Characterization of vitamin D3 biotransformation by the cell lysate of Actinomyces hyovaginalis CCASU-A11-2

A former work conducted in our Lab, lead to in a effective scale up of vitamin D3 bioconversion into calcitriol by Actinomyces (A.) hyovaginalis isolate CCASU-A11-2 in Lab fermenter (14 L) resulting in 32.8 µg/100 mL of calcitriol. However, the time needed for such a bioconversion process was up to 5 days. Therefore, the objective of this study was to shorten the bioconversion time by using cell-free lysate and studying different factors influencing bioconversion. The crude cell lysate was prepared, freeze-dried, and primarily fractionated into nine fractions, of which, only three fractions, 50, 100, and 150 mM NaCl elution buffers showed 22, 12, and 2 µg/10 mL, calcitriol production, respectively. Ammonium sulfate was used for protein precipitation, and it did not affect the bioconversion process except at a concentration of 10%w/v. Secondary fractionation was carried out using 80 mL of the 50 mM NaCl elution buffer and the results showed the 80 mL eluent volume was enough for the complete elution of the active protein. The pH 7.8, temperature 28 °C, and 6 h reaction time were optimum for maximum calcitriol production (31 µg/10 mL). In conclusion, the transformation of vitamin D3 into calcitriol was successfully carried out within 6 h and at pH 7.8 and 28 °C using fractionated cell lysate. This process resulted in a 10-fold increase in calcitriol as compared to that produced in our previous study using a 14 L fermenter (32.8 µg/100 mL). Therefore, cell-free lysate should be considered for industrial and scaling up vitamin D3 bioconversion into calcitriol.

Bioconversion of vitamin D3 into calcitriol by Actinomyces hyovaginalis isolate CCASU- A11-2

Vitamin D₃ is a fat-soluble prohormone that is activated inside the liver to produce 25-hydroxyvitamin D₃ (calcidiol), and in the kidney to produce the fully active 1α, 25-dihydroxy vitamin D₃ (calcitriol). A previous work piloted in our laboratory, resulted in a successful recovery of a local soil-promising Actinomyces hyovaginalis isolate CCASU-A11-2 capable of converting vitamin D₃ into calcitriol. Despite the rising amount of research on vitamin D₃ bioconversion into calcitriol, further deliberate studies on this topic can significantly contribute to the improvement of such a bioconversion process. Therefore, this work aimed to improve the bioconversion process, using the study isolate, in a 14 L laboratory fermenter (4 L fermentation medium composed of fructose (15 g/L), defatted soybean (15 g/L), NaCl (5 g/L), CaCO₃ 2 g/L); K₂HPO₄, (1 g/L) NaF (0.5 g/L) and initial of pH 7.8) where different experiments were undertaken to investigate the effect of different culture conditions on the bioconversion process. Using the 14 L laboratory fermenter, the calcitriol production was increased by about 2.5-fold (32.8 µg/100 mL) to that obtained in the shake flask (12.4 µg/100 mL). The optimal bioconversion conditions were inoculum size of 2% v/v, agitation rate of 200 rpm, aeration rate of 1 vvm, initial pH of 7.8 (uncontrolled); addition of vitamin D₃ (substrate) 48 h after the start of the main culture. In conclusion, the bioconversion of vitamin D₃ into calcitriol in a laboratory fermenter showed a 2.5-fold increase as compared to the shake flask level where, the important factors influencing the bioconversion process were the aeration rate, inoculum size, the timing of substrate addition, and the fixed pH of the fermentation medium. So, those factors should be critically considered for the scaling-up of the biotransformation process.

Phytoestrogen β-Sitosterol Exhibits Potent In Vitro Antiviral Activity against Influenza A Viruses

Influenza is a contagious infection in humans that is caused frequently by low pathogenic seasonal influenza viruses and occasionally by pathogenic avian influenza viruses (AIV) of H5, H7, and H9 subtypes. Recently, the clinical sector in poultry and humans has been confronted with many challenges, including the limited number of antiviral drugs and the rapid evolution of drug-resistant variants. Herein, the anti-influenza activities of various plant-derived phytochemicals were investigated against highly pathogenic avian influenza A/H5N1 virus (HPAIV H5N1) and seasonal low pathogenic human influenza A/H1N1 virus (LPHIV H1N1). Out of the 22 tested phytochemicals, the steroid compounds β-sitosterol and β-sitosterol-O-glucoside have very potent activity against the predefined influenza A viruses (IAV). Both steroids could induce such activity by affecting multiple stages during IAV replication cycles, including viral adsorption and replication with a major and significant impact on the virus directly in a cell-free status "viricidal effect". On a molecular level, several molecular docking studies suggested that β-sitosterol and β-sitosterol-O-glucoside exhibited viricidal effects through blocking active binding sites of the hemagglutinin surface protein, as well as showing inhibitory effects against replication through the binding with influenza neuraminidase activity and blocking the active sites of the M2 proton channel activity. The phytoestrogen β-sitosterol has structural similarity with the active form of the female sex hormone estradiol, and this similarity is likely one of the molecular determinants that enables the phytoestrogen β-sitosterol and its derivative to control IAV infection in vitro. This promising anti-influenza activity of β-sitosterol and its O-glycoside derivative, according to both in vitro and cheminformatics studies, recommend both phytochemicals for further studies going through preclinical and clinical phases as efficient anti-influenza drug candidates.

