Effect of Atypical Antipsychotics on Serum BDNF in an Egyptian First Samples of First Episode Schizophrenia Patients

Aim: The study is one of only few studies that was concerned with effect of atypical antipsychotics on serum Brain-Derived Neutorophic Factor (BDNF) level, as well as the relation between serum BDNF level and severity of symptoms. Methods: This was a prospective study conducted on 45 patients with first episode schizophrenia, patients were diagnosed by Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), severity of symptoms assessed by PANSS (Positive And Negative Syndrome) scale, serum level of BDNF was assessed in all patients before starting their medication and after 6 weeks of receiving atypical antipsychotic. Results: Serum BDNF levels were decreased after 6 weeks of treatment with atypical antipsychotic in patients with first episode schizophrenia, risperidone and quetiapine showed statistically significant decrease (p values 0.004, 0.041 respectively) in BDNF level after 6 weeks of therapy. PANSS score was decreased after 6 weeks of treatment with atypical antipsychotic in patients with first episode schizophrenia. Quetiapine showed the highest mean difference 65.4 ± 13.5 and the amisulpride showed the least mean difference 43.7 ± 4.9. There was no significant correlation between serum BDNF level and severity of the symptoms (p value 0.328), while we established a negative correlation between BDNF level and negative symptoms (r = -0.321). We did not establish significant differences (p value = 0.604) between subtypes of schizophrenia regarding BDNF level. Conclusions: Further cognitive, neuropsychological and psychopathological assessment could be useful to clarify the involvement of BDNF in the endophenotypic characteristics of schizophrenia

Effect of Using Intracanal Cryotherapy Versus Ultrasonic Activated Irrigation on Post-Operative Pain in Single Visit Endodontic Treatment of Teeth with Symptomatic Irreversible Pulpitis “Randomized Clinical Trial”

Aim : This study was designated to evaluate the effect of using intracanal cryotherapy versus ultrasonic activated irrigation on postoperative pain in single visit endodontic treatment of mandibular first molar with symptomatic, irreversible pulpitis using numerical rate scale (NRS) at 6, 12, 24, 48,72 hr and 1 week postoperatively. Materials and Methods: seventy-eight patients diagnosed with symptomatic irreversible pulpitis in mandibular first molar with no periapical involvement. The cases were randomly divided into three groups according to final irrigation protocol after root canal preparation using Pro Taper Next; Groups A, B and C, twenty-six patients each group (n=26). Group A: final irrigation with room temperature saline using Navi-Tip; double side-port needle (31-gauge,27mm). Group B: final irrigation with room temperature saline with ultrasonic activation using (Ultra-X). Group C: final irrigation with 2.5ºc cold saline using Navi-Tip; double side-port needle (31-gauge,27mm). After a single visit root canal treatment and a specific final irrigation protocol, depending on each group, the patients were given a questionnaire on which the patient would mark the degree of pain in a scale from 0 to 10 at 6, 12, 24, 48, and 72 h and 7 days post-obturation. Data were statistically analyzed with a significance level of p ≤ 0.05. Results: ultrasonic group (Group B) showed statistically the least incidence and intensity of postoperative pain compared to the other groups after 6, 12 and 24 hours. Cryotherapy group (group B) showed lower Incidence and intensity of postoperative pain after 6,12, 24 and 48 hours. While control group (group A) showed statistically the highest incidence and intensity of post-operative pain compared to the other groups after 6,12, 24,48 and 72 hours. After 1 week there were no significant difference among the three groups where pain scores declined among the groups till it reaches score (0) at day 7. Incidence and number of analgesic intake was significantly higher in patients of the control group compared to ultrasonic and cryotherapy groups. Conclusion: The least post-operative pain incidence and intensity were associated with ultrasonic irrigation on the first day. The incidence and severity of post-endodontic pain are decreased when cold saline (cryotherapy) is used as the final irrigant during endodontic treatment of teeth with symptomatic irreversible pulpitis

Redesigning Price Setting under the Universal Health Insurance in Egypt / إعادة تصميم التسعير في ظل التأمين الصحي الشامل في مصر

Since the Sustainable Development Goals were adopted by the United Nations Development Programme, Universal Health coverage became the main target for many nations. One of the main challenges facing the governments to achieve universal health coverage is maintaining adequate policies to set fair pricing for the healthcare services. Each country has different strategies to apply fair pricing and this paper is discussing the current pricing methods in Egypt and suggesting three policies to tackle its challenges

Effect of Low-Level Laser Therapy in Treatment of Chemotherapy Induced Oral Mucositis

