Vitamin D receptor gene polymorphism in Egyptian multiple sclerosis patients.

One of the most common neurological illnesses in the world is multiple sclerosis (MS), a chronic autoimmune demyelinating disease of the central nervous system (CNS). MS has both a genetic and an environmental origin. In terms of environmental factors, vitamin D deficiency is one of the most important risk factors and closely connected with gene polymorphisms involved in vitamin D metabolism, transport, or activity. Since vitamin D activity requires a receptor-mediated response, any changes to the vitamin D receptor (VDR) may have an effect on the pathophysiology of the disease. In this study, we aimed to identify the relationship between VDR gene polymorphisms, FokI A>G (rs2228570), ApaI A>C (rs7975232) and BsmI C>T (rs1544410) and MS. FokI, ApaI and BsmI genotypes were determined in 50 patients with relapsing remitting MS (RRMS) and in 50 control subjects. DNA was isolated from blood samples, and then FokI, ApaI and BsmI gene polymorphisms were identified using allelic discrimination real time polymerase chain reaction (PCR) assay. The distribution of FokI, ApaI and BsmI polymorphisms did not show any significant differences between MS patients and controls. Thus, we concluded that there is no association between the studied VDR gene polymorphisms and MS.

Preferability of Molnupiravir, an Anti-COVID-19 Drug, toward Purine Nucleosides: A Quantum Mechanical Study.

Structural aspects of molnupiravir complexed with the RNA of the SARS-CoV-2 virus have been recently resolved inside the RNA-dependent RNA polymerase (RdRp), demonstrating the interactions of molnupiravir with purine nucleosides. However, the preference of molnupiravir to interact with one purine nucleoside over another has not been clearly investigated. Herein, the complexation of molnupiravir in its active form with guanosine and adenosine was compared, using sundry density functional theory calculations. The plausible tautomeric structures of the molnupiravir drug in complex with guanosine/adenosine were minutely scrutinized. The relative energy findings outlined the favorability of amino-molnupiravir···keto-amino-guanosine and imino-molnupiravir···amino-adenosine optimized complexes. According to the interaction (Eint) and binding (Ebind) energy values, higher preferential base-pairing of molnupiravir with guanosine over the adenosine one was recognized with Eint/Ebind values of -31.16/-21.81 and -13.93/-12.83 kcal/mol, respectively. This could be interpreted by the presence of three and two hydrogen bonds within the former and latter complexes, respectively. Observable changes in the electronic properties and global indices of reactivity of the studied complexes also confirmed the preferential binding within the studied complexes. The findings from the quantum theory of atoms in molecules and the noncovalent interaction index also support the partially covalent nature of the investigated interactions. For both complexes, changes in thermodynamic parameters outlined the spontaneous, exothermic, and nonrandom states of the inspected interactions. Inspecting the solvent effect on the studied interactions outlined more observable amelioration within the water medium compared with the gas one. These results would be a durable ground for the forthcoming studies concerned with the interactions of the molnupiravir drug with purine nucleosides.

An Exploratory Mixed Method Cross-Sectional Study to Identify Opportunities to Increase Enrollment and Retention of Native Hawaiian Students in an Undergraduate Dietetic Program.

BACKGROUND: Native Hawaiians (NH) are underrepresented in dietetics, contributing to less than 1% of the profession nationally. Increasing the number of NH Registered Dietitian Nutritionists (RDN) is one mechanism to facilitate improved health outcomes in disparate populations. OBJECTIVES: 1) Identify and summarize NH student interests in the field of nutrition and dietetics; 2) Identify and contextualize factors that support and prohibit achievement of academic goals and aspirations; 3) Identify NH students' responsibility to the community; 4) Explore the context around NH alumni enrollment in nutrition and dietetics and their perceived impact of RDNs in the community; 5) Identify and describe supporting agencies that foster academic and professional success. DESIGN: This exploratory mixed-methods cross-sectional study surveyed all levels of NH nutrition and dietetics students in the University of Hawai'i (UH) System. In addition, in-depth interviews were conducted with NH students, NH alumni, and supporting agencies to identify supports and barriers, explore the context of NH enrollment in nutrition and dietetics, and the contribution of dietetics to the NH community. PARTICIPANTS/SETTING: Eighty-one NH students enrolled in a nutrition course across the UH system were surveyed. Nine of the 81 NH students surveyed, eight NH alumni, and persons from 15 identified supporting agencies were interviewed. ANALYSIS: Survey responses were descriptively analyzed. Open-ended survey questions and interviews were analyzed through content analysis. To ensure findings were guided by NH perspective, data were triangulated by researchers and a NH dietetics advisory council. RESULTS: Food and chronic disease prevention and management were topics that drew NH students to the field. Bridge/scholarship programs supported NH academic achievement. Education-related cost was a perceived barrier. Alumni and students shared varying degrees of responsibility to serve the NH community. Increasing the connection between NH values and the nutrition and dietetics curriculum are an identified need. CONCLUSION: Findings illuminate opportunities to drive future programmatic efforts. The framework used in this study should be adaptable to other programs to support overall dietetics diversity initiatives.

