Study of the Urinary Ratio of 6 β-Hydroxycortisol/Cortisol as a Biomarker of CYP3A4 Activity in Egyptian Patients with Chronic Liver Diseases

The urinary ratio of 6 β-hydroxycortisol/cortisol (6 β-OHC/C) as a biomarker of CYP3A4 metabolizing activity has been studied in Egyptian patients with chronic liver cirrhosis associated with previous hepatic Schistosomiasis infection to determine any possible alteration in enzyme activity. The ratio of 6-β OHC/C was determined in morning urine samples collected from 8:00 a.m. to 12:00 p.m. in healthy adults (n = 36) and patients with liver cirrhosis (n = 57). The median age for control was 27 years (range: 18–50 years) and 50 years (range: 27–75 years) for patients. 6 β-OHC was detected in urine by ELIZA kits (Stabiligen, France). Patients with liver cirrhosis were categorized according to Child Pugh Classification into Child B (n = 28) and Child C (n = 29) classes. Cholestasis was observed in 9/28 of Child B class and 8/29 of Child C class of patients. The control subjects showed gender-related difference in the urinary ratio of 6 β-OHC/C. A significant reduction (P < 0.001) in 6 β-OHC/C ratio was observed only in Child C patients in comparison with control subjects. Regression analysis showed a significant correlation (P < 0.05) between 6 β-OHC/C ratio and serum albumin. The influence of cholestasis on the urinary ratio of 6-β OHC/C was observed on cirrhotic patients of Child B class. In conclusion, patients with chronic liver cirrhosis might have a reduction of metabolizing activity of CYP3A4 enzymes which could be identified by measuring the urinary ratio of 6 β-OHC/C. This reduction is more apparent in severe liver injury (Child C class). Therefore, it is important to understand the metabolic fate of drugs metabolized by 3A4 enzymes in patients with liver cirrhosis to avoid drug accumulation that might lead to development of drug toxicity

Safety and efficacy of venous mechano-chemical ablation of the great saphenous vein

Introduction: Endovenous mechano-chemical ablation of the incompetent great saphenous vein (MOCA) is a new technique that combines mechanical endothelial injury and infusion of a sclerosant agent. Material and methods: This is a prospective study was conducted on 40 patients who presented with the chronic venous disease at Kasr Al Ainy outpatient vascular surgery clinic with CEAP classification namely C2-C6. Results: A total of 40 patients were presented with great saphenous vein incompetency, the mean age was (30), 23 patients were male and 17 were female. The vein occlusion rate at one month was 93 percent and at six months was 87 percent respectively. Conclusions: Endovenous mechanochemical ablation is a safe and effective method for the management of incompetent great saphenous veins compared to open surgery

Using probiotics to improve the utilization of chopped dried date palm leaves as a feed in diets of growing Farafra lambs

The study determined the ability of three probiotics to improve the nutritional value of date palm leaves in diets of growing lambs. Twenty male Farafra lambs (26 ± 0.33 kg) were randomly allocated to one of four treatments (n = 6) and fed: a control or basal diet (C; 70% concentrate + 30% date palm leaves without additives) and supplemented with Bacillofort containing 2 × 1011 CFU of Bacillus subtilis/g (BAC treatment), Lacotpro containing 1 × 1012 CFU of Lactobacillus acidophilus/g (LAC treatment) or ZAD containing 6 × 108 CFU of R. albus/g (ZAD treatment) at 4 g of all additives for 150 days. As a result of this study, LAC improved (P < 0.05) growth performance and feed efficiency compared to control. Additives increased (P = 0.001) concentrations of albumin, triiodothyronine, and thyroxine, hemoglobin concentration and red blood cells and decreased (P = 0.001) globulin and urea-N. Additives increased hot carcass (P = 0.040) while BAC increased Longissimus dorsi, meat and fat without affecting water holding capacity compared to other treatments. In the metabolism experiment, BAC increased the digestibility of crude protein, while BAC and ZAD increased the digestibility of dry matter, organic matter, and neutral detergent fiber. Additives did not affect nitrogen (N) intake and urinary N; however, decreased fecal N and increased N balance compared to the control. BAC and ZAD increased ruminal volatile fatty acids concentration compared to the control. Based on our results, Lacotpro could be used to improve growth performance and feed efficiency, while Bacillofort could be used to improve meat quality of in lambs

The accessibility and safety of inserting proximal basilic and axillary veins central lines in neonates

Objectives: to evaluate the accessibility, success rate, and attributable complications and to describe the maneuver for central line insertion via proximal basilic or axillary veins in neonates. Methods: This retrospective study included all infants admitted to the neonatal intensive care unit and had an axillary central line inserted or attempted. Success rate, complications, and outcomes were reviewed. Results: Axillary central line was attempted in 85 infants and was successful in 78 infants with a success rate of 91.7%. The median postnatal age of patients was 8 days (2 days–92 days), and the median weight of patients at the procedure was 2600 g (590 g–3900 g). The median corrected gestational age of patients at the procedure was 36 weeks (23 weeks–46 weeks). No serious complication was observed in any of the 85 infants. Conclusion: This study demonstrated a high success rate for insertion of proximal basilic and axillary veins central lines in neonates with difficult vascular access. This procedure was feasible in very low birth and extremely low birth preterm infants, especially in those who failed previous central line attempts

Survival of infants born at periviable gestation: The US national database

Summary: Background: Substantial differences exist in the approach to resuscitating infants born at periviable gestation. Evaluation of current survival may help guide prenatal counselling and provide accurate expectations of clinical outcomes. We aimed to assess the US national survival trends in periviable infants born at gestational age (GA) ≤24 weeks. Methods: We used de-identified patient data obtained from the US Healthcare Cost and Utilization Project (HCUP) from 2007 to 2018. All infants with documented GA ≤24 weeks were included. The Cochran-Armitage test was used for trend analyses. Regression analyses were conducted for variables associated with survival. Findings: A total of 44,628,827 infant records were identified with 124,345 (0.28%) infants born ≤24 weeks; of those, 77,050 infants 500 g compared to ≤500 g (aOR = 4.62, CI:3.23–5.02 &amp; aOR = 5.44, CI: 4.59–5.84, respectively). Black (aOR = 1.33, CI: 1.31–1.36 &amp; aOR = 1.24, CI: 1.20–1.32, respectively) and Hispanic (aOR = 1.29, CI: 1.27–1.32 &amp; aOR = 1.27, CI: 1.22–1.30, respectively) had higher survival than White. Interpretation: There is a national increase in survival over the years in infants born at periviable GA. BW >500 is associated with >4 folds higher survival compared to ≤500 g. The results of this study should be cautiously interpreted as long-term outcomes are unknown Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors