Efficacy and Safety of Methotrexate in Articular and Cutaneous Manifestations of systemic Lupus Erythematosus

Aim:  A prospective open-label study comparing the efficacy and safety of methotrexate (MTX) and chloroquine (CQ) in articular and cutaneous manifestations of systemic lupus erythematosus (SLE). Methods:  Consecutive SLE patients were randomly assigned to either 10 mg MTX weekly or 150 mg CQ daily during 24 weeks. Outcome measures were: numbers of swollen and tender joints, duration of morning stiffness, visual analog scale (VAS) for articular pain, physician global assessment index, patient global assessment index, SLE Disease Activity Index (SLEDAI), disappearance of skin rash and erythrocyte sedimentation rate (ESR). Results:  Forty-one patients consented to participate, 15 were allocated in the MTX group and 26 in the CQ group. Two patients on MTX dropped out due to side-effects and two in the CQ group, one due to side-effects and one due to inefficacy. Baseline demographic, clinical and laboratory parameters of the two groups were nearly identical. In both groups the clinical and laboratory parameters improved significantly over 24 weeks, except the ESR in the MTX group. The results of the outcome measures at the end of the trial did not differ significantly between the two groups, except morning stiffness (P < 0.05 in favor of the MTX group) and ESR (P < 0.01 in favor of the CQ group). Rise of serum alanine aminotransferase was observed in two cases in the MTX group and in none in the CQ group. Conclusion:  Low-dose MTX appears to be as effective as CQ in patients with articular and cutaneous manifestations of SLE, having an acceptable toxicity profile. Results of this prospective study need to be confirmed in a larger study

Hydrogen storage in depleted gas reservoirs: A comprehensive review

Hydrogen future depends on large-scale storage, which can be provided by geological formations (such as caverns, aquifers, and depleted oil and gas reservoirs) to handle demand and supply changes, a typical hysteresis of most renewable energy sources. Amongst them, depleted natural gas reservoirs are the most cost-effective and secure solutions due to their wide geographic distribution, proven surface facilities, and less ambiguous site evaluation. They also require less cushion gas as the native residual gases serve as a buffer for pressure maintenance during storage. However, there is a lack of thorough understanding of this technology. This work aims to provide a comprehensive insight and technical outlook into hydrogen storage in depleted gas reservoirs. It briefly discusses the operating and potential facilities, case studies, and the thermophysical and petrophysical properties of storage and withdrawal capacity, gas immobilization, and efficient gas containment. Furthermore, a comparative approach to hydrogen, methane, and carbon dioxide with respect to well integrity during gas storage has been highlighted. A summary of the key findings, challenges, and prospects has also been reported. Based on the review, hydrodynamics, geochemical, and microbial factors are the subsurface\u27s principal promoters of hydrogen losses. The injection strategy, reservoir features, quality, and operational parameters significantly impact gas storage in depleted reservoirs. Future works (experimental and simulation) were recommended to focus on the hydrodynamics and geomechanics aspects related to migration, mixing, and dispersion for improved recovery. Overall, this review provides a streamlined insight into hydrogen storage in depleted gas reservoirs

A review of toolkits and case definitions for detecting enteric fever outbreaks in Asian and African countries from 1965-2019

Background: This review assessed the case definitions, diagnostic criteria, antimicrobial resistance, and methods used for enteric fever outbreaks and utilization of any unified outbreak score or checklist for early identification and response in Asia and Africa from 1965-2019.Methods: We searched enteric fever outbreaks using PubMed, Google Scholar, and the Cochrane library. Studies describing a single outbreak event of enteric fever in Asia and Africa from 1965-2019 were reviewed. We excluded case reports, letter to editors, studies reporting typhoid in conjunction with other diseases, the Centers for Disease Control and Prevention (CDC) trip reports, the World Health Organization (WHO) bulletins report, data from mathematical modeling and simulation studies, reviews and ProMed alert. Also, non-typhoidal salmonella outbreaks were excluded.Results: A total of 5063 articles were identified using the key terms and 68 studies were selected for data extraction. Most (48, 71%) outbreaks were from Asian countries, 20 (29%) were reported from Africa. Only 15 studies reported the case definition used for case identification during an outbreak and 8 of those were from Asia. A third (20, 29%) of the studies described antibiotic resistance pattern. 43 (63%) studies contained information regarding the source of the outbreak. Outcomes (hospitalization and deaths) were reported in a quarter of studies. Only 23 (29%) of the studies reported outbreak control strategies while none reported any unified outbreak score or a checklist to identify the outbreak.Conclusion: This review highlights the variability in detection and reporting methods for enteric fever outbreaks in Asia and Africa. No standardized case definitions or laboratory methods were reported. Only a few studies reported strategies for outbreak control. There is a need for the development of a unified outbreak score or a checklist to identify and report enteric fever outbreaks globally

Accuracy of autonomic symptoms in detection of severe cardiac autonomic neuropathy

