Fecal Lactoferrin As A Diagnostic and Prognostic Marker in Egyptian IBD Patients

Background: Inflammatory bowel diseases (IBD) are organic chronic inflammation of the gastrointestinal tract characterized by variable disease activity with repeated periods of remission and exacerbation. Irritable bowel syndrome (IBS) is prevalent in up to fifth of population; diarrhea type has the broadest differential diagnosis. To distinguish inflammatory versus functional disorder fecal biomarkers as fecal lactoferrin (FL), being non-invasive acute phase proteins produced by inflamed mucosa, can help to avoid invasive procedures. Objective: The aim of this study was to assess sensitivity and specificity of fecal lactoferrin as a non-invasive biomarker in Egyptian patients with IBD and to detect its role in assessment of disease severity. Patients and methods: This comparative case control study was held through one year duration. Patients were recruited from Internal Medicine and Hepatology Department at a University Hospital. 50 subjects were classified into 3 groups: Group I included 30 patients with inflammatory bowel disease, Group II included 10 patients with irritable bowel syndrome, Group III included 10 healthy subjects as control group. Results: fecal lactoferrin assay (FLA) levels were highest in patients with IBD in comparison with IBS patients and healthy group. Moreover FLA levels also correlated significantly with disease severity in patients with IBD as higher levels of FLA were found in patients with severe ulcerative colitis (UC) or Crohn`s disease. Conclusion: Fecal lactoferrin can be used to differentiate IBD from IBS with 96.7% sensitivity and 100% specificity at cutoff value of 37 ug/ml while at cutoff value 7.2 ug/ml FLA has 100% sensitivity and specificity in differentiating IBD patients from healthy subjects in Egyptian population. Yet it can’t differentiate ulcerative colitis versus Crohn’s disease

Serum Calprotectin as a Non-invasive Diagnostic Marker for Spontaneous Bacterial Peritonitis in Egyptian Cirrhotic Patients

ABSTRACT BACKGROUND and AIM: Delayed diagnosis of spontaneous bacterial peritonitis (SBP) is associated wit

Cabbage and fermented vegetables : From death rate heterogeneity in countries to candidates for mitigation strategies of severe COVID-19

Large differences in COVID-19 death rates exist between countries and between regions of the same country. Some very low death rate countries such as Eastern Asia, Central Europe, or the Balkans have a common feature of eating large quantities of fermented foods. Although biases exist when examining ecological studies, fermented vegetables or cabbage have been associated with low death rates in European countries. SARS-CoV-2 binds to its receptor, the angiotensin-converting enzyme 2 (ACE2). As a result of SARS-CoV-2 binding, ACE2 downregulation enhances the angiotensin II receptor type 1 (AT(1)R) axis associated with oxidative stress. This leads to insulin resistance as well as lung and endothelial damage, two severe outcomes of COVID-19. The nuclear factor (erythroid-derived 2)-like 2 (Nrf2) is the most potent antioxidant in humans and can block in particular the AT(1)R axis. Cabbage contains precursors of sulforaphane, the most active natural activator of Nrf2. Fermented vegetables contain many lactobacilli, which are also potent Nrf2 activators. Three examples are: kimchi in Korea, westernized foods, and the slum paradox. It is proposed that fermented cabbage is a proof-of-concept of dietary manipulations that may enhance Nrf2-associated antioxidant effects, helpful in mitigating COVID-19 severity.Peer reviewe

Nrf2-interacting nutrients and COVID-19 : time for research to develop adaptation strategies

There are large between- and within-country variations in COVID-19 death rates. Some very low death rate settings such as Eastern Asia, Central Europe, the Balkans and Africa have a common feature of eating large quantities of fermented foods whose intake is associated with the activation of the Nrf2 (Nuclear factor (erythroid-derived 2)-like 2) anti-oxidant transcription factor. There are many Nrf2-interacting nutrients (berberine, curcumin, epigallocatechin gallate, genistein, quercetin, resveratrol, sulforaphane) that all act similarly to reduce insulin resistance, endothelial damage, lung injury and cytokine storm. They also act on the same mechanisms (mTOR: Mammalian target of rapamycin, PPAR gamma:Peroxisome proliferator-activated receptor, NF kappa B: Nuclear factor kappa B, ERK: Extracellular signal-regulated kinases and eIF2 alpha:Elongation initiation factor 2 alpha). They may as a result be important in mitigating the severity of COVID-19, acting through the endoplasmic reticulum stress or ACE-Angiotensin-II-AT(1)R axis (AT(1)R) pathway. Many Nrf2-interacting nutrients are also interacting with TRPA1 and/or TRPV1. Interestingly, geographical areas with very low COVID-19 mortality are those with the lowest prevalence of obesity (Sub-Saharan Africa and Asia). It is tempting to propose that Nrf2-interacting foods and nutrients can re-balance insulin resistance and have a significant effect on COVID-19 severity. It is therefore possible that the intake of these foods may restore an optimal natural balance for the Nrf2 pathway and may be of interest in the mitigation of COVID-19 severity

