ECONOMIC EVALUATION OF IMIPENEM-CILASTATIN VERSUS DORIPENEM IN VENTILATORASSOCIATED PNEUMONIA IN EGYPT

Objective: One of the most common complications of critical illness among surgical and trauma patients is ventilator-associated pneumonia (VAP). The mortality rate increases due to inappropriate empiric treatment of VAP. The rates of Pseudomonas aeruginosa (PA) VAP susceptibility to doripenem (DOR) are higher than those to imipenem-cilastatin (IMI). Cost-effectiveness analysis was developed to define outcome differences between strategies of empiric treatment of VAP with DOR versus IMI in Egyptian patients.Methods: A cost-effectiveness model was designed comparing empiric treatment of VAP with DOR versus IMI from the health insurance perspectives. The differences in the total costs and quality-adjusted life years (QALYs) under each scenario were examined, and sensitivity analyses were conducted to determine the stability of our estimates. Drug costs were taken from health insurance hospitals, with other inputs derived from the literature.Results: Deterministic baseline results from the model of DOR compared to IMI in the treatment of VAP suggest that DOR is more effective and less expensive than IMI. The total costs for IMI and DOR were Egyptian pound (EGP) 4646.93 and EGP 4197.58, respectively. QALYs for IMI and DOR were 0.53 and 0.54, respectively.Conclusions: Given the microbiologic sensitivity profile of PA to DOR and IMI, and depending on the local susceptibility patterns in institutions where DOR in vitro susceptibilities are superior to those of other carbapenems for PA clinical isolates, empiric treatment of VAP with DOR may dominate that with IMI by being both life- and cost-saving

REVIEW ONPHARMACOKINETICS OF EMPAGLIFLOZIN, AN INHIBITOR OF THE SODIUM GLUCOSE CO-TRANSPORTER-2 (SGLT-2)

ABSTRACT Empagliflozin is an inhibitor of the sodium glucose co-transporter-2 (SGLT-2), which is found almost exclusively in the proximal tubules of nephrotic components in the kidneys. SGLT-2 accounts for about 90 percent of glucose reabsorption into the blood. Blocking SGLT-2 reduces blood glucose by blocking glucose reabsorption in the kidney and thereby excreting glucose (i.e., blood sugar) via the urine. Sodium glucose co-transporter-2 (SGLT-2) inhibitors are an optional second-line therapy after metformin; they are generally well tolerated with low risk of hypoglycemia. The various compounds differ with respect to their pharmacokinetic properties; however, their clinical efficacy appears to be similar. The clinical differences between the various compounds stem from effects other than hypoglycemic effects, their safety and side effects profile. The aim of this review was to investigate the different pharmacokinetic studies of empagliflozin in a concise way in the form of tables.Â

Antioxidant, anti-cancer and ameliorative activities of Spirulina platensis and pomegranate juice against hepatic damage induced by CCl4

Due to the excessive impact of synthetic drugs, unravelling and employing safe, natural alternatives are now needed to resolve a number of diseases. In this research, we have evaluated hepatoprotective and antioxidant activities of Spirulina platensis and pomegranate juice in rats against hepatotoxicity induced by carbon tetrachloride (CCl4). Spirulina crude carotenoid extract was screened by UPLC-MS / MS. Activities of liver marker enzymes; measured aspartate aminotransferase (AST) and alanine aminotransferase (ALT), and determined lipid peroxidation and antioxidant status as reduced glutathione (GSH) in liver homogenate. The infusion of CCl4 (2 ml/kg b.wt) greatly increases levels of liver marker enzymes and lipid peroxidation, resulting in depletion of antioxidants. Treatment of Spirulina platensis (Sp), pomegranate juice (Pj)or mixture (PJSP) of Spirulina water extract 10% and pomegranate juice 90% (1 ml/100 g b.wt) to CCl4-disrupted rats resulted in decreased activity of liver marker enzymes, lipid peroxidation with increased antioxidant status. Chromatographic separation showed that ß-carotene is the predominant carotenoid extract. This carotenoid extract was tested for colon carcinoma (HCT-116), liver carcinoma (HepG2) and intestinal carcinoma cell lines (CACO) LC50 for 21.8, 14 and 11.3 ug / ml, respectively. Total phenolic phytochemicals, total carotenoids and total flavonoids were also measured in Spirulina. Our study clearly demonstrates that Spirulina platensis and pomegranate juice had hepatoprotective effect on CCl4-caused hepatotoxicity in rats through its antioxidant activity

