Silymarin and management of liver function in non-alcoholic steatohepatitis: a case report

Non-alcoholic fatty liver disease (NAFLD) and its progressive form (non-alcoholic steatohepatitis; NASH) are the main reason for chronic liver disease in the general population, characterized by fat accumulation in hepatocytes (steatosis) and anomalies in liver biochemical analyses. To date, no pharmacological agents have been approved for NAFLD or NASH treatment. However, silymarin, the active ingredient in milk thistle, has been used in the last decades for the treatment of several liver diseases. In this case report, treatment with silymarin 140 mg three-times daily highlighted moderate efficacy and a good safety profile in the management of NASH and liver function, as it decreased serum AST and ALT levels over the treatment period with no side-effects, supporting silymarin as a promising supplemental intervention that can normalize liver activity in NAFLD and NASH. This article is part of the Current clinical use of silymarin in the treatment of toxic liver diseases: a case series. Special Issue: https://www.drugsincontext.com/special_issues/current-clinical-use-of-silymarin-in-the-treatment-of-toxic-liver-diseases-a-case-series.

Seroprevalence of HBV/HCV coinfection among patients with HCV screened during the national campaign for HCV eradication in Egypt

BACKGROUND AND STUDY AIMS

Little is known about the true prevalence of hepatitis B virus (HBV) coinfection in patients with hepatitis C virus (HCV). This multicenter nationwide study aimed to assess the seroprevalence of HBV among Egyptian patients with HCV and its possible risk factors.

PATIENTS AND METHODS

This is a cross-sectional, multicenter, nationwide study. Data were extracted from the National Network of Viral Hepatitis Treatment Centers database. Baseline data of patients proved to be viremic during the national campaign for HCV eradication (October 2018-April 2019) were retrieved. Data included demographics, laboratory tests (HBsAg, CBC, liver biochemical profile, creatinine, AFP, HbA1c, and viral load), FIB-4 score calculation, and abdominal ultrasound results.

RESULTS

Results of 297,965 patients showed that HBsAg was positive in 2,347 (0.8%) patients. Patients with HBV/HCV were 57% females and had a mean age of 51 ± 13 years. Patients with positive HBsAg showed significantly more tobacco consumption, intravenous drug abuse, hypertension, and diabetes. No significant difference was noted in HCV viremia between patients with HCV and those with HBV/HCV. Only 14% of patients with HBV/HCV had cirrhosis compared with the 9% of those with HCV; two of them had HCC.

CONCLUSION

Although Egypt has a heavy HCV burden, the overall prevalence of HBV is low among patients with HCV infection. Comorbid conditions seem to favor coinfection.

The Effect of Passive Ultrasonic Irrigation and XP-Endo Finisher on Post-operative Pain after Endodontic Retreatment on Patients (Randomized Controlled Clinical Trial)

AIM: To evaluate the effect of passive ultrasonic irrigation or XP-Endo Finisher on postoperative pain in patients with underextended filling in previously endodontically treated mandibular first molar teeth requiring endodontic retreatment using visual analog scale (VAS) scale at 6, 12, 24, 48, 72 h, and 7 daytime intervals. METHODS: Seventy-eight patients with mandibular first molars which need endodontic retreatment were randomly allocated into one of three separate groups (n = 26); NaviTip group (control), XP-Endo Finisher group, or Ultra X group. Data were statistically analyzed with a significance level of p ≤ 0.05. RESULTS: XP-Endo Finisher agitation and ultrasonic agitation as a final irrigation protocol showed significantly lower pain values than the control group, but there was no significant difference in pain values between the experimental groups. CONCLUSION: Within the limitation of this study, it can be concluded that agitation techniques used during endodontic retreatment decreased the incidence and intensity of post-operative pain.

Cochlear implants: Visual evoked potentials study

Cochlear implants (CIs) are a successful alternative in cases with severe-to-profound HL. In these individuals, visual cross-modal re-organization can occur because of hearing loss where the visual cortex will recruit auditory cortical areas for visual processing.

OBJECTIVES

This work is designed to study visual evoked potentials (VEPs) in children fitted with CIs in comparison to normal hearing children.