Speckle tracking echocardiographic assessment of left ventricular longitudinal strain in female patients with subclinical hyperthyroidism.

BACKGROUND: Patients with subclinical hypothyroidism (SCH) are subjected to many cardiac changes. However, these changes are of gradual onset and cannot be usually detected using conventional diagnostic methods. Speckle tracking echocardiography (STE) is capable to detect cardiac function alterations usually unidentified by conventional echocardiography. The present study aimed to evaluate the role of STE in the detection of early cardiac changes in female patients with SCH. METHODS: The study included 33 female patients with SCH and 30 matched healthy volunteer women with normal thyroid functions who served as controls. Upon recruitment, all participants were subjected to careful history taking, thorough clinical examination and routine laboratory investigations, including thyroid-stimulating hormone and Free T4. The echocardiographic examination included conventional, color Doppler and two-dimensional STE. RESULTS: Analysis of conventional echocardiographic data revealed that patients had significantly higher end-systolic volume when compared with controls. In addition, it was noted that SCH patients had significantly lower mitral E/A ratio, isovolumetric relaxation time and significantly higher left atrium volume index in comparison to controls. In respect to STE data, we noted that patients had significantly lower values of mid-anteroseptal, apical lateral, apical septal, apical apex, AP4L strain and global strain % when compared with controls. CONCLUSIONS: Patients with SCH have deteriorated global strain in comparison to healthy controls.

Child and adolescent injury burden in the eastern mediterranean region: Findings from the Global Burden of Disease 1990-2017.

BACKGROUND: Child and adolescent injury is one of the leading causes of child death globally with a large proportion occurring in Low- and Middle-Income Countries (LMICs). Similarly, the Eastern Mediterranean Region (EMR) countries borne a heavy burden that largely impact child and adolescent safety and health in the region. We aim to assess child and adolescent injury morbidity and mortality and estimate its burden in the Eastern Mediterranean Region based on findings from the Global Burden of Disease (GBD), Injuries and Risk Factors study 2017. METHODS: Data from the Global Burden of Disease GBD 2017 were used to estimate injury mortality for children aged 0-19, Years of Life Lost (YLLs), Years lived with Disability (YLDs) and Disability Adjusted Life Years (DALYs) by age and sex from 1990 to 2017. RESULTS: In 2017, an estimated 133,117 (95% UI 122,587-143,361) children died in EMR compared to 707,755 (95% UI 674401.6-738,166.6) globally. The highest rate of injury deaths was reported in Syria at 183.7 (95% UI 181.8-185.7) per 100,000 population. The leading cause of injury deaths was self-harm and interpersonal violence followed by transport injury. The primary cause of injury DALYs in EMR in 2017 was self-harm and interpersonal violence with a rate of 1272.95 (95% UI 1228.9 - 1319.2) almost 3-times the global rate. CONCLUSION: Almost 19% of global child injury related deaths occur in the EMR. Concerted efforts should be integrated to inform policies and adopt injury preventive strategies to reduce injury burden and promote child and adolescent health and well-being in EMR countries.

Distribution of essential heavy metals in the aquatic ecosystem of Lake Manzala, Egypt.

