Hepatic Injury in COVID-19 Patients

لقد أثبتت الدراسات العملية بالفعل أن الفحوصات المخبرية للكبد مفيدة للغاية في تقييم وعلاج مرضى القصور الكبدي. لقد وجد أن بعض الإنزيمات والمنتجات النهائية للمسار الأيضي مثل مصل البيليروبين ، ألانين أمينو ترانسفيراز، أسبارتات أمينو ترانسفيراز ، نسبة الأمينو ترانسفيراز ، الفوسفاتيز القلوي ، جاما جلوتاميل ترانسفيراز ، 5 'نيوكليوتيداز، سيرولوبلازمين التي تعتبر حساسة للغاية لحدوث الشذوذ و يمكن اعتبارها علامة كيميائية حيوية بارزة لخلل في وظائف الكبد. كما لوحظ بشكل واضح أن فيروس كورونا المستجد المتلازمة التنفسية الحادة الوخيمة Corona Virus-2 (SARS-CoV-2) قد أدى في الغالب إلى متلازمة الضائقة التنفسية ، ولكن في نفس الوقت تم توثيق إصابة الكبد أيضًا. في واقع الأمر ، فإن آلية إصابة الكبد محدودة وغير مفهومة بشكل جيد ، لذلك قد تكون الإصابة الكبدية نتيجة استجابة التهابية جهازية ، أو عدوى فيروسية لخلايا الكبد ، أو ناتجة عن علاج العناية المركزة أو الأدوية. تسمم . مستقبلات الإنزيم المحول للأنجيوتنسين 2 (ACE2) ، والتي يتم توزيعها على نطاق واسع في الخلايا السنخية من النوع 2 ، هي المسار المقترح لمدخل الفيروس. من المثير للاهتمام أن نلاحظ أن مستقبلات الإنزيم المحول للأنجيوتنسين 2 توجد في خلايا الكبد الصفراوية وبطانة الأوعية الدموية والجهاز الهضمي. كما لوحظت صور نسيجية متوافقة مع التغيرات الوعائية ، والتي تتميز بزيادة عدد فروع الوريد البابي المرتبطة بالتوسع الهائل في التجويف، والتخثر اللمعي الجزئي أو الكامل للأوعية البابية والجيوب الأنفية ، وتليف السبيل البابي ، والتضخم بشكل ملحوظ والتليف.The practical studies have already proved that  the laboratory liver tests are  highly  useful in the evaluation and treatment of patients with hepatic dysfunction. It has been found that  some of the enzymes and the end products of the metabolic pathway such as serum bilirubin, alanine amino transferase, aspartate amino transferase, ratio of aminotransferases, alkaline phosphatase, gamma glutamyl transferase, 5’ nucleotidase, ceruloplasmin  that  are very sensitive for the abnormality occurred  may be considered as an outstanding  biochemical marker of liver dysfunction. It is noticed that  the novel coronavirus Severe Acute Respiratory Syndrome Corona Virus-2 (SARS-CoV-2) infection mostly leads to respiratory distress syndrome, at the same time  liver injury is also documented. As a matter of fact, the mechanism of liver injury is limited and poorly understood. Therefore, the hepatic injury  might be due to a consequence of systemic inflammatory response, viral infection of hepatocytes, or  it comes as a result of intensive care treatment or drug toxicity. The host angiotensin-converting enzyme 2 (ACE2) receptors, which are widely distributed in type 2 alveolar cells, are the proposed route of viral entrance. It is interesting to note that ACE2 receptors are found in the liver's cholangiocytes, vascular endothelium, and gastrointestinal tract.            Histological pictures compatible with vascular alterations are observed, characterized by  the increase in number of portal vein branches associated with lumen massive dilatation, partial or complete luminal thrombosis of portal and sinusoidal vessels, fibrosis of portal tract, focally markedly enlarged and fibrotic

Preparation and Histological Study of Multi-Walled Carbon Nanotubes Bone Graft in Management of Class II Furcation Defects in Dogs

BACKGROUND: The main target of periodontal disease and alveolar bone defeat treatment is the regeneration of the lost structures. AIM: This work deals with the evaluation of the effect of functionalised multi-walled carbon nanotubes (MWCNTs), as grafting material in the management of furcation defects created in dogs. MATERIAL AND METHODS: Potential cytotoxicity of the grafting material was assessed. Scanning electron microscope (SEM) and energy dispersive x-ray (EDX) analysis after incubation of the grafting material in simulated body fluid (SBF) at pH 7.4 and 37°C for one week was done. In six healthy mongrel dogs' full-thickness mucoperiosteal flaps were raised on the buccal aspects to create two walls intrabony defects at the furcation areas. The mandibular premolar area received the grafting material. Histological evaluation was carried out at 1, 2- and 3-months’ period. RESULTS: Cytotoxicity results proved the safety of grafting material application. The prepared material exhibited good Ca-apatite crystal patterns at the surface revealed by SEM and high calcium content showed by EDX results. Good bone formation ability was also apparent histologically. CONCLUSION: The prepared grafting material (MWCNTs) can serve as a delivery vehicle for osteogenic cells and osteogenic growth factor proteins in the bone development process

Evaluation of community pharmacists' awareness towards Middle East respiratory syndrome: a simulated client method.