Characterization and anti-biofilm activity of bacteriophages against urinary tract Enterococcus faecalis isolates

Strong biofilm-forming Enterococcus feacalis urinary tract pathogens (n = 35) were used to determine the lytic spectrum of six bacteriophages isolated from sewage samples. Only 17 Enterococcus feacalis isolates gave lytic zones with the tested bacteriophages from which five isolates were susceptible to all of them. The isolated enterococcal phages are characterized by wide range of thermal (30–90 °C) and pH (3–10) stability. They belong to order Caudovirales, from which four bacteriophages (EPA, EPB, EPD, EPF) belong to family Myoviridae and two (EPC, EPE) belong to family Siphoviridae. In addition, they have promising antibiofilm activity against the tested strong-forming biofilm E. faecalis isolates. The enterococcal phages reduced the formed and preformed biofilms to a range of 38.02–45.7% and 71.0–80.0%, respectively, as compared to the control. The same promising activities were obtained on studying the anti-adherent effect of the tested bacteriophages on the adherence of bacterial cells to the surface of urinary catheter segments. They reduced the number of adherent cells to a range of 30.8–43.8% and eradicated the pre-adherent cells to a range of 48.2–71.1%, as compared to the control. Overall, the obtained promising antibiofilm activity makes these phages good candidates for application in preventing and treating biofilm associated Enterococcus faecalis infections.

Better outcome of COVID-19 positive kidney transplant recipients during the unremitting stage with optimized anticoagulation and immunosuppression

INTRODUCTION

COVID-19 is an ongoing pandemic with high morbidity and mortality and with a reported high risk of severe disease in kidney transplant recipients (KTR).

AIM

We aimed to report the largest number of COVID-19-positive cases in KTR in a single center and to discuss their demographics, management, and evolution.

METHODS

We enrolled all the two thousand KTR followed up in our center in Kuwait and collected the data of all COVID-19-positive KTR (104) from the start of the outbreak till the end of July 2020 and have reported the clinical features, management details, and both patient and graft outcomes.

RESULTS

Out of the one hundred and four cases reported, most of them were males aged 49.3 ± 14.7 years. Eighty-two of them needed hospitalization, of which thirty-one were managed in the intensive care unit (ICU). Main comorbidities among these patients were hypertension in 64.4%, diabetes in 51%, and ischemic heart disease in 20.2%. Management strategies included anticoagulation in 56.7%, withdrawal of antimetabolites in 54.8%, calcineurin inhibitor (CNI) withdrawal in 33.7%, the addition of antibiotics in 57.7%, Tocilizumab in 8.7%, and antivirals in 16.3%. During a follow-up of 30 days, the reported number of acute kidney injury (AKI) was 28.7%, respiratory failure requiring oxygen therapy 46.2%, and overall mortality rate was 10.6% with hospital mortality of 13.4% including an ICU mortality rate of 35.5%.

CONCLUSION

Better outcome of COVID-19-positive KTR in our cohort during this unremitting stage could be due to the younger age of patients and early optimized management of anticoagulation, modification of immunosuppression, and prompt treatment of secondary bacterial infections. Mild cases can successfully be managed at home without any change in immunosuppression.

A new grading system for female sexual dysfunction based on the female sexual function index in Egyptian women: a cross-sectional study

Objective

To provide a grading system that accurately reflects the grades of female sexual dysfunction (FSD) severity.

Patients and methods

A cross-sectional study was conducted in Assiut University Hospital. It included 500 women who answered the Arabic version of the Female Sexual Function Index (FSFI) after getting their consent. A gradient of FSD severity was created, classifying FSD into five grades: severe, moderate, mild to moderate, mild, and no FSD.

Results

According to our grading system, FSD was detected in 339 women (67.8 %); Mild FSD in 20.4%, mild to moderate in 41.6%, moderate in 15.3%, and severe in 22.7%. Mean scores of desire show a linear trend of reduction from 3.8 in mild to 3.36 in mild to moderate to 2.25 in moderate and markedly reduced to 2.1 in severe grade. This difference was highly statistically significant (p= 0.002). The same was reported in arousal, orgasm, and satisfaction domains, while in lubrication and pain domains, the difference was not statistically significant.

Conclusion

In this study, our grading system was complementary to the FSFI. Moreover, it seems to be more practical and useful in grading the severity of FSD.