METHOD

This work included 2 groups of children: Group I included 20 normal hearing children and study group included 25 children fitted with unilateral CIs. All cases were subjected to Thorough otological history. Check up on CIs performance using physical check and Aided sound field examination, ophthalmic examination and Pattern Visual Evoked Potentials (pVEPs).

RESULTS

Both groups showed no significant difference as regard age or sex. And both had normal ophthalmic examinations. Children of the study groups showed satisfactory aided response. As regard pVEPs, the study group showed significant higher P100 amplitude in comparison to the control group.

CONCLUSION

This study showed that deafness could induced cortical organization in the visual cortex and not limited to the auditory cortex only.

Assessment of circulating levels of microRNA-326, microRNA-424, and microRNA-511 as biomarkers for hepatocellular carcinoma in Egyptians

BACKGROUND

Hepatocellular carcinoma (HCC) is the fifth most common cancer. Differential expression of microRNAs (miRNAs)-326, miRNA-424, and miRNA-511 has been associated with the diagnosis and prognosis of HCC in different populations. However, limited information is available regarding their expression in Egyptian HCC patients.

AIM

To assess the role of circulating miRNAs-326, miRNA-424, and miRNA-511 in Egyptian HCC patients.

METHODS

This prospective observational study included 70 HCC patients and 25 healthy controls. The circulating levels of these three miRNAs were evaluated by real-time PCR. Receiver operating characteristic curve analysis was used to test the diagnostic accuracy of microRNA expression levels.

RESULTS

All miRNAs were differentially expressed in HCC patients; miRNAs326 and miRNA-424 were upregulated, while miRNA-511 was downregulated. Both miRNA-326 and miRNA-424 showed sensitivity and specificity of 97%, 71.4%, and 52%, 60%, respectively, to differentiate HCC from controls. Moreover, miRNA-326 was associated with survival and could differentiate between Child grades (A vs B); miRNA-424 significantly differentiated early vs intermediate stages of HCC; while miRNA-511 was significantly correlated with response to modified Response Evaluation Criteria in Solid Tumors (mRECIST).

CONCLUSION

We conclude that miRNA-326, miRNA-424, and miRNA-511 have diagnostic and prognostic roles in Egyptian patients with hepatitis C virus-related HCC and should be considered for better disease management.

Post-operative Pain after Different Root Canal Irrigant Activation Methods in Patients with Acute Apical Periodontitis (Randomized Clinical Trial)

Objective To evaluate the degree of postoperative pain in patients with necrotic teeth with symptomatic apical periodontitis after applying ultrasonic irrigation or manual dynamic agitation. Methods Seventy-eight patients diagnosed with necrotic mandibular first molar with symptomatic apical periodontitis were randomly allocated into 1 of 3 separate groups (n=26); Manual Dynamic Agitation group, Ultra X group, or NaviTip group (control). After a single-visit root canal treatment and a specific method of agitation, depending on each group, the patients were given a questionnaire on which they would mark the degree of pain in a scale from 0 to 10 at 6, 12, 24, 48, 72 hours and 7 days post-operative. Data were statistically analyzed with a significance level of P ≤ 0.05. Results Final irrigation protocol including Ultrasonic agitation and NaviTip (control) groups showed significantly lower values of pain than the MDA group. There was a reduction in pain values by time in all groups. Conclusion There was significantly less pain associated with passive ultrasonic agitation and side vented needle (NaviTip) irrigation compared to Manual Dynamic Agitation.

