Oral manifestations of inflammatory bowel disease

Inflammatory bowel diseases (IBD), including Crohn\u2019s disease and ulcerative colitis, have important extraintestinal manifestations, notably in the oral cavity. These oral manifestations can constitute important clinical clues in the diagnosis and management of IBD, and include changes at the immune and bacterial levels. Aphthous ulcers, pyostomatitis vegetans, cobblestoning and gingivitis are important oral findings frequently observed in IBD patients. Their presentations vary considerably and might be well diagnosed and distinguished from other oral lesions. Infections, drug side effects, deficiencies in some nutrients and many other diseases involved with oral manifestations should also be taken into account. This article discusses the most recent findings on the oral manifestations of IBD with a focus on bacterial modulations and immune changes. It also includes an overview on options for management of the oral lesions of IBD

Exploiting gelatin nanocarriers in the pulmonary delivery of methotrexate for lung cancer therapy.

Gelatin has many merits that encourage its use in the pulmonary delivery of anticancer drugs. It is a biodegradable denatured protein which possesses several functional groups that could be modified. Additionally, it has balanced hydrophilic and hydrophobic characters, which facilitate the loading of chemotherapeutic agents. Accordingly, the purpose of the current work was to exploit this valuable biomaterial in the efficient pulmonary delivery of methotrexate in case of lung cancer. Gelatin nanoparticles were prepared via a desolvation method and the fabrication process was optimized using Box Behnken design of experiment. A comparative study on uptake of gelatin nanoparticles by lung adenocarcinoma cells and macrophages was implemented using flow cytometry. Investigation of the effect of different methotrexate loading techniques: encapsulation, post loading and chemical conjugation on the nanoparticles characteristics and cellular cytotoxicity was performed. Nano-in-microparticles were prepared by co-spray drying optimized nanoparticles with leucine. Results showed that Box Behnken design was able to optimize preparation parameters to yield uniform nanoparticles with suitable particle size for cancer cells uptake. The prepared nanoparticles demonstrated a preferential uptake by lung cancer cells. Additionally, methotrexate loaded nanoparticles demonstrated up to four fold significant reduction in methotrexate IC50. The spray dried gelatin nano-in microparticles demonstrated good aerosolization properties enabling lung deposition in the respirable airways. Thus, providing a promising platform for lung cancer therapy

Multi-dimensional simulation of underground subway spaces coupled with geoenergy systems

Old and deep subway lines suffer from overheating problems, particularly during summer, which is detrimental for passenger comfort and health. Geothermal systems could serve as one of the potential energy efficient cooling solutions, compared to energy intensive conventional cooling. The waste heat of the subway tunnel can be harnessed, to provide heating to residential and commercial blocks above the tunnels. This paper presents a multi-scale co-simulation framework for quantifying the amount of useful heat that can be extracted from overheated underground subway tunnels using geothermal heat exchangers. The co-simulation is applied and tested on a representative section of the London Underground's Central Line. The Central Line is modelled using a 1D heat and mass transfer model. The geothermal system, on the other hand, is represented using a 3D finite element model. The 1D and 3D models are co-simulated, using the subway tunnel's outer wall temperatures as boundary conditions. The model is run parametrically to identify the best arrangement and depth of geothermal heat exchangers for extracting excess heat from subway tunnels. Results show that the depth of 15 m. below the tunnel is sufficient for vertical closed loop heat exchangers to yield temperature drop of 4C in the subway tunnel and platforms. Partially insulated boreholes, alternating between extracting and injecting heat into the soil, are also assessed for their potential to provide heating and cooling demand simultaneously and improve the overall geothermal system efficiency. The heat extracted along a representative section of the tunnels is compared to the heating demand of the buildings above ground

“Different Strokes”: A management dilemma

Stroke is a common medical emergency resulting from numerous pathophysiological mechanisms and with varied clinical manifestations; as such, the diagnosis of stroke requires diligent clinical assessment. When different stroke syndromes occur in the same patient, it may cause a dilemma in terms of diagnosis and management. This continuing medical education article describes an interesting patient with recurrent neurological events, highlighting the complex pathophysiological processes associated with cerebrovascular syndromes. It offers readers the opportunity to apply their own basic neuroscience knowledge and clinical skills to solve the challenges encountered during the course of diagnosing and treating this patient. Specifically, the article aims to familiarise readers with an approach to diagnosing brainstem strokes and the diverse manifestations of a common stroke syndrome. Keywords: Stroke; Lacunar Stroke; Cerebral Hemorrhage; Cerebral Small Vessel Disease; Continuing Medical Education