Autonomic neuropathy is a troublesome complication of diabetes mellitus often is not addressed by the physicians. The aim was to see the accuracy of autonomic symptoms in the detection of severe cardiac autonomic neuropathy (CAN). This study was done in BIRDEM in 62 adult patients with type 2 diabetes mellitus and cardiac autonomic neuropathy. Cardiac autonomic neuropathy was detected clinically by heart rate and blood pressure change to maneuvers such as deep breathing, valsalva and standing. Eight symptoms of autonomic neuropathy, namely exercise intolerance, dizziness, dysphagia, abdominal bloating, constipa- tion, diarrhea, gustatory sweating and impotence were tested. In this study, impotence was the most common symptom (58%). There was no difference in the frequency of autonomic symptoms between severe and non-severe cardiac autonomic neuropathy. Taking clinical tests as gold standard, gustatory sweating had the highest specificity (96%) and constipation had the highest sensitivity (54.05%) in detection of severe cardiac autonomic neuropathy. Sensitivity increased to 78.37 when a constellation of symptoms were tested. Autonomic symptoms are common in patients with type 2 diabetes and cardiac autonomic neuropathy. Collection of symptoms was associated with a high sensitivity for detection of severe cardiac autonomic neuropathy. BSMMU J 2022; 15(1): 11-1

Sequence stratigraphic evolution of The post-rift MEGASEQUENCE in The northern part of The Nile Delta basin, Egypt

The stratigraphic succession of the subsurface Pliocene-Quaternary post-rift megasequence in the north-central part of the Nile Delta includes the rock units; Kafr El-Sheikh Formation (Early-Middle Pliocene), El- Wastani Formation (Late Pliocene), Mit-Ghamr and Bilqas formations (Quaternary). These rock units were analyzed according to the sequence stratigraphic principles to construct their stratigraphic architecture and discuss the depositional events influencing their evolution. Accordingly, seven 3rd order depositional sequences were encountered, of which six 3rd order seismic depositional sequences (sequences 1–6) are found in the Early–Middle Pliocene Kafr El-Sheikh Formation, whereas sequence-7 includes the Quaternary rock units. Sequences 1 and 7 were further subdivided, on the basis of high-resolution sequence stratigraphy into 8 and 11 4th order subsequences respectively. The results of the sequence stratigraphic analyses suggested that the depositional evolution of the examined Pliocene-Quaternary megasequence represents a complete prograding depositional phase during the Nile Delta history. The lower part of Kafr El-Sheikh Formation (sequences 1, 2, 3 and 4) was deposited as a thick outer marine shelf succession over which the younger rock units were deposited. However, the depositional sequences 5 & 6 of Kafr El-Sheikh Formation and the lower parts of El-Wastani Formations may indicate a deposition within active prograding prodelta sub-aqueous deltaic-subenvironments. The upper parts of El-Wastani Formation were deposited as a constructive delta-front pushing its way northward. The Pleistocene Mit-Ghamr Formation was evolved as a direct result of a huge fluvial input, organized as coalescing laterally extensive sand-rich bars. These were laid-down by active fluvial distributary streams that dominated the delta plain as the final phases of the present deltaic subaqueous environments

Synergistic effects of activated carbon and nano-zerovalent copper on the performance of hydroxyapatite-alginate beads for the removal of As\u3csup\u3e3+\u3c/sup\u3e from aqueous solution

© 2019 Elsevier Ltd In this study, activated carbon (AC) and nano-zerovalent copper (nZVCu) functionalized hydroxyapatite (HA) and alginate beads were synthesized and used for the removal of As3+ from aqueous solution. The characterization by X-ray diffraction, scanning electron microscopy, X-ray energy dispersive spectroscopy, X-ray photoelectron spectroscopy, transmission electron microscopy, high resolution transmission electron microscopy, BET surface area analysis, thermogravimetric analysis, and Fourier transform infrared spectroscopy revealed successful formation of the AC/nZVCu/HA-alginate, nZVCu/HA-alginate, AC/HA-alginate, and HA-alginate beads. The scanning electron microscopy and surface analysis revealed the prepared beads to be highly mesoporous which led to the maximum adsorption of As3+, i.e., 13.97, 29.33, 30.96, and 39.06 mg/g by HA-alginate, AC/HA-alginate, nZVCu/HA-alginate, and AC/nZVCu/HA-alginate beads, respectively. The thermogravimteric analysis showed the nZVCu/HA-alginate beads to be highly stable while the AC composite beads as the least stable to heat treatment. The HA-alginate beads achieved 39% removal of As3+, however, removal efficiency was promoted to 95% by coupling AC and nZVCu with HA-alginate beads at a reaction time of 120 min. The removal of As3+ by the prepared AC & nZVCu coupled HA-alginate beads was promoted with increasing [As3+]0 and [AC/nZVCu/HA-alginate]0. The pH of aqueous solution significantly influenced the removal of As3+ by AC/nZVCu/HA-alginate beads and maximum removal was achieved at pH 5.8. Freundlich adsorption isotherm and pseudo-second-order kinetic models were found to best fit the removal of As3+ by the synthesized beads. The high performance of AC/nZVCu/HA-alginate beads in the removal of As3+ even after seven cyclic treatment as well as least leaching of Cu ions into aqueous solution suggest enhanced reusability and stability of HA-alginate beads by coupling with AC and nZVCu. The results suggest that the synthesized beads have good potential for the removal of As3+ from aqueous solutions