Middle East Respiratory Syndrome (MERS) is a viral respiratory disease caused by a coronavirus variant in the Arabian Peninsula. There is a lack of information regarding awareness and practices of community pharmacists in Qatar for this contagious disease. To determine the quality of the MERS-related information, recommendations, and counselling practices provided by Qatar's community pharmacists by using Simulated Client Method (SCM). An observational cross-sectional study using a non traditional SCM was conducted in community pharmacies of Qatar from February 2017 to April 2017. A total of 30 community pharmacies were visited twice by two independent simulated clients and data regarding, provision of evidence -based information, recommendations and counselling practices were collected to assess the competency of pharmacists in managing MERS as a primary care problem. Both descriptive and inferential statistical methods were used for data analysis. In present study, majority of pharmacists encountered were male and younger than 45 -year -old with 44 (73.3%) each. The average number of pharmacists who did not ask about the patient's current medical conditions 56 (93.3), medications 58 (97.5%), allergies, and smoking status in both scenarios were not asked by any of the pharmacist. Most of the pharmacists gave an incorrect explanation of MERS 43 (71.7%). The overall quality counselling score for the pharmacists (mean +/- SD; median (IQR)) was {27.5 +/- 4.5; 28.5 (25.3-30.0)}. Quality counselling was significantly related to the type of pharmacy (p=0.0478). Qatar community pharmacist's MERS related information, recommendations, and counselling practices were below expectations and inconsistent, thus urging the need for continuous professional development

Clinical Profile of Non-Motor Symptoms in Patients with Essential Tremor: Impact on Quality of Life and Age-Related Differences

Background: Identifying the clinical phenotypes of non-motor symptoms (NMSs) of essential tremor (ET) among different populations is necessary due to their impact on the quality of life (QoL). This study aimed to investigate the clinical phenotype and impact of NMSs on QoL in Egyptian patients with ET. Methods: Thirty ET patients were compared to 30 matched controls. Subjects were evaluated by the Fahn-Tolosa-Marin Tremor Rating Scale, Non-Motor Symptoms Scale (NMSS), Montreal Cognitive Assessment, Hamilton Anxiety Rating Scale, Beck Depression Inventory, Pittsburgh Sleep quality Index, and the Short Form 36 Health Survey Questionnaire. Both groups were divided into two subgroups of younger (45 years, 16 patients) groups, to investigate age-related differences. Results: ET patients showed significantly worse cognition, depression, anxiety, sleep and NMSS domains (p < 0.001), compared to controls, that negatively affected and predicted QoL. Older patients had more cognitive impairment (p = 0.003) and worse sleep/fatigue (p = 0.032) and sexual functions (p = 0.006), compared to younger group. Discussion: The study supports that NMSs are integral part of ET, negatively affect QoL, and similarly affect younger and older patients. Therefore, NMSs should be explored for proper care of ET patients

Oral peptide vaccine against hookworm infection: correlation of antibody titers with protective efficacy

Approximately 0.4 billion individuals worldwide are infected with hookworm. An effective vaccine is needed to not only improve the health of those affected and at high risk, but also to improve economic growth in disease-endemic areas. An ideal anti-hookworm therapeutic strategy for mass administration is a stable and orally administered vaccine. Oral vaccines are advantageous as they negate the need for trained medical staff for administration and do not require strict sterility conditions. Vaccination, therefore, can be carried out at a significantly reduced cost. One of the most promising current antigenic targets for hookworm vaccine development is the aspartic protease digestive enzyme (APR-1). Antibody-mediated neutralization of APR-1 deprives the worm of nourishment, leading to reduced worm burdens in vaccinated hosts. Previously, we demonstrated that, when incorporated into vaccine delivery systems, the APR-1-derived p3 epitope (TSLIAGPKAQVEAIQKYIGAEL) was able to greatly reduce worm burdens (≥90%) in BALB/c mice; however, multiple, large doses of the vaccine were required. Here, we investigated a variety of p3-antigen conjugates to optimize antigen delivery and establish immune response/protective efficacy relationships. We synthesized, purified, and characterized four p3 peptide-based vaccine candidates with: (a) lipidic (lipid core peptide (LCP)); (b) classical polymeric (polymethylacrylate (PMA)); and (c) novel polymeric (polyleucine in a branched or linear arrangement, BL10 or LL10, respectively) groups as self-adjuvanting moieties. BL10 and LL10 induced the highest serum anti-p3 and anti-APR-1 IgG titers. Upon challenge with rodent hookworms, the highest significant reduction in worm burden was observed in mice immunized with LL10 . APR-1-specific serum IgG titers correlated with worm burden reduction. Thus, we provide the first vaccine-triggered immune response-protection relationship for hookworm infection

