Improving the bioavailability and therapeutic efficacy of felodipine for the control of diabetes-associated atherosclerosis: In vitro and in vivo characterization.

Felodipine has proven to be effective as an atherosclerosis therapy because it increases blood flow to the vessel wall. However, the poor solubility, low bioavailability, and hepatic first-pass metabolism of oral felodipine compromise its therapeutic effectiveness. The study's goal is to create a nasal pH-sensitive hydrogel of felodipine-loaded invasomes (IPHFI) that will improve felodipine's release, permeation, bioavailability, and efficacy as a potential diabetes-associated atherosclerosis therapy. According to the pre-formulation study, the felodipine-loaded invasomes formulation composed of phospholipid (3%w/v), cholesterol (0.16%w/v), ethanol (3%v/v) and cineole (1%v/v) was chosen as the optimum formulation. The optimum formulation was characterized in vitro and then mixed with a mixture of chitosan and glyceryl monooleate to make the IPHFI formulation. The IPHFI formulation enhanced the release and permeation of felodipine by 2.99 and 3-fold, respectively. To assess the efficacy and bioavailability of the IPHFI formulation, it was studied in vivo using an experimental atherosclerosis rat model. Compared to oral free felodipine, the nasal administration of the IPHFI formulation increased the bioavailability by 3.37-fold and decreased the serum cholesterol, triglycerides, LDL, and calcification score by 1.56, 1.53, 1.80, and 1.18 ratios, respectively. Thus, nasal IPHFI formulation may represent a promising diabetes-associated atherosclerosis therapy.

Translation, cross-cultural adaptation, and psychometric properties of the Arabic version of the MedRisk instrument for measuring patient satisfaction with physical therapy care.

PURPOSE: This study aimed to translate, cross-culturally adapt, and validate the MedRisk Instrument for Measuring Patient Satisfaction with Physical Therapy Care into Arabic (MRPS-Ar). MATERIALS AND METHODS: The 20-Item MRPS was translated and cross-culturally adapted into Arabic following international guidelines. Patients (n = 229) with musculoskeletal conditions who received physical therapy care completed the MRPS-Ar and global rating of change scale. Of these patients, 95 completed the MRPS-Ar twice. Factor structure, floor and ceiling effects, internal consistency, test-retest reliability, and construct validity of the MRPS-Ar were evaluated. RESULTS: Principal component analysis suggested 3-factor solution: a 7-item facility experience, 6-item therapeutic experience, and 3-item positive experience. The MRPS-Ar and its factors showed acceptable internal consistency (Cronbach's alpha coefficients ranged from 0.819 to 0.936) and excellent test-retest reliability (ICCs ranged from 0.965 to 0.983). The global measures of satisfaction were significantly correlated with the global rating of change (Spearman's rho = -0.678, p < 0.001 for item "overall satisfaction" and Spearman's rho = -0.690, p < 0.001 for item "would return"). CONCLUSIONS: The 18-item MRPS-Ar displayed adequate psychometric properties for measuring patients' satisfaction with physical therapy care. The MRPS-Ar is a reliable and valid instrument that can be used in medical, clinical, and research fields.

Prognostic role of annexin A2 and cancer-associated fibroblasts in advanced non-small cell lung cancer: Implication in epithelial-mesenchymal transition and gefitinib resistance.

