Validation of a modified cow’s milk-related symptom score (CoMISS) for screening of lactose intolerance in adults

Introduction: Lactose intolerance (LI) is the failure to digest foods and beverages containing the lactose present in milk. LI can present by many digestive symptoms. Objective: To validate the modified CoMiSS score for prediction of LI, that was confirmed by a stool acidity test. Patients and methods: A cross-sectional study, was conducted at Ain Shams University Hospitals/Gastrointestinal Clinics, and included one hundred adult participants during the period from December 2018 to December 2019. Enrolled patients had one or more gastrointestinal symptoms and were subjected to a stool acidity test (fecal PH test) as a reference test and modified CoMiSS as an index test. Results: The mean age of participants was 35.30 ± 10.714 years old; 55% were females, and their mean body mass index (BMI) was 23.08 ± 2.080 kg/m2, with no significant relation between LI and patients` gender or BMI. Out of the studied participants 24% had positive stool PH, LI diagnosed according to modified CoMISS was present among 19% of them. The mean value of modified CoMISS Score was significantly higher in positive cases (12.37) compared to negative LI participants (2.33) as p < .001. Area under ROC Curve was 0.998, at the selected cut-off value 8, the sensitivity was 89.5% and specificity was 100% thus, levels of questionnaire scoring of 8 or higher would indicate presence of lactose intolerance. Conclusion: Modified CoMiSS is a simple, fast, and easy-to-use tool that can predict LI, with a cut-off value of >8, the Area under the ROC Curve was 0.998, sensitivity 89.5%, and specificity was 100%

COVID-19 PANDEMIC: PSYCHO-SOCIAL CONSEQUENCES DURING THE SOCIAL DISTANCING PERIOD AMONG NAJRAN CITY POPULATION

Background: COVID-19 is a global pandemic that endanger the health and enforced social distancing for the whole world. Social distancing may generate stress, anxiety, and depression. Understanding the psychosocial consequences of COVID19 during social distancing may help decision-makers to take suitable decisions that help in increasing awareness.This study aims to evaluate the psychosocial consequences of COVID-19 pandemic during the social distancing period and explore the relationship between social media use and psychological stress during COVID-19 outbreak among Najran city population. Subjects and methods: Descriptive correlational research design was utilized to carry out this study. A snowball sampling technique, was used to recruit participants live in Najran city during the COVID-19 pandemic (1508 participant). Results: A statistically significant differences (P<0.05) are observed between Saudi and non-Saudi participants in all social aspects assessed except for time spent on social media. In addition, a high mean of depression, stress, and anxiety subscale scores are observed in non-Saudi compared to the Saudi participants with statistically significant differences (p=0.000). As well as high DASS-21 total scores in non Saudi compared to the Saudi participants. Also, there are positive statistically significant correlations (≤0.05) between participants\u27 time spent in social media and their depression, stress, anxiety, and total DASS scores during the COVID-19 outbreak. Conclusion: The findings of the present study indicate that COVID-19 pandemic generates stress, anxiety and depression among Najran population especially, non-Saudi. This poor psychological condition is exaggerated with prolonged social media use. COVID-19 also has negative impact on social wellbeing and use of social media cannot replace direct contact with friends. The current study results may be utilized to formulate interventions that enhance psychosocial health and resilience during the COVID-19 outbreak

Risk Factors of Hypocalcemic Patients at Surgical Intensive Care Unit of Zagazig University Hospitals

Background: Hypocalcemia may be present as an asymptomatic laboratory finding or as a severe life-threatening condition. Objective: The study aimed to estimate incidence rate of hypocalcemia and to identify risk factors associated with hypocalcemia in patients of Surgical Intensive Care Unit of Zagazig University Hospitals. Patients and methods: This study involved 310 patients who enrolled to Surgical Intensive Care Unit, Zagazig University Hospitals over a period of six months. Total serum calcium concentration and ionized calcium concentration were measured. Results: The distribution of the studied cases according to admission diagnosis, 40% of the studied cases were admitted to ICU due to sepsis and septic shock, 16% polytrauma, 10% respiratory failure, 10% post-operative monitoring, 6% with ICH, 6% with uncontrolled HTN, 4% with ischemic stroke, 2% pancreatitis, 2% dehydration and electrolyte imbalance, 2% DKA and one case due to organophosphorus poisoning and 1% rhabdomyolysis. There was statistically significant negative correlation between GCS score and Ca total and ionized at 3rd day. However, a statistically significant positive correlation was detected between Ph and Ca total at 3rd day. Only sepsis, septic shock, hypertensive crisis, aminoglycosides, respiratory failure and APACHE score were significant risk factors for hypocalcemia. Conclusion: Hypocalcemia is more common in cases with sepsis and septic shock, hypertensive crisis, respiratory failure and cases with electrolyte disturbance