The role of sildenafil citrate in the treatment of fetal growth restriction: a randomized controlled trial

Background: This study was aimed to evaluate the effect of sildenafil citrate on Doppler velocity indices in patients with fetal growth restriction (FGR) associated with impaired placental circulation.Methods: A double-blinded, parallel group randomized clinical trial (clinicaltrials.gov NCT02590536) was conducted in Ain Shams Maternity Hospital, in the period between October 2015 and June 2017. Ninety pregnant women with documented intrauterine growth retardation at 24-37 weeks of gestation were randomized to either sildenafil citrate 25 mg orally every 8 hours or placebo visually-identical placebo tablets with the same regimen. The primary outcome of the study was the change in umbilical artery and fetal middle cerebral artery indices.Results: There was a significant improvement in umbilical and middle cerebral artery indices after sildenafil administration p<0.001. Present study observed that, sildenafil group, in comparison to placebo, has a significantly higher mean neonatal birth weight. 1783±241g vs 1570±455g (p<0.001). There was a significantly higher mean gestational age at delivery in women in sildenafil group 35.3±1.67 weeks, whereas it was lower in the placebo group 33.5±1.7 weeks. The side effects as headache, palpitation and facial flushing were significantly higher in sildenafil group compared to placebo group.Conclusions: The use sildenafil citrate in pregnancies with fetal growth restriction (FGR) improved the feto-placental Doppler indices (pulsatility index of umbilical artery and middle cerebral artery) and improved neonatal outcomes

Oral progesterone for the prevention of recurrent preterm birth: systematic review and metaanalysis

Objective The purpose of this study was to perform a systematic review and metaanalysis of randomized controlled trials on oral progesterone compared with placebo or other interventions for preterm birth prevention in singleton pregnancies with previous spontaneous preterm birth. The primary outcome was preterm birth at <37 weeks gestation; the secondary outcomes included preterm birth rate at <34 weeks gestation, neonatal morbidity/death, and maternal side-effects. Study Searches were performed in PubMed, Scopus, ClinicalTrials.gov, PROSPERO, EMBASE, and the Cochrane Register with the use of a combination of words related to “preterm birth,” “preterm delivery,” “progesterone,” “progestogens,” and “oral” from inception of each database to April 2018. Additionally, systematic reviews on progesterone for preterm birth prevention that were identified in our search were also reviewed for additional studies. We included all randomized trials of asymptomatic singleton gestations with previous spontaneous singleton preterm birth that had been randomized to prophylactic treatment with oral progesterone vs placebo, no treatment, or other preterm birth intervention. Exclusion criteria included quasirandomized trials, trials that involved women with preterm labor/membrane rupture at the time of randomization or multiple gestations. Study Appraisal and Synthesis Methods The risk of bias and quality of evidence were assessed for each study. All analyses were done with an intention-to-treat approach. The primary outcome was incidence of preterm birth at 30% was used to identify heterogeneity. Results The search strategy identified 79 distinct studies. Three trials on oral progesterone vs placebo (involved 386 patients: 196 in oral progesterone and 190 in placebo) met the inclusion criteria; there were no studies on oral progesterone vs other intervention that met inclusion criteria. Metaanalysis demonstrated a significantly decreased risk of preterm birth at <37 weeks gestation (42% vs 63%; P=.0005; relative risk, 0.68; 95% confidence interval, 0.55–0.84), preterm birth at <34 weeks gestation (29% vs 53%; P<.00001; relative risk, 0.55; 95% confidence interval, 0.43–0.71), and increased gestational age of delivery (mean difference, 1.71 weeks; 95% confidence interval, 1.11–2.30) with oral progesterone compared with placebo. There was a significantly lower rate of perinatal death (5% vs 17%; P=.001; relative risk 0.32; 95% confidence interval, 0.16–0.63), neonatal intensive care admission (relative risk, 0.39; 95% confidence interval, 0.25–0.61), respiratory distress syndrome (relative risk, 0.21; 95% confidence interval, 0.05–0.93), and higher birthweight (mean difference, 435.06 g; 95% confidence interval, 324.59–545.52) with oral progesterone. There was a higher rate of maternal adverse effects with oral progesterone that included dizziness (relative risk, 2.95; 95% confidence interval, 1.47–5.90), somnolence (relative risk, 2.06; 95% confidence interval, 1.29–3.30), and vaginal dryness (relative risk, 2.37; 95% confidence interval, 1.10–5.11); no serious adverse effects were noted. Conclusion Oral progesterone appears to be effective for the prevention of recurrent preterm birth and a reduction in perinatal morbidity and mortality rates in asymptomatic singleton gestations with a history of previous spontaneous preterm birth compared with placebo. There were also increased adverse effects with oral progesterone therapy compared with placebo, although none were serious. Further randomized study on oral progesterone compared with other established therapies for the prevention of recurrent preterm birth are warranted

