Proposed Strategies to Improve Adult Asthma Management in Egypt: Expert Review and Recommendations

Background: Several challenges face asthma management in Egypt, including the high percentage of uncontrolled patients, inadequate compliance, and overuse of short-acting beta-agonists (SABAs) leading to increased asthma-related morbidity and mortality. In this regard, the recent Global Initiative for Asthma (GINA) recommendations included inhaled corticosteroids containing therapy for mild asthma. Local healthcare systems and healthcare professionals (HCPs) often experience practical challenges when implementing global guidelines. Objective: The present expert review aims to outline the development of local guidelines and health policies that integrate global advances in asthma management while addressing unmet needs and challenges in Egypt. Methods: A steering committee of health policymakers and respiratory experts from the principal healthcare sectors in Egypt came together in March 2021 to develop a consent and national guideline for local asthma management, codifying the current challenges and the required elements for adequate control. The recommendations were either evidence-based or consensus-based from the clinical expertise and perspectives of the committee. Results: The committee identified vital challenges facing all chronic airway diseases with initial focus on asthma management in Egypt in diagnosis, data collection, policymaking, patients’ awareness, and physicians’ attitudes. In general, the committee stated that globally adapted management protocols necessitate addressing from diverse perspectives through policymakers, HCPs, and patients. Accordingly, it is vital to provide relevant education for the patient and HCPs. The recommendations emphasize key elements concerning baseline assessment, diagnosis, treatment strategy with regular review of patient progress, and compliance toward the introduced reforms. Conclusions: Full integration of these recommendations into local practice allows physicians to sustain adequate management while reducing preventable exacerbations and unnecessary burdens. The proposed strategies outline efficient patient-centered management that approaches asthma as an inflflammatory condition, encouraging health promotion and patients’ compliance

Interleukin-6 and tumour necrosis factor-alpha inflammatory markers association with arterial stiffness in Vitamin D3 deficiency, obese and diabetic emirati population

Introduction: Cardiovascular diseases (CVDs) are the leading cause of death both globally and in the United Arab Emirates (UAE). Vitamin D deficiency, obesity and diabetes mellitus (DM) are significantly prevalent in the UAE population and are considered high-risk factors for CVDs. In the meantime, arterial stiffness has been reported to be an independent predictor of CVDs with a strong association with vascular inflammatory reactions. Aims and Objectives: Identify and analyze specific inflammatory biomarkers associated with arterial stiffness in order to enhance the detection and prevention of cardiovascular diseases (CVDs) among high-risk patients. Materials and Methods: We have recruited 23 middle-aged Emiratis with the following criteria: 11 individuals as controls (Vitamin D level >20 ng and body mass index [BMI] <30), 9 patients with Vitamin D deficiency (Vitamin D level ≤20 ng) and obese (BMI ≥30) and 3 patients with Vitamin D deficiency (Vitamin D level ≤20 ng), obese (BMI ≥30) and previously diagnosed with type 2 DM. Several inflammatory biomarkers were measured in the plasma samples using Luminex Human Cytokine Pre-mixed Kit. Results: Arterial stiffness was measured using pulse-wave velocity (PWV). The PWV relative to age was significantly higher in both patient groups compared to the control group. Furthermore, there is a significant increase in the plasma protein levels of interleukin (IL)-6 cytokine (P = 0.0229) and tumor necrosis factor-alpha (TNF-α) cytokine (P = 0.0258) in Vitamin D deficiency, obese and diabetic patients compared to the control group. The rest of the inflammatory markers did not show statistically significant changes in the plasma levels. Conclusion: Our findings reveal that individuals with Vitamin D deficiency, obesity, and DM exhibit elevated plasma protein levels of IL-6 and TNF-α cytokines when compared to the control group and individuals with only Vitamin D deficiency or obesity. These increased levels of cytokines are closely associated with arterial stiffness, highlighting their potential as biomarkers for early detection of vascular damage in high-risk patients, thereby aiding in the prevention of CVDs. However, further research with a larger cohort is warranted to validate and explore these significant pathways and biomarkers in greater detail