Serotyping and Antimicrobial Resistance Profile of Enteric Nontyphoidal Salmonella Recovered from Febrile Neutropenic Patients and Poultry in Egypt

A total of 300 human fecal samples were collected from febrile neutropenic patients suffering from severe gastroenteritis, followed by identification and serological characterization of recovered isolates. Fifty nontyphoidal Salmonella (NTS) serovars were recovered. A total of serologically identified 50 NTS serovars recovered from poultry of the same geographical area and during the same period as well as one standard strain S. Poona were supplied by the Bacterial Bank of Animal Health Research Institute of Egypt. Antibiogram analysis revealed that the human and poultry serovars exhibited similar antimicrobial resistance patterns against 28 different antimicrobial agents, particularly against ampicillin, cefotaxime, oxytetracycline, and erythromycin. Plasmids harboring bla_CTX-m, bla_SHV, bla_TEM, and aac(6’)-Ib were detected in 11 (22%) and 8 (16%) of human and poultry serovars, respectively. Molecular detection of the most clinically relevant virulence genes and analysis of the associated virulence genotypes proved that the human (n = 11) and poultry serovars (n = 12) shared 11 genotypes. Enterobacterial repetitive intergenic consensus PCR analysis revealed that human and poultry serovars were clustered together in 3 out of the 4 clusters with a similarity index ranged from 0.15 to 1. Since poultry are usually consumed by humans, the presence of resistant bacteria harboring transmissible genetic elements is of great health concern.

Modulatory effect of concomitant administration of sitagliptin and vitamin E on inflammatory biomarkers in rats fed with high fat diet: role of adiponectin

Sitagliptin (SIT) is an antidiabetic used worldwide to ameliorate the hyperglycemia and insulin insensitivity induced dysmetabolism. In this study, we investigated the effect of sitagliptin and vitamin E on metabolic dysfunction in high-fat diet (HFD) fed rats. Sixty-four male rats were allocated into 8 groups (n = 8) as follow; control, control + vitamin E, control + sitagliptin, control + sitagliptin + vitamin E, HFD, HFD + vitamin E, HFD + sitagliptin and HFD + sitagliptin + vitamin E. Control groups were fed with chow diet for 15 weeks, while HFD groups were fed with HFD for the same duration. Vitamin E and sitagliptin were administered in the last 4 weeks of the study. At the end of the 15^th week, body weight, liver weight/body weight ratio, weight gain, glucose, lipid profile, liver enzymes, adiponectin and pro-inflammatory cytokines as interleukin 6 (IL-6), high sensitive C reactive protein (hs-CRP) and tumour necrosis factor-α (TNF-α) were measured. Additionally, gene expressions of senescence marker protein 30 (SMP30), Bcl-2, and Bax were measured. Total antioxidant capacity (TAC) and thiobaribituric acid reactive substances (TBARS) were assayed. HFD increased TBARS, IL-6, hs-CRP and TNF-α significantly and decreased TAC and adiponectin. Sitagliptin produced a comparable result through increasing adiponectin, sitagliptin alone or in combination with vitamin E increased the TAC, and gene expression of SMP30 and Bcl-2 and decreased TBARS with downregulation of the overexpressed Bax. Vitamin E, as a natural antioxidant, ameliorates the oxidative stress with insignificant change in lipid profile and inflammatory cytokine levels. Concomitant sitagliptin and vitamin E reduced the hepatic dysfunction induced by HFD.

The effect of menopausal symptoms on the quality of life among postmenopausal Egyptian women

Objective: The current study aims to assess the prevalence of menopausal symptoms among postmenopausal Egyptian women and their effect on the quality of these women's lives.Study design: A cross-sectional study was carried out in a tertiary university hospital between January and December 2017. We enrolled 350 postmenopausal women aged 45-70 years. All women were interviewed using the Menopause-Specific Quality of Life (MENQOL) questionnaire after translation into the Arabic language by a certified translation expert. The Mann-Whitney test and the Kruskal-Wallis test were used to compare MENQOL item scores.Results: Low backache was the most common complaint among the study participants (86%). The sexual domain imposed the greatest impact on quality of life (mean = 3.12 ± 1.66), followed by physical (mean = 3.18 ± 0.92), psychological (mean = 3.08 ± 0.98), and vasomotor (mean = 3.01 ± 1.78) domains. Moreover, we found a significant positive moderate correlation between body mass index (BMI) and the total score (r = 0.689, p < 0.001). Multivariable linear regression analysis found that the best-fitting predictors for the MENQOL score were age (p < 0.001), BMI (p < 0.001), and exercise (p < 0.001).Conclusions: Physical symptoms were the most prevalent symptoms in this study. In general, older women, housewives, hand workers, less physically active women, and those of low socioeconomic status had poor quality of life.

Uterine exteriorization versus intraperitoneal repair: effect on intraoperative nausea and vomiting during repeat cesarean delivery - A randomized clinical trial

OBJECTIVE

The current study aims to compare the rate of intraoperative nausea and vomiting after repeat cesarean delivery (CD) under two different approaches: by intraperitoneal incision repair or by uterus exteriorization for incision reapair.