Localized primary renal aspergillosis in a diabetic patient following lithotripsy – a case report

<p>Abstract</p> <p>Background</p> <p>Primary renal aspergillosis is rare in diabetic patients. Diagnosis of localized primary renal <it>Aspergillus </it>infection in diabetic patients requires careful investigations due to its benign presentation and lack of associated systemic clinical features. There is also paucity of information on the role of conservative treatment of such localized infection with antifungal agents only. Here, we describe a case of localized renal aspergillosis in a type 2 diabetic patient with a brief review of literature.</p> <p>Case presentation</p> <p>We describe a case of unilateral renal aspergillosis following intracorporeal pneumatic lithotripsy (ICPL) in a type 2 diabetic man. The patient presented with mild pain in the left lumbar region and periodic expulsion of whitish soft masses per urethra, which yielded growth of <it>Aspergillus fumigatus</it>. He was treated initially with amphotericin B; however, it was stopped after 2 weeks, as he could not tolerate the drug. Subsequently, he was successfully treated with oral itraconazole.</p> <p>Conclusion</p> <p>Localized renal aspergillosis may be suspected in diabetic patients having history of urinary tract instrumentation, mild lumbar pain, passage of suspicious masses in urine and persistent pyuria. Examination of the suspicious substances expelled per urethra is essential for diagnosis as routine multiple urine analysis may yield negative results. Conservative treatment with oral itraconazole alone is effective in cases with incomplete obstruction.</p

Effect of quercetin on steroidogenesis and folliculogenesis in ovary of mice with experimentally-induced polycystic ovarian syndrome

IntroductionPolycystic Ovary syndrome (PCOS) affects the health of many women around the world. Apart from fundamental metabolic problems connected to PCOS, focus of our study is on the role of quercetin on genes relevant to steroidogenesis and folliculogenesis.MethodsEighteen mature parkes strain mice (4-5 weeks old) weighing 18–21 g were randomly divided into three groups of six each as follows: Group I serves as the control and was given water and a regular chow diet ad lib for 66 days; group II was given oral gavage administration of letrozole (LETZ) (6 mg/kg bw) for 21 days to induce PCOS and was left untreated for 45 days; For three weeks, Group III received oral gavage dose of LETZ (6 mg/kg), after which it received Quercetin (QUER) (125 mg/kg bw orally daily) for 45 days.ResultsIn our study we observed that mice with PCOS had irregular estrous cycle with increased LH/FSH ratio, decreased estrogen level and decline in expression of Kitl, Bmp1, Cyp11a1, Cyp19a1, Ar, lhr, Fshr and Esr1 in ovary. Moreover, we observed increase in the expression of CYP17a1, as well as increase in cholesterol, triglycerides, testosterone, vascular endothelial growth factor VEGF and insulin levels. All these changes were reversed after the administration of quercetin in PCOS mice.DiscussionQuercetin treatment reversed the molecular, functional and morphological abnormalities brought on due to letrozole in pathological and physiological setting, particularly the issues of reproduction connected to PCOS. Quercetin doesn’t act locally only but it acts systematically as it works on Pituitary (LH/FSH)- Ovary (gonad hormones) axis. the Side effects of Quercetin have to be targeted in future researches. Quercetin may act as a promising candidate for medical management of human PCOS

Synthesis and mechanistic studies of diketo acids and their bioisosteres as potential antibacterial agents

A series of diketo esters and their pertinent bioisosteres were designed and synthesized as potent antibacterial agents by targeting methionine amino peptidases (MetAPs). In the biochemical assay against purified MetAPs from Streptococcus pneumoniae (SpMetAP1a), Mycobacterium tuberculosis (MtMetAP1c), Enterococcus faecalis (EfMetAP1a) and human (HsMetAP1b), compounds 3a, 4a and 5a showed more than 85% inhibition of all the tested MetAPs at 100 μM concentration. Compounds 4a and 5a also exhibited antibacterial potential with MIC values 62.5 μg/mL (S. pneumoniae), 31.25 μg/mL (E. faecalis), 62.5 μg/mL (Escherichia coli) and 62.5 μg/mL (S. pneumoniae), 62.5 μg/mL (E. coli), respectively. Moreover, 5a also significantly inhibited the growth of multidrug resistant E. coli strains at 512 μg/mL conc., while showing no cytotoxic effect towards healthy CHO cells and thus being selected. Growth kinetics study showed significant inhibition of bacterial growth when treated with different conc. of 5a. TEM analysis also displayed vital damage to bacterial cells by 5a at MIC conc. Moreover, significant inhibition of biofilm formation was observed in bacterial cells treated with MIC conc. of 5a as visualized by SEM micrographs. Interestingly, 5a did not cause an alteration in the hemocyte density in Galleria mellonella larvae which is considered in vivo model for antimicrobial studies and was non-toxic up to a conc. of 2.5 mg/mL