The Effect of Passive Ultrasonic Irrigation or XP-Endo Finisher on Post-Operative Pain in Patients with Necrotic Teeth with Apical Periodontitis (Randomized Controlled Clinical Trial)

Objective To evaluate the effect of passive ultrasonic irrigation or XP-Endo Finisher on post-operative pain in patients with necrotic teeth with apical periodontitis using (VAS) scale at 6, 12, 24, 48, 72 hours, and 7 day time intervals. Methods Seventy-eight patients diagnosed with necrotic mandibular first molar with symptomatic apical periodontitis were randomly allocated into 1 of 3 separate groups (n=26); Navitip group (control), XP-Endo Finisher group, or Ultra X group. After a single visit root canal treatment and a specific method of agitation, depending on each group, the patients were given a questionnaire on which the patient would mark the degree of pain in a scale from 0 to 10 at 6, 12, 24, 48, 72 hours and 7 days post-obturation. Data were statistically analyzed with a significance level of P ≤ 0.05. Results Ultrasonic agitation and XP-Endo Finisher agitation as a final irrigation protocol showed significantly lower pain values than the control group, but there was no significant difference in pain values between the experimental groups. Conclusion There was significantly less pain associated with ultrasonic and XP-Endo Finisher agitation compared to Navitip irrigation.

The views of African and Middle Eastern Gastroenterologists on the management of mild-to-moderate, non-erosive gastro-esophageal reflux disease (GERD)

INTRODUCTION

Gastro-esophageal reflux disease (GERD) is a common gastrointestinal disorder that occurs when backflow of the gastric contents into the esophagus results in troublesome symptoms. Though GERD has been extensively studied in Western populations, literature on the management of GERD in patients in Africa and Middle East (AME) is scarce.

AREAS COVERED

In this review, we provide an overview of the management of mild-to-moderate GERD in AME. Here we focus on the efficacy and safety of currently available treatments for GERD to help physicians and community pharmacists appropriately manage patients with mild-to-moderate GERD in the primary healthcare setting, detailing specific situations and patient scenarios that are relevant to the region, including management of GERD during Ramadan and post-bariatric surgery.

EXPERT OPINION

Under-appreciation of the burden of GERD in the region has resulted in a lack of consensus on management. Barriers that currently prevent the adoption of treatment guidelines in the primary healthcare setting may include lack of availability of local guidelines and referral systems, a paucity of region-specific research, and dogmatic adherence to traditional practice. By increasing awareness, strengthening knowledge, and by more effective utilization of resources, physicians and pharmacists could optimize GERD management strategies to better support patients.

Changes in Serum Interferon Gamma and Interleukin-10 in Relation to Direct-Acting Antiviral Therapy of Chronic Hepatitis C Genotype 4: A Pilot Study

Introduction

This study analyzes the changing levels of circulating inflammatory cytokines Interferon gamma (IFN-γ) and interleukin (IL)-10 (as the main cytokines of T-helper-1 and T-helper-2 immune responses) in patients with chronic hepatitis C virus (HCV) infection undergoing therapy with direct-acting antivirals (DAAs) and to correlate them with laboratory markers.

Methods

This Pilot study included 50 HCV monoinfected patients who received DAAs for 12 or 24 weeks. They were followed up monthly during therapy and 3 months after the end of the treatment. Liver disease was determined by transient elastography, in addition to FIB-4 indices. Analysis of IFN-gamma and IL-10 was carried out using an enzyme-linked immunosorbent assay.

Results

All patients carried HCV genotype 4. The Sustained virological response was 100% and 92% in cirrhotics and noncirrhotics, respectively. There was no significant difference between groups in baseline IL-10 or IFN-gamma. In noncirrhotics, IL-10 showed a significant reduction at Week 4 after treatment start. In cirrhotics, IL-10 showed a significant reduction at Week 4 after treatment starts and a significant reduction at Week 12 after the end of the treatment. At Week 12 after the end of the treatment, serum IL-10 levels were significantly lower in cirrhotics. IFN-γ showed nonsignificant changes in noncirrhotics. A significant increase of IFN-γ occurred in cirrhotics from Week 4 after treatment starts to 12 weeks after the end of the treatment. IFN-γ was significantly higher in cirrhotics at Week 12 after the end of the treatment. IFN-γ and IL-10 showed different correlations with laboratory markers.

Conclusion

Viral eradication induced by DAAs caused a significant change in IL-10 and IFN-gamma.