Lake Manzala is the largest and most productive lake of Egypt's northern coastal lakes and has socio-economic impacts. Pollution by heavy metals is the most significant type of pollution worldwide, particularly in Lake Manzala, which receives mixed discharges from densely populated areas. Water samples were collected at twelve sites around the lake in winter and summer of 2015. Samples of Eichhornia crassipes were collected in the winter, and Oreochromis niloticus samples were collected at two sites (8 and 10). V, Cr, Mn, Fe, Co, Ni, Cu, and Zn were analysed in these samples using inductively coupled plasma-mass spectrometry. The average metal concentrations were below the internationally accepted upper permissible limits and are improved compared to those in previous studies. However, the metal concentrations at the eastern and southeastern sites were higher than the allowable limits due to multiple waste discharges. Pollution assessment using pollution risk indicators indicated low to moderate concentrations of metal enrichment in the sediment and biota of the lake, except at sites near the eastern and southeastern drains; these latter sites were considered to be hazardous and should be taken into account in the current development efforts of the lake. Complete removal of floating plants transported by drains is recommended.

Vitamin D Increases Percentages of Interleukin-10 Secreting Regulatory T Cells in Children with Cow's Milk Allergy.

Cow's milk allergy (CMA) is known to be either IgE- or non-IgE mediated. Regulatory T (Treg) cell defect is involved in the pathogenesis of both types. Vitamin D has been suggested to improve the generation of allergen-specific Treg cell populations with the potential to provide safe and long-term alleviation of disease symptoms. This study aimed to assess Vitamin D status in children with physician-diagnosed CMA and to investigate the effect of in vitro cultivation with Vitamin D on the percentage of antigen-driven CD4+CD25highFoxp3+IL10+ Treg cells following in vitro stimulation of cells with cow's milk allergen in culture. This cross-sectional study included 20 children with CMA and 20 healthy age and sex-matched children as a control group. All patients were subjected to clinical evaluation, cow's milk skin prick test (SPT), cow's milk elimination and oral re-challenge test in patients with negative cow's milk SPT and in those with gastrointestinal presentation, measurement of serum Vitamin D level and assessment of the percentage of antigen-driven CD4+CD25highFoxp3+IL10+ Treg cells in response to stimulation with cow's milk allergen extract with and without Vitamin D in culture. Vitamin D deficiency was detected in 80% of children with CMA. Percentage of Foxp3+ and IL10+ co-expression on Treg cells was significantly increased after stimulation with cow's milk allergen extract in the presence of Vitamin D. A significant positive correlation was observed between serum Vitamin D level and percentage of antigen-driven CD4+CD25highFoxp3+IL10+ Treg cells as well as level of Foxp3+ and IL10+ co-expression on Treg cells at baseline (control cultures without stimulation) and after PBMCs stimulation with cow's milk allergen extract in the presence of Vitamin D. Re-stimulation with cow's milk allergen extract was performed in vitro in order to evaluate milk-induced immune stimulation and regulation. In conclusion, patients with CMA whether IgE- or non-IgE mediated had Vitamin D deficiency with a decreased number of CD4+CD25highFoxp3+IL10+ Treg cells which increased after in vitro addition of Vitamin D with increased Foxp3 and IL10 co-expression.

Adsorption of Methylene Blue and Pb2+ by using acid-activated Posidonia oceanica waste.

Dead leaves of seagrass Posidonia oceanica were activated by using one mol L-1 acetic acid and used as an eco-adsorbent for the removal of methylene blue (MB) and Pb2+ from aqueous solutions. The seagrass was characterized by chemical and physical measurements that confirmed the acid-activation of seagrass. The favourable conditions for MB and Pb2+ adsorption onto the activated seagrass (SGa) were determined to be a pH range of 2-12 and ≥6, an adsorbent dosage of 3.0 and 0.5 g L-1, respectively, and a shaking time of 30 min, which are suitable for a wide range of wastewaters. The equilibrium data were analysed using the Langmuir, Freundlich and Dubinin-Raduskavich-Kaganer (DRK) adsorption isotherm models. The Freundlich and DRK models best describe the adsorption processes of MB and Pb2+, on SGa with capacities of 2681.9 and 631.13 mg g-1, respectively. The adsorption isotherm fitting and thermodynamic studies suggest that the adsorption mechanism of MB may combine electrostatic and physical multilayer adsorption processes, in which MB may be present as monomers as well as dimers and trimers which were confirmed from UV spectroscopy whereas Pb2+ is chemically adsorbed onto SGa. The pseudo-2nd-order kinetic model was utilized to investigate the kinetics of adsorption processes. The removal process was successfully applied for MB-spiked brackish waste water from Manzala Lake, Egypt, with removal efficiencies of 91.5-99.9%.

