Skeletal muscle fibrosis : an overview

Extracellular matrix (ECM) is an essential component of skeletal muscle. It provides a framework structure that holds myofibers and blood capillaries and nerves supplying the muscle. In addition, it has a principal role in force transmission, maintenance and repair of muscle fibers. Excessive accumulation of ECM components, especially collagens, either due to excessive ECM production, alteration in ECM-degrading activities, or a combination of both is defined as fibrosis. Skeletal muscle fibrosis impairs muscle function, negatively affects muscle regeneration after injury and increases muscle susceptibility to re-injury, therefore, it is considered a major cause of muscle weakness. Fibrosis of skeletal muscle is a hallmark of muscular dystrophies, aging and severe muscle injuries. Thus, a better understanding of the mechanisms of muscle fibrosis will help to advance our knowledge of the events that occur in dystrophic muscle diseases and develop innovative anti-fibrotic therapies to reverse fibrosis in such pathologic conditions. This paper explores an overview of the process of muscle fibrosis, as well as different murine models for studying fibrosis in skeletal muscles. In addition, factors regulating fibrosis and strategies to inhibit muscle fibrosis are discussed.The author is supported by a Postdoctoral Fellowship from the University of Pretoria, South Africa.http://link.springer.com/journal/4412020-11-12hj2018Anatomy and Physiolog

Trend of Change in Cultivated Area and Water Budget for Major Crops in Egypt using GIS and Field Survey Technique

Agricultural survey, based on GIS scheme, using satellite images and topographic maps, field survey was carried out during 2008/2009 winter and 2009 summer seasons to determine the whole land cover of the Nile Delta and Valley. This was done using CLAC’s recent (2006) digital shape file data for different geographic layers (Roads, railways, irrigation channels, water bodies and cultivated areas), and SPOT 5 satellite images (2007). Data show that the cultivated area of wheat was about 2.9 million feddans (4200 m2) in 2008 depending on the ministry of agriculture and land reclamation (MALR) statistics, while the area of wheat in the same year according to GIS and field survey was about 2.5 million feddans. There was about 13% difference between the two concerned methods (GIS + field survey) and MALR’s conventional statistical method. However, the cultivated barley area in 2008 winter season was 148 thousand feddans according to GIS + field survey data, whilst the statistical data was 181 thousand feddans. &#x0D; The GIS + field survey data showed that the area of cotton were decreased sharply in the season of 2009 to 250 thousand feddans compared to 284 thousand feddans with the MALR’s statistical method. Water budget during winter survey for the whole crop pattern was increased from 11 billion cubic meters in 1980 to 24 billion cubic meters in 2013, while water budget during summer survey was increased from 20 billion cubic meters in 1980 to 25 billion cubic meters in 2012. The average water budget for the whole crop pattern in Nile Delta and Nile Valley was 49 billion cubic meters during 2012 /2013.</jats:p

Morphological study of the hard palate in the Egyptian goats (Capra hircus) : a scanning electron microscopic study

The aim of this study was to investigate the morphology of the goat hard palate by light and scanning electron microscopy (SEM), in addition to gross and morphometric analysis. A total of twelve goat heads, from normal adult and apparently healthy goats of both sexes, were collected from local slaughterhouses in Qena province, Egypt. Samples were subjected to gross examination, morphometric analysis, light microscopy and SEM. The hard palate in the goats was long and could be divided into a rostral narrow part and a caudal wide part with about 12–15 transverse palatine ridges from which the rostral palatine ridges were serrated on their free caudal edges. The dental pad replaced the upper incisors; its caudal border had a serrated appearance. At higher magnification, the epithelial surface of the palatine rugae and incisive papilla revealed a variety in the shape of the microplicae and the pattern of the micropits. These adaptations of the goat's hard palate might increase its efficiency during ingestion and mastication of coarse roughages and in directing the food backwards. To our knowledge, this is the first study showed the detailed anatomical description of the hard palate of the goat with SEM.South Valley Universityhttps://wileyonlinelibrary.com/journal/ahe2019-10-01hj2018Anatomy and Physiolog

Clinical and genetic assessment of pediatric patients with Gaucher’s disease in Upper Egypt

Background: Gaucher’s disease (GD) is an autosomal recessive genetic disorder that results from pathogenic mutations of GBA gene encoding the enzyme glucocerebrosidase (acid b-glucosidase). Of the approximately 300 mutations associated with GD, 4 accounts for the majority of mutations seen in GD patients: N370S, L444P, 84 GG and IVS2+1.Aim: Establishing and providing, clinical and molecular backgrounds of pediatric patients with GD in Upper Egypt.Subjects and methods: The present study is a cross sectional study, carried out on 26 pediatric patients with GD. They were recruited from the pediatric outpatient clinics and inpatients Pediatric departments of Assiut and Qena University hospitals, Upper Egypt. Clinical evaluation and mutation analysis using commercially available strip assay kit after PCR amplification of the target gene were done for all included GD patients.Results: Consanguinity between patients’ parents was present in 73.1% of the included patients. 76.9% of included patients were of type 1 GD, while 23.1% were of type 3 GD and none of our patients was classified as type 2 GD. The main frequent clinical presentations of GD in this study were hepatosplenomegaly (88.5%); pallor (76.9%); abdominal distension (61.5%) and musculoskeletal involvement (37.1%). Neurological abnormalities of type 3 GD included in this study were squint, seizures and delayed mental development. Five different genotypes were detected, homozygous for the mutation L444P, homozygous for the mutation N370S, heterozygous for the mutations N370S and rec Ncil, heterozygous for IVS2 +1 and rec NciI, heterozygous for L444P and IVS2 +1. Conclusions: Non-neuropathic type 1 and type 3 GD were the only clinical types found in the present study. The most common mutant alleles found in this study were L444P and N370S

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Time to entry of generic medicines in Malaysia: Implications for pharmaceutical cost containment

Objectives: Generic medicine availability is crucial for maintaining the Malaysian heavily subsidised public healthcare system, and for reducing rising national pharmaceutical expenditure. This paper analyses the time to entry of generic medicines following patent expiration on innovator drug products in Malaysia. Methods: This study utilised a robustly constructed dataset of 12 best-selling single-entity prescription drug products that experienced loss of patent protection and subsequent generic entry between January 2001 and December 2009. Time to entry was measured as the time lag between expiration dates of basic patent of the innovator active drug substances and marketing approval dates of the first generic equivalents. Patent data of the drug substances were sourced from Malaysian and international patent databases. Marketing approval data of both the innovator and generic drug products were sourced from the product registration databases of the Malaysian drug regulatory authority. Key findings: A total of 154 (mean (M) =12.83, standard deviation (SD) =9.61) generic entries occurred during the data period for the entire 12 active drug substances. The mean time to entry (in days) following basic patent expiration was 396.92 (SD=507.49). A significant difference was found between the hypothesised time to entry and the study mean time to entry. Conclusions: Time to generic entry in Malaysia is significantly delayed beyond the day following basic patent expiration of innovator product, thereby delaying the onset of generic competition with potential negative implications on pharmaceutical expenditure.Scopu

Do health professionals have positive perception towards consumer reporting of adverse drug reactions?

Aim: The aim of this study was to evaluate the perceptions of general practitioners (GPs) and community pharmacists (CPs) in Penang, Malaysia, towards consumer reporting of Adverse Drug Reactions (ADRs). Methodology: A cross-sectional mail survey was adopted for the performance of the study. Survey questionnaires were sent to 192 CPs and 400 GPs in the state of Penang, Malaysia. Reminders were sent to all the non-respondents after 3 weeks of the initial mailing. Data which were collected from the questionnaires were analyzed by using the Statistical Package for Social Science (SPSS), version 15. The Chi-square test was used to determine as to whether there was any significant difference between expected and observed frequencies at the alpha level of 0.05. Results: Only 104 respondents (47 CPs and 57 GPs) returned the survey, with a response rate of 18.0%- a figure which could be considered to be low. This study indicated that GPs and CPs were aware about the importance and benefits of consumer reporting. A majority of them (88.0%) thought that consumer reporting would add more benefits to the existing pharmacovigilance program. Similarly, 97% of the respondents agreed that reporting of ADRs was necessary and 87.0% respondents had seen ADRs among their patients. However, 57 of them (6.0%), had not been aware that the national program in Malaysia allowed consumers to report ADRs. A majority of them (97.0%) agreed that consumers needed more education regarding ADR reporting. Most of them (84.0%) thought that consumers could not write valid reports which were similar to reports which were made by healthcare professionals (HCPs). A majority of the respondents (68.0%) had not heard about the consumer reporting program in Malaysia and half of them did not believe that consumer reporting could overcome under-reporting, which was the main problem of the national pharmacovigilance program in Malaysia. Conclusion: The GPs and CPs were aware about the importance and benefits of consumer reporting. Such reporting will add more benefits to the existing programmes in Malaysia, although the barrier that we are facing now is the doubt that they hold over patients' ability to write valid reports which are similar to reports which are made by healthcare professionals (HCPs). Therefore, the consumers need to be educated more about their medications, on how to validate any complaints that they had about the drug consumption and on how to file a proper report and channel it to the 'right' person or bodies. Equally importantly, the media and the non-governmental organizations (NGOs) should play an important role in determining the success of consumer reporting.Scopu