Effect of Different Surface Treatments of Glass Fiber Posts on their Surface Roughness and Flexure Properties

AIM: This study aimed to assess the effect of different surface treatments on the surface roughness and flexure properties of glass fiber posts “GFPs.” MATERIALS AND METHODS: A total of 40 GFPs were divided into four groups (n = 10): GC – no surface treatment (control), GSB – sandblasted, GHF – hydrofluoric acid etched, and GL – Er: YAG laser irradiated. Surface roughness was detected using surface profilometer and the 3-points bending flexural test measured flexural strength and elastic modulus. RESULTS: GSB showed the highest mean roughness followed by GHF, then GL, while GC had lowest roughness mean value. The 3 points bending test results were calculated and recorded, GSB exhibited the highest flexure stress (MPa) compared to GHF and GL. Modulus of elasticity (GPa) showed significant differences between the tested groups, GSB showed the highest modulus of elasticity compared to GHF and GL, while GC showed insignificant differences with all tested groups. CONCLUSION: Different surface treatments postulated in this study showed alternations of GFPs surfaces without jeopardizing the mechanical properties of GFPs.

Validation of a machine learning approach using FIB-4 and APRI scores assessed by the metavir scoring system: A cohort study

BACKGROUND AND STUDY AIM

The study aim was to improve and validate the accuracy of the fibrosis-4 (FIB-4) and aspartate aminotransferase-to-platelet ratio index (APRI) scores for use in a potential machine-learning (ML) method that accurately predicts the extent of liver fibrosis.

PATIENTS AND METHODS

This retrospective multicenter study included 69,106 patients with chronic hepatitis C planned for antiviral therapy from January 2010-December 2014 with liver biopsy results. FIB-4 and APRI scores were calculated and their performance for predicting significant liver fibrosis (F3-F4) assessed against the Metavir scoring system. ML was used for feature selection and reduction to identify the most relevant attributes (CfsSubseteval/best first) for prediction.

RESULTS

In this study, 57,492 (83.2%) patients were F0-F2, and 11,615 (16.8%) patients were F3-F4. The revalidation of FIB-4 and APRI showed lower accuracy and higher disagreement with the biopsy results, with AUCs of 0.68 and 0.58, respectively. FIB-4 diagnosed fewer (14%) F3-F4 patients, and the high specificity and negative predictive values of FIB-4 and APRI reflected the low prevalence of F3-F4 in the study population. Out of 15 attributes, age (>35 years), AFP (>6.5 ng/ml), and platelet count (<150,000/mm³) were the most relevant risk attributes, and patients with one or more of these risk factors were likely to be F3-F4, with a classification accuracy of ≤ 92% and receiver operating characteristics area of 0.74.

CONCLUSION

FIB-4 and APRI scores were not very accurate and missed diagnosing most of the F3-F4 patients. ML implementation improved medical decisions and minimized the required clinical data to three risk factors.

Budd-Chiari syndrome diagnosed with pregnancy in a patient with inherited thrombophilia

An 18-year-old primigravida was referred to our high risk pregnancy (HRP) department at 34 weeks of gestation for birth panning as she has Budd-Chiari syndrome (BCS). Her history was significant for familial thrombophilia. She had portal hypertension manifestations. Her work-up revealed factor V Leiden gene mutation, hepatic and portal vein thrombosis. A multidisciplinary team of physicians from the gastroenterology and hepatology, haematology and HRP departments puts a management plan; it culminated into safe delivery of the patient at 36 weeks of gestation. The patient was referred to a specialised BCS centre where she had successful liver transplantation done.

The interrelation between lipid profile in chronic HCV patients and their response to antiviral agents

OBJECTIVES

This study aims to assess the changes of lipid profile in chronic HCV patients; before, during, and after treatment with DAAs and their association with treatment response.

METHODS

301 chronic HCV patients who received SOF-based therapy were included. Serum lipid profile was assessed at different check points; baseline, 6 weeks on treatment, end of treatment (EOT) and 12 weeks after EOT; and compared between SVR and non-SVR groups.

RESULTS

SVR group had significantly higher baseline lipid parameters compared to non-SVR group with significant increase in lipid parameters at different time points apart from HDL-C. Non-SVR group showed non-significant change in lipid parameters apart from LDL-C. On week6 on treatment, cholesterol level > 125 mg/dl was 92.8% sensitive, 97.3% specific with 95.5% NPV, and AUC of 0.989 in prediction of SVR. Similarly, LDL > 57 mg/dl was 83.7% sensitive, 100% specific with 93.3%, NPV and AUC of 0.952. Baseline cholesterol and LDL were significantly associated with SVR.

