Current Animal Models of Postoperative Spine Infection and Potential Future Advances.

Implant related infection following spine surgery is a devastating complication for patients and can potentially lead to significant neurological compromise, disability, morbidity, and even mortality. This paper provides an overview of the existing animal models of postoperative spine infection and highlights the strengths and weaknesses of each model. In addition, there is discussion regarding potential modifications to these animal models to better evaluate preventative and treatment strategies for this challenging complication. Current models are effective in simulating surgical procedures but fail to evaluate infection longitudinally using multiple techniques. Potential future modifications to these models include using advanced imaging technologies to evaluate infection, use of bioluminescent bacterial species, and testing of novel treatment strategies against multiple bacterial strains. There is potential to establish a postoperative spine infection model using smaller animals, such as mice, as these would be a more cost-effective screening tool for potential therapeutic interventions

An economic assessment of the Ramsar site of Massa (Morocco) with travel cost and contingent valuation methods

As the only protected area in the whole south west of Morocco, the Souss Massa National Park (SMNP) is characterized by a remarkable biodiversity, with more than 300 plants species, 250 bird species, 20 mammal species and also by the high diversity of its ecosystems, such as the Aragnia spinosa forest, steppes, dunes and coastal wetlands. This park can play a leading role in the region by enhancing its ecotourism potential and therefore contributing to its economic development. We intended to demonstrate in this study, by estimating the recreational value, one popular area, the RAMSAR site of the Estuary of Massa River (EOM). It is located 50 km from the urban center of Agadir City and it attracts about 30,000 visitors a year. To determine its recreational value, the contingent valuation method and travel cost method were applied. The results from 480 surveys, conducted during 2010, showed that the consumer surplus per person per visit is estimated at DH 490,196 ($US 65.36) and the willingness to pay per visitor is about DH 46,523 ($US 6.20). According to this economic valuation, any future local development must take into account, the opportunity that EOM offers as a recreational site, with high ecotourism potential.Key words: Estuary of Massa River, recreational value, contingent valuation, travel cost method, willingness to pay, consumer surplus

Prevalence and clinical value of IgA and hidden rheumatoid factors in juvenile rheumatoid arthritis

Background: Juvenile rheumatoid arthritis (JRA) is so difficult to be diagnosed early and a small subgroup of patients has positive IgM rheumatoid factor (RF) detected by the standard agglutination techniques.Objective: To investigate the prevalence of IgA and hidden RFs among patients with JRA, to evaluate their diagnostic value in comparison to classic RF and to outline their relation to disease activity, severity as well as to therapy.Methods: The study included 46 patients with JRA (31 females and 15 males). Thirty patients had polyarticular JRA, 9 had oligoarticular JRA and 7 had systemic-onset JRA. Twelve patients had active disease. Thirteen systemic lupus erythematosus patients and 32 healthy subjects were studied as controls. Evaluation was carried out clinically and radiologically (using modified Larsen scoring). Laboratory investigations included CBC, ESR, classic IgM RF (latex agglutination), ANA (indirect  immunofluorescence), IgA-RF (ELISA) and hidden RF seropositivity (ion exchange chromatography).Results: All JRA patients had significantly higher IgA-RF (121.5 ± 195.4 mg/dL) and positivity of hidden RF (56.5%) than lupus (14 ± 6.6 mg/dL and 7.7% respectively) and healthy controls (13.7 ± 6.2 mg/dL and 0% respectively). Classic IgM RF had only 10.9% sensitivity in diagnosing JRA. IgA and hidden RFs had higher sensitivities (50% and 56.5% respectively). Specificity, positive and negative predictive values of IgA-RF were 97.7%, 95.8% and 65.7% and for hidden RF, they were 95.5%, 92.9% and 68.3%. Interestingly, combined positivity of IgA and hidden RFs had 100% specificity and positive predictive value for JRA. Classic RF did not correlate with disease activity and severity in terms of ESR, activity score and Larsen Index. In contrast, patients with active disease had significantly higher value of IgA-RF and positivity of hidden RF than those with quiescent disease. Also, IgA-RF had significant positive correlation with ESR, activity score and Larsen index. Similarly, patients with positive hidden RF had significantly higher values of ESR, activity score and Larsen index than those with negative hidden RF. Steroid therapy was associated with significantly higher level of IgA-RF and positivity of hidden RF, perhaps related to disease severity.Conclusion: IgA and hidden RFs are more sensitive tests in diagnosing JRA than classic IgM RF. Also, the combined positivity of IgA and hidden RFs can confirm the diagnosis of JRA in doubtful cases. The fact that IgA and hidden RFs gave positive results in the meantime that classic RF was negative, together with their significant relation to disease activity and severity highlights their clinical value as reliable laboratory markers of JRA.Key words: juvenile rheumatoid arthritis, rheumatoid factors, IgA-RF, hidden RF, SLE