PROTECTIVE ROLE OF POMEGRANATE JUICE BLENDED WITH WHEATGRASS AND LEMON EXTRACTS FOR RELIEVE CARBOHYDRATE INTOLERANCE

Characteristics and protective effect of pomegranate juice (PJ), lemon juice (LJ), wheatgrass juice (WGJ) and their functional blends were evaluated. Total phenolics (TP), flavonoids (TF) content as well as free radical scavenging activity were determined. Meanwhile, total acidity, pH values were determined and the organoleptic attributes were evaluated. Also, the protective effect of functional blending juice against carbohydrate intolerance in patients was investigated by hydrogen breath test.  The results revealed that the WGJ are low acidic in nature. While, the PJ and LJ showed high acidity which raised the total acidity in the functional blending juice. PJ had high content of total phenolics 17.45 mg/ml followed by 5.85 mg/ml for functional blending juice. While, the LJ showed high acidity which raised the total acidity in the in the functional blending juice. PJ had high content of total phenolics 17.45 mg/ml followed by 13.25 mg/ml for functional blending juice. While, significant increase in the TF 22.15 mg/ml in the wheatgrass juice followed by functional blending juice 5.70 mg/ml significant increase in the TF 25.25 mg /ml in the functional blending juice followed by 22.15 mg/ml for wheatgrass juice. Whereas, the results showed that functional blending juice recorded the highest antioxidant activity, which revealed great free radical scavenging activity 98.16%. Depending on sensory evaluation, the proportions of fourth blend WGJ: PJ: LJ in ratio 20:70:10 was most preferred for consumption by the panelists compared to other blending ratios.  After one month for patients group treated by functional blending juice at blinds ratio (WGJ 20: PJ 70: LJ 10), showed a significant decrease in the concentration of the hydrogen level in the exhalation air to reach a significant level of the control patients group, indicating the ability of the active compounds in functional blending juice to relieve the problems of carbohydrate intolerance. Accordingly, healthy promoting beverages can be produced by addition blending of pomegranate juice, lemon juice and wheatgrass juice

