Immune Thrombocytopenia Purpura in Children in Lebanon: Prevalence, Treatment Modalities, and Clinical Outcomes in a Retrospective Study

Background: Immune thrombocytopenia purpura (ITP) is one of the most common autoimmune diseases in children characterized by a decreased number of circulating platelets combined with impaired platelet production. There is limited literature data on the prevalence and treatment modalities, and outcome of ITP in children from Lebanon. Methods: We retrospectively reviewed the demographic and clinical data of 59 patients aged 0–18 years diagnosed with ITP between January 2007 and April 2016 in different hospitals in Beirut and the south of Lebanon. Results: ITP patients represented 2.5% of the total number of children admitted to these hospitals during this period. Among the ITP children, 55.93% were male and 44.07% were female. The greatest number of ITP children were in the 1–4 year group, followed by the 5–9 year group. As for the clinical course of the disease, 40.68% of the ITP children presented acute ITP, whereas 59.32% presented chronic ITP. Among the different therapeutic approaches adopted to treat these ITP children, intravenous immunoglobulin was the most commonly used, followed by steroids, a combination of these both agents, cyclosporine, and splenectomy. Interestingly, these therapeutic modalities induced a statistically significant increase in the patients’ platelet count. In addition, the clinical course of ITP was not significantly associated with each of the age group, the platelet count at diagnosis, and gender of patients. Conclusion:This study showed the prevalence of ITP among children from Lebanon, where more than half of ITP children presented a chronic disease. Further studies are needed to evaluate additional predictors of chronic ITP among children from Lebanon and help medical providers make informed decisions about treating childhood ITP.   Doi: 10.28991/SciMedJ-2022-04-04-02 Full Text: PD

Bioengineering bacterial encapsulin nanocompartments as targeted drug delivery system

The development of Drug Delivery Systems (DDS) has led to increasingly efficient therapies for the treatment and detection of various diseases. DDS use a range of nanoscale delivery platforms produced from polymeric of inorganic materials, such as micelles, and metal and polymeric nanoparticles, but their variant chemical composition make alterations to their size, shape, or structures inherently complex. Genetically encoded protein nanocages are highly promising DDS candidates because of their modular composition, ease of recombinant production in a range of hosts, control over assembly and loading of cargo molecules and biodegradability. One example of naturally occurring nanocompartments are encapsulins, recently discovered bacterial organelles that have been shown to be reprogrammable as nanobioreactors and vaccine candidates. Here we report the design and application of a targeted DDS platform based on the Thermotoga maritima encapsulin reprogrammed to display an antibody mimic protein called Designed Ankyrin repeat protein (DARPin) on the outer surface and to encapsulate a cytotoxic payload. The DARPin9.29 chosen in this study specifically binds to human epidermal growth factor receptor 2 (HER2) on breast cancer cells, as demonstrated in an in vitro cell culture model. The encapsulin-based DDS is assembled in one step in vivo by co-expressing the encapsulin-DARPin9.29 fusion protein with an engineered flavin-binding protein mini-singlet oxygen generator (MiniSOG), from a single plasmid in Escherichia coli. Purified encapsulin-DARPin_miniSOG nanocompartments bind specifically to HER2 positive breast cancer cells and trigger apoptosis, indicating that the system is functional and specific. The DDS is modular and has the potential to form the basis of a multi-receptor targeted system by utilising the DARPin screening libraries, allowing use of new DARPins of known specificities, and through the proven flexibility of the encapsulin cargo loading mechanism, allowing selection of cargo proteins of choice

Drug-Induced Exposure of Schistosoma mansoni Antigens SmCD59a and SmKK7

BACKGROUND: Schistosomiasis is a serious health problem especially in developing countries and affects more than 243 million people. Only few anthelmintic drugs are available up to now. A major obstacle for drug treatment is the different developmental stages and the varying host compartments during worm development. Anthelmintic drugs have been tested mainly on adult schistosomes or freshly transformed cercariae. Knowledge concerning the larval stages is lacking. METHODOLOGY/PRINCIPAL FINDINGS: In this study, we used in vitro-grown schistosomula (aged between 2 to 14 days) to investigate drug effects of the three anthelmintics praziquantel, artemether, and oxamniquine. Further, we analyzed the antibody accessibility of two exemplary schistosome antigens SmCD59a and SmKK7, before and after drug treatment. Our results demonstrated that praziquantel applied at a concentration of 1 μM inhibited development of all life stages. Application of 10 μM praziquantel led to dramatic morphological changes of all schistosomula. Artemether at 1 and 10 μM had differential effects depending on whether it was applied to 2-day as compared to 7- and 14-day schistosomula. While 2-day schistosomula were not killed but inhibited from further development, severe morphological damage was seen in 7- and 14-day schistosomula. Oxamniquine (1 and 10 μM) led to severe morphological impairment in all life stages. Analyzing the accessibility of the antigens SmCD59a and SmKK7 before drug treatment showed no antibody binding on living intact schistosomula. However, when schistosomula were treated with anthelmintics, both antigens became exposed on the larvae. Oxamniquine turned out to be most effective in promoting antibody binding to all schistosomula stages. CONCLUSION: This study has revealed marked differences in anthelmintic drug effects against larvae. Drug treatment increases surface antigen presentation and renders larvae accessible to antibody attack

Mechanical Thrombectomy in Acute Ischemic Stroke Patients Greater than 90 years of age experience in 26 patients in a Large Tertiary Care Center: Outcome comparison with younger patients