MATERIALS AND METHODS

We conducted a single-blinded randomized clinical trial (NCT03009994) at a tertiary University Hospital between the 1st of September 2016 and the 31st of December 2017. The study included pregnant women at term of gestation (>37 weeks) scheduled for repeat CD under spinal anesthesia. Women were assigned to either uterine exteriorization for incision repair (Group I) or intraperitoneal incision repair (Group II). The primary assessed was the rate of nausea and vomiting during CD.

RESULTS

The study included 1028 women in the final analysis. The rate of intraoperative nausea and vomiting was significantly lower in the intraperitoneal repair group compared to the exteriorization group (24% versus 38.7%, p= 0.001). Likewise, occurrence of uterine atony and the need for additional uterotonics were significantly lower in the intraperitoneal repair group (p= 0.001 and 0.02 respectively). Postoperatively, the rate of nausea and vomiting (12.6 % versus 21 %; P=0.001), and the time to the first recognized bowel movement (12.3 hours versus 14.1 hours; P=0.003) were significantly lower in the intraperitoneal repair group compared to the exteriorization group.

CONCLUSIONS

Intraperitoneal repair of the uterine incision during repeat CD is beneficial compared to exteriorization. Improvements in the rate of intra- and postoperative nausea, vomiting, uterine atony and time to the first recognized bowel movement were observed in patients operated with this technique.

Vaginal progesterone for prevention of preterm delivery in women with twin pregnancy: a randomized controlled trial

BACKGROUND

The aim of this study is to evaluate the efficacy of vaginal progesterone to prevent preterm delivery in twin pregnancies and its effect on perinatal outcome.

MATERIALS AND METHODS

A randomized, open label, controlled trial (NCT02350231) was carried out over 70 women, in three different hospitals in Egypt, between February 2015 and January 2017. All eligible pregnant women with twin pregnancies were randomly allocated in a 1:1 ratio into two groups. Group I (Progesterone group) was dispensed, 400 mg of progesterone through a vaginal pessary, each day at bedtime, from the 28th week of pregnancy until delivery. Group II (Control group) received no treatment other than the normal tonics taken during pregnancy. The two study groups were followed until delivery. The primary outcome was the rate of preterm delivery <37 weeks.

RESULTS

No significant differences were observed among both groups of women in terms of delivery <37 weeks (16.9% versus 25.4%; p=0.06) and mode of delivery (vaginal versus cesarean; p=0.31). The mean gestational age at delivery was comparable between both groups (p=0.09). Additionally, no difference, regarding the neonatal outcome, was observed between both groups.

CONCLUSION

Dispensing vaginal progesterone [400 mg] after 28 weeks of gestation does not prevent preterm delivery in twin gestations.

Lack of pain relief during labor is blamable for the increase in the women demands towards cesarean delivery: a cross-sectional study

BACKGROUND

This study aims to assess knowledge, attitude and acceptance of antenatal women for pain relief methods during labor and to know the effect of presumed availability of pain relief methods during labor on the attitude of women towards the mode of delivery.

MATERIALS AND METHODS

A cross sectional study was conducted at a tertiary hospital between January and December 2016. A structured interview questionnaire had been administered including data related to current pregnancy, knowledge, attitude and previous experience of pain, labor analgesia, women's attitude toward the mode of delivery and its relation to the availability of adequate analgesia during labor. Visual analog scale (VAS) was used to assess pregnant women's attitude towards pain in general and that related to the process of labor (past and expected experience).

RESULTS

Eight hundred and fourteen women were included in the study. The majority of our participants (82.9%) were unaware about the availability of labor analgesia. Sixty of the study participants preferred cesarean section (CS) to avoid labor pain. Availability of adequate pain relief during labor could decrease the women decision of CS by more than 50% in women expecting moderate and severe pain during labor compared to non-availability of pain relief (9.6% vs. 22.7% and 8.2% vs. 28.1% respectively).

CONCLUSION

There is a great lack of knowledge regarding the availability of pain relief during labor. Lack of pain relief during labor can be responsible for more than half of women's intention to prefer CS as a mode of delivery.

Effect of female genital mutilation/cutting; types I and II on sexual function: case-controlled study

Background

The existing literature is contradictory regarding effects of female genital mutilation/cutting (FGM/C) on sexual functions. The aim of this study was to explore the impact of type I and II FGM/C on sexual function of Egyptian women.

Methods

We recruited 197 cut women and 197 control women from those visiting Assiut University hospitals for different reasons. We asked each woman to fill the Arabic female sexual function index (FSFI) (a self reported 19-item questionnaire assessing the main domains of female sexual function). Genital Examination was done to confirm the type of FGM.

Results

Female sexual dysfunction (FSD) was found in 83.8% of FGM/C cases in contrast to 64.5% of the control. The total FSFI score in the FGM/C group (19.82 ± 7.1) was significantly lower than in the control group (23.34 ± 8.1). Concerning the types of FGM/C, type 73.6% of cases had type I and 26.4% had type II. Type I FGM/C was performed mainly by physicians (62.1%) while type II was performed mainly by midwives (44.4%).

