Rapid diagnosis of fungal keratitis in patients with corneal ulcer using Calcofluor White stain

Background: The prevalence of fungal keratitis has risen in recent years significantly. To avoid additional complications, diagnosing and treating fungal keratitis is crucial. This study aims to measure the efficacy of a calcofluor white (CFW) stain for the quick diagnosis of fungal keratitis and to contrast the positive rates, sensitivity, and specificity with a 10% potassium hydroxide (KOH)-based smear and culture technique. Methods:From individuals with clinically suspected corneal ulcers, 30 corneal scrapings had been collected. Data on demographics had been analyzed. Results: Of the 30 patients, 40% were women and 60% were men. There was a 1.5:1 man-to-woman ratio. The age of patients ranged from 29 to 71 years (mean 46.67 ± 10.90). The age presentation of those between the ages of 41 and 50 years was the most frequent (36.7%). The majority of cases were farmers (43.3%). Trauma was the most common predisposing factor (46.6%). Twenty-four (80%) cases were culture positive. Eleven (36.7%) were fungal, 13 (43.3%) were bacterial and 6 (20%) showed no growth. Fusarium was the most common fungal isolate (36.4%), followed by Aspergillus (27.3%). While Staphylococcus aureus was the most common bacterial isolate (46.2%), followed by Pseudomonas (38.4%). The sensitivity of KOH wet mount and CFW stain was 72.7% and 90.9%, respectively. The specificity of both KOH wet mount and CFW stain was 100%. Conclusion:The early diagnosis of fungal keratitis can be made rapidly by direct microscopic examination of fungal elements using CFW stain. When diagnosing fungal keratitis, CFW has higher sensitivity to KOH

Consensus evidence-based clinical practice recommendations for the diagnosis and treat-to-target management of osteoporosis in chronic kidney disease stages G4-G5D and post-transplantation: An initiative of Egyptian Academy of Bone Health

The aim of this study was to reach a consensus on an updated version of the recommendations for the diagnosis and Treat-to-Target management of osteoporosis that is effective and safe for individuals with chronic kidney disease (CKD) G4-G5D/kidney transplant. Delphi process was implemented (3 rounds) to establish a consensus on 10 clinical domains: (1) study targets, (2) risk factors, (3) diagnosis, (4) case stratification, (5) treatment targets, (6) investigations, (7) medical management, (8) monitoring, (9) management of special groups, (10) fracture liaison service. After each round, statements were retired, modified, or added in view of the experts' suggestions, and the percent agreement was calculated. Statements receiving rates of 7-9 by more than 75% of experts' votes were considered as achieving consensus. The surveys were sent to an expert panel ( = 26), of whom 23 participated in the three rounds (2 were international experts and 21 were national). Most of the participants were rheumatologists (87%), followed by nephrologists (8.7%), and geriatric physicians (4.3%). Eighteen recommendations, categorized into 10 domains, were obtained. Agreement with the recommendations (rank 7-9) ranged from 80 to 100%. Consensus was reached on the wording of all 10 clinical domains identified by the scientific committee. An algorithm for the management of osteoporosis in CKD has been suggested. A panel of international and national experts established a consensus regarding the management of osteoporosis in CKD patients. The developed recommendations provide a comprehensive approach to assessing and managing osteoporosis for all healthcare professionals involved in its management. [Abstract copyright: Copyright © 2022 by The Author(s). Published by S. Karger AG, Basel.

Accessibility to biologics and its impact on disease activity and quality of life in patients with rheumatoid arthritis in Kuwait

Objective: Biologics are indicated in rheumatoid arthritis (RA) in case of persistent high disease activity despite conventional disease-modifying anti-rheumatic drugs (cDMARDs) or patients with contraindications to cDMARDs or poor prognostic factors. The purpose of this study was to compare the prescription rates of biologics in Kuwaiti and non-Kuwaiti patients and to assess whether this had an impact on disease activity and quality of life in RA patients. Methods: Data were extracted from the Kuwait Registry for Rheumatic Diseases. Adult patients who satisfied the ACR classification criteria for RA from four major hospitals in Kuwait were evaluated from February 2013 through May 2018. The treatment agents, disease activity, and quality of life of Kuwaiti patients were compared with non-Kuwaiti patients. Results: A total of 1651 RA patients were included; 806 (48.8%) were Kuwaiti patients. Among Kuwaiti patients, 62.5% were on biologic drugs in comparison with 14% of non-Kuwaiti patients. In comparison with non-Kuwaiti patients, Kuwaiti patients had significantly lower numbers of swollen joints (p < 0.001) and disease activity score-28 scores (p = 0.02) and less steroid use (p < 0.001) yet a significantly higher health assessment questionnaire-disability index (p < 0.001). Regression analysis showed that DAS-28 scores were significantly associated with the treatment type (p < 0.001) and that nationality was significantly predictive of the treatment type (p < 0.001). Conclusion: In the setting of easy accessibility to treatment for Kuwaiti patients, biologics were prescribed by rheumatologists at a higher rate than for non-Kuwaitis. This may explain the lower disease activity and the lower rate of steroid use in Kuwaiti patients than non-Kuwaitis. Key points: • Significant discrepancies in the rates of prescribing biologic therapies between KP and NKP in Kuwait were observed. • Several treatment outcomes were significantly better in the KP group than in the NKP group even after adjustment of confounding factors. • The poor access to biologic therapies was suggested to limit the effectiveness of RA treatments in the NKP group