FOURIER TRANSFORM INFRARED SPECTROSCOPY TECHNIQUE FOR DETECTION OF HONEY AUTHENTICATION

Physico-chemical properties of honey and honey samples adulterated with glucose or sucrose were determined. Total soluble solids (TSS), pH and electrical conductivity of honey and its adulterated samples ranged between (84.10-84.50%), (3.80-4.63) and (11.73 – 232.32µS), respectively. Sensory properties of honey and its adulterated samples showed that, no differences in the sensorial properties were found in authentic honey and honey adulterated with 25% sucrose or 25% glucose. Increasing adulteration ratio to 50% glucose decreased taste, flavor, color and general appearance, while adulterated honey with 50% sucrose caused significant decrease in taste and general appearance. The possibility of using HPLC to detect adulteration of honey through determining their sugars content was evaluated. The obtained results indicated that, authentic honey was characterized with its higher fructose/glucose ratio (1.21) compared to adulterated honey samples (ranged between 0.35 - 0.94). FT-IR spectroscopic technique was used to evaluate honey quality. Reliability FT-IR for quantitative and qualitative analysis of sucrose, glucose and fructose were evaluated.  The main FT-IR spectral bands of sucrose, glucose and fructose were identified at different concentration levels. The relationship between sugars concentration (sucrose, glucose and fructose) and its spectral bands absorbance (peak height) were evaluated to prepare sugars standard curves and their linear equations. Selected main peaks of sucrose, glucose and fructose provide the best calibration model with correlation coefficient (r2) higher than (0.9). Honey samples adulterated with glucose were characterized with specific spectral peaks, in which the absorbance was increased by increasing the ratio of adulteration with glucose at 1087, 1105, 1189 and 984 cm-1, while the adulteration with sucrose lead to increase in the absorbance of spectral bands of sucrose as 1054, 1149 and 984 cm-1 especially in honey adulterated with 50 % sucrose

POTENTIAL EFFECTS OF SOME NATURAL DIETARY SUPPLEMENTS ON ANTHROPOMETRIC CHARACTERISTICS AMONGST WEIGHTLIFTER ATHLETES

This work was carried out to study the effect of using some natural dietary supplements; i.e. powders of date palm pits and pollen, ginseng roots, moringa leaves and royal jelly which giving orally in capsule to improve endurance of weightlifter athletes throughout 12 weeks in camp of sport Championship Sector belongs to the Armed Forces, Ministry of Defense, Future City, Cairo, Egypt. Collecting data showed that the suggested dietary supplement capsule had the highest value of the antioxidant activity (96.3%) and significant increases in total phenolic and flavonoids content (52.42 & 63.1 mg/g, respectively). Also, the anthropometric measurements showed a significant increase in weight and height in males compared to females. likewise, waist and mid upper arm circumference had significant increases in males compared to females, Male weightlifter athletes had significant muscles mass bigger than female one, and the fat mass for male was assessed as ‘‘Fitness’’ which ranged between (14 and 17%) but the female had fat mass that assessed as ‘‘Athletes’’ which ranged between (14 and 20%). The weights lifting by male and female increased during three months, and also revealed a significant increase in the efficiency of males in lifting weights higher than in the females during the period of 12 weeks. Thus, the results indicated that by incorporating natural dietary supplement powders in suggesting capsule, it is possible to enhance the performance of weightlifter athletes

Giant confinement of excited surface electrons in a two-dimensional metal-organic porous network

Two-dimensional metal-organic porous networks (2D-MOPNs) are highly ordered quantum boxes for exploring surface confinements. In this context, the electron confinement from occupied Shockley-type surface states (SS) has been vigorously studied in 2D-MOPNs. In contrast, the confinement of excited surface states, such as image potential states (IPSs), remains elusive. In this work, we apply two-photon photoemission to investigate the confinement exemplarily for the first image state in a Cu-coordinated T4PT porous network (Cu-T4PT). Due to the lateral potential confinement in the Cu-T4PT, periodic replicas of the IPS as well as the SS are present in a momentum map. Surprisingly, the first IPS transforms into a nearly flat band with a substantial increase of the effective mass (> 150 %), while the band dispersion of the SS is almost unchanged. The giant confinement effect of the excited electrons can be attributed to the wavefunction location of the first IPS perpendicular to the surface, where the majority probability density mainly resides at the same height as repulsive potentials formed by the Cu-T4PT network. This coincidence leads to a more effective scattering barrier to the IPS electrons, which is not observed in the SS. Our findings demonstrate that the vertical potential landscape in a porous architecture also plays a crucial role in surface electron confinement