Acute Treatment of Migraine: Expert Consensus Statements from the United Arab Emirates (UAE)

INTRODUCTION

Migraine, characterized by recurrent headaches and often accompanied by other symptoms like nausea, vomiting, and sensitivity to light and sound, significantly impacts patients' quality of life (QoL) and daily functioning. The global burden of migraines is reflected not only in terms of reduced QoL but also in the form of increased healthcare costs and missed work or school days. While UAE (United Arab Emirates)-specific consensus-based recommendations for the effective use of preventive calcitonin gene-related peptide (CGRP)-based migraine therapies have been published previously, an absence of such regional guidance on the management of acute migraine represents a gap that needs to be urgently addressed.

METHODS

A task force of eight neurologists from the UAE with expertise in migraine management conducted a comprehensive literature search and developed a set of expert statements on the management of acute migraine that were specific to the UAE context. To ensure diverse perspectives are considered, a Delphi panel comprising 16 neurologists plus the task force members was set up. Consensus was achieved using a modified Delphi survey method. Consensus was predefined as a median rating of 7 or higher without discordance (if > 25% of the Delphi panelists rate an expert statement as 3 or lower on the Likert scale). Expert statements achieving consensus were adopted.

RESULTS

The Modified Delphi method was used successfully to achieve consensus on all nine expert statements drafted by the task force. These consensus statements aim to provide a comprehensive guide for UAE healthcare professionals in treating acute migraine. The statements cover all aspects of acute migraine treatment, including what goals to set, the timing of treatment, treatment strategy to use in case of inadequate response to triptans, safety aspects of combining gepants for acute attacks with preventive CGRP-based therapies, special population (pregnant and pediatric patients) considerations, and the management of the most bothersome symptoms (MBS).

CONCLUSIONS

Adopting these consensus statements on the treatment of acute migraine can help enhance patient care, improve outcomes, and standardize treatment practices in the UAE. The collaborative effort of experts with diverse experiences in developing these consensus statements will strengthen the credibility and applicability of these statements to various healthcare settings in the country.

Consensus-Based Recommendations on the Use of CGRP-Based Therapies for Migraine Prevention in the UAE

INTRODUCTION

Migraine is a common debilitating neurological disorder affecting a large proportion of the general population. Calcitonin gene-related peptide (CGRP), a 37-amino acid neuropeptide, plays a key role in the pathophysiology of migraine, and the development of therapies targeting the anti-CGRP pathway has revolutionized the field of migraine treatment.

METHODS

An expert task force of neurologists in the United Arab Emirates (UAE) developed and critically assessed recommendations on the use of CGRP-based therapies in migraine treatment and management in the UAE, based on available published literature. A consensus was reached for each statement by means of an open-voting process, based on a predefined agreement level of at least 60%.

RESULTS

The consensus recommendations advocate the need for guidelines for the appropriate use of CGRP-based therapies by defining patient cohorts and appropriate monitoring of therapeutic response as well as standardizing the initiation, assessment, and cessation of treatment. The consensus recommendations were primarily formulated on the basis of international studies, because of the limited availability of regional and local data. As such, they may also act as guidelines for global healthcare providers.

CONCLUSIONS

These are the first consensus recommendations for the UAE that address the use of CGRP-based therapies in the treatment and management of migraine, integrating both clinical evidence and medical expertise to enhance clinical judgment and decision-making.

Efficient inactivation of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in human apheresis platelet concentrates with amotosalen and ultraviolet A light

Objectives

The detection of SARS-CoV-2 RNA in blood and platelet concentrates from asymptomatic donors, and the detection of viral particles on the surface and inside platelets during in vitro experiments, raised concerns over the potential risk for transfusion-transmitted-infection (TTI). The objective of this study was to assess the efficacy of the amotosalen/UVA pathogen reduction technology for SARS-CoV-2 in human platelet concentrates to mitigate such potential risk.

Material and methods

Five apheresis platelet units in 100% plasma were spiked with a clinical SARS-CoV-2 isolate followed by treatment with amotosalen/UVA (INTERCEPT Blood System), pre- and posttreatment samples were collected as well as untreated positive and negative controls. The infectious viral titer was assessed by plaque assay and the genomic titer by quantitative RT-PCR. To exclude the presence of infectious particles post-pathogen reduction treatment below the limit of detection, three consecutive rounds of passaging on permissive cell lines were conducted.

Results

SARS-CoV-2 in platelet concentrates was inactivated with amotosalen/UVA below the limit of detection with a mean log reduction of > 3.31 ± 0.23. During three consecutive rounds of passaging, no viral replication was detected. Pathogen reduction treatment also inhibited nucleic acid detection with a log reduction of > 4.46 ± 0.51 PFU equivalents.

Conclusion

SARS-CoV-2 was efficiently inactivated in platelet concentrates by amotosalen/UVA treatment. These results are in line with previous inactivation data for SARS-CoV-2 in plasma as well as MERS-CoV and SARS-CoV-1 in platelets and plasma, demonstrating efficient inactivation of human coronaviruses.

Amotosalen and ultraviolet A light efficiently inactivate MERS-coronavirus in human platelet concentrates

Objective

This study aimed to assess the efficacy of the INTERCEPT™ Blood System [amotosalen/ultraviolet A (UVA) light] to reduce the risk of Middle East respiratory syndrome‐Coronavirus (MERS‐CoV) transmission by human platelet concentrates.

Background

Since 2012, more than 2425 MERS‐CoV human cases have been reported in 27 countries. The infection causes acute respiratory disease, which was responsible for 838 deaths in these countries, mainly in Saudi Arabia. Viral genomic RNA was detected in whole blood, serum and plasma of infected patients, raising concerns of the safety of blood supplies, especially in endemic areas.

Methods

Four apheresis platelet units in 100% plasma were inoculated with a clinical MERS‐CoV isolate. Spiked units were then treated with amotosalen/UVA to inactivate MERS‐CoV. Infectious and genomic viral titres were quantified by plaque assay and quantitative real‐time reverse transcription polymerase chain reaction (RT‐qPCR). Inactivated samples were successively passaged thrice on Vero E6 cells to exclude the presence of residual replication‐competent viral particles in inactivated platelets.

Results

Complete inactivation of MERS‐CoV in spiked platelet units was achieved by treatment with Amotosalen/UVA light with a mean log reduction of 4·48 ± 0·3. Passaging of the inactivated samples in Vero E6 showed no viral replication even after nine