The neurotoxic effects of Methotrexate (MTX) on rat hippocampus and to explore the neuroprotective role of Alpha Lipoic Acid (ALA): Review article

Background: The hippocampus is a major component of the mammalian brains and the brains of other vertebrates. It belongs to the limbic system and plays important roles in memory consolidation. Methotrexate (MTX) belongs to the antimetabolite group, which is an antineoplastic group of drugs. MTX has a wide range of therapeutic effects: e.g. at high doses in many malignancies and at low doses in autoimmune diseases such as rheumatoid arthritis and psoriasis, due to its anti-inflammatory and immunosuppressive effects. The therapeutic actions of Alpha Lipoic Acid (ALA) is based on its antioxidant properties including its capacity in regenerating endogenous antioxidants, its metal chelating abilities, its action as a scavenger of reactive oxygen species (ROS) and its capability to repair oxidative damage.Objective: This work aimed to study the neurotoxic effects of methotrxate (MTX) on rat hippocampus and to explore the neuroprotective role of alpha lipoic acid (ALA).Methods: The databases were searched for articles published in English in 4 data bases [PubMed – Google scholar- Science direct and Egyptian bank of knowledge] and Boolean operators (and, or, not) had been used such as neurotoxic effects of methotrxate and rat hippocampus OR alpha lipoic acid and in reviewed articles.Conclusion: So, from this review article, it can be concluded that, alpha lipoic acid administration along with methotrxate therapy can ameliorate the harmfull effects of methotrxate on hippocampus

α-Globin Messenger Ribonucleic Acid as a Molecular Marker for Determining the Age of Human Blood Spots in Different Temperatures

Background: Analyzing recovered evidence, such as blood which is one of the most encountered types of biological evidence, can provide information to establish the definite time when a crime was committed. This study aims to investigate the time- and temperature-related effects on human bloodstain’s α-globin messenger RNA expression and to estimate the bloodstain’s age using α-globin mRNA. Methods: A total of 22 blood samples were collected from healthy middle-aged volunteers (12 women and 10 men). After preparation, the samples were exposed to temperatures of 4°C, 24°C, and 40°C. Next, the mRNA expression of the α-globin gene was quantified by real-time RT-PCR at different time intervals of 0, 30, 90, and 150 days.Results: The α-globin gene expression showed the highest mean values by 0 day and at 4°C and the lowest mean values by 150 days and at 40°C. Samples from male participants showed higher mean values of α-globin gene expression compared to their female counterparts. A significant negative correlation was detected between α-globin gene expression and time interval. Meanwhile, a regression equation was formulated to estimate the time interval using the α-globin gene concentration.Conclusion: α-Globin mRNA could be a useful marker to estimate the age of human blood spots

Case Study in Refractory Non-Hodgkin's Lymphoma: Successful Treatment with Plerixafor

The present case study describes our experience in treating a young woman diagnosed with a relapsing case of diffuse large cell lymphoma, who was heavily pre-treated with chemotherapy and radiotherapy. Our only chance to improve her survival was by using high-dose chemotherapy, followed by peripheral stem cell rescue. Unfortunately, in this patient, collecting sufficient stem cells for bone marrow transplantation proved to be very difficult since she had already been heavily treated with chemotherapy and radiotherapy. Currently, granulocyte colony-stimulating factor (G-CSF) alone or G-CSF plus chemotherapy are the most commonly used treatments for stem cell mobilization. However, 5–30% of patients do not respond to these agents. Plerixafor is a new hematopoietic stem cell-mobilizing drug that antagonizes the binding of chemokine stromal cell-derived factor-1α to CXC chemokine receptor 4. It is indicated in combination with G-CSF to mobilize hematopoietic stem cells to the peripheral blood for collection and subsequent autologous transplantation in patients with non-Hodgkin's lymphoma and multiple myeloma [Kessans et al.: Pharmacotherapy 2010;30:485–492; Jantunen: Expert Opin Biol Ther 2011;11:1241–1248]. Based on our findings, we consider plerixafor to be a very efficient and practical solution to mobilize and collect stem cells among all patients in such a situation, enabling us to proceed to autologous bone marrow transplantation and peripheral stem cell rescue in order to improve the patients’ overall survival