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Serum procalcitonin in Egyptian patients with acute meningitis and a negative direct cerebrospinal fluid examination

Summary: Background: To reduce the morbidity and mortality related to bacterial meningitis, it is important to discriminate bacterial meningitis from aseptic meningitis during the acute phase of the disease, when the clinical symptoms are often similar. Objectives: To test the reliability of serum procalcitonin (PCT) to discriminate bacterial meningitis from aseptic meningitis in patients who have a negative direct cerebrospinal fluid (CSF) examination, and to evaluate the role of serum PCT to assess treatment efficacy compared with the total leukocyte count (TLC), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Materials and methods: Forty patients with suspected acute meningitis and negative gram stains were included, and ten healthy persons were included as controls. According to the clinical examination and the CSF cytochemical analysis and cultures, the patients were divided into bacterial and aseptic groups. The measurements of serum PCT, ESR, CRP and TLC were performed. Results: Patients in the bacterial group had a higher value of serum PCT at admission and at 3 days post-treatment than those in the aseptic group, with a highly significant difference between them. Conclusion: Serum PCT and, to a lesser extent, TLC had prognostic value in patients with acute meningitis, and PCT is more useful because it can be frequently measured for the diagnosis and follow-up of bacterial meningitis. Keywords: Acute meningitis, Negative gram stain, Procalcitoni

Bias-Correcting the Maximum and Minimum Air Temperatures of Egypt Using a High-Resolution Regional Climate Model (RegCM4)

The regional climate model (RegCM4) was used to project the maximum and minimum air temperatures (Tmax and Tmin) of Egypt considering the worst-case scenario: Representative Concentration Pathway 8.5 (RCP8.5). To achieve this goal, the spatial pattern of the simulated Tmax and Tmin was first examined. After that, the simulated Tmax and Tmin were bias-corrected in the historical period with respect to station observations using the Linear-Scaling (LS) technique. Finally, the LS was used to correct the two future scenarios. To downscale the RegCM4, the medium resolution of the Earth System Model of the Max Planck Institute (MPI-ESM-MR) was used to provide the lateral boundary condition and sea surface temperature. The results showed that both Tmax and Tmin exhibit the highest increase in the far-future period (2081–2100) particularly over Western Egypt, the Red Sea, and Upper Egypt (by 4–6 °C). Additionally, the RegCM4 performance is remarkably improved when the LS method is used. Such performance is indicated by a low mean bias in the validation period compared to the evaluation period over majority of stations. Further, the added value of the LS is noted in Tmin more than Tmax. Therefore, the RegCM4 can be used to project the Tmax and Tmin using the LS over the location of interest. In addition, using multiple General Circulation Models (GCMs) is necessary to account for uncertainty associated with the atmospheric forcing

Thyroid dysfunction and inflammatory biomarkers in chronic obstructive pulmonary disease: Relation to severity and exacerbation