The role of healthcare professionals in establishing unhealthy pharmaceutical promotion activities in Yemen

Background: Recently, the relationship between healthcare professionals and pharmaceutical companies has been given considerable attention worldwide and has been criticised with the companies being blamed for corrupting the medical profession. Objective: A study was carried out in Yemen to provide a comprehensive understanding of the nature of this relationship and the role of healthcare professionals in establishing unhealthy promotional activities. Method: A cross-sectional study was designed and conducted using a self-administered questionnaire for physicians, medical representatives and pharmacists. Opinions and knowledge of respondents about the ethical problems created by healthcare professionals were quantitatively analysed. Results: Participants reported that the current state of pharmaceutical promotion is non-ethical and that there is a mutual influence between them toward establishing the unhealthy state. Physicians contribute to this unhealthy state through their demanding attitudes they practice on medical representatives, which results from the promotion activities. These relationships impact the pharmacy business, pharmacist dispensing behaviours and the ethical status of the medicine profession. Participants reflected a high level of concern that the physicians' attitudes directly contribute in establishing undesirable promotional activities as they request for services in exchange for prescriptions. Moreover, physicians considered that they were entitled for these services from the pharmaceutical companies, as pharmaceutical companies earn profits from their prescribing. Physicians' low income is considered a contributing factor for a need to enhance their income through pharmaceutical services; and pharmaceutical companies take this opportunity to tempt the physicians. Conclusion: The results of this study demonstrated that relationships between healthcare professionals and the pharmaceutical companies are common and conflict with the ethical criteria of drug promotion, also that the influence between them is mutual. At the end of this study, suggestions are given to help health policy makers and regulatory bodies understand and address the current controversial relationship involving pharmaceutical companies and physicians.Scopu

Impact of pharmaceutical promotion on healthcare professional's practices and behaviour: Views from general practitioners, medicine dispensers and medical representatives in Yemen

The relationship between pharmaceutical companies and medical professionals should serve the patients' best interests and improve the use of medicine in society. The aim of this study is to explore the current status of pharmaceutical promotion and its influence on healthcare professionals' practices and behaviour in Yemen. A qualitative approach was used to gain a better understanding of the current status of pharmaceutical promotions and its influence on the quality use of medicine among healthcare professionals in Yemen. A total of 30 doctors, medical representatives and medicine dispensers were interviewed using a semistructured interview guide. The saturation point of the interview was reached after the fourth interview, and no new themes emerged from the subsequent four interviews. All interviews were transcribed verbatim and analyzed by means of a standard content analysis framework. A total of five themes were identified from the interview analysis: evaluation of current pharmaceutical promotions, types and importance of promotional techniques, the importance of satisfying doctors' needs, the influence of the economic situation and the influence of doctor/medical representative interactions on the medicine dispensers' business behaviour. We concluded that all of the offered promotional items were in exchange for the doctors' prescriptions. The participants assured us that pharmaceutical companies use unfavourable promotional methods to ensure that their products sell. They also believed that the doctors' low income and the patients' inability to afford medications was a suitable environment for unethical pharmaceutical promotion. Doctors benefitted from this situation by demanding that pharmaceutical companies satisfy their needs, either scientifically or personally. The absence of official regulation encourages such an environment. This study identified a number of key themes that might be useful in enhancing awareness concerning the nature of the current pharmaceutical companies' relationship with healthcare professionals and its impact on healthcare professionals' practices and behaviour.Scopu