Enhanced thermal stability of “environmentally friendly” biodegradable poly(Lactic acid) blends with cellulose acetate. an experimental and molecular modeling study

© 2017 by the authors. Cellulose acetate (CA) is added to the “Environmentally friendly” poly(lactic acid) (PLA) to improve its materials stiffness and thermal stability for use in various applications. Stress-strain showed that small amounts of CA had contributed to PLA flexibility while maintaining high values for the stress. The improved mechanical properties of the samples signifies the stability of the blend due to the formation of 3D-hydrogen bonding network between the CA and PLA chains as indicated by FTIR analysis. Extended thermal degradation highlighted the susceptibility of neat PLA chains to degradation over extended periods of time. The presence of CA component protected PLA chains as a result of the crosslinking between the resultant free radicals and the polymeric chains, which increased the molecular weight of the samples and its overall toughness. Molecular simulations showed that enthalpy of mixing had positive values at low temperatures indicating blend instability as the entropic contribution to free energy of mixing was not sufficient to overcome the enthalpic-driven phase separation. Greater free energy values at higher PLA content coincided with the experimental observation that blends with high PLA content showed appreciable mechanical response whereas those with higher CA content showed no mechanical integrity as predicted by molecular modeling

Role of Multidetector Computed Tomography (CT) Virtual Hysteroscopy in the Evaluation of Abnormal Uterine Bleeding in Reproductive Age

Background. Abnormal uterine bleeding (AUB) may be acute or chronic and is defined as bleeding from the uterine corpus that is abnormal in regularity, volume, frequency, or duration and occurs in the absence of pregnancy. It is a widespread complaint in the primary care units. The prevalence of abnormal bleeding is up to 30% among women of reproductive age. Objective. To assess the role of CT virtual hysteroscopy in the evaluation of the uterine cavity in cases with abnormal uterine bleeding in reproductive age. Methods. Cross sectional study was performed at Obstetrics and Gynecology Department and Radiology Department, Zagazig University hospitals, Egypt, on 124 women with abnormal uterine bleeding in reproductive age, and their uterine cavity was evaluated by both row multidetector computed tomography (MDCT) scanner and Office hysteroscopy. Results. Mean age of studied group was 28.54 ± 5.99 years, and virtual hysteroscopy showed sensitivity 91.1% and specificity 85.3% in detection of abnormalities within uterine cavity. It showed sensitivity 91.1% and specificity 85.3% in cases of endometrial polyps. It yielded 88.5 % sensitivity and 100 % specificity in cases with submucous fibroids, while it yielded only 57.9 % sensitivity and 82.9% specificity in cases of thick endometrium. Conclusion. Virtual CT hysteroscopy is a good negative test in cases of abnormal uterine bleeding but has some limitations that decrease its sensitivity

Unveiling the molecular Culprit of arterial stiffness in vitamin D deficiency and obesity:Potential for novel therapeutic targets

Cardiovascular diseases (CVDs) are highly associated with both vitamin D deficiency and obesity, two prevalent health conditions worldwide. Arterial stiffness, an independent predictor of CVDs, is particularly elevated in both conditions, yet the molecular mechanisms underlying this phenomenon remain elusive, hindering effective management of CVDs in this population. We recruited 20 middle-aged Emiratis, including 9 individuals with vitamin D deficiency (Vit D level ≤20 ng) and obesity (BMI ≥30) and 11 individuals as control with Vit D level &gt;20 ng and BMI &lt;30. We measured arterial stiffness using pulse wave velocity (PWV) and performed whole transcriptome sequencing to identify differentially expressed genes (DEGs) and enriched pathways. We validated these findings using qRT-PCR, Western blot, and multiplex analysis. PWV was significantly higher in the vitamin D deficient and obese group relative to controls (p ≤ 0.05). The DEG analysis revealed that pathways related to interleukin 1 (IL-1), nitrogen metabolism, HIF-1 signaling, and MAPK signaling were over-activated in the vitamin D deficient and obese group. We found that HIF-1alpha, NOX-I, NOX-II, IL-1b, IL-8, IL-10, and VEGF were significantly upregulated in the vitamin D deficient and obese group (p &lt; 0.05). Our study provides new insights into the molecular mechanisms of arterial stiffness in vitamin D deficiency and obesity, demonstrating the role of oxidative stress and inflammation in this process. Our findings suggest that these biomarkers may serve as potential therapeutic targets for early prevention of CVDs. Further studies are needed to investigate these pathways and biomarkers with larger cohort.</p