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

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

Relation between hyper-uricemia and renal resistivity index in non diabetic non hypertensive patients

Background: Relationship between uric acid and renal artery resistive index (RRI) in hypertensive subjects was recently suggested. Aim: The aim was to evaluate the effect of hyper-uricemia on RRI in adult Egyptian subjects with no other risk factors of renal vascular disease, and to assess the impact of therapeutic control of serum uric acid on the RRI. Patients and methods: 50 adult hyper-uricemic subjects were included in this study, who underwent abdominal ultrasound with Doppler examination of the kidneys. The RI was automatically calculated by the US equipment. Intra-renal resistance was measured at inter-lobar arteries three times in different regions of each kidney (upper, middle, and lower zones) and the mean RI value was calculated. Each case had its pre and post 3 and 6 weeks treatment duplex measurement of RI together with uric acid measurement and correlation. Results: Mean value of the baseline RI was 0.768 ± 0.01355 SD, and mean serum uric acid value was 10.86 ± 0.65 SD, with a positive significant correlation between both values. Mean value of the difference of the serum uric acid level and RRI prior to and 3 weeks after treatment was 2.68 ± 0.49, 0.04 ± 0.01 respectively, with positive significant correlation between the two values p-value: 0.001. Mean value of the difference of the serum uric acid level and RRI 3 and 6 weeks after treatment was 2.18 ± 0.5 and 0.06 ± 0.01 respectively, with significant positive correlation between the two values and p-value 0.00. Mean value of the total change of serum uric acid and RRI over the treatment period was: 2.38 ± 0.43 and 0.049 ± 0.01 with positive significant correlation between the two values and p-value: 0.00. Conclusion: Serum uric acid significantly correlates with RRI in the absence of other risk factors affecting renal vasculature. Improvement of serum uric acid is accompanied by the improvement in RRI

A randomized trial comparing the effects of electrical stimulation of the quadriceps muscle and decreased trigger sensitivity plus exercise breathing after discharge on mechanically ventilated patients with chronic obstructive pulmonary disease to those receiving standard care in terms of 30-day mortality, hospital readmission, and health-related quality of life

Background To compare the effectiveness of ES and TS plus exercise breathing after discharge on mechanically ventilated patients with chronic obstructive pulmonary disease (COPD) to those receiving standard care in terms of 30-day mortality, hospital readmission, and health-related quality of life (HRQOL). Patients and methods The current study was a randomized controlled trial. It included 108 newly admitted patients with COPD to RICU, Chest Department, Assiut University Hospital, Egypt, between June 2018 and May 2020. They were divided into two groups: group I received the usual care plus ES and TS plus breathing exercise, and group II received the usual care alone. Thirty-day mortality, hospital readmission, and HRQOL assessed by MFR-28 were recorded and evaluated. Student t test, Mann–Whitney U test, χ2 test, and Fisher exact test were performed to analyze the data. Results A total of 108 patients with COPD were included. Early rehabilitation program (ES and TS) plus exercise breathing for patients with COPD in the ICU showed decreased 30-day mortality, decreased hospital readmission, and improved HRQOL as compared with patients with COPD who received usual care. Conclusion Patients with COPD who were treated with an early rehabilitation program (ES and TS) combined with exercise breathing had a better prognosis and a higher QOL. Clinical trial.gov The study was registered under NCT03253380

Cytokeratin 18 as a non invasive marker in diagnosis of NASH and its usefulness in correlation with disease severity in Egyptian patients

Background: A simple noninvasive test that accurately distinguishes NASH from NAFL as well as determines the disease severity is urgently needed. Recently, it was found that determination of cytokeratin-18 (CK-18) fragments in the blood, predicts and correlates with histological NASH in which there is development of lobular inflammation, cell ballooning and fibrosis, supporting its usefulness in clinical practice. Aims: To evaluate the role of CK-18 as a non invasive marker in diagnosis of NASH and its usefulness in correlation with disease severity in Egyptian patients. Patients and methods: 90 subjects were divided into 3 groups: group I: including 30 patients with NASH, group II: including 30 patients with NAFL, and group III: including 30 healthy subjects as control. Diagnosis of NASH and its discrimination from NAFL was done by liver biopsy. CK-18 level in plasma was measured for all subjects using ELISA. Results: CK-18 was significantly elevated in patients of group I in comparison to group II and III patients, with mean ± SD: 460 ± 279, 167 ± 56 and 149 ± 57, respectively, and P value: 0.001. The (ROC) curve diagnostic performance of CK18 in diagnosis of NASH shows: cutoff value of >240 U/L, with sensitivity 76.7%, specificity 95.0%. Ck-18 was found to correlate with disease severity assessed by NAS scoring system with P value: 0.001. Conclusion: Measurement of CK18 in NASH is a useful screening, diagnostic and staging biomarker