CONCLUSION

Higher baseline lipid parameters and their further elevation starting from week 6 on treatment are good predictors of SVR in HCV patients. Successful HCV therapy with DAAs is associated with a significant increase in lipid parameters.

Adsorption of Pb(II) ions from contaminated water by 1,2,3,4-butanetetracarboxylic acid-modified microcrystalline cellulose: Isotherms, kinetics, and thermodynamic studies

Microcrystalline cellulose (MCC) has been utilized as an adsorbent material for the removal of Pb(II) ions from aqueous solution after treatment with 1,2,3,4-butanetetracarboxylic acid (BTCA) at elevated temperature to obtain MMCC. The resulting adsorbent was characterized for point of zero point charge (pHZPC), estimation of carboxyl content, Fourier transform infrared spectroscopy (FT-IR), scan electron microscopy (SEM), and textural properties, including surface area, and subsequently utilized for the removal of Pb(II) ions from aqueous solution. The adsorption process was probed by investigating the effect of adsorbent dose, pH of solution, temperature, agitation time, and Pb(II) ion concentration. The results showed successful functionalization of MCC using BTCA, significantly improved the binding properties of the adsorbent towards Pb(II) ions. Isothermal adsorption data was analyzed using Langmuir, Freundlich and Temkin models, evaluated via nonlinear regression analysis. The maximum adsorption capacity was found to be 1155 mg/g (at pH 5 and 30 °C) from Langmuir theory, and appears independent of surface area. The Freundlich model was found to provide the best fit and the constant n was determined to be 2.69, indicating that adsorption of Pb(II) ions onto MMCC is favorable. Kinetic modelling showed good agreement for the pseudo-second order kinetic model, supporting the theory that chemisorption is involved in the adsorption process, which is promoted by a high density of active sites. Thermodynamic analysis showed that the adsorption of Pb(II) ions onto MMCC was endothermic and nonspontaneous; hence, MMCC offers an effective method of Pb(II) ion removal from aqueous solutions, with potential for water remediation processes.

Improving Quality of Cancer Care by Participating in Quality Oncology Practice Initiative Certification Program

PURPOSE

ASCO developed the Quality Oncology Practice Initiative (QOPI) to ensure patient safety in oncology outpatient services. We evaluated the impact of participation in QOPI certification on patient care at our institution.

METHODS

To participate in QOPI, we created a multidisciplinary team, and we chose the required modules and began QOPI participation per program requirement. In the initial round, we scored lower than the required score of 75% to be eligible for QOPI certification. We then implemented multiple measures and interventions, and we conducted multiple Plan, Do, Study, Act cycles (PSDA) cycles to achieve our goal.

RESULTS

Our score in the initial round was 68%; in the second round, our score remained low at 65%; in the third round, we exceeded the target score by achieving 93%. We completed the certification process with a site visit. In October 2018, we became the first QOPI-certified center in the Middle East and Asia.

CONCLUSION

We learned many lessons during our journey toward QOPI certification. Essential elements of success included timely assembly of the right multidisciplinary team and clear communication between team members within the institution and with the ASCO QOPI team.

Clinical genomics expands the morbid genome of intellectual disability and offers a high diagnostic yield