FSD was found in 83.4% of FGM/C I cases and in 84.6% of FGM/C II cases. There was no statistically significant difference between the two types of FGM/C as regards total and individual domain scores except for the pain domain. There were significantly lower total and individual domain scores in both FGM/C types except for the desire domain compared to control.

Conclusion

In this study, FGM/C was associated with reduced scores of FSFI on all domains scores, and among both types I and II, both were associated with sexual dysfunction.

Effect of pregnancy-lactation overlap on the current pregnancy outcome in women with substandard nutrition: a prospective cohort study

BACKGROUND

Pregnancy during lactation is common in Egypt and is often unplanned. Overlap between pregnancy and lactation could be associated with an increased risk for the pregnant mother, her fetus as well as her nursing child.

AIM OF THE STUDY

The current study aims to compare the maternal and perinatal outcome of pregnancies occurred during lactation with those occurred after weaning in women with substandard nutrition.

MATERIALS AND METHODS

A prospective-cohort study was carried out in six Maternal and Child Health Centers in Assiut-Egypt. Estimated sample size was 540 women divided equally into two groups; the first included women who got pregnant during breastfeeding (PDBF), while the second included women who got pregnant after weaning (PAW). Tools were consisted of structured interview questionnaire including personal history, obstetrical data, breastfeeding, family planning histories and dietary intake during pregnancy. Pregnant women had been followed up to delivery to assess different maternal and fetal outcomes.

RESULTS

Miscarriage rate was not statistically significant between both groups (2.2% in PDBF and 0.4% in PAW, p = 0.284). Women in PDBF group had higher prevalence of maternal anemia (54.1% versus 30.7%), intrauterine growth restriction (16.7% versus 4.8%), cesarean delivery (43.7% versus 31.5%), prolonged labor (13.3% versus 11.1%) and low birth weight infants (15.7% versus 8.8%) compared to women in PAW group.

CONCLUSION

Pregnancy during breastfeeding is associated with an increase in the overall complications of pregnancy as compared to PAW. Although it does not increase the miscarriage rate, it increases the prevalence of maternal anemia, delayed fetal growth, prolonged labor, cesarean section delivery and the prevalence of low birth weight infants.

Effect of fluoxetine and resveratrol on testicular functions and oxidative stress in a rat model of chronic mild stress-induced depression

Our objective was to investigate the effects of chronic unpredictable mild stress (CUMS) with or without selective serotonin reuptake inhibitor (fluoxetine) and anti-oxidant (resveratrol) on testicular functions and oxidative stress in rats. Fifty male rats were divided into 2 groups; control and CUMS. CUMS group was further subdivided into 4 subgroups administered water, fluoxetine, resveratrol and both. Sucrose intake, body weight gain, serum corticosterone, serotonin and testosterone levels, sperm count and motility, testicular malondialdehyde, superoxide dismutase (SOD), catalase, glutathione (GSH), and gene expression of steroidogenic acute-regulatory (StAR) protein and cytochrome P450 side chain cleavage (P450scc) enzyme were evaluated. CUMS decreased sucrose intake, weight gain, anti-oxidants (SOD, catalase, GSH), testosterone, serotonin, StAR and cytochrome P450scc gene expression, sperm count and motility and increased malondialdehyde and corticosterone. Fluoxetine increased malondialdehyde, sucrose intake, weight gain, serotonin and decreased anti-oxidants, StAR and cytochrome P450scc gene expression, sperm count and motility, testosterone, corticosterone in stressed rats. Administration of resveratrol increased anti-oxidants, sucrose intake, weight gain, serotonin, StAR and cytochrome P450scc gene expression, testosterone, sperm count and motility, and decreased malondialdehyde and corticosterone in stressed rats with or without fluoxetine. In conclusion, CUMS induces testicular dysfunctions and oxidative stress. While treatment of CUMS rats with fluoxetine decreases the depressive behavior, it causes further worsening of testicular dysfunctions and oxidative stress. Administration of resveratrol improves testicular dysfunctions and oxidative stress that are caused by CUMS and further worsened by fluoxetine treatment.

Effect of vitamin E on cerebral cortical oxidative stress and brain-derived neurotrophic factor gene expression induced by hypoxia and exercise in rats