Tunable polymeric mixed micellar nanoassemblies of Lutrol F127/Gelucire 44/14 for oral delivery of praziquantel: a promising nanovector against hymenolepis nana in experimentally-infected rats

Hymenolepiasis represents a parasitic infection of common prevalence in pediatrics with intimidating impacts, particularly amongst immunocompromised patients. The present work aimed to snowball the curative outcomes of the current mainstay of hymenolepiasis chemotherapy, praziquantel (PRZ), through assembly of polymeric mixed micelles (PMMs). Such innovative nano-cargo could consolidate PRZ hydrosolubility, extend its circulation time and eventually upraise its bioavailability, thus accomplishing a nanoparadigm for hymenolepiasis tackling at lower dose levels. For consummating this goal, PRZ-PMMs were tailored via thin-film hydration technique integrating a binary system of Lutrol F127 and Gelucire 44/14. Box-Behnken design was planned for optimizing the nanoformulation variables employing Design-Expert® software. Also, in Hymenolepis nana-infected rats, the pharmacodynamics of the optimal micellar formulation versus the analogous crude PRZ suspension were scrutinized on the 1st and 3rd days after administration of a single oral dose (12.5 or 25 mg/kg). Moreover, in vitro ovicidal activity of the monitored formulations was estimated utilizing Fuchsin vital stain. Furthermore, the in vivo pharmacokinetics were assessed in rats. The optimum PRZ-PMMs disclosed conciliation between thermodynamic and kinetic stability, high entrapment efficiency (86.29%), spherical nanosized morphology (15.18 nm), and controlled-release characteristics over 24 h (78.22%). 1H NMR studies verified PRZ assimilation within the micellar core. Additionally, the in vivo results highlighted a significant boosted efficacy of PRZ-PMMs manifested by fecal eggs output and worm burden reduction, which was clearly evident at the lesser PRZ dose, besides a reversed effect for the intestinal histological disruptions. At 50 µg/mL, PRZ-PMMs increased the percent of non-viable eggs to 100% versus 47% for crude PRZ, whilst shell destruction and loss of embryo were only clear with the applied nano-cargo. Moreover, superior bioavailability by 3.43-fold with elongated residence time was measured for PRZ-PMMs compared to PRZ suspension. Practically, our results unravel the potential of PRZ-PMMs as an oral promising tolerable lower dose nanoplatform for more competent PRZ mass chemotherapy

Biliary fistula and late recurrence of liver hydatid cyst: Role of cysto-biliary communication: A prospective multicenter study

Background: Hydatid cyst disease (HCD) is common in certain locations. Surgery is associated with postoperative biliary fistula (POBF) and recurrence. The primary aim of this study was to identify whether occult cysto-biliary communication (CBC) can predict recurrent HCD. The secondary aim was to assess the role of cystic fluid bilirubin and alkaline phosphatase (ALP) levels in predicting POBF and recurrent HCD. Aim: To identify whether occult CBC can predict recurrent HCD. The secondary aim was to assess the role of cystic fluid bilirubin and ALP levels in predicting POBF and recurrent HCD. Methods: From September 2010 to September 2016, a prospective multicenter study was undertaken involving 244 patients with solitary primary superficial stage cystic echinococcosis 2 and cystic echinococcosis 3b HCD who underwent laparoscopic partial cystectomy with omentoplasty. Univariable logistic regression analysis assessed independent factors determining biliary complications and recurrence. Results: There was a highly statistically significant association (P ≤ 0.001) between cystic fluid biochemical indices and the development of biliary complications (of 16 patients with POBF, 15 patients had high cyst fluid bilirubin and ALP levels), where patients with high bilirubin-ALP levels were 3405 times more likely to have biliary complications. There was a highly statistically significant association (P ≤ 0.001) between biliary complications, biochemical indices, and the occurrence of recurrent HCD (of 30 patients with recurrent HCD, 15 patients had high cyst fluid bilirubin and ALP; all 16 patients who had POBF later developed recurrent HCD), where patients who developed biliary complications and high bilirubin-ALP were 244.6 and 214 times more likely to have recurrent hydatid cysts, respectively. Conclusion: Occult CBC can predict recurrent HCD. Elevated cyst fluid bilirubin and ALP levels predicted POBF and recurrent HCD