Intellectual disability (ID) is a measurable phenotypic consequence of genetic and environmental factors. In this study, we prospectively assessed the diagnostic yield of genomic tools (molecular karyotyping, multi-gene panel and exome sequencing) in a cohort of 337 ID subjects as a first-tier test and compared it with a standard clinical evaluation performed in parallel. Standard clinical evaluation suggested a diagnosis in 16% of cases (54/337) but only 70% of these (38/54) were subsequently confirmed. On the other hand, the genomic approach revealed a likely diagnosis in 58% (n=196). These included copy number variants in 14% (n=54, 15% are novel), and point mutations revealed by multi-gene panel and exome sequencing in the remaining 43% (1% were found to have Fragile-X). The identified point mutations were mostly recessive (n=117, 81%), consistent with the high consanguinity of the study cohort, but also X-linked (n=8, 6%) and de novo dominant (n=19, 13%). When applied directly on all cases with negative molecular karyotyping, the diagnostic yield of exome sequencing was 60% (77/129). Exome sequencing also identified likely pathogenic variants in three novel candidate genes (DENND5A, NEMF and DNHD1) each of which harbored independent homozygous mutations in patients with overlapping phenotypes. In addition, exome sequencing revealed de novo and recessive variants in 32 genes (MAMDC2, TUBAL3, CPNE6, KLHL24, USP2, PIP5K1A, UBE4A, TP53TG5, ATOH1, C16ORF90, SLC39A14, TRERF1, RGL1, CDH11, SYDE2, HIRA, FEZF2, PROCA1, PIANP, PLK2, QRFPR, AP3B2, NUDT2, UFC1, BTN3A2, TADA1, ARFGEF3, FAM160B1, ZMYM5, SLC45A1, ARHGAP33 and CAPS2), which we highlight as potential candidates on the basis of several lines of evidence, and one of these genes (SLC39A14) was biallelically inactivated in a potentially treatable form of hypermanganesemia and neurodegeneration. Finally, likely causal variants in previously published candidate genes were identified (ASTN1, HELZ, THOC6, WDR45B, ADRA2B and CLIP1), thus supporting their involvement in ID pathogenesis. Our results expand the morbid genome of ID and support the adoption of genomics as a first-tier test for individuals with ID.

Enhancement of the Adsorption of Co(II) and Ni(II) Ions onto Peanut Hulls through Esterification Using Citric Acid

Peanut hulls were modified chemically by esterification with citric acid under conditions which yielded hulls rich in carboxyl content. The esterified products thus obtained were used in the removal of Co(II) and Ni(II) ions from aqueous solutions. The factors affecting the esterification reaction and the adsorption of the metal cations onto the peanut hulls before and after esterification were thoroughly investigated. The results obtained highlighted the following conclusions. The optimum conditions for esterification involve the treatment of peanut hulls (1 g) with 12.4 mmol citric acid in the presence of a very small amount of water for 2 h at 140°C. Similarly, the optimum pH for the adsorption of cobalt(II) ions onto the peanut hulls citrate was 7.0. The adsorption capacity, qe (mg/g), of Co(II) ions onto the peanut hulls citrate increased on increasing the extent of esterification, expressed as mequiv. —COOH/100 g sample. The maximum values for the adsorption capacity, qmax, were 28.7 mg/g and 270.3 mg/g on native and peanut hulls citrate, respectively. The qmax values for of Ni(II) ion adsorption were 5 mg/g and 175.4 mg/g on native and peanut hulls citrate, respectively. The equilibrium data were well fitted by the Langmuir and Freundlich adsorption models and showed the large capacity of peanut hulls citrate in the removal of Co(II) and Ni(II) ions from aqueous solutions.

γ-Induced Graft Copolymerization onto Cellulosic Fabric Waste for Cationic Dye Removal

Radiation grafting of itaconic acid (IA) onto cellulosic fabric in the presence of dimethylformamide (DMF) as a solvent by the mutual method is discussed. Factors affecting the radiation graft copolymerization were investigated. These factors include the radiation dosage, the monomer concentration and the solvent. The grafted samples were characterized using FT-IR spectroscopy, thermogravimetric analysis (TGA) and scanning electron microscopy (SEM). Utilization of the grafted cellulosic fabric waste in the removal of Methylene Blue (MB) from aqueous solution was examined. The adsorption data showed that the maximum adsorption capacity of Methylene Blue onto grafted cellulosic fabric waste was 38 mg/g. The adsorption data also obeyed the Langmuir and Freundlich isotherms.