Introduction: Several independent randomized control trials have shown the superior efficacy of mechanical thrombectomy for acute ischemic stroke (AIS). However, the elderly has been underrepresented or excluded in these trials. In this study, we investigated the feasibility and safety of mechanical thrombectomy in patients with AIS aged 90 years or greater. Methods: A retrospective review of patients age 90 years or older presenting with AIS who underwent mechanical thrombectomy between 2010 and 2018. Results: Of total 453 patients with AIS, 5.74 % (26) were aged 90 or older, and 69.32 % (314) ranged from 60-89 years of age. Of all baseline characteristics between both groups, there is a significant difference in age, gender, body mass index (BMI), smoking, hyperlipidemia (HLD), atrial fibrillation, and diabetes mellitus. The mean NIHSS upon admission was higher in the nonagenarians (17 vs. 15). Similar proportions of both groups received tPA (57.69%, 15 vs. 42.68%, 134, p=0.14). There was no difference in peri & post-procedural complications, good TICI score (88.46%, 23 vs. 87.58%, 275, p=1.00), “good” mRS scores (34.62%, 4 vs. 49.36%, 155, p=0.40), and mortality (11.54%, 3 vs. 13.06%, 41, p= 0.82). Discussion: Age is one of the factors that affect functional outcome following mechanical thrombectomy. Advancements in catheter techniques, technical experience, and great outcomes with mechanical thrombectomy allow for pushing the envelope to deal with age as one of the factors, rather, than an exclusion criterion. Our results show that mechanical thrombectomy is safe and feasible in nonagenarians

ZnO-based scintillating bolometers: New prospects to study double beta decay of 64^{64}Zn

The first detailed study on the performance of a ZnO-based cryogenic scintillating bolometer as a detector to search for rare processes in zinc isotopes was performed. A 7.2 g ZnO low-temperature detector, containing more than 80\% of zinc in its mass, exhibits good energy resolution of baseline noise 1.0--2.7 keV FWHM at various working temperatures resulting in a low-energy threshold for the experiment, 2.0--6.0 keV. The light yield for $\beta$/$\gamma$ events was measured as 1.5(3) keV/MeV, while it varies for $\alpha$ particles in the range of 0.2--3.0 keV/MeV. The detector demonstrate an effective identification of the $\beta$/$\gamma$ events from $\alpha$ events using time-properties of only heat signals. %(namely, Rise time parameter). The radiopurity of the ZnO crystal was evaluated using the Inductively Coupled Plasma Mass Spectrometry, an ultra-low-background High Purity Ge $\gamma$-spectrometer, and bolometric measurements. Only limits were set at the level of $\mathcal{O}$(1--100) mBq/kg on activities of \Nuc{K}{40}, \Nuc{Cs}{137} and daughter nuclides from the U/Th natural decay chains. The total internal $\alpha$-activity was calculated to be 22(2) mBq/kg, with a major contribution caused by 6(1) mBq/kg of \Nuc{Th}{232} and 12(2) mBq/kg of \Nuc{U}{234}. Limits on double beta decay (DBD) processes in \Nuc{Zn}{64} and \Nuc{Zn}{70} isotopes were set on the level of $\mathcal{O}(10^{17}$--$10^{18})$ yr for various decay modes profiting from 271 h of acquired background data in the above-ground lab. This study shows a good potential for ZnO-based scintillating bolometers to search for DBD processes of Zn isotopes, especially in \Nuc{Zn}{64}, with the most prominent spectral features at $\sim$10--20 keV, like the two neutrino double electron capture. A 10 kg-scale experiment can reach the experimental sensitivity at the level of $\mathcal{O}(10^{24})$ yr.Comment: Prepared for submission to JINST; 27 pages, 9 figures, and 7 table

Primary undifferentiated embryonal sarcoma of the liver mistaken for hydatid disease

Primary undifferentiated embryonal sarcoma of the liver is a rare tumor with a peak incidence between the ages of 6 and 10 years. We report a case of a primary hepatic undifferentiated embryonal sarcoma arising in a 21-year-old male mistaken for hydatid disease of the liver. The rapid recurrence of this tumor along the site of attempted percutaneous drainage illustrates some important management points regarding this malignancy

Effect of Probiotic “L.Reuteri” Association on the Reduction of Serum Bilirubin in Neonatal Jaundice

Objective: Evaluate the effect of probiotics association in reducing the total bilirubin level in the serum of neonates with jaundice. Methods: 69 neonates with indirect hyperbilirubinemia were divided randomly into two groups: control and treatment. The control group was treated using phototherapy and the treatment group was treated using phototherapy plus L.Reuteri probiotic. Inclusion criteria: all term newborns admitted for phototherapy for unconjugated hyperbilirubinemia. Exclusion criteria: septic or ill newborn, phenobarbital therapy, transfusion and parents ‘refusal to enter the study. Baseline bilirubin level was obtained prior to initiating phototherapy and then daily for an average of 3 days. Results: Before treatment, the level of bilirubin was similar in the two groups (p>0.05). We noted a more significant difference in bilirubin at day 1 (p=0.000), day 2 (=0.000) and day 3 (p=0.000) during treatment in the probiotic group when compared to the control group. We also noticed a more significant decrease in bilirubin between day 1 and day 2 (p=0.000) and between day 2 and day 3 (p=0.000) in the probiotic group when compared to the control group. Conclusion: The decrease of bilirubin in neonates with jaundice is more rapid and more significant in the group receiving probiotics as an adjuvant to phototherapy in case of presence of incompatibility or not