretransplant DSA despite negative crossmatch on the outcome of kidney transplantation. One hundred and eleven kidney recipients were prospectively enrolled in this study after being transplanted at Hamed Al-Essa Organ Transplant Center of Kuwait between January 2011 and December 2013. Of them, 50 recipients with positive DSA at the time of transplant were subjected to desensitization (Group 1). Three local protocols were utilized; first included plasma exchange, high-dose intravenous immunoglobulin (IVIG), and rituximab; second included immunoadsorption plus RTX, and the third included high-dose IVIG and rituximab. The second group included 61 recipients with negative DSA. All recipients had negative CDC-XM and flow cytometry crossmatch at the time of transplant. Panel-reactive antibody (±DSA) levels with mean fluorescence intensity and graft function were monitored along the first 24 months for all patients. There were no statistically significant differences between the two groups regarding early posttransplant graft function, patient and graft survivals. Pretransplant DSA with negative CXM carries a minimal clinical risk with optimized immunosuppression.

Synthesis, Characterization, and Computational Chemical Study of Aliphatic Tricationic Surfactants as Corrosion Inhibitors for Metallic Equipment in Oil Fields.

Aliphatic tricationic surfactants were prepared by the esterification reaction, followed by a quaternization reaction to protect oil well facilities from corrosion problems. Microelemental analysis and Fourier transform infrared and 1H NMR spectroscopic techniques were performed to explore the obtained motifs. The performance of these amphiphiles as inhibitors for metallic S90 steel corrosion in formation water was investigated through electrochemical tests (potentiodynamic polarization and electrochemical impedance spectroscopy). The results revealed significant inhibition effectiveness improvement with increasing concentrations of these amphiphiles. Its maximum inhibition efficiency reaches 93.07% at 250 ppm for the compound (AED). Potentiodynamic polarization graphs demonstrated that tricationic amphiphiles behave as mixed-type inhibitors. In addition, the adsorption of the tricationic surfactant at the S90 steel surface followed Langmuir isotherm. Atomic force microscopy revealed that a protective layer formed at the surface of S90 steel caused the inhibition of corrosion. During the inhibition procedure of S90 steel corrosion, theoretical research has been performed to validate electrochemical experiments and to clearly demonstrate the mechanism of these amphiphiles. Finally, quantum chemical calculations were calculated to achieve the justification for the obtained empirical results.

Early Versus Late Acute Antibody-Mediated Rejection Among Renal Transplant Recipients in Terms of Response to Rituximab Therapy: A Single Center Experience.

OBJECTIVES: There are no comparable trials concerning the use of rituximab among renal transplant recipients with acute antibody-mediated rejection. Here, we compared early and late acute antibody-mediated rejection in renal transplant recipients in terms of response to rituximab therapy. MATERIALS AND METHODS: Of 1230 kidney transplants performed at Hamed Al-Essa Organ Transplant Center (Kuwait) over the past 10 years, 103 recipients developed acute antibody-mediated rejections and were subcategorized into 4 groups according to the onset of rejection and rituximab treatment. All patients received the standard treatment for acute antibody-mediated rejection according to our protocol (plasma exchange and intravenous immunoglobulin). We added rituximab to the treatment regimen in 2 groups of patients: 27 patients with early rejection (group 1) and 38 patients with late rejection (group 2). Groups 3 and 4 represented nonrituximab groups, with 20 patients with early (group 3) and 18 patients with late rejection (group 4). We compared the 4 groups regarding graft and patient outcomes. RESULTS: All patients were comparable regarding patient age, sex, pretransplant type of dialysis, viral profile, type of induction, donor criteria, and pretransplant comorbidities. We observed that delayed and slow graft function were significantly higher in groups 1 and 3 (P = .016); however, we found no significant differences in the 4 groups regarding new-onset diabetes after transplant, BK viral infection, and malignancy. Graft outcomes were significantly better in groups 1 and 2 than in groups 3 and 4 (P = .028). However, patient outcomes were comparable in the 4 groups (P > .05). CONCLUSIONS: Early acute antibody-mediated rejection in renal transplant recipients had significantly better outcomes when rituximab was added to the standard treatment regimen.

The early detection and management of unstable concentric closed reduction of DDH with percutaneous K-wire fixation in infants 6 to 12 months of age.