Preparation and Characterization of Cationized Cellulose for the Removal of Anionic Dyes

The factors influencing the cationization of microcrystalline cellulose with 3-chloro-2-hydroxypropyl triethylammonium chloride in the presence of NaOH were investigated. The course of the reaction was followed by estimating the nitrogen content of the cationized product while its structural features were confirmed by IR analysis. The ability of cationized cellulose to adsorb anionic dyes, viz. Acid Orange 7, Direct Blue 75 and Direct Violet 31, was investigated at 25°C and 50°C. The equilibrium data obtained were fitted by the Langmuir and Freundlich isotherm models, allowing the corresponding adsorption parameters to be determined. The results showed that the adsorption capacity was dependent on the adsorbent, temperature, the nature of the dye and (to some extent) on van der Waals and hydrogen bonding. Cationized cellulose exhibited a much better adsorption capacity towards anionic dyes than cellulose.

The water–boryl radical as a proton-coupled electron transfer reagent for carbon dioxide, formic acid, and formaldehyde — Theoretical approach

The thermochemistry of the hydrogen atom transfer reactions from the H2O–BX2 radical system (X = H, CH3, NH2, OH, F) to carbon dioxide, formic acid, and (or) formaldehyde, which produce hydroxyformyl, dihydroxymethyl, and hydroxymethyl radicals, respectively, were investigated theoretically at ROMP2/6–311+G(3DF,2P)//UB3LYP/6–31G(D) and UG3(MP2)-RAD levels of theory. Surprisingly, in the cases of a strong Lewis acid (X = H, CH3, F), the spin transfer process from the water–boryl radical to the carbonyl compounds was barrier-free and associated with a dramatic reduction in the B–H bond dissociation energy (BDE) relative to that of isolated water–borane complexes. Examining the coordinates of these reactions revealed that the entire hydrogen atom transfer process is governed by the proton-coupled electron transfer (PCET) mechanism. Hence, the elucidated mechanism has been applied in the cases of weak Lewis acids (X = NH2, OH), and the variation in the accompanied activation energy was attributed to the stereoelectronic effect interplaying in CO2 and HCOOH compared with HCHO. We ascribed the overall mechanism as a SA-induced five-center cyclic PCET, in which the proton transfers across the so-called complexation-induced hydrogen bond (CIHB) channel, while the SOMOB–LUMOC=O′ interaction is responsible for the electron migration process. Owing to previous reports that interrelate the hydrogen-bonding and the rate of proton-coupled electron-transfer reactions, we postulated that “the rate of the PCET reaction is expected to be promoted by the covalency of the hydrogen bond, and any factor that enhances this covalency could be considered an activator of the PCET process.” This postulate could be considered a good rationale for the lack of a barrier associated with the hydrogen atom transfer from the water-boryl radical system to the carbonyl compounds. Light has been shed on the water–boryl radical reagent from the thermodynamic perspective.

Updated thresholds for alanine aminotransferase do not exclude significant histological disease in chronic hepatitis C

BACKGROUND AND AIM

Histological changes in hepatitis C virus (HCV)-infected patients with persistently normal alanine aminotransferase (PNALT) have not been evaluated for updated upper limits of normal (ULN; ≤ 19/30 U/L for females/males). We assessed significant fibrosis (≥ F2, METAVIR) in patients with PNALT and persistently elevated alanine aminotransferase (PEALT).

PATIENTS AND METHODS

Nine hundred and twenty consecutive, unselected HCV patients were stratified into four groups: Group I: (n = 124) PNALT within the updated ULN [0.5 × ULN (corresponding to ≤ 19 U/L) for females; 0.75 × ULN (corresponding to ≤ 30 U/L) for males]; Group II (n = 173): PNALT ≤ 1 × ULN but greater than Group I; Group III (n = 313): PEALT 1-2 × ULN; and Group IV (n = 310): PEALT > 2 × ULN. PNALT was defined as ≥ 3 determinations within the normal range over ≥ 6 months.