EEG changes and neuroimaging abnormalities in relevance to severity of autism

Background: Autism is currently viewed as a genetically determined neurodevelopmental disorder although its defi nite underlying etiology remains to be established.Aim of the Study: Our purpose was to assess autism related morphologicalneuroimaging changes of the brain and EEG abnormalities in correlation to the degree of disease severity.Patients and Methods: Seventeen cases with classic autism, 13 males and 4 females were included in the study. Severity of the disease was assessed both clinically and by Childhood Autism Rating Scale (CARS). MRI changes and EEG abnormalities were detected in seven patients, mostly severely and moderately affected.Results: Hypoplasia of cerebellar vermian lobules is the most replicated MRI abnormality in our patients (18%). Periventricular white matter dysmyelination is detected in 12% of studied cases. 29% of the cases have EEG abnormalities. Head circumference above 97th centiles is detected in 18% of cases. The increased head circumference, when in combination with EEG abnormalities, positively correlates with the degree of disease severity. Conclusion: Although, no defi nite correlation could be established between the studied parameters and disease severity, most patients in the present study who exhibited MRI abnormality, EEG changes and/or increased head circumference (H.C) manifested severe form of autism. The absence of correlation may be attributed to lack of statistical power, resulting from small sample size. However, the correlation was not solidly excluded therefore, the recommendation of further neuroradiological evaluation as well as the implementation ofnewer techniques, might help future elucidating the etiology of autism.Keywords: Autism, MRI, EEG, brain development

Soluble TWEAK and Cardiovascular Morbidity and Mortality in Chronic Kidney Disease Patients

Introduction: Cardiovascular disease (CVD) is a major cause of morbidity and mortality in chronic kidney patients (CKD). The aim of this study was to demonstrate the role of soluble tumor necrosis factor (TNF) weak inducer of apoptosis (sTWEAK) as a marker of cardiovascular morbidity and mortality in CKD patients.Methods: The study included 75 CKD patients classified according to eGFR into three groups; group-1 included 15 patients with stage-1 CKD, group-2 included 30 patients with stage-2 and stage-3 CKD, and group-3 included 30 patients with stage-4 and stage-5 CKD. The three groups were compared to 20 matched controls. Interleukin-6 (IL-6) and sTWEAK were measured using ELISA and chemiluminescent techniques respectively. Carotid intima-media thickness (IMT) was also measured.Results: We found that IL-6 showed significant difference between patient groups and controls, being highest in stage 4 and 5 CKD patients and lowest in controls. Soluble TWEAK showed significant difference between patient groups and controls, being lowest in stage 4 and 5 CKD patients and highest in controls. Soluble TWEAK level showed significant negative correlation with IL-6 (r = -0.68; P<0.01) and carotid IMT (r = -0.95; P<0.01). After two years follow up, nine out of 75 CKD patients developed ischemic heart disease (IHD). Two patients developed cerebrovascular stroke and another patient developed peripheral arterial disease. These patients had significantly lower levels of sTWEAK at baseline compared to other patients (160.5± 60.2 versus 274.8±90 pg/mL; P < 0.05).Conclusion: Soluble TWEAK can be a novel biomarker of atherosclerosis and endothelial dysfunction as well as cardiovascular outcome in CKD patients

Angiogenic output in viral hepatitis, C and B, and HCV-associated hepatocellular carcinoma

Introduction: Angiogenesis is known to play a pivotal role in most of malignancy, including HCC, and in chronic inflammation.Aim: To investigate the angiogenic output in HCV and HBV infection and its implication in the development of HCV associated HCC.Materials and methods: Blood samples were collected and grouped as; HS healthy subjects control group; HCC–HCV; chronic HCV infected patient group (HCV+ve) who are positive for serum anti-HCV antibodies and HCV–RNA; anti-HCV antibody positive and HCV–RNA negative patient group (HCVve); patients with positive HBsAg and HBV-DNA group (HBV+ve); and HBsAg positive and HBV-DNA negative patient group (HBVve). Serum levels of vascular endothelial growth factor, angiopoietin-2, endostatin and angiostatin were assessed in different studied groups.Results: The level of sVEGF was insignificantly elevated in both HCV+ve and HCVve groups when compared with controls, while Ang-2, sES and sAS were significantly elevated in both groups as compared with healthy controls. The studied parameters were significantly elevated in HBV-+ve patients when compared with the control. However, HBVve patients showed significantly elevated levels in sAng-2, sES and sAS when compared with the control while the level of sVEGF was equal to that of controls. In patients with HCC, the studied parameters showed a significant elevation when compared with healthy controls and patients either with HBV or HCV infection except for sAS in the case of HCV-+ve patients and VEGF for HBV-+ve patients who were also higher but not significant.Conclusion: The increased hepatic angiogenesis in chronic HCV and HBV could provide the molecular basis for liver carcinogenesis and contribute to the increased risk of HCC in patients with cirrhosis due to HCV and/or HBV.KEYWORDS Angiogenesis; HCC; HCV; HB