BACKGROUND: In some infants with developmental dysplasia of the hip, concentric closed reduction, although initially achievable, cannot be maintained even by casting because of a deficient posterior acetabular wall. Usually, these hips will redislocate in the cast and a rereduction will be necessary, often requiring an open reduction subsequently. METHODS: A 3-year retrospective review of 88 infants, (M/F; 14/74) 6 to 12 months of age with 124 dislocated hips, was conducted to assess the efficacy of percutaneous Kirschner wire fixation in achieving permanent hip stability. A "hip-at-risk" instability test was developed to detect potentially unstable hips at the time of closed reduction that might redislocate in the hip spica cast, and these hips were stabilized with a percutaneous K-wire through the greater trochanter into the pelvic bone. RESULTS: The hip instability test was positive in 27 hips and negative in 97. Percutaneous K-wire fixation was used to stabilize 21 hips with a positive hip instability test. All 21 unstable hips that were stabilized with the K-wire technique maintained their concentric reduction and went on to stable development. No K-wire breakage was encountered and only 1 superficial pin tract infection occurred. CONCLUSIONS: K-wire stabilization of unstable closed reductions is a safe, reliable technique for maintaining concentric hip reduction in infants 6 to 12 months of age with developmental dislocation of the hips. LEVEL OF EVIDENCE: Level II retrospective study.

Detection of Helicobacter pylori in adenotonsillar tissue of children with chronic adenotonsillitis using rapid urease test, PCR and blood serology: a prospective study.

OBJECTIVE: Contradictory results have been reported regarding Helicobacter pylori (H. pylori) detection in adenotonsillar tissue. The aims of this study were to investigate whether adenotonsillar tissue of symptomatic children with chronic adenotonsillitis harbors the H. pylori organism, using two biopsy-based invasive methods namely; rapid urease test (RUT) and polymerase chain reaction (PCR) as well as blood serology and to compare the results obtained from each of these methods to the "gold standard". METHODS: This prospective clinical study was carried out on 20 children aged between 2 and 10 years scheduled for tonsillectomy +/- adenoidectomy in a tertiary referral center. Exclusion criteria included: use of antacids, H(2) blockers or antibiotics during the previous month before surgery and adenotonsillectomy for obstructive sleep apnea. Core biopsy samples from resected adenotonsillar tissue was tested for H. pylori detection using both RUT and PCR assay for the ureC gene. Preoperative patient venous blood samples were also tested for H. pylori IgG antibodies. As a "gold standard", examined tissue was considered to be H. pylori infected if the two biopsy specimen-based methods (RUT and PCR) yielded positive results. RESULTS: Thirty adenotonsillectomy specimens were tested (20 tonsils and 10 adenoids). RUT was positive in 16 (53.3%) specimens (12 tonsils and 4 adenoids). According to the "gold standard", 11/16 were considered false-positive, yielding this test sensitivity 100% and specificity 56%. The ureC gene sequence was detected by PCR in 5 (16.6%) specimens (3 tonsils and 2 adenoids), all of which were also positive by RUT, thus were considered H. pylori infected. Accordingly, PCR had a 100% sensitivity and specificity. Serology testing was positive for H. pylori IgG antibodies in 4/20 patients (20%), only two of them were found to have H. pylori infected adenotonsillar tissue. CONCLUSIONS: Based on our findings it seems that adenotonsillar tissue may constitute an extra-gastric reservoir for H. pylori in symptomatic children with chronic adenotonsillitis. RUT was found to be of less accuracy than PCR in H. pylori detection in an extra-gastric location, thus results of previous studies using this test alone for detection of oral H. pylori should be treated with caution.

Lipomas of the head and neck: presentation variability and diagnostic work-up.

INTRODUCTION: Head and neck lipomas have seldom drawn attention in the literature, except in isolated case reports. AIMS: This study aimed to assess the presentation variability of head and neck lipomas as well as the relative importance and efficiency of pre-operative diagnostic methods used. MATERIALS AND METHODS: A retrospective review was undertaken of medical records and imaging studies of 24 patients with histopathologically proven head and neck lipomas, over a three-year period. RESULTS: The 24 patients had 26 lipomas. Men predominated (62.5 per cent). The posterior subcutaneous neck was the most common site. Three patients had deep lipomas affecting the hypopharynx, larynx and parotid gland; all were correctly diagnosed pre-operatively. Computed tomography (CT) scan with specific radiodensity recording was the preferred pre-operative investigation. CONCLUSIONS: Lipomas should be considered in the differential diagnosis of soft-tissue head and neck masses even in rare locations. A CT or magnetic resonance imaging scan can correctly diagnose a lipoma pre-operatively, thereby allowing better treatment planning.