Perspectives, practices, and challenges of online teaching during COVID-19 pandemic: A multinational survey

The result of the movement restrictions during the COVID-19 pandemic was an impromptu and abrupt switch from in-person to online teaching. Most focus has been on the perception and experience of students during the process. The aim of this international survey is to assess staffs' perspectives and challenges of online teaching during the COVID-19 lockdown. Cross-sectional research using a validated online survey was carried out in seven countries (Brazil, Saudi Arabia, Jordan, Indonesia, India, the United Kingdom, and Egypt) between the months of December 2021 and August 2022, to explore the status of online teaching among faculty members during the COVID-19 pandemic. Variables and response are presented as percentages while logistic regression was used to assess the factors that predict levels of satisfaction and the challenges associated with online instruction. A total of 721 response were received from mainly male (53%) staffs. Most respondents are from Brazil (59%), hold a Doctorate degree (70%) and have over 10 years of working experience (62%). Although, 67% and 79% have relevant tools and received training for online teaching respectively, 44% report that online teaching required more preparation time than face-to-face. Although 41% of respondents were uncertain about the outcome of online teaching, 49% were satisfied with the process. Also, poor internet bandwidth (51%), inability to track students' engagement (18%) and Lack of technical skills (11.5%) were the three main observed limitations. Having little or no prior experience of online teaching before the COVID-19 pandemic [OR, 1.58 (95% CI, 1.35–1.85)], and not supporting the move to online teaching mode [OR, 0.56 (95% CI,0.48–0.64)] were two main factors independently linked with dissatisfaction with online teaching. While staffs who support the move to online teaching were twice likely to report no barriers [OR, 2.15 (95% CI, 1.61–2.86)]. Although, relevant tools and training were provided to support the move to online teaching during COVID-19 lockdown, barriers such as poor internet bandwidth, inability to track students’ engagement and lack of technical skills were main limitations observed internationally by teaching staffs. Addressing these barriers should be the focus of higher education institution in preparation for future disruptions to traditional teaching modes

Consensus evidence-based clinical practice recommendations for the diagnosis and treat-to-target management of osteoporosis in chronic kidney disease stages G4-G5D and post-transplantation: An initiative of Egyptian Academy of Bone Health

The aim of this study was to reach a consensus on an updated version of the recommendations for the diagnosis and Treat-to-Target management of osteoporosis that is effective and safe for individuals with chronic kidney disease (CKD) G4-G5D/kidney transplant. Delphi process was implemented (3 rounds) to establish a consensus on 10 clinical domains: (1) study targets, (2) risk factors, (3) diagnosis, (4) case stratification, (5) treatment targets, (6) investigations, (7) medical management, (8) monitoring, (9) management of special groups, (10) fracture liaison service. After each round, statements were retired, modified, or added in view of the experts' suggestions, and the percent agreement was calculated. Statements receiving rates of 7-9 by more than 75% of experts' votes were considered as achieving consensus. The surveys were sent to an expert panel ( = 26), of whom 23 participated in the three rounds (2 were international experts and 21 were national). Most of the participants were rheumatologists (87%), followed by nephrologists (8.7%), and geriatric physicians (4.3%). Eighteen recommendations, categorized into 10 domains, were obtained. Agreement with the recommendations (rank 7-9) ranged from 80 to 100%. Consensus was reached on the wording of all 10 clinical domains identified by the scientific committee. An algorithm for the management of osteoporosis in CKD has been suggested. A panel of international and national experts established a consensus regarding the management of osteoporosis in CKD patients. The developed recommendations provide a comprehensive approach to assessing and managing osteoporosis for all healthcare professionals involved in its management. [Abstract copyright: Copyright © 2022 by The Author(s). Published by S. Karger AG, Basel.