Background: Thyroid dysfunction or non-thyroidal illness syndrome (NTIS) is frequently detected in chronic, systemic diseases. The systemic manifestations of chronic obstructive pulmonary disease (COPD) include a number of endocrine disorders. The severity of hypoxia and airway obstruction in COPD patients might cause alterations in thyroid function. The aim of this study is to assess serum levels of thyroid hormones and the inflammatory biomarkers; IL-6, TNF-α in COPD patients during stability and acute exacerbation of the disease, and also to assess the relation between severity of COPD and levels of thyroid hormones. Subjects and methods: Forty stable COPD patients and twenty COPD patients with acute exacerbation were included in this study as patient groups and twenty healthy age-matched non smoker subjects with normal pulmonary function as a control group. The diagnosis of COPD and acute exacerbation of COPD were established according to GOLD (2011) criteria. Stable COPD patients were further subdivided into Mild-to-moderate COPD patient group (FEV1 ⩾ 50% of predicted value, which included 14 patients) and Severe COPD patient group (FEV1 < 50% of predicted value, which included 26 patients). All enrolled patients were subjected to measurements of pulmonary function tests (FEV1%, FVC% and FEV1/FVC ratio), arterial blood gases (ABGs) (PaO2, PaCO2, pH), serum levels of thyroid hormones (TSH, total T3, total T4, free T3 and free T4) and the inflammatory biomarkers IL-6 and TNF-α on the first day of admission to RICU or first visit to the outpatient clinics. Results: There was a significant decrease in serum total T3 and free T3 levels in stable COPD patients when compared to control subjects. Also, there was a significant decrease in serum total T3, free T3, TSH levels and TT3/TT4 ratio in the COPD exacerbation patient group when compared to control subjects and when compared to stable COPD patients. There were no statistically significant differences in serum levels of total T4, free T4 between the studied groups. Regarding disease severity, serum total T3, free T3 levels and TT3/TT4 ratio were significantly decreased in severe COPD patients when compared to mild-to-moderate COPD patients. There were significant positive correlations between PaO2 and both serum total T3 and TT3/TT4 ratio in the stable COPD group. Serum IL-6 and TNF-α levels were significantly increased in both stable and exacerbation phase COPD patient groups when compared to control subjects. Conclusion: COPD is a systemic disease that may produce significant alterations in serum levels of thyroid hormones, especially in severe COPD patients and during exacerbation phases of COPD where NTIS is more evident. There was a significant decrease in serum total T3 and free T3 levels in stable COPD patients and this decrease was more significantly evident with a superadded significant decrease in serum TSH levels during the exacerbation phase of COPD. The hormonal alterations are especially related to severity of the disease and hypoxemia. Serum IL-6 and TNF-α levels were increased even in stable COPD and this rise is magnified with increased disease severity and during exacerbation phases of COPD

Characterization and cytotoxicity and antihuman renal cell carcinoma potentials of starch capped-copper oxide nanoparticles synthesized by ultrasonic irradiation: Introducing a novel chemotherapeutic drug

In this research article we have demonstrated the sustainable green synthesis of a novel starch templated CuO NP following a clean and non-hazardous pathway. Ultrasonic irradiation was used to promote the reaction in alkaline medium. The numerous hydroxyl groups present in starch was exploited in the green reduction of immobilized copper ions in situ. They also helped to stabilize the as synthesized Cu NPs by encapsulation or capping. The morphology and physicochemical characteristics were ascertained over an array of analytical techniques like Scanning Electron Microscopy (SEM), Energy-Dispersive X-ray Spectroscopy (EDS), Elemental Mapping, Transmission Electron Microscopy (TEM), X-ray Diffraction (XRD), and Inductively Coupled Plasma-Atomic Emission Spectrometry (ICP-AES). Biologically, the nanocomposite exhibited excellent cytotoxicity against human renal cell carcinoma (RCC-GH, CaKi-2 and HEK293) cell lines without affecting the normal (HUVEC) cell line. IC50 values of the nanocomposite were found at 139, 208and 125 against RCC-GH, CaKi-2 and HEK293 cell lines respectively and accordingly, HEK293 afforded the best adenocarcinoma activity

Metabolic Profiling of <i>Jasminum grandiflorum</i> L. Flowers and Protective Role against Cisplatin-Induced Nephrotoxicity: Network Pharmacology and In Vivo Validation

Cisplatin (CP) is a powerful chemotherapeutic agent; however, its therapeutic use is restricted due to its nephrotoxicity. In this work, we profiled the phytoconstituents of Jasminum grandiflorum flower extract (JGF) using LC-MS/MS and explored the possible molecular mechanisms against acute renal failure through pharmacological network analysis. Furthermore, the possible molecular mechanisms of JGF against acute renal failure were verified in an in vivo nephrotoxicity model caused by cisplatin. LC-MS analysis furnished 26 secondary metabolites. Altogether, there were 112 total hit targets for the identified metabolites, among which 55 were potential consensus targets related to nephrotoxicity based on the network pharmacology approach. Upon narrowing the scope to acute renal failure, using the DisGeNET database, only 30 potential targets were determined. The computational pathway analysis illustrated that JGF might inhibit renal failure through PI3K-Akt, MAPK signaling pathway, and EGFR tyrosine kinase inhibitor resistance. This study was confirmed by in vivo experiment in which kidneys were collected for histopathology and gene expression of mitogen-activated protein kinase 4 (MKK4), MKK7, I-CAM 1, IL-6, and TNF receptor-associated factor 2 (TRAF2). The animal-administered cisplatin exhibited a substantial rise in the expression levels of the MMK4, MKK7, I CAM 1, and TRFA2 genes compared to the control group. To summarize, J. grandiflorum could be a potential source for new reno-protective agents. Further experiments are needed to confirm the obtained activities and determine the therapeutic dose and time