BACKGROUND: Despite advances in treatment of non-small cell lung cancer (NSCLC), its prognosis remains dismal. Development of drug resistance is a major obstacle against success of targeted epidermal growth factor receptor (EGFR) -tyrosine kinase inhibitors (TKI) therapy. This study aimed to assess the prognostic role of annexin A2 (ANXA2) expression, within both tumor cells and stroma, as well as cancer associated fibroblasts (CAFs) in NSCLC and to investigate their potential role in induction of epithelial mesenchymal transition (EMT) and resistance to gefitinib. METHOD: Immunohistochemistry was performed to evaluate tumoral and stromal ANXA2 expression and α-SMA-stained CAFs in 110 advanced NSCLC patients. Furthermore, STAT3 and E-cadherin mRNA expression was studied by quantitative reverse transcription PCR (qRT-PCR). RESULTS: Both tumoral and stromal ANXA2 as well as CAFs were significantly related to clinical stage IV and malignant pleural effusion, while tumoral ANXA2 was significantly related to poor tumor differentiation. EGFR mutation and high tumoral ANXA2 were independent factors for poor overall survival, whereas high stromal and tumoral ANXA2 and high CAFs were independent predictors for poor progression-free survival. Moreover, high ANXA2 and CAFs were significantly associated with high STAT3 and low E-cadherin mRNA expression. Focusing on EGFR mutated cases, gefitinib resistance was significantly associated with high tumoral and stromal ANXA2, high CAFs, high STAT3 and low E-cadherin. CONCLUSION: CAFs and ANXA2 could be considered as poor prognostic parameters in advanced NSCLC and are potential factors for gefitinib therapy resistance through EMT induction.

Effect of Low-Level Laser Therapy on Knee Range of Motion and Functional Abilities After Total Knee Arthroplasty.

OBJECTIVE: The aim of this study was to determine the effectiveness of combined low-level laser therapy (LLL) and rehabilitation in patients following recent total knee replacement (TKR). METHODS: A double-blind randomized controlled study was conducted at the Orthopedic Department of Mansoura University Hospital. Forty-four patients were chosen from a total of 58 patients who met the inclusion criteria and were assigned randomly into control and experimental groups of equal size. Ultimately, 40 patients completed the study (20 from each group). Both groups participated in an intensive functional rehabilitation program, and the experimental group also received LLL therapy around the knee at the incisional line, the medial and lateral intra-articular space, above and below the patella, and at the popliteal fossa at low fluence (6 J/cm2, 650 nm continuous wave) and 60 s per point with a total dose of 48 J per session over 12 treatment sessions for six weeks. Knee range of motion (ROM) was measured with a digital goniometer, and functional abilities were assessed with the Arabic version of the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index. RESULTS: There were significant differences in all variables pre- and post-treatment within each group. Before treatment, there was no significant difference in any of the measured variables between the groups (P>0.05). After treatment, there were significant differences in knee flexion ROM and WOMAC index (P<0.05) but no significant difference in knee extension ROM between the groups (P>0.05). CONCLUSION: The addition of low-level laser therapy to a rehabilitation program post-TKR resulted in substantial enhancements in knee flexion range of motion and the WOMAC index.

Circulating spexins in children with obesity: relation to cardiometabolic risk.

BACKGROUND/OBJECTIVES: The role of spexin (SPX) in energy metabolism, endocrinal homeostasis, and vasculopathy is emerging. However, scarce data are available about its role in childhood obesity and obesity-related vasculopathy. Hence, we aimed to assess the level of SPX in obese and normal-weight children, and to correlate it with aortic distensibility (AD) and aortic stiffness index (ASI). SUBJECTS/METHODS: Forty obese children were compared to 40 matched normal-weighed children. Weight, height, and body mass index (BMI) z score and mean blood pressure (Bl-Pr) percentile on three different occasions were obtained. SPX, fasting triglycerides, cholesterol, low-density (LDL), high-density lipoproteins (HDL), and insulin were measured with calculation of the homeostatic model assessment insulin resistance (HOMA-IR). Internal aortic diameter was measured with calculation of AD, strain (AS), and ASI. RESULTS: Children with obesity had significantly lower SPX (P = 0.004), HDL (P < 0.001), and AD (P < 0.001) and higher systolic Bl-Pr (P < 0.001), diastolic Bl-Pr (P < 0.001), LDL (P = 0.011), HOMA-IR (P < 0.001), and ASI (P < 0.001). Significant negative correlation was found between SPX and BMI z score (r = -0.646, P < 0.001), systolic Bl-Pr (r = -0.641, P < 0.001), diastolic Bl-Pr (r = -0.427, P < 0.001), HOMA-IR (r = -0.349, P = 0.028), and ASI (r = -0.389, P = 0.013), while significant positive correlation was found between SPX and AS (P < 0.001, r = 0.633) and AD (P < 0.001, r = 0.612). However, no significant correlation was found between SPX and age (r = -0.01, P = 0.953), TG (r = 0.048, P = 0.767), total cholesterol (r = -0.023, P = 0.887), LDL (r = -0.299, P = 0.061), and HDL (r = 0.193, P = 0.232). CONCLUSIONS: Children with obesity had significantly lower SPX than controls. SPX was correlated with BMI, Bl-Pr, HOMA-IR, and vasculopathy in children with obesity independent of their age and lipid profile. Further studies should explore the pathomechanism of SPX and its potential role in the management of obesity and obesity-related cardiometabolic risk.