Cyclic Dipeptides: The Biological and Structural Landscape with Special Focus on the Anti-Cancer Proline-Based Scaffold

Cyclic dipeptides, also know as diketopiperazines (DKP), the simplest cyclic forms of peptides widespread in nature, are unsurpassed in their structural and bio-functional diversity. DKPs, especially those containing proline, due to their unique features such as, inter alia, extra-rigid conformation, high resistance to enzyme degradation, increased cell permeability, and expandable ability to bind a diverse of targets with better affinity, have emerged in the last years as biologically pre-validated platforms for the drug discovery. Recent advances have revealed their enormous potential in the development of next-generation theranostics, smart delivery systems, and biomaterials. Here, we present an updated review on the biological and structural profile of these appealing biomolecules, with a particular emphasis on those with anticancer properties, since cancers are the main cause of death all over the world. Additionally, we provide a consideration on supramolecular structuring and synthons, based on the proline-based DKP privileged scaffold, for inspiration in the design of compound libraries in search of ideal ligands, innovative self-assembled nanomaterials, and bio-functional architectures

Can Low Level Laser Therapy Benefit Bone Regeneration in Localized Maxillary Cystic Defects? - A Prospective Randomized Control Trial

AIM: The aim of the study was to evaluate the effect of Low-Level Laser Therapy (LLLT) on bone formation in cystic defects following cyst enucleation.PATIENTS AND METHODS: The sample was composed of sixteen patients with enucleated maxillary bony cystic lesions. With an age range from 20 - 44 grouped as eight Laser and eight Control patients. Laser group was subjected to low intensity diode laser immediately after surgery and then for three times per week for two weeks using a therapeutic laser irradiation. Group B (control group): patients were not subjected laser therapy.RESULTS: The predictor variable was exposure of bone defect to LLLT or none. The outcome variable was bone density changes measured by digital radiographs at day 1 and days 90 postoperatively. Descriptive and bivariate statistics were computed. There were no statistically significant differences between the 2 groups for the bone density at day 1. There was a statistically significant difference in bone density changes in each group at day 90: Significant at P ≤ 0.05. After adjusting for differences in day 1 for bone density, the estimated mean change in bone density changes at day 90 was significantly larger for Laser compared with control.CONCLUSION: The results of this study suggested that LLLT can enhance bone healing in maxillary cystic defects. This can serve as an adjunct method in preventing possible delayed healing and pathological fractures This also will be helpful for more researchers in early loading in case of dental implants to accelerate osseointegration

Value of diffusion MRI versus [18F]FDG PET/CT in detection of cervical nodal metastases in differentiated thyroid cancer patients

Background: In differentiated thyroid cancer (DTC) patients, cervical nodal metastasis is a negative prognostic factor. Preoperative imaging plays an important role in treatment planning for nodal metastasis and recurrence. The aim of the study is to compare the diagnostic performance of the diffusion-weighted magnetic resonance imaging (DW-MRI) and the F-18 flurodeoxyglucose positron emission computed tomography ([18F]FDG PET/CT) in detection of cervical nodal deposits in DTC patients. Materal and methods: The study was conducted on 30 patients, each performed both modalities just before the surgery. The gold standard was the pathological specimens with post-operative clinico-radiological follow-up, to assess the diagnostic performance of each modality. Results: Based on pathological and post-operative clinico-radiological follow up data. Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV) and accuracy were 84%, 80%, 50%, 95% and 83% for PET/CT compared to 84%, 60%, 42.8%, 91.3% and 80% for DW-MRI. On comparing the diagnostic performance of combined DW-MRI and PET/CT to each modality alone, the sensitivity and NPV were improved to 96% and 80% respectively. Conclusions: [18F]FDG PET/CT study is a valuable diagnostic modality for the assessment of cervical nodal deposits in DTC patients, surpassing DW-MRI. Combined PET/CT and DW-MRI techniques seemed to have synergistic performance, mainly in terms of sensitivity and NPV, for detection of nodal metastases