Introduction: Oral mucositis (OM) is an unavoidable condition of the oral cavity that accompanies chemotherapy for various malignant cases. Chemotherapy-induced oral Mucositis (COM) is a frequent complication due to mucotoxic drugs and is known to deteriorate the general health significantly, while negatively affecting the quality of life (QOL). Studies have reported that low-level laser therapy (LLLT) promotes the tissue healing. The objective of the present study was to explore the efficacy of gallium-arsenide (GaAs) laser in treating COM and its impact on inflammatory cytokine levels in patients receiving chemotherapy for various malignancies.Methods: A total of 80 patients with COM received LLLT 6 days/week. OM was graded according to the World Health Organization (WHO) grading scale. The outcome parameters were the serum levels of tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) measured before, during and after administration of LLLT.Results: After LLLT, a significant decrease was found in the mean values of mucositis grade from 2.35 ± 0.695 to 1.13 ± 0.333 after (P < 0.001). A significant reduction in the level of TNF-α was found after LLLT among breast cancer patients (P = 0.0045), but not in head and neck cancer and lymphoma patients. A significant reduction was also found in IL-6 level after treatment among head and neck and breast cancer patients (P = 0.0307 and 0.019, respectively).Conclusion: The use of GaAs LLLT in treating COM in patients with various malignancies is well tolerated by patients, it results in improvement of mucositis, however; mechanism of action does not seem to be completely linked to the change of pro or anti-inflammatory cytokines

The Protective Properties of the Strawberry (Fragaria ananassa) against Carbon Tetrachloride-Induced Hepatotoxicity in Rats Mediated by Anti-Apoptotic and Upregulation of Antioxidant Genes Expression Effects

The strawberry (Fragaria ananassa) has been extensively used to treat a wide range of ailments in many cultures. The present study was aimed at evaluating the hepatoprotective effect of strawberry juice on experimentally induced liver injury in rats. To this end, rats were introperitoneally injected with carbon tetrachloride (CCl4) with or without strawberry juice supplementation for 12 weeks and the hepatoprotective effect of strawberry was assessed by measuring serum liver enzyme markers, hepatic tissue redox status and apoptotic markers with various techniques including biochemistry, ELISA, quantitative PCR assays and histochemistry. The hepatoprotective effect of the strawberry was evident by preventing CCl4-induced increase in liver enzymes levels. Determination of oxidative balance showed that strawberry treatment significantly blunted CCl4-induced increase in oxidative stress markers and decrease in enzymatic and non-enzymatic molecules in hepatic tissue. Furthermore, strawberry supplementation enhanced the anti-apoptotic protein, Bcl-2, and restrained the pro-apoptotic proteins Bax and caspase-3 with a marked reduction in collagen areas in hepatic tissue. These findings demonstrated that strawberry (Fragaria ananassa) juice possessed antioxidant, anti-apoptotic and anti-fibrotic properties, probably mediated by the presence of polyphenols and flavonoids compounds

Genomic characterization of SARS-CoV-2 in Egypt: insights into spike protein thermodynamic stability

The overall pattern of the SARS-CoV-2 pandemic so far has been a series of waves; surges in new cases followed by declines. The appearance of novel mutations and variants underlie the rises in infections, making surveillance of SARS-CoV-2 mutations and prediction of variant evolution of utmost importance. In this study, we sequenced 320 SARS-CoV-2 viral genomes isolated from patients from the outpatient COVID-19 clinic in the Children’s Cancer Hospital Egypt 57357 (CCHE 57357) and the Egypt Center for Research and Regenerative Medicine (ECRRM). The samples were collected between March and December 2021, covering the third and fourth waves of the pandemic. The third wave was found to be dominated by Nextclade 20D in our samples, with a small number of alpha variants. The delta variant was found to dominate the fourth wave samples, with the appearance of omicron variants late in 2021. Phylogenetic analysis reveals that the omicron variants are closest genetically to early pandemic variants. Mutation analysis shows SNPs, stop codon mutation gain, and deletion/insertion mutations, with distinct patterns of mutations governed by Nextclade or WHO variant. Finally, we observed a large number of highly correlated mutations, and some negatively correlated mutations, and identified a general inclination toward mutations that lead to enhanced thermodynamic stability of the spike protein. Overall, this study contributes genetic and phylogenetic data, as well as provides insights into SARS-CoV-2 viral evolution that may eventually help in the prediction of evolving mutations for better vaccine development and drug targets

Perceived Risk of falls among Acute Care Patients

Purpose: In an effort to lower the number of falls that occur among hospitalized patients, several facilities have begun introducing various fall prevention programs. However, the efficacy of fall prevention programs is diminished if patients do not consider themselves to be at risk for falls and do not follow recommended procedures. The goal of this study was to characterize how patients in four different acute care specialist services felt about their risk of falling while in the hospital. Methods: One hundred patients admitted to the study hospital with a Morse Fall Scale score of 45 or higher were given the Patient Perception Questionnaire, a tool designed to assess a patient's perception of their own fall risk, fear of falling, and motivation to take part in fall prevention efforts. Scores on the Morse Fall Scale were gathered through a historical assessment of medical records. Descriptive statistics, Pearson's correlation coefficients, and independent sample t tests were used to examine the data. Results: The average age was 65, and around half (52%) were men and half (48%) were women. Based on their ratings on the Morse Fall Scale, all 100 participants were classified as being at high risk for falls. However, only 55.5% of the individuals agreed with this assessment. The likelihood that a patient would seek assistance and the degree to which they feared falling both declined as their faith in their mobility improved. Patients hospitalized after a fall exhibited considerably lower confidence scores and greater fear scores than patients who had not been injured in a fall. Conclusions: Patients who have a high fall risk assessment score may not believe they are at risk for falls and may not take any steps to reduce their risk. The prevalence of falls in hospitals might be mitigated by the creation of a fall risk assessment technique that takes into account both objective and subjective factors

Comprehensive virtual screening of the antiviral potentialities of marine polycyclic guanidine alkaloids against SARS-CoV-2 (COVID-19)

The huge global expansion of the COVID-19 pandemic caused by the novel SARS-corona virus-2 is an extraordinary public health emergency. The unavailability of specific treatment against SARS-CoV-2 infection necessitates the focus of all scientists in this direction. The reported antiviral activities of guanidine alkaloids encouraged us to run a comprehensive in silico binding affinity of fifteen guanidine alkaloids against five different proteins of SARS-CoV-2, which we investigated. The investigated proteins are COVID-19 main protease (Mpro) (PDB ID: 6lu7), spike glycoprotein (PDB ID: 6VYB), nucleocapsid phosphoprotein (PDB ID: 6VYO), membrane glycoprotein (PDB ID: 6M17), and a non-structural protein (nsp10) (PDB ID: 6W4H). The binding energies for all tested compounds indicated promising binding affinities. A noticeable superiority for the pentacyclic alkaloids particularly, crambescidin 786 (5) and crambescidin 826 (13) has been observed. Compound 5 exhibited very good binding affinities against Mpro (∆G = −8.05 kcal/mol), nucleocapsid phosphoprotein (∆G = −6.49 kcal/mol), and nsp10 (∆G = −9.06 kcal/mol). Compound 13 showed promising binding affinities against Mpro (∆G = −7.99 kcal/mol), spike glycoproteins (∆G = −6.95 kcal/mol), and nucleocapsid phosphoprotein (∆G = −8.01 kcal/mol). Such promising activities might be attributed to the long ω-fatty acid chain, which may play a vital role in binding within the active sites. The correlation of c Log P with free binding energies has been calculated. Furthermore, the SAR of the active compounds has been clarified. The Absorption, Distribution, Metabolism, Excretion, and Toxicity (ADMET) studies were carried out in silico for the 15 compounds; most examined compounds showed optimal to good range levels of ADMET aqueous solubility, intestinal absorption and being unable to pass blood brain barrier (BBB), non-inhibitors of CYP2D6, non-hepatotoxic, and bind plasma protein with a percentage less than 90%. The toxicity of the tested compounds was screened in silico against five models (FDA rodent carcinogenicity, carcinogenic potency TD50, rat maximum tolerated dose, rat oral LD50, and rat chronic lowest observed adverse effect level (LOAEL)). All compounds showed expected low toxicity against the tested models. Molecular dynamic (MD) simulations were also carried out to confirm the stable binding interactions of the most promising most promising compounds, 5 and 13, with their targets. In conclusion, the examined 15 alkaloids specially 5 and13 showed promising docking,ADMET,toxicity and MD results which open the door for further investigations for them against SARS-CoV-2

A Role of Therapy that Targets Immune Checkpoint Proteins for the Treatment of Melanoma Brain Metastasis, Liver, Breast, Pancreatic Cancer and Pancreatic Adenocarcinoma

Checkpoint inhibitors are a type of immune therapy used to treat different types of cancers. These drugs block different checkpoint proteins, for example, CTLA-4, PD-1, and PD-L1 inhibitors. They block proteins that stop the immune system from attacking the cancer cells.  Checkpoints are also described as a type of monoclonal antibody that antagonizes binding between B7 to CTLA-4 and PD-L1 to PD-1.  Immune checkpoint inhibitors are used to treat BARCA mutated triple-negative breast cancer (TNBCS) in patients who do not respond to chemotherapy, and also in the treatment of highly mutated and solid tumors such as brain tumors, liver, and pancreatic cancers. Immune checkpoint inhibitors exhibit an effect on solid tumors by suppressing CTLA-4, PD-1, and PDL-1. Anti-PD-1 is less toxic than anti-CTLA-4. For melanoma Brain metastasis immune checkpoint therapy is more effective and Combination therapy has great efficacy and less toxicity which improves overall survival rather than individual therapy liver cancer as hepatocellular carcinoma and cholangiocarcinoma used treatment with Genetics based therapy while using alternative immune checkpoint ligands, co-inhibitory (eg. LAG-3) or decreased t-cell infiltration causing therapy failure. Clinical studies for pancreatic cancer have not been completed yet and treating PDA needs more research as immune checkpoint inhibitors is a new treatment against  PDA. A new potent class of nivolumab, pembrolizumab, and ipilimumab have been FDA approved. For mutated tumors, Combination therapy between checkpoint inhibitors and chemotherapy has great efficacy and improves the city of life and overall survival, rather than individual therapy when using radiation or chemotherapy alone