Validation of the Arabic Severe Respiratory Insufficiency Questionnaire.

BACKGROUND/OBJECTIVES: Assessment of Health-Related Quality of Life (HRQL) in patients with chronic respiratory insufficiency requiring Home Mechanical Ventilation (HMV) requires a valid measurement tool. The Severe Respiratory Insufficiency (SRI) questionnaire, originally developed in German, has been translated into different languages and tested in different contexts, but has so far not been in use in Arabic-speaking populations. The objective of this study is to validate the Arabic version of the SRI questionnaire in a sample of Arabic-speaking patients from Lebanon. METHODS: Following forward/backward translations, the finalized Arabic version was administered to 149 patients (53 males-96 females, age 69.80 ± 10 years) receiving HMV. Patients were recruited from outpatient clinics and visited at home. The Arabic SRI and the 36-Item Short-Form Health Survey (SF-36) were administered, in addition to questions on sociodemographics and medical history. Exploratory Factor Analysis (EFA) was used to explore dimensionality; internal consistency reliability of the unidimensional scale and its subscales was assessed using Cronbach's alpha. External nomological validity was examined by assessing the correlation between the SRI and SF-36 scores. RESULTS: The 49-item Arabic SRI scale showed a high internal consistency reliability (Cronbach alpha for the total scale was 0.897 and ranged between 0.73 and 0.87 for all subscales). Correlations between the SF-36-Mental Health Component MHC and SF-36-Physical Health Component with SRI-Summary Scale were 0.57 and 0.66, respectively, with higher correlations observed between the SF-36 and specific sub-scales such as the Physical Functioning and the Social Functioning subscales [r = 0.81 and r = 0.74 (P < 0.01), respectively]. CONCLUSION AND RECOMMENDATIONS: The Arabic SRI is a reliable and valid tool for assessing HRQL in patients with chronic respiratory insufficiency receiving home mechanical ventilation.

Intermittent Fasting Attenuates High-Fat Diet-Induced Cerebellar Changes in Rats: Involvement of TNF-α, Autophagy, and Oxidative Stress.

