Impact of mhGAP-IG training on primary care physicians' knowledge of mental, neurological and substance use disorders in Iraq.

To address the growing need for good-quality mental health service provision to patients in Iraq, mhGAP-IG 2.0 training in mental, neurological and substance use (MNS) disorders was delivered for primary care physicians in May-June 2022 by the Royal College of Psychiatrists (RCPsych) volunteers scheme. An innovative hybrid model was used to deliver this training to improve engagement compared with virtual training alone. Pre- and post-training assessment tools showed a significant improvement in participants knowledge of MNS disorders. Follow-up fortnightly supervision sessions by RCPsych volunteers were planned to help participants consolidate their learning in managing MNS disorders.

Biofertilizer effect of some zinc dissolving bacteria free and encapsulated on Zea mays growth.

Crop nutrition depends on zinc for enzymatic, oxidative, and metabolic processes. In the current study 20 different bacteria were isolated from five soil samples collected from different fields in Egypt. Bacterial isolates were screened for their ability to solubilize insoluble zinc oxide and zinc carbonate. The ability of selected isolates to tolerate soluble zinc was determined using different concentrations of (ZnSO4). Three bacterial isolates were selected with efficiency in solubilizing zinc oxide and zinc carbonate while tolerating high levels of soluble zinc. Molecular identification by 16S rRNA sequencing of the chosen isolates identified them as B3 (Acinetobacter calcoaceticus), B5 (Bacillus proteolyticus) and C6 (Stenotrophomonas pavanii). Sodium alginate beads formulated with the isolated bacteria were tested for stability under different storage conditions for 3 months. A pot experiment was conducted to study and compare the effect of using chosen isolates as an in vivo Zn solubilizer with amended ZnCO3 either alone or embedded in beads as carrier in the soil and its effect on growth parameters of Zea mays after 2 months. There was an increase in Zn uptake in all treatments compared to the control. However, plants grown in a pot treated with ZnCO3 and Acinetobacter calcoaceticus showed the highest zinc content and plant dry weight as compared to the control. Finally, selected isolates in both free and encapsulated forms showed improved plant growth parameters and higher zinc content and can be applied as biofertilizers to enhance soil fertility.

De Novo Hepatocellular Carcinoma in Hepatitis C-Related Cirrhosis: Are Advanced Glycation End Products a Key Driver?

Background and Purpose: The advanced glycation end products (AGEs) have been implicated in different diseases' pathogenesis, but their role in hepatocellular carcinoma (HCC) is still a matter of debate. This study aims to investigate the association of AGEs with HCC development in patients with hepatitis C-related cirrhosis. Methods: Only 153 of the 181 non-diabetic patients with cirrhosis were consecutively involved in this pilot cohort prospective study, along with 34 healthy control participants. Demographic characteristics, biochemical parameters, clinical data, and AGEs levels in all subjects at the starting point and every year after that for two years were assessed. Multivariable Cox regression analysis was used to settle variables that could predict HCC development within this period. Results: HCC developed in 13 (8.5%) patients. Univariate Cox regression analysis reported that body mass index (P=0.013), homeostatic model assessment-insulin resistance (P=0.006), alpha-fetoprotein (P <0.001), and AGEs levels (P <0.001) were related to HCC development. After adjusting multiple confounders, the multivariable Cox regression model has revealed that AFP and AGEs were the powerful parameters related to the HCC occurrence (all P<0.05). AGEs at a cutoff value of more than 79.6 ng/ml had 100% sensitivity, 96.4% specificity, and 0.999 area under the curve (all P<0.001), using the receiver operating characteristic curve, for prediction of HCC development. Conclusion: This work suggests that AGEs are associated with an increased incidence of HCC, particularly in cirrhosis, which is encouraging in decreasing the risk of HCC in these patients.

De novo Portal Vein Thrombosis in Non-Cirrhotic Non-Alcoholic Fatty Liver Disease: A 9-Year Prospective Cohort Study.

Background and Aims: Approximately 30-40% of portal vein thrombosis (PVT) remains of unknown origin. The association between non-alcoholic fatty liver disease (NAFLD) and PVT is a matter of debate. This study aimed to investigate the association between PVT and NAFLD. Methods: We included 94 out of 105 consecutive NAFLD patients in this prospective cohort study in addition to 94 from the healthy control group. We evaluated biochemical, clinical, immunological, and histopathological parameters; waist circumference (WC); leptin; adiponectin; and leptin/adiponectin ratio (LAR) for all participants at baseline and every 3 years thereafter. We described the characteristics of participants at baseline and showed individual WC, LAR, and PVT characteristics. Potential parameters to predict PVT development within 9 years were determined. Results: PVT developed in eight (8.5%) patients, mainly in the portal trunk. Univariate analysis showed three PVT-associated factors: diabetes mellitus (P = 0.013), WC (P < 0.001), and LAR (P = 0.002). After adjusting multiple confounding variables, the multivariate model showed that the only significant variables were WC and LAR. By applying the receiver operating characteristic curve, WC had 98.8% specificity, 87.5% sensitivity, and 0.894 area under the curve (AUC) for prediction of PVT (P < 0.001) at cutoff values of > 105 cm. In comparison, LAR had 60.5% specificity, 87.5% sensitivity, and 0.805 AUC for PVT prediction (P < 0.001) at cutoff values of >7.5. Conclusions: This study suggests that increased central obesity and LAR were independently associated with PVT development in non-cirrhotic NAFLD patients, and they should be considered risk factors that may participate in PVT multifactorial pathogenesis.

Interrelationship between Toll-like receptors and infection after orthotopic liver transplantation.

Early microbial recognition by the innate immune system is accomplished by Toll-like receptors (TLRs), with resultant initiation of a pro-inflammatory response against infecting organisms. In spite of presence of an abundance of Toll-like receptors on the surface of the liver, gut bacteria does not elicit an inflammatory reaction in healthy individuals due to tolerance to these TLRs, suggesting that the inflammatory responses seen in the liver are the result of breakdown of this tolerance. While orthotopic liver transplantation is often life saving in many instances, death following this procedure is most commonly due to infection that occurs in up to 80% of transplant recipients, most commonly due to microbial causes in up to 70% of cases and viral infections in 20%, while fungal infections affect only 8% of cases. The probability of acquiring infection following hepatic transplantation is heightened due to affection of the innate immune defense mechanisms of the host following this procedure. Single nucleotide polymorphisms of TLRs have been associated with increased likelihood of either development of post-transplant infection or eradication of infecting organism. However, conflicting reports from other studies reveal that prevalence of this single nucleotide polymorphism is not increased in infected patients.