Brain-derived neurotrophic factor (BDNF) is involved in the proliferation of neurons, and its expression increases significantly with exercise. We aimed to investigate the effects of chronic exercise (swimming) and sustained hypoxia on cortical BDNF expression in both the presence and absence of vitamin E. Sixty four male Sprague-Dawley rats were divided into two equal groups; a normoxic group and a hypoxic group. Both groups were equally subdivided into four subgroups: sedentary, sedentary with vitamin E, chronic exercise either with or without vitamin E supplementation. Arterial PO(2), and the levels of cortical malondialdehyde (MDA), antioxidants (reduced glutathione GSH, superoxide dismutase (SOD), catalase (CAT) and vitamin E) and BDNF gene expression were investigated. Hypoxia significantly increased MDA production and BDNF gene expression and decreased the antioxidants compared to control rats. Chronic exercise in hypoxic and normoxic rats increased MDA level and BDNF gene expression and decreased the antioxidants. Providing vitamin E supplementation to the hypoxic and normoxic rats significantly reduced MDA and BDNF gene expression and increased antioxidants. We conclude that sustained hypoxia and chronic exercise increased BDNF gene expression and induced oxidative stress. Moreover, vitamin E attenuated the oxidative stress and decreased BDNF gene expression in sustained hypoxia and chronic exercise which confirms the oxidative stress-induced stimulation of BDNF gene expression.

Early corticosteroids requirement after the diagnosis of ulcerative colitis diagnosis can predict a more severe long-term course of the disease - a nationwide study of 1035 patients

BACKGROUND

There are limited data regarding clinical outcomes in ulcerative colitis (UC) patients who require early corticosteroids (CS) use.

AIM

To evaluate the rate of early CS utilisation (within 30 days of diagnosis) as a predictive marker for long-term outcomes, colectomy and CS dependency, in a population-based cohort of incident UC cases.

METHODS

Nationwide data were obtained from the Veterans Affairs (VA) health care system for the period 2001-2011. Incident UC cases were identified. A retrospective cohort design and time-to-event survival analysis were used to track outcomes of interest. Cox regression multivariate analysis was employed.

RESULTS

One thousand and thirty-five newly diagnosed patients with UC were identified and included in the analysis; 236 (23%) of those patients required early CS therapy. Patients were followed-up over a median time of 4.7 years (IQR 2.8-6.8) after UC diagnosis. The 5-year cumulative probability of requiring colectomy varied significantly by early CS use status (13% among early CS users compared to 4% among those who did not require early CS treatment, P < 0.001). Similar variation in the 5-year cumulative probability of CS dependency by early CS status was observed. Early CS users were more likely to require colectomy 2.9 (CI 1.7-5.0, P < 0.001) and to become CS dependent 4.5 (95% CI 3.6-5.7, P < 0.001) than non-users.

CONCLUSIONS

Early CS use can help identify those patients who have a more active disease course of UC. Recognising this can be among the indicators that can help physicians identify patients who may require early initiation of more aggressive therapy.

A new scoring model for characterization of adnexal masses based on two-dimensional gray-scale and colour Doppler sonographic features

OBJECTIVE

To determine the most discriminating two-dimensional gray-scale and colour Doppler sonographic features that allow differentiation between malignant and benign adnexal masses, and to develop a scoring model that would enable more accurate diagnosis with those features.

METHODS

A cross sectional prospective study was conducted on patients scheduled for surgery due to presence of adnexal masses at Woman's Health Center, Assiut University, Egypt between October 2012 and October 2013. All patients were evaluated by 2D ultrasound for morphological features of the masses combined with colour Doppler examination of their vessels. The final diagnosis, based on histopathological analysis, was used as a gold standard.

RESULTS

One hundred forty-six patients were recruited, 104 with benign masses, 42 with malignant masses. Features that allowed statistically significant discrimination of benignity from malignancy were; volume of mass, type of mass, presence and thickness of septae, presence and length of papillary projections, location of vessels at colour Doppler and colour score. A scoring model was formulated combining these features together; Assiut Scoring Model (ASM). The cut-off level with the highest accuracy in detection of malignancy, was ≥6, had a sensitivity of 93.5% and specificity of 92.2%.

CONCLUSION

Our Scoring Model; a multiparameter scoring using four gray-scale ultrasound and two colour Doppler features, had shown a high sensitivity and specificity for prediction of malignancy in adnexal masses compared with previous scoring systems.

Effect of age on the contractile response of the rat carotid artery in the presence of sympathetic drugs and L-NAME

For evaluating the age-related change in noradrenaline (NA)-induced contraction of isolated rat carotid artery (CA), the effect of α and β adrenoreceptor (AR) blockers and the role of nitric oxide (NO) were investigated.

METHODS

Concentration-response curves to NA (10-10-10-4 M) and α1 agonist phenylephrine (PE; 10-10-10-5 M) were constructed in isolated CA rings from young and middle-aged rats. The effects of nitric oxide synthase (NOS) inhibitor (L-NAME; 100 μM), α1-AR antagonist (prazosin; 0.1 μM), α2-AR antagonist (yohimbine; 0.1 μM) and β-AR antagonist (propranolol; 1 μM) on NA-induced contraction of isolated CA rings were examined. In CA rings preconstricted with NA, the responses to α2-AR agonist (clonidine; 10-7-10-5 M), β-AR agonist (isoprenaline; 10-8-10-5 M),), sodium nitroprusside (SNP; 10-9-10-5 M) were assessed.