Obesity has become a prevalent global health issue, and recently it has been reported to be intimately associated with neuronal health. Obesity triggers peripheral inflammatory responses concomitant with neuroinflammation, elevated oxidative stress, and compromised autophagy. Intermittent fasting (IF) positively influences lowering body weight and improving the metabolic changes accompanying obesity. IF also has a beneficial impact on neuronal function; however, no studies have discussed this effect on high-fat diet (HFD)-induced cerebellar damage. This study examines the effect of IF on the cerebellum of HFD-fed rats. Male Wister Albino rats (n = 16) were fed HFD for 16 weeks (HFD group); half of them were subjected to IF alternating with HFD for 6 weeks starting at the 11th week till the end of the experiment (fasting + HFD group). The control group of rats (n = 8) was kept on a basal diet. The animals were euthanized after 16 weeks. Their tissue was harvested and processed for morphology using H&E, cresyl violet, and luxol fast stains, and immunohistochemical staining was carried out for inflammatory marker (TNF-α), gliosis marker (GFAP), and autophagy markers (LC3 II and P62). Oxidative stress markers (SOD, MDA) were measured, and protein expression of phosphorylated-AMP-activated protein kinase (p-AMPK) and phosphorylated-rapamycin complex (p-mTOR) in cerebellar tissue was detected via western blotting. IF mitigated HFD-induced cerebellar morphological changes, reduced cerebellar TNF-α expression, decreased oxidative stress markers, and balanced p-AMPK and p-mTOR with autophagy improvement. Moreover, a decrease in body weight and ameliorated obesity-induced metabolic changes in the serum levels of glucose, insulin, cholesterol, and triglyceride were seen. These observations suggest that IF can improve both peripheral and central changes prompted by HFD through attenuating inflammation, oxidative stress, and reestablishing the autophagy balance.

Independent of Calorie Intake, Short-term Alternate-day Fasting Alleviates NASH, With Modulation of Markers of Lipogenesis, Autophagy, Apoptosis, and Inflammation in Rats.

Non-alcoholic steatohepatitis (NASH) is a worldwide health problem. Alternate-day fasting (ADF), although thought to be aggressive, has proven safety and efficacy. We aimed to evaluate the effect of short-term ADF against already established high-fat-fructose (HFF)-induced NASH, independent of the amount of calorie intake, and to study the effect of ADF on lipogenesis, apoptosis, and hepatic inflammation. Male Sprague Dawley rats were divided into two groups: (1) negative control and (2) NASH group fed on HFF for 9 weeks, and then randomized into two subgroups of either HFF alone or with ADF protocol for 3 weeks. The ADF could improve HFF-related elevation in serum lactate dehydrogenase and could decrease the mRNA expression of lipogenesis genes; acetyl CoA carboxylase, peroxisome proliferator-activated receptor γ, and peroxisome proliferator-activated receptor α; apoptotic genes caspase-3, p53, and inflammatory cyclo-oxygenase 2; and immunohistochemical staining for their proteins in liver with upregulation of LC3 and downregulation of P62 immunoexpression. Moreover, ADF ameliorated HFF-induced steatosis, inflammation, ballooning, and fibrosis through hematoxylin and eosin, Oil Red O, and Sirius Red staining, confirmed by morphometric analysis, without significant weight loss. Significant correlation of morphometric parameters with levels of gene expression was found. These findings suggest ADF to be a safe effective therapeutic agent in the management of NASH.

Nomogram of age-specific anti-Müllerian hormone levels in healthy Egyptian females.

BACKGROUND: Anti-Müllerian hormone (AMH) is an important determinant of ovarian reserve in fertility workups in many clinical settings. Thus, we investigated the age dependent decline in AMH specific to the Egyptian population and sought to establish an age dependent reference interval parametrically. METHODS: Serum samples were collected from 841 apparently healthy women. AMH was measured using an electro-chemiluminescent technique. Box-Cox power transformation was used to make the AMH distribution Gaussian for parametric derivation of reference intervals. RESULTS: Power of 0.4 was found optimal for Gaussian transformation of AMH reference values. We demonstrate the strong negative relation between circulating AMH and female age with Spearman's correlation coefficient of rS = -0.528. Age-specific reference interval was determined for every 5 years of age from 16 to 49, and nomogram was constructed by smoothing the lines connecting adjacent lower and upper reference limits. CONCLUSION: The age-specific reference intervals and the age-AMH nomogram could be valuable in the clinical practice of in reproductive medicine. To our knowledge, this is the first study to confirm AMH levels in Egyptian females. We were able to explore age-related AMH levels specific to Egyptian females in the fertile age group and to treat skewed AMH data in a multi-step scheme using power transformation. Thus, a more accurate nomogram was constructed accommodating a profile delineated for a wide age range and a rescaled AMH axis improving its usability.

Foot characteristics and mechanics in individuals with knee osteoarthritis: systematic review and meta-analysis.

BACKGROUND: Foot characteristics and mechanics are hypothesized to affect aetiology of several lower extremity musculoskeletal conditions, including knee osteoarthritis (KOA). The purpose of this systematic review was to identify the foot characteristics and mechanics of individuals with KOA. METHODS: Five databases were searched to identify relevant studies on foot characteristics and mechanics in people with KOA. Meta-analyses were performed where common measures were found across included studies. Included studies were evaluated for data reporting quality using the STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) checklist. RESULTS: Thirty-nine studies were included in this systematic review. Two studies reported participants with KOA had statistically significantly (P < 0.05) more pronated foot postures than those without. Meta-analyses for foot progression angle (FPA) and peak rearfoot eversion angle found no difference between those with and without KOA (FPA mean difference:-1.50 [95% confidence interval - 4.20-1.21]; peak rearfoot eversion mean difference: 0.71 [1.55-2.97]). CONCLUSION: A more pronated foot posture was noticed in those with KOA. However, it was not possible to establish a relationship between other foot characteristics or mechanics in people with KOA due to heterogeneity between the included study and limited number of studies with similar measurements. There is need for identifying common measurement techniques and reporting metrics when studying the foot in those with KOA.

Mind-Mindedness and Stress in Parents of Children with Developmental Disorders.

Relations between mind-mindedness (assessed using the describe-your-child interview) and stress were investigated in parents of children with developmental disorders (ADHD, n = 51, ASD, n = 23, Down's Syndrome, n = 38, and 22q11.2 Deletion Syndrome, 22q11.2DS, n = 32) and typically-developing children (n = 89). Mind-mindedness did not differ across diagnostic groups, and mind-mindedness predicted parenting stress across groups. Parenting stress was lowest in the typically-developing and Down's Syndrome groups. Across all groups, mind-minded and positive descriptions predicted lower parenting stress, and negative descriptions predicted higher stress. In the developmental disorder groups, describing the children with reference to their disorder was negatively correlated with mind-mindedness. Results are discussed with regard to interventions for families where children have developmental disorders.

Bioenergetic signature as a target of zinc oxide nanoparticles in Ehrlich ascitic carcinoma-bearing mice.

The current study aims to evaluate the modulatory effect of zinc oxide nanoparticles (ZnO NPs) on the bioenergetic signature biomarkers in the Ehrlich ascitic carcinoma (EAC) model. To achieve this goal, 90 female albino mice were included in this study and were divided into six equal groups (n =15 per group): saline-treated group, ZnO NP-treated, EACs-bearing mice, and three groups of EACs-bearing mice treated with ZnO NPs at a dose of 20 mg/kg every other day, 10 mg/kg every other day, 10 mg/kg every day, respectively, for 14 days. The tissues from treated groups and control groups were homogenized and used for the assay of glyceraldehyde 3-phosphate dehydrogenase (GAPDH) and F1 beta subunit of adenosine triphosphate (ATP) synthase levels, as well as the determination of lactate level. The survival time of mice was improved in all ZnO NP-treated groups, especially in EACs-bearing mice treated with ZnO NPs at a dose of 10 mg/kg every other day. This improvement was associated with an increased F1 beta subunit of ATP synthase level and a decreased GAPDH level. Also, the lactate level was significantly decreased in all treated groups when compared with the untreated group. The overall effect was the increased bioenergetic signature as compared with EC.These results implied that ZnO NPs have a significant efficacy against cancer cells and they significantly increased the bioenergetic signature.

Relation of Asthma Control with Quality of Life among a Sample of Egyptian Asthmatic School Children.