Bioengineered uterine tissue supports pregnancy in a rat model.

OBJECTIVE: To create a bioengineered uterine patch for uterine repair of a partially defect uterus. DESIGN: Three different decellularized uterine scaffolds were recellularized in vitro with primary uterine cells and green fluorescent protein- (GPF-) labeled bone marrow-derived mesenchymal stem cells (GFP-MSCs). The patches were transplanted in vivo to investigate their tissue adaptation and supporting capacity during pregnancy. SETTING: Research laboratory. ANIMAL(S): Female Lewis rats (n = 9) as donors to generate whole-uterus scaffolds using three different protocols (n = 3 per protocol); Sprague Dawley rats (n = 40) for primary uterus cell isolation procedures (n = 10) and for transplantation/pregnancy studies (n = 30); and male Sprague Dawley rats (n = 12) for mating. INTERVENTION(S): Decellularization was achieved by whole-uterus perfusion with buffered or nonbuffered Triton-X100 and dimethyl sulfoxide (DMSO; group P1/P2) or with sodium deoxycholate (group P3). Primary uterine cells and GFP-MSCs were used to develop uterine tissue constructs, which were grafted to uteri with partial tissue defects. MAIN OUTCOME MEASURE(S): Recellularization efficiency and graft quality were analyzed morphologically, immunohistochemically, and by real-time quantitative polymerase chain reaction (PCR). The location and number of fetuses were documented during pregnancy days 16-20. RESULT(S): Pregnancy and fetal development were normal in groups P1 and P2, with fetal development over patched areas. Group P3 showed significant reduction of fetal numbers, and embryos were not seen in the grafted area. Quantitative PCR and immunohistochemistry revealed uterus-like tissue in the patches, which had been further reconstructed by infiltrating host cells after transplantation. CONCLUSION(S): Primary uterine cells and MSCs can be used to reconstruct decellularized uterine tissue. The bioengineered patches made from triton-X100+DMSO-generated scaffolds were supportive during pregnancy. These protocols should be explored further to develop suitable grafting material to repair partially defect uteri and possibly to create a complete bioengineered uterus.

Uterine rejection after allogeneic uterus transplantation in the rat is effectively suppressed by tacrolimus.

OBJECTIVE: To evaluate the effects of the immunosuppressant tacrolimus on rejection of a transplanted uterus and on uterine expression of markers of inflammation and implantation. DESIGN: Experimental study. SETTING: University laboratory. ANIMAL(S): Female rats. INTERVENTION(S): Uteri from brown Norway rats were transplanted to Lewis rats, receiving either tacrolimus or no treatment. Sham groups underwent either hemihysterectomy or tacrolimus treatment. MAIN OUTCOME MEASURE(S): Gross morphology, histology, density of T-lymphocytes by immunohistochemistry, and mRNA levels of interleukin (IL)-1α, leukemia inhibitory factor (LIF), galectin-1, CD200, IL-15, interferon-inducible protein-10 (IP-10), and nuclear factor-κB (NF-κB) at 14 days' post-transplantation. RESULT(S): Nontreated uterine grafts showed rejection with necrosis. Sham groups and the tacrolimus-treated transplanted group exhibited normal uterine morphology with low numbers of T-lymphocytes in all uteri except in two out of seven uteri of the tacrolimus-treated transplant group. Uteri of the nontreated transplanted group showed elevated mRNA expression of IL-1α and IP-10 and reduced galectin-1, compared with the tacrolimus-treated transplanted group. There was no difference between any groups concerning uterine expression of LIF, NF-κB, IL-15, and CD200. CONCLUSION(S): Tacrolimus monotherapy suppresses rejection of an allotransplanted uterus and normalizes the expression of IL-1α and IP-10 and prevents T-lymphocyte infiltration.

Thymic hyperplasia in a patient with Grave's disease.

Hyperplastic changes of the thymus may be found in patients with Graves' disease. However, this rarely presents as an anterior mediastinal mass, particularly among adults. In this report, we describe a 46-year old woman with Graves' disease and thymic hyperplasia.

Treatment of laser complications.