Selective inhibition of Rhizopus eumelanin biosynthesis by novel natural product scaffold-based designs caused significant inhibition of fungal pathogenesis.

Melanin is a dark color pigment biosynthesized naturally in most living organisms. Fungal melanin is a major putative virulence factor of Mucorales fungi that allows intracellular persistence by inducing phagosome maturation arrest. Recently, it has been shown that the black pigments of Rhizopus delemar is of eumelanin type, that requires the involvement of tyrosinase (a copper-dependent enzyme) in its biosynthesis. Herein, we have developed a series of compounds (UOSC-1-14) to selectively target Rhizopus melanin and explored this mechanism therapeutically. The compounds were designed based on the scaffold of the natural product, cuminaldehyde, identified from plant sources and has been shown to develop non-selective inhibition of melanin production. While all synthesized compounds showed significant inhibition of Rhizopus melanin production and limited toxicity to mammalian cells, only four compounds (UOSC-1, 2, 13, and 14) were selected as promising candidates based on their selective inhibition to fungal melanin. The activity of compound UOSC-2 was comparable to the positive control kojic acid. The selected candidates showed significant inhibition of Rhizopus melanin but not human melanin by targeting the fungal tyrosinase, and with an IC50 that are 9 times lower than the reference standard, kojic acid. Furthermore, the produced white spores were phagocytized easily and cleared faster from the lungs of infected immunocompetent mice and from the human macrophages when compared with wild-type spores. Collectively, the results suggested that the newly designed derivatives, particularly UOSC-2 can serve as promising candidate to overcome persistence mechanisms of fungal melanin production and hence make them accessible to host defenses

Ramadan intermittent fasting is associated with ameliorated inflammatory markers and improved plasma sphingolipids/ceramides in subjects with obesity: lipidomics analysis

Abstract Intermittent fasting (IF) is associated with enormous metabolic alterations that underpin its diverse health effects. Changes in lipid metabolism, particularly ceramides, and other sphingolipids, are among the most notable of these alterations. This study investigated the lipidomic alterations associated with 29–30 days of Ramadan diurnal intermittent fasting (RIF) in metabolically healthy overweight and obese subjects. A prospective cohort of 57 overweight and obese adults (70% males, 38.4 ± 11.2 years), with an age range of 18–58 years was observed prior to and at the conclusion of Ramadan. At both time points, anthropometric, biochemical (lipid profile, glycemic, and inflammatory markers), and dietary intake measurements were taken. Using liquid chromatography-mass spectrometry, a lipidomic analysis of ceramides and other sphingolipids was conducted. Using paired sample t-tests, pre- and post-Ramadan anthropometric, biochemical, and dietary values were compared. RIF was associated with improved levels of lipid profile compartments and inflammatory markers. In addition, RIF was associated with a decrease in plasma sphingosine and sphinganine, which was accompanied by a decrease in sphingosine 1-phosphate and sphinganine 1-phosphate. In addition, RIF was associated with decreased C17, C22, and C24 sphingomyelin, but not C14, C16, C18, C20, and C24:1 sphingomyelin, as well as C20, C22, C24, and C24:1 dihydrosphingomyelin, but not C16 and C18 dihydrosphingomyelin. This study demonstrates that RIF is associated with improvements in plasma sphingosine, sphinganine sphingomyelin, and dihydrosphingomyelin lipid species, as well as improved lipid profile and inflammatory markers, which may confer short-term protection against cardiometabolic problems in patients with overweight/obesity