BACKGROUND: Asthma is considered a chronic health illness that not only resulted in physical symptoms but also emotional effects. It is; therefore, so important to assess the quality of life of asthmatic patients besides their level of disease control. AIM: To determine the correlation of asthma control with the health-related quality of life (HRQOL) of asthmatic children in Egypt. METHODS: One hundred and twenty-eight asthmatic Egyptian children were enrolled in the study. They were subjected to asthma severity grading, asthma control questionnaire (ACQ) and pediatric asthma quality of life questionnaire (PAQLQ). Studied cases were taken from 6 primary and preparatory schools, Giza governorate. RESULTS: The mean child control score was significantly higher in not well-controlled asthmatics compared to well-controlled asthmatics (p < 0.005). The not well controlled asthmatic children showed significantly lower activity limitation score, symptoms score, and overall asthmatic score compared to controlled asthmatic children (p < 0.05). The severity of asthma shows significant positive correlation with symptoms score, emotional function score and overall asthmatic score (p < 0.05). CONCLUSION: The quality of life for the asthmatic children is strongly correlated with the level of asthma control and severity.

Pentraxin 3: A Potential Novel Predictor for Neonatal Pulmonary Hypertension.

BACKGROUND: Persistent pulmonary hypertension of the newborn (PPHN) is a serious neonatal problem which has a high mortality rate even with advanced modes of mechanical ventilation. Pentraxin 3 is one of the long pentraxins, which plays an essential role in regulation of cell proliferation and angiogenesis. AIM: This study aims to assess serum pentraxin 3 levels in neonates with pulmonary arterial hypertension and compare them in those who have other congenital heart diseases and healthy neonates. Also, we intended to evaluate serum levels of CRP as a mediator of inflammation in the studied groups. METHODS: The study is a case-control study. Cases were recruited from El Galaa Teaching Hospital, classified into three groups; each group had thirty cases. The first one: cases with pulmonary hypertension (PHT), the second one: cases with congenital heart diseases (CHD) without pulmonary hypertension and the third group included healthy neonates. All participants were subjected to full history taking and full clinical examination. Diagnosis of congenital heart disease and pulmonary hypertension was made according to echocardiographic findings by pediatric cardiologist using echocardiography machine. Laboratory investigations included measurement of serum pentraxin 3, Routine CBC, CRP. RESULTS: This study found that the mean serum pentraxin 3 in PHT neonates was significantly higher than that of the control and CHD neonates (p ≤ 0.001, p = 0.02 respectively). Also, the mean Pentraxin3 of the CHD neonates was significantly higher than that of the control (p = 0.06). Also, the mean CRP of the PHT neonates was significantly higher than that of the control (p = 0.01). Regression analysis showed that Pentraxin3 was the main predictor of PAP (P = 0.01). CONCLUSION: Serum pentraxin 3 is significantly elevated in neonates with pulmonary hypertension, so measurement of pentraxin 3 levels in neonates may be valuable as a predictor for pulmonary hypertension in neonates.

Cervical high-risk human papillomavirus infection among women residing in the Gulf Cooperation Council countries: Prevalence, type-specific distribution, and correlation with cervical cytology.

BACKGROUND: The scarcity of updated data on the prevalence of cervical human papillomavirus (HPV) infection in the Gulf Cooperation Council (GCC) countries hampers the establishment of cervical cancer screening and HPV vaccination programs. The current study estimated the prevalence of cervical high-risk (HR) HPV infection among women residing in some countries of the GCC and analyzed the correlation between HR-HPV infection types and cytology results. METHODS: In total, 2478 women residing in the Kingdom of Saudi Arabia, Qatar, the United Arab Emirates, and Bahrain were enrolled in this study. Cervical specimens were subjected to simultaneous liquid-based cytology and HR-HPV DNA analysis. RESULTS: Of 2478 women, 520 (21%) tested positive for HR-HPV. Other non-HPV genotype 16 (HPV16)/HPV18 HR-HPV was the most frequently detected infection type, accounting for 63.7%. Non-Arab women had a significantly higher HR-HPV positivity rate compared with Arab women (31.6% vs 16.4%; P < .001). The HR-HPV positivity rate was highest among women residing in Qatar (31.3%), followed by women living in Bahrain (20%), the Kingdom of Saudi Arabia (17.2%), and the United Arab Emirates (14.7%). The overall prevalence of HR-HPV infections declined significantly with advancing age (P < .001). Women with abnormal cytology had a significantly higher HR-HPV positivity rate than those with normal cytology (50.6% vs 14.7%; P < .001). The HR-HPV positivity rate increased as the severity of the cytological lesion increased. CONCLUSIONS: The current study provides updated data on HR-HPV prevalence in the GCC countries and delivers an evidence base for supporting the introduction of regional/national vaccination and screening programs in these countries.