Modern lasers and light-based sources that were developed based on the theory of selective photothermolysis are capable of destroying specific tissue targets while minimizing the risk of scarring and pigmentary changes. This is accomplished through the use of a wavelength and pulse duration that is best absorbed by a specific chromophore such as melanin or hemoglobin. However, not all lasers and light sources adhere to this principle. Continuous wave (CW) lasers are least selective and may produce unwanted tissue damage and scarring through heat conduction to normal skin. Quasi-CW lasers limit excessive thermal destruction by delivery of a series of brief laser pulses but still pose a higher risk of nonspecific tissue damage and thermal injury. The pulsed and Q-switched (QS) systems adhere most closely to the principles of selective photothermolysis and result in the highest degree of selective destruction with the lowest risk of scarring from excessive thermal diffusion. Certainly, any laser system potentially can result in scarring and tissue damage when used incorrectly; therefore, adequate operator education and skill are essential. Side effects and complications that occur as a consequence of laser treatment can be significantly reduced if diagnosed and treated in an expeditious manner.

A comparative study to evaluate the effect of honey dressing and silver sulfadiazene dressing on wound healing in burn patients.

To compare the effect of honey dressing and silver-sulfadiazene (SSD) dressing on wound healing in burn patients. Patients (n=78) of both sexes, with age group between 10 and 50 years and with first and second degree of burn of less than 50% of TBSA (Total body surface area) were included in the study, over a period of 2 years (2006-08). After stabilization, patients were randomly attributed into two groups: 'honey group' and 'SSD group'. Time elapsed since burn was recorded. After washing with normal saline, undiluted pure honey was applied over the wounds of patients in the honey group (n=37) and SSD cream over the wounds of patients in SSD group (n=41), everyday. Wound was dressed with sterile gauze, cotton pads and bandaged. Status of the wound was assessed every third and seventh day and on the day of completion of study. Patients were followed up every fortnight till epithelialization. The bacteriological examination of the wound was done every seventh day. The mean age for case (honey group) and control (SSD group) was 34.5 years and 28.5 years, respectively. Wound swab culture was positive in 29 out of 36 patients who came within 8 hours of burn and in all patients who came after 24 hours. The average duration of healing in patients treated with honey and SSD dressing at any time of admission was 18.16 and 32.68 days, respectively. Wound of all those patients (100%) who reported within 1 hour became sterile with honey dressing in less than 7 days while none with SSD. All of the wounds became sterile in less than 21 days with honey, while tthis was so in only 36.5% with SSD treated wounds. The honey group included 33 patients reported within 24 hour of injury, and 26 out of them had complete outcome at 2 months of follow-up, while numbers for the SSD group were 32 and 12. Complete outcome for any admission point of time after 2 months was noted in 81% and 37% of patients in the honey group and the SSD group. Honey dressing improves wound healing, makes the wound sterile in lesser time, has a better outcome in terms of prevention of hypertrophic scarring and post-burn contractures, and decreases the need of debridement irrespective of time of admission, when compared to SSD dressing.

National athletic trainers' association position statement: preventing, detecting, and managing disordered eating in athletes.

OBJECTIVE: To present recommendations for the prevention, detection, and comprehensive management of disordered eating (DE) in athletes. BACKGROUND: Athletes with DE rarely self-report their symptoms. They tend to deny the condition and are often resistant to referral and treatment. Thus, screenings and interventions must be handled skillfully by knowledgeable professionals to obtain desired outcomes. Certified athletic trainers have the capacity and responsibility to play active roles as integral members of the health care team. Their frequent daily interactions with athletes help to facilitate the level of medical surveillance necessary for early detection, timely referrals, treatment follow-through, and compliance. RECOMMENDATIONS: These recommendations are intended to provide certified athletic trainers and others participating in the health maintenance and performance enhancement of athletes with specific knowledge and problem-solving skills to better prevent, detect, and manage DE. The individual biological, psychological, sociocultural, and familial factors for each athlete with DE result in widely different responses to intervention strategies, challenging the best that athletics programs have to offer in terms of resources and expertise. The complexity, time intensiveness, and expense of managing DE necessitate an interdisciplinary approach representing medicine, nutrition, mental health, athletic training, and athletics administration in order to facilitate early detection and treatment, make it easier for symptomatic athletes to ask for help, enhance the potential for full recovery, and satisfy medicolegal requirements. Of equal importance is establishing educational initiatives for preventing DE.