RESULTS

The maximum contractile response of CA to NA and to PE was higher in younger than in middle-aged rats. Prazosin reduced the contractile response to NA in both groups, while propranolol, yohimbine and L-NAME did not affect NA-induced contraction in either of them. Clonidine, isoprenaline and SNP produced a dose-dependent vasorelaxation of CA rings, isoprenaline-induced vasodilatation was lower in middle-aged rats, while there was no difference in clonidine or SNP-induced relaxant effect between the two groups.

CONCLUSIONS

NA-induced contraction of isolated rat CA rings is decreased in old rats, this is related to α1-AR. β-AR mediated dilatation was compromised in middle-aged rats (endothelium-dependent). α2-AR and SNP-mediated dilator effect seems to be unchanged.

Long-term oral mesalazine adherence and the risk of disease flare in ulcerative colitis: nationwide 10-year retrospective cohort from the veterans affairs healthcare system

BACKGROUND

Adherence is a major factor in determining disease activity in ulcerative colitis (UC). There are limited data on long-term nationwide adherence levels among patients with UC.

AIM

To evaluate the long-term adherence levels to oral mesalazine (mesalamine) in the Veterans Affairs (VA) healthcare system, to determine the impact of non-adherence on the risk of flares, and to evaluate the different pharmacy data-based adherence indicators.

METHODS

Nationwide data were obtained from the VA for the period 2001-2011. UC patients who started mesalazine maintenance during the inclusion period were included. Level of adherence was assessed using three different indicators: medication possession ratio (MPR), continuous single-interval medication availability (CSA) and continuous multiple-interval medication gaps (CMG). Cox regression modelling was used to predict disease flares and assess the predictive value of each adherence indicator.

RESULTS

We included 13 062 patients into the analysis with median follow-up time of 6.1 years. Percentage of patients with high adherence was 47%, 43%, 31% as identified by CSA, MPR and CMG respectively. Low adherers had a significant increase in the risk of flares compared with high adherers (Hazard ratio: 2.8, 1.7 and 1.8, P < 0.001 for CSA, MPR and CMG, respectively). Compared with other adherence indicators, CSA offered the best trend in predicting disease flares.

CONCLUSIONS

Long-term high-adherence level was lower than previously reported. Adherence was a significant factor in predicting disease flares. Pharmacy adherence indicators may be useful to healthcare providers in identifying patients at high risk of exacerbations.

A retrospective study of Rift Valley fever in Saudi Arabia

A retrospective study was undertaken to examine domestic ruminant sera for Rift Valley fever (RVF) virus antibodies. The sera were collected between 1992 and 1995 from cattle, sheep and goats from various locations in Saudi Arabia. The standard capture enzyme-linked immunosorbent assay system was employed to detect specific RVF antibodies in the animals and the results indicated an absence of RVF antibodies. This finding confirms the assumption that Saudi Arabia was free from RVF up until at least 1995 and most probably before the 2000 epidemic. The finding also confirms that RVF was not endemic in Saudi Arabia.

The life span of sperm motility and pattern in cumulus coculture

OBJECTIVE

To study the effect of cumulus cell coculture on human sperm motility, life span, and patterns.

DESIGN

Controlled prospective study of 50 normal semen samples. Sperm motility and forward grade was observed in droplets of Ham's F-10 media with cumulus cell coculture and compared with sperm in droplets of Ham's F-10 only.

SETTING

The Egyptian IVF-ET Center.

MAIN OUTCOME MEASURES

Sperm motility, life span, and forward progressive pattern.

RESULTS

The time course of loss of sperm motility in cumulus coculture was significantly slower than without cumulus. Also, the percentage of motile sperm with linear progressive motility of grade 4,3 was significantly higher in cumulus coculture.

CONCLUSION

Cumulus cell coculture has a positive effect on prolongation of sperm motility life span and its forward progression.

Ovarian superstimulation and intrauterine insemination for the treatment of unexplained infertility

OBJECTIVE

To evaluate the efficacy of controlled ovarian hyperstimulation (COH) and IUI in the treatment of unexplained infertility.

DESIGN

The pregnancy rate (PR) in patients with unexplained infertility treated by COH and IUI (group A) was compared with a no-treatment control (group B).

SETTING

The Egyptian IVF-ET Center.

PARTICIPANTS

Four hundred ninety-two patients with the diagnosis of unexplained infertility.

INTERVENTION

Controlled ovarian hyperstimulation and IUI.

MAIN OUTCOME MEASURES

Cycle fecundity per treatment cycle and PR per patient.

RESULTS

In group A cycle fecundity was 20.1% per treatment cycle, and the PR was 34.7% per patient. In group B the PR was 8.9% per patient. Pregnancy rate per patient was significantly higher in group A when compared with the spontaneous PR in group B.

CONCLUSION

Controlled ovarian hyperstimulation and IUI significantly increased the PR in patients with unexplained infertility when compared with a no-treatment control group.