Luteolin and 5-flurouracil act synergistically to induce cellular weapons in experimentally induced Solid Ehrlich Carcinoma: Realistic role of P53; a guardian fights in a cellular battle.

BACKGROUND: Solid Ehrlich Carcinoma (SEC) is an undifferentiated tumor used in tumor studies and chemotherapy investigations. AIM: to assess the anti-tumor potential of luteolin when used either alone or combined to 5-fluorouracil (5-FU) against SEC. METHOD: SEC was induced in 40 female mice; they were categorized into 4 equal groups; group I (untreated SEC), group II (5-FU treated SEC), group III (luteolin treated SEC) and group IV (5-FU + luteolin treated SEC). Tumor volume and weight were calculated. P53, p21, caspase 3 and damage regulated autophagy modulator (DRAM) were assessed. Biomarkers of oxidant/antioxidant status in addition to immunohistochemistry for cylin D1 were evaluated. RESULTS: combined administration of luteolin and 5-FU in SEC model increased levels of p53, p21, caspase 3, DRAM and survivability while, tumor volume, weight, thioredoxin reductase one (TR1) activity and cyclin D1 expression showed the reverse with restoration of oxidant/antioxidant indices. CONCLUSION: current results proved the antitumor therapeutic effects of luteolin alone or combined with 5-FU as a novel strategy for cancer therapy.

Serum Apelin: A New Marker of Early Atherosclerosis in Children with Type 1 Diabetes Mellitus.

INTRODUCTION: Type 1 diabetes mellitus (T1DM) is one of the most common chronic diseases in children that may be complicated by micro or macrovascular complications. Measurement of the carotid intima-media thickness (CIMT) allows the early detection of atherosclerotic alterations of blood vessels that may complicate T1DM. SUBJECTS AND METHODS: This study is a case-control study. Participants were classified into two groups. The first group included 40 children with T1DM and the second group included 30 matched healthy controls. The studied cases were recruited from Endocrinology and Diabetology Unit, Pediatric Hospital, Ain Shams University. Serum apelin, cholesterol, TG, LDL were measured for every case. Also, albumin level was analyzed in urine. Measurement of the carotid intima-media thickness (CIMT) was done for all cases. RESULTS: Comparison between T1DM patients and controls revealed that serum apelin, cholesterol, TG, LDL and albuminuria were significantly increased in cases compared to controls. Significant positive correlations were detected between HbA1C, albuminuria and lipid profile with apelin in the diabetic group (p < 0.05). CIMT has significant positive correlation with serum apelin levels (r = 0.36, p = 0.05). Also, this study found positive correlations between CIMT and some variables as LDL, SBP z-score and duration of the illness. CONCLUSION: Increased levels of serum apelin in T1DM patients may be considered as predicting factor for the ongoing development of vascular sequels. This study highlighted the possible validity of apelin assay as an early predictor of atherosclerosis in T1DM children. Evaluating CIMT in these patients is of at most important for early detection of subclinical atherosclerosis.

Emotions in labour: Italian obstetricians' experiences of presence during childbirth.