RESULTS

Advanced ≥ F3 and ≥ F2 fibrosis increased incrementally across Groups I; II; III; and IV: 24.2 and 45.2%; 25.4 and 56.1%; 36.1 and 64.2%; and 50 and 77.1% respectively (P<0.0001 for both). Multivariable logistic regression analysis identified age [odds ratio (OR), 1.05; 95% confidence intervals (CI): 1.02-1.08; P<0.0001], alanine aminotransferase (ALT) groups (OR 1.38; 95% CI: 1.03-1.83; P = 0.030), presence of moderate-severe steatosis (OR 2.70; 95% CI: 1.19-6.15; P = 0.018) and ≥ A2 necroinflammation (OR 17.9; 95% CI: 8.88-36.20; P < 0.0001) as independent predictors of ≥ F2 fibrosis. Updated ULN for ALT were better at excluding ≥ F2 fibrosis compared with traditional ULN (90.6 vs. 74.2%, P = 0.0041) but less specific (20.8 vs. 44%, P = 0.0007) with similar positive/negative predictive values.

CONCLUSIONS

HCV patients with 'updated' normal ALT have the lowest prevalence of significant fibrosis, although utilizing these levels without resorting to biopsy would miss significant fibrosis in almost one-half of such patients.

Preparation, Characterization and Utilization of Amidoximated Poly(AN/MAA)-grafted Alhagi Residues for the Removal of Zn(II) Ions from Aqueous Solution

Radiation grafting by the mutual method of methacrylic acid/acrylonitrile (MAA/AN) onto Alhagi residues in the presence of dimethylformamide (DMF) as a solvent is discussed. The factors affecting the radiation graft copolymerization were investigated. These included radiation dose, co-monomer composition and concentration. The grafted samples were characterized using FT-IR spectroscopy and scanning electron microscopy (SEM), as well as by the estimation of their nitrogen and carboxyl group contents. The grafted samples were then amidoximated by treatment with hydroxylamine hydrochloride in an alkaline medium. Such amidoximated poly(MAA/AN)-grafted Alhagi residues were utilized for the removal of Zn(II) ions from aqueous solution by adsorption and the factors affecting such adsorption processes were studied. These factors were the pH of the adsorbate solution, the adsorbent dosage, the contact time and the adsorption temperature.

The adsorption data obeyed the Langmuir and Freundlich isotherms. The Langmuir adsorption capacity (Qmax) of the amidoximated poly(MAA/AN)-grafted Alhagi residues towards Zn(II) ions was found to be 212.76 and 344.8 mg/g at 30 °C and 50 °C, respectively. Similarly, the Freundlich constants, KF and 1/n, at 30 °C were found to be 21.47 and 0.3489, respectively.

The study showed that amidoximated poly(MAA/AN)-grafted Alhagi residues were effective in the adsorption of Zn(II) ions from aqueous solutions. The thermodynamics parameters of the adsorption process, viz. ΔH0, ΔG0 and ΔS0, were evaluated. The results showed that the adsorption of Zn(II) ions onto amidoximated poly(MAA/AN)-grafted Alhagi residues was endothermic and spontaneous. The adsorption data followed second-order kinetics.

Treatment of Alhagi Residues with Tartaric Acid for the Removal of Zn(II) Ions from Aqueous Solution

Alhagi cellulose tartrate (ACT) with a high carboxyl group content was prepared by treatment of Alhagi residues (AR) with tartaric acid (TA) at high temperature. Factors influencing the reaction were investigated, viz. tartaric acid concentration, dehydration temperature, particle size and dehydration time. The prepared Alhagi cellulose tartrate samples were characterized using FT-IR spectroscopy and by estimation of the carboxyl group content. The esterified samples were utilized for the adsorptive removal of Zn(II) ions from aqueous solution with all the factors influencing the process being studied. These factors were the pH value of the adsorbate solution, the adsorbent concentration, agitation time and temperature.

The Langmuir and Freundlich models were applied to the data obtained from the adsorption studies. It was demonstrated that the Alhagi cellulose tartrate samples could be used effectively for the adsorption of Zn(II) ions from aqueous solutions. The thermodynamics constants of the adsorption process, viz. ΔH0, ΔS0 and ΔG0, were evaluated. The results showed that the adsorption of Zn(II) ions onto ACT was exothermic and spontaneous. The adsorption data followed second-order kinetics, with the equilibrium data being only satisfactorily described by the Langmuir isotherm.