Treatment of acute exacerbations of chronic obstructive airways disease--a comparison of amoxycillin and ciprofloxacin

Ciprofloxacin and amoxycillin were compared in the treatment of acute exacerbations of chronic obstructive airways disease. One hundred and forty patients were evaluable for overall outcome: 60 patients' sputum specimens yielded positive bacteriological cultures. The predominant pathogens were Haemophilus influenzae (43.3%) and Streptococcus pneumoniae (25.0%). Both regimens were safe and produced few adverse effects. An independent observer judged ciprofloxacin to produce a 91.8% success rate (complete success 21.9%; partial success 69.9%) whilst a 73.1% rate (complete success 10.4%; partial success 62.7%) was seen with amoxycillin.

Ciprofloxacin versus amoxycillin/clavulanic acid in the treatment of urinary tract infections in general practice

An open, randomized general practice study was performed to assess the comparative efficacy and tolerability of ciprofloxacin and amoxycillin/clavulanic acid in the treatment of uncomplicated urinary tract infection. One hundred and eighty nine patients were recruited into the study. In comparison of pre- and post-treatment urine cultures and symptomatology, ciprofloxacin was significantly more effective (P less than 0.01) than amoxycillin/clavulanic acid. Both drugs were well tolerated with minimal adverse side effects. Ciprofloxacin is an effective and safe treatment for uncomplicated urinary tract infection in general practice.

An outbreak of rotavirus infection in a geriatric hospital

We describe an outbreak of rotavirus infection in a geriatric hospital. The outbreak lasted for 6 weeks, and affected 14 patients of 68 at risk. Diarrhoea was the main symptom, lasting only 1 day in most patients. Rising or high rotavirus antibody titres were demonstrated in six patients. Of 96 staff only one member was infected.

Penetration of ceftazidime into the human prostate gland following intravenous injection

The concentration of ceftazidime in human prostatic tissue obtained by transurethral resection was measured by microbiological assay in 24 patients after the intravenous administration of one 2 g dose. The average concentration of ceftazidime in the tissue was 10.1 micrograms/g 70 min after injection and 6.1 micrograms/g 140 min after injection; these levels were each approximately 14% of the corresponding serum levels. The concentration of ceftazidime achieved in the prostatic tissue was greater than the minimum inhibitory concentrations of ceftazidime for Gram-negative pathogens.

Ceftazidime: a new approach in the treatment of moderate and severe infections

Ninety patients with serious infections, including 61 with septicaemia, pneumonia, peritonitis or meningitis, were treated with ceftazidime. Of these patients, 85.6% were clinically cured (73.3%) or improved (12.2%) by the antibiotic. In this study, 57.7% had infections due to Escherichia coli (24.7%), Klebsiella sp. (14.5%) and Pseudomonas sp. (18.5%). Two children with cystic fibrosis and Pseudomonas pneumonia and an adult with Legionella pneumonia responded well to ceftazidime treatment. Seventy patients had fever before treatment and most of them became apyrexial in less than 2 to 3 days. Ceftazidime was given either intramuscularly (42 patients) or intravenously (48 patients), in a dose of 1 g tds in 71 patients or 2 g tds in severe infections in 11 patients, or reduced to suit the renal function (7 patients) or in paediatric doses (2 children). Blood ceftazidime levels were measured in eight patients with normal renal function. The average level one hour post dosing was 45.2 mg/l and the average trough level was 8.1 mg/l. Six patients were suffering from variable degrees of renal insufficiency (serum creatinine 149 to 668 mmol/l). Their average blood level 1 h post-dosing was 68.8 mg/l. In a patient with meningitis, the CSF level was 2.4 mg/l 2 h after a 1 g dose. These levels are several times the ceftazidime MIC values for most clinical bacterial isolates. Ceftazidime is a valuable and safe alternative to aminoglycoside therapy.

A comparative trial of amoxycillin 3g bd and conventional amoxycillin therapy in the treatment of urinary tract infection in a general practice population

An open, randomised, General Practice study was carried out to determine the comparative efficacy and tolerability of two doses of amoxycillin 3 g and amoxycillin 250 mg tds for five days in the treatment of uncomplicated urinary tract infection. Two hundred and seven patients entered the study, of these 98 were shown to have negative bacteriology. Using pre- and post-treatment MSU culture and symptomatology as measures of efficacy it was found that the two treatment groups were not significantly different on both measures. Both treatments were well tolerated with only a low level of gastrointestinal side effects reported.

Prophylactic netilmicin in surgery

Seventy-seven elective or emergency surgical patients were treated with a prophylactic course of netilmicin. Netilmicin (150 mg intramuscularly) was given 1 hour prior to operation and continued 12 hourly until the patient was free of risk of post-operative infection. There was no microbiological or clinical evidence of post-operative infection in general surgical or orthopaedic patients. Netilmicin seems to be less nephrotoxic than other aminoglycosides. Netilmicin serum levels were within expected values. Netilmicin was found to be an effective and well-tolerated antibiotic, and prophylactic treatment shortened the mean patient bed-stay and hence costs incurred.