OBJECTIVE: The present study represents a qualitative research aimed to explore the obstetricians' psychological experiences of birth. BACKGROUND: During labour the role of obstetricians assumes a fundamental importance in hospitalised childbirth. However, literature analysis has shown that the psychological side of birth has been investigated only considering the woman's and midwife's points of view. The obstetricians' psychological experiences have not been considered enough and only a few studies at a quantitative level have been performed. METHODS: Seven focus groups for a total of 72 obstetricians were conducted in hospital contexts in Italy. The qualitative methodology of grounded theory was adopted. FINDINGS: The results were divided into three different core themes: obstetricians' approaches to delivery, critical aspects about relationships in the delivery room, and obstetricians' feelings and emotions in the delivery room. Each theme was subdivided into different subthemes. CONCLUSION: The results highlight different ways obstetricians approach their profession, the complex and multifaceted relationship with the woman and the extraordinary variety of feelings and emotions, which enrich, but also may complicate, life in the delivery room. Further studies could provide more details to help researchers to develop new and more effective strategies to support obstetricians' training and work.

Effect of cerebrolysin on the cerebellum of diabetic rats: An imunohistochemical study.

BACKGROUND: Diabetes mellitus represents one of the disorders in the metabolism that affects all body systems including CNS. Cerebrolysin contains many neurotrophic factors, and many studies reported that it can be used treatment of many neurological disorders. AIM OF THE WORK: The aim of the current study was to study the potential neuroprotective effect of cerebrolysin on the cerebellum of diabetic rat. MATERIALS AND METHODS: Sprague Dawley male rats were divided randomly into four groups: control, cerebrolysin (Cbl), diabetes and diabetes treated with Cbl groups. Induction of diabetes was performed by intraperitoneal injection of 60mg/kg streptozotocin once. Eight weeks later, the rats were anaesthetized, sacrificed and the cerebellum was removed. Cerebellum oxidative stress markers were analysis. Cerebellar tissue was subjected to histolopathological examination and immune-histological assessment of GFAP and Synaptophysin. RESULTS: As compared to the control group, diabetes caused degenerative changes in the cerebellum with significant elevation of MDA and decrease of SOD levels and gliosis confirmed by increase the GFAP expression area fraction. Diabetes increased significantly the optical density of synaptophysin expression with increase in its area fraction in the granular layer. Although Cbl treatment succeeded in minimizing the changes in the oxidative stress markers, it had no effect on pathological changes of the diabetic cerebellum. Cerebrolysin treatment of diabetic rats decreased the area fraction of GFAP positive immunoreactivity and had no effect on synaptophysin expression. CONCLUSION: Cerebrolysin can potentially protect against diabetes induced changes in the cerebellum through minimizing the oxidative stress and improving the gliosis.

Influence of Interleukin-6 (174G/C) Gene Polymorphism on Obesity in Egyptian Children.

BACKGROUND: Obesity is a multi-factorial chronic disorder. A considerable number of studies have been performed to figure out whether there is an association between obesity and polymorphisms of gene IL-6 (174G/C), but the results are equivocal. AIM: This study aimed to find out whether the IL-6 (174G/C) gene was associated with the risk of developing obesity in Egyptian children. SUBJECTS AND METHODS: The study included 149 children and adolescents with age ranged between 9.5 - 18 years. Eighty-five of them were obese which BMIZ-score is > 2, and sixty-four children with BMIZ-score ≤ 2 served as control group. Serum level of IL-6 and genetic analysis for IL-6 (174G/C) gene polymorphism were done. RESULTS: Obese children had significantly higher serum levels of IL-6 as compared to those of control children (P = 0.003). A high percentage of IL-6 polymorphism GC was found in obese subjects (93.7%), while the control group had a higher percentage of IL-6 polymorphism GG (70.6 %). CONCLUSION: Our study showed that carriers of the C allele for the IL-6 (174G/C) polymorphism have higher BMI. As the G174C polymorphism is likely to affect IL-6 expression and its physiological regulation; consequently this polymorphism may affect adiposity.