Spectrum of Cerebral Venous Thrombosis in Oman

Objectives: Cerebral venous thrombosis (CVT) can have varied and life-threatening manifestations. This study aimed to examine the spectrum of its clinical presentations and outcomes in a tertiary hospital in Oman. Methods: This retrospective study was conducted at the Sultan Qaboos University Hospital, Muscat, Oman, between January 2009 and December 2017. The medical records of all patients with CVT were reviewed to determine demographic characteristics, clinical features and patient outcomes. Results: A total of 30 patients had CVT. The mean age was 36.8 ± 11 years and the male-to-female ratio was 2:3. Common manifestations included headache (83%), altered sensorium (50%), seizures (43%) and hemiparesis (33%). Underlying risk factors were present in 16 patients (53%). Computed tomography or magnetic resonance imaging of the brain was abnormal in all patients, with indications of infarcts (40%) and major sinus thrombosis (100%). There were five cases (20%) of deep CVT. The patients were treated with low-molecular-weight heparin, mannitol and anticonvulsants. The majority (77%) had no residual neurological deficits at follow-up. Conclusion: These findings indicate that CVT is a relatively uncommon yet treatable disorder in Oman. A high index of suspicion, early diagnosis, prompt anticoagulation treatment and critical care may enhance favourable patient outcomes. Keywords: Venous Thrombosis; Cerebral Thrombosis; Cranial Venous Sinuses; Neurological Manifestations; Patient Outcome Assessment; Oman

Assessment of Sleep Pattern in Egyptian Elderly Subjects with Vascular Dementia: An Egyptian Study on Elderly Population

Background: Sleep is considered to be very important for cognitive function and also cognitive deficits and sleep disorders are influenced by one another. Currently, growing evidence suggests that sleep disturbances is common in vascular dementia (VaD). Study Objectives: The goal of the current study was to assess the disturbance in sleep pattern in patients with vascular dementia(VaD) and compare it to healthy normally cognitive elderly individuals. The study further investigated whether meaningful differences in the Subjective sleep assessment (ESS and PSQI) and sleep measurements (PSG) in VaD patients. Study Design/Method: Overnight PSG recordings and self-reported sleep measures were obtained from 20 healthy elderly subjects and 20 VaD patients at the sleep laboratory. Results: This study showed abnormal subjective sleep quality in all patients and revealed that the most common sleep complaintsamong VaD patients were excessive daytime sleepiness (EDS), sleep disordered breathing (SDB), insomnia and RLS and PLMS and REM behavioral disordered, respectively. Moreover, patients spent more time in stage I sleep, but less time in SWS and REM sleep compared to control populations, with delayed REML and less 1st REML. In addition, increased sleep fragmentation (WASO and SFI) and increased AI and PLMS index were detected in VaD patients. Finally, VaD patients had significantly (p < 0.05) high apnea, hypopnea and RDI score with high average SpO2 desaturation. Conclusions: It is conclude that sleep is significantly (p < 0.05) impaired in patients with VaD at both the objective and subjective levels which may be used as a diagnostic marker of VaD. SBD is a common feature of VaD leading to fragmented sleep, increased nocturnal confusion and excessive daytime sleepiness. Subjective sleep assessment questionnaire by (ESS and PSQI) can be used in VaD patients when objective sleep assessment by PSG recordings is difficult to be done. The PSG study of sleep continuity, sleep architecture and REM sleep may help in the prevention of progression of VaD

Egyptian consensus on treat-to-target approach for osteoporosis: a clinical practice guideline from the Egyptian Academy of bone health and metabolic bone diseases

Background: This study was carried out to achieve an Egyptian expert consensus on a treat-to-target managementstrategy for osteoporosis using Delphi technique. A scientific committee identified researchers and clinicians with expertise in osteoporosis in Egypt. Delphi process was implemented (2 rounds) to establish a consensus on 15 clinical standards: (1) concept, (2) diagnosis, (3) case identification, (4) whom to treat, (5) who should treat?, (6) case stratification and intervention thresholds, (7) falls risk, (8) investigations, (9) treatment target, (10) management, (11) optimum treatment duration, (12) monitoring, (13) drug holiday, (14) osteoporosis in men, and (15) post-fracture care and fracture liaison service. Results: The surveys were sent to an expert panel (n = 25), of whom 24 participated in the two rounds. Respondents were drawn from different governorates and health centres across Egypt including the Ministry of Health. Most of the participants were rheumatologists (76%), followed by internists (8%), orthopaedic doctors (4%), rehabilitation doctors (4%), primary care (4%), and ortho-geriatrics (4%) physicians. Seventy-two recommendations, categorised into 15 sections, were obtained. Agreement with the recommendations (rank 7–9) ranged from 83.4 to 100%. Consensus was reached (i.e. ≥ 75% of respondents strongly agreed or agreed) on the wording of all 15 clinical standards identified by the scientific committee. An algorithm for the management of postmenopausal osteoporosis has been suggested. Conclusion: A wide and representative panel of experts established a consensus regarding the management of osteoporosis in Egypt. The developed guidelines provide a comprehensive approach to the assessment and management of osteoporosis for all Egyptian healthcare professionals who are involved in its management