The effect of fluoxetine and imipramine on the improvement of depressive-like behaviors and HPA axis (hypothalamic-pituitary-adrenal cortex) activity – an animal model

Depression is one of the most common mental disorders and numerous medications are used to reduce the psychotic symptoms. The aim of this study was to evaluate the therapeutic effects of two commonly used antidepressant drugs, including Fluoxetine (Flx) and Imipramine (IMP) to improve depressive-like behaviors as well as the activity of hypothalamic pituitary-adrenal cortex (HPA). Methods: Initially, 40 adult male albino rats weighing 25±5g were selected for this experimental study. The animals were kept or housed in separate cages under standard temperature (25±1°C) and light-dark conditions (12 hours light/dark cycle). Rats were divided into four groups: each group containing 10 rats, control, immobility stress, Flx receiver, and IMP receiver. Polyethylene restrainer was used to induce immobility stress for 14 days. Finally, the parameters of IMT, ST, serum levels of corticosterone and glucose were evaluated in all four mentioned groups. Results: The results showed that the patient group's immobility time (IMT) increased compared to the control group, but the patient group's swimming time (ST) decreased compared to the control group. The effect of immobility stress on IMT, ST, corticosterone, and glucose factors in the patient group was increasing and decreasing, respectively, whereas the effect of Flx drug on these mentioned factors was decreasing, increasing and respectively, while the effect of IMP on all mentioned factors was decreasing and increasing, respectively. Conclusion: Based on the results, it can be concluded that the antidepressant Flx and IMP drugs have various effects on the HPA activity, and the application of immobility stress causes depressive-behavior. Moreover, Flx is more effective than IMP in the treatment of depressive behaviorsДепрессия является одним из самых распространенных психических расстройств, и для уменьшения психотических симптомов используются многочисленные лекарства. Целью этого исследования была оценка терапевтических эффектов двух широко используемых антидепрессантов, включая флуоксетин (Flx) и имипрамин (IMP), для улучшения депрессивного поведения, а также активности оси гипоталамо-гипофизарно-надпочечников (HPA). Методы: Сначала для этого экспериментального исследования было отобрано 40 взрослых самцов крыс-альбиносов весом 25±5 г. Животных содержали в отдельных клетках при стандартной температуре (25±1°C) и условиях свет-темнота (12-часовой цикл свет/темнота). Крысы были разделены на четыре группы: каждая группа содержала 10 крыс, контрольную группу, группа иммобилизационного стресса, группа, получавшая Flx и группа, получавшая IMP. Полиэтиленовый фиксатор использовался для создания иммобилизационного стресса в течение 14 дней. Наконец, параметры IMT, ST, сывороточные уровни кортикостерона и глюкозы оценивали во всех указанных четырех группах. Результаты: Результаты показали, что время недвижимости (IMT) в группе пациентов увеличилось по сравнению с контрольной группой, но время плавания (ST) в группе пациентов уменьшилось по сравнению с контрольной группой. Влияние иммобилизационного стресса на факторы IMT, ST, кортикостерон и глюкозы в группе иммобилизованных пациентов увеличивалось и уменьшалось соответственно, тогда как влияние препарата Flx на эти факторы уменьшалось, увеличивалось и усиливалось, соответственно, тогда как влияние IMP на все упомянутые факторы соответственно, уменьшался и усиливался. Вывод: Основываясь на полученных результатах, можно сделать вывод, что антидепрессанты Flx и IMP оказывают разное влияние на активность HPA, а применение иммобилизационного стресса вызывает депрессивное поведение. Кроме того, Flx более эффективен, чем IMP, в лечении депрессивного поведения.Депресія є одним з найпоширеніших психічних розладів, і для зменшення психотичних симптомів використовуються численні ліки. Метою цього дослідження була оцінка терапевтичних ефектів двох широко використовуваних антидепресантів, включаючи флуоксетин (Flx) та іміпрамін (IMP), для покращення депресивної поведінки, а також активності гіпоталамо-гіпофізарно-надниркової кори (HPA). Методи: Спочатку для цього експериментального дослідження було відібрано 40 дорослих самців щурів-альбіносів вагою 25±5 г. Тварин утримували в окремих клітках при стандартній температурі (25±1°C) та умовах світло-темря (12-годинний цикл світло/темрява). Щури були розділені на чотири групи: кожна група містила 10 щурів, контрольну групу, група іммобілізаційного стресу, група, що отримувала Flx та група, що отримувала IMP. Поліетиленовий фіксатор використовувався для створення іммобілізаційного стресу протягом 14 днів. Нарешті, параметри IMT, ST, сироваткові рівні кортикостерону та глюкози оцінювали у всіх чотирьох зазначених групах. Результати: Результати показали, що час нерухомості (IMT) у групі пацієнтів збільшився порівняно з контрольною групою, але час плавання (ST) у групі пацієнтів зменшився порівняно з контрольною групою. Вплив іммобілізаційного стресу на фактори IMT, ST, кортикостерон та глюкози у групі пацієнтів збільшувався та зменшувався відповідно, тоді як вплив препарату Flx на ці фактори зменшувався, збільшувався та посилювався, відповідно, тоді як вплив IMP на всі згадані фактори відповідно зменшувався та посилювався. Висновок: Грунтуючись на отриманих результатах можна зробити висновок, що антидепресанти Flx та IMP мають різний вплив на активність HPA, а застосування іммобілізаційного стресу викликає депресивну поведінку. Крім того, Flx більш ефективний, ніж IMP, у лікуванні депресивної поведінк

Serum IL-21 level and its relation to activity and severity of alopecia areata

Background: Alopecia areata (AA) is a non-cicatricial alopecia that is postulated to be a hair-specific autoimmune disease, with genetic factors playing a role in disease susceptibility and severity. The disease presentation ranges from circular patches on the scalp to complete hair loss with devastating psychosocial consequences.Patients and methods: This was a case control study carried out on 40 patients diagnosed as alopecia areata. They were recruited from the outpatient clinic of Dermatology, Andrology and STDs Department, Mansoura University Hospitals. In addition 40 normal healthy subjects with matched age and sex were selected to act as a control group.Results: Serum levels of IL-21 were significantly increased in AA patients, and showed significant positive correlation with activity of the disease. Higher serum levels of IL-21 in active cases support its role as predictor of disease activity. There were no significant differences in IL-21 level with different SALT scores. Receiver Operating Characteristic (ROC) curve analysis of IL-21 was conducted to evaluate the sensitivity and specificity of serum IL-21 as a diagnostic index for AA. The AUC-ROC of IL-21 was excellent (0.962); and the best cut off point for IL-21 was determined to be 22.22 pg/ml. It was good predictive value. Its accuracy was 86.3%.Conclusions: The results of this study indicate that the serum IL-21 could be promising marker in the diagnosis of alopecia areata, and also can be used as prognostic marker of its activity

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Validated spectrophotometric methods for the evaluation of Oseltamivir counterfeit pharmaceutical capsules

Four rapid, reliable and economical spectrophotometric methods have been established for the quantitative determination of Oseltamivir phosphate (OST) without the interference of ascorbic acid (ASC) found in some of its counterfeit capsules. The first method involves the use of derivative spectrophotometry with the zero-crossing technique where OST was easily determined using its 1D (Δλ = 3) at 219 nm. The second method is based on a first-order derivative ratio spectrophotometry (1DD, Δλ = 5) where 218 nm was selected for its quantification, while the third method applies a more advanced spectrophotometric method based on the ratio difference spectrophotometry (RD) in which the difference in absorbance ratio was measured between 217 and 210 nm. In the fourth method, difference spectrophotometric method (ΔA) is applied by subtracting absorbance at 252 from that at 263 nm where the difference in absorbance was zero for ASC. The proposed methods were validated for linearity, accuracy, precision and selectivity. Synthetic mixtures of different proportions and commercial capsules were assayed by the proposed methods and the results revealed good accuracy and repeatability of the developed methods

Development and assessment of health education program regarding food safety among food handlers at Ain Shams university hospitals, Cairo, Egypt

Background: Food safety at hospitals is of significant importance for the recovery and wellbeing of patients. Reasons beyond unsafe food at hospitals may be related to consumption of food contaminated with microorganisms or their toxins, which may result from unsafe sources, inadequate cooking or unhygienic practices during food preparation, handling and storage. Objectives: to identify the baseline knowledge and food handling practices of food safety among the food handlers in Ain Shams University Hospitals (ASU), and to develop a health education program about food safety for the food handlers and assess its outcome in ASU Hospitals. Method: one arm intervention study was carried out at the kitchens of ASU hospitals.&nbsp; All food handlers (n=75) in ASU hospital kitchens were recruited in this study. The study was carried out in three phases, the first phase was evaluation of baseline knowledge and practices of participants using self-administered questionnaire and on site observation checklist (Pre-intervention phase), the second phase was health education program for food handlers (Intervention phase) which included several activities such as power point lecture, demonstration, playing video, interactive discussion and distribution of brochures

Erlotinib in Patients with Advanced Non-small Cell Lung Cancer in Middle Eastern Population