Pleiotropic Effects of Tetracyclines in the Management of COVID-19: Emerging Perspectives

Coronavirus disease 2019 (COVID-19) is a global infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Approximately 15% of severe cases require an intensive care unit (ICU) admission and mechanical ventilation due to development of acute respiratory distress syndrome (ARDS). Tetracyclines (TCs) are a group of bacteriostatic antibiotics, like tetracycline, minocycline, and doxycycline, effective against aerobic and anaerobic bacteria as well as Gram-positive and Gram-negative bacteria. Based on available evidences, TCs may be effective against coronaviruses and thus useful to treat COVID-19. Thus, this review aims to provide a brief overview on the uses of TCs for COVID-19 management. SARS-CoV-2 and other coronaviruses depend mainly on the matrix metalloproteinases (MMPs) for their proliferation, cell adhesion, and infiltration. The anti-inflammatory mechanisms of TCs are linked to different pathways. Briefly, TCs inhibit mitochondrial cytochrome c and caspase pathway with improvement of lymphopenia in early COVID-19. Specifically, minocycline is effective in reducing COVID-19–related complications, through attenuation of cytokine storm as apparent by reduction of interleukin (IL)-6, IL-1, and tumor necrosis factor (TNF)-a. Different clinical trials recommend the replacement of azithromycin by minocycline in the management of COVID-19 patients at high risk due to two main reasons: 1) minocycline does not prolong the QT interval and even inhibits ischemia-induced arrhythmia; 2) minocycline displays synergistic effect with chloroquine against SARS-CoV-2. Taken together, the data presented here show that TCs, mainly doxycycline or minocycline, may be potential partners in COVID-19 management, derived pneumonia, and related complications, such as acute lung injury (ALI) and ARDS.The authors thank all members of the College of Medicine, Al-Mustansiyria University. NC-M acknowledges the Portuguese Foundation for Science and Technology under the Horizon 2020 Program (PTDC/PSI-GER/28076/2017)

Tuberculosis in Sudan: a study of Mycobacterium tuberculosis strain genotype and susceptibility to anti-tuberculosis drugs

BACKGROUND: Sudan is a large country with a diverse population and history of civil conflict. Poverty levels are high with a gross national income per capita of less than two thousand dollars. The country has a high burden of tuberculosis (TB) with an estimated 50,000 incident cases during 2009, when the estimated prevalence was 209 cases per 100,000 of the population. Few studies have been undertaken on TB in Sudan and the prevalence of drug resistant disease is not known. METHODS: In this study Mycobacterium tuberculosis isolates from 235 patients attending three treatment centers in Sudan were screened for susceptibility to isoniazid, rifampicin, ethambutol and streptomycin by the proportion method on Lowenstein Jensen media. 232 isolates were also genotyped by spoligotyping. Demographic details of patients were recorded using a structured questionnaire. Statistical analyses were conducted to examine the associations between drug resistance with risk ratios computed for a set of risk factors (gender, age, case status--new or relapse, geographic origin of the patient, spoligotype, number of people per room, marital status and type of housing). RESULTS: Multi drug-resistant tuberculosis (MDR-TB), being resistance to at least rifampicin and isoniazid, was found in 5% (95% CI: 2,8) of new cases and 24% (95% CI: 14,34) of previously treated patients. Drug resistance was associated with previous treatment with risk ratios of 3.51 (95% CI: 2.69-4.60; p < 0.001) for resistance to any drug and 5.23 (95% CI: 2.30-11.90; p < 0.001) for MDR-TB. Resistance was also associated with the geographic region of origin of the patient, being most frequently observed in patients from the Northern region and least in the Eastern region with risk ratios of 7.43 (95%CI:3.42,16.18; p: < 0.001) and 14.09 (95%CI:1.80,110.53; p:0.026) for resistance to any drug and MDR-TB. The major genotype observed was of the Central Asia spoligotype family (CAS1_Delhi), representing 49% of the 232 isolates examined. CONCLUSIONS: We conclude that emergence of drug resistant tuberculosis has the potential to be a serious public health problem in Sudan and that strengthened tuberculosis control and improved monitoring of therapy is needed. Further surveillance is required to fully ascertain the extent of the problem

4-Thioxo-3,5-dithia-1,7-hepta­nedioic acid

The complete molecule of the title compound, C5H6O4S3, is generated by crystallographic twofold symmetry with the C=S group lying on the rotation axis. The molecules are linked through weak hydrogen-bond contacts by glide-plane operations to form R 2 2(20) rings and ladder-like C(4) chains along the c axis