Background: Although erlotinib is widely used in the management of non-small cell lung cancer (NSCLC), no prior studies were conducted in Middle Eastern population. Our study aims at evaluating erlotinib prospectively in this population. Patients and Methods: This open-label, prospective, single-arm, multicenter Phase IV clinical trial of erlotinib as single agent evaluated safety and efficacy of Erlotinib in Middle Eastern patients with advanced NSCLC. Results: A total of 56 patients were enrolled in five sites in Saudi Arabia. Majority of patients were males (60%) with median age of 57 years (34–80), Stage IV (98%), and adenocarcinoma (84%). Eastern Cooperative Oncology Group performance Status III (41.1%). Epidermal growth factor receptor (EGFR) mutations were present in 24 patients out of 36 patients tested (67%). The most common reported adverse events (AEs) were rash 36 (64%), diarrhea 29 (52%), fatigue 10 (18%), and anorexia 5 (9%). Grade 4 or 5 AEs were not observed. Complete response was achieved in 2 (3.6%) and overall disease control was 60.8%. Median overall survival (OS) was significantly longer in patients with EGFR mutation than wild type (20 vs. 3 months, P = 0.002). Progression-free survival was 10 months and significantly longer in patients with EGFR mutation than wild type (16 vs. 6 months, P = 0.037). Patients with unknown EGFR status had PSF and OS better than wild-type patients and worse than patients with EGFR mutation. Cox regression analysis showed that older age (P = 0.029, HR 1.064), EGFR wild type (P = 0.014, hazard ratio [HR]: 8.497), and receiving radiation (P = 0.033, HR 6.433) significantly increase risk of death for patients receiving erlotinib. Conclusion: Erlotinib has efficacy and safety profile in Middle Eastern population similar to the reported literature. The empiric use of erlotinib in patients with unknown EGFR status in our patient population is warranted due to high prevalence of the mutation. However, it should not be used in confirmed wild-type disease

Silver Nanoparticle Synthesis by <i>Rumex vesicarius</i> Extract and Its Applicability against Foodborne Pathogens

The consumption of foods polluted with different foodborne pathogens such as fungus, viruses, and bacteria is considered a serious cause of foodborne disease in both humans and animals. Multidrug-resistant foodborne pathogens (MRFP) cause morbidity, death, and substantial economic loss, as well as prolonged hospitalization. This study reports on the use of aqueous Rumex leaf extract (ARLE) in the synthesis of silver nanoparticles (ARLE-AgNPs) with versatile biological activities. The synthesized ARLE-AgNPs had spherical shapes with smooth surfaces and an average hydrodynamic size of 27 nm. ARLE-AgNPs inhibited the growth of Escherichia coli ATCC25721, Pseudomonas aeruginosa ATCC27843, Streptococcus gordonii ATCC49716, Enterococcus faecalis ATCC700813, and Staphylococcus aureus ATCC4342. The ARLE-AgNPs were more active against Escherichia coli ATCC25721 than other harmful bacterial strains (26 ± 3 mm). The zone of inhibition for antibacterial activity ranged between 18 ± 3 mm and 26 ± 3 mm in diameter. The nanoparticles’ MIC values varied from 5.19 µg/mL to 61 µg/mL, while their MBC values ranged from 46 µg/mL to 119 µg/mL. The nanoparticles that were created had antioxidant potential. The cytotoxic activity was tested using normal fibroblast cell lines (L-929), and the enhanced IC50 value (764.3 ± 3.9 g/mL) demonstrated good biological compatibility. These nanoparticles could be evolved into new antibacterial compounds for MRFP prevention

Thromboprophylaxis and mortality among patients who developed venous thromboembolism in seven major hospitals in Saudi Arabia

Introduction: Venous thromboembolism (VTE) during hospitalization is a serious and potentially fatal condition. Despite its effectiveness, evidence-based thromboprophylaxis is still underutilized in many countries including Saudi Arabia. Objective of the Study: Our objectives were to determine how often hospital-acquired VTE patients received appropriate thromboprophylaxis, VTE-associated mortality, and the percentage of patients given anticoagulant therapy and adherence to it after discharged. Methods: This study was conducted in seven major hospitals in Saudi Arabia. From July 1, 2009, till June 30, 2010, all recorded deep vein thrombosis (DVT) and pulmonary embolism (PE) cases were noted. Only patients with confirmed VTE diagnosis were included in the analysis. Results: A total of 1241 confirmed VTE cases occurred during the 12-month period. Most (58.3%) of them were DVT only, 21.7% were PE, and 20% were both DVT and PE. 21.4% and 78.6% of confirmed VTE occurred in surgical and medical patients, respectively. Only 40.9% of VTE cases received appropriate prophylaxis (63.2% for surgical patients and 34.8% for medical patients; P 0.05). Appropriate thromboprophylaxis was associated with 4.11% absolute risk reduction in mortality (95% confidence interval: 0.24%–7.97%). Most (89.4%) of the survived patients received anticoagulation therapy at discharge and 71.7% of them were adherent to it on follow-up. Conclusion: Thromboprophylaxis was underutilized in major Saudi hospitals denoting a gap between guideline and practice. This gap was more marked in medical than surgical patients. Hospital-acquired VTE was associated with significant mortality. Efforts to improve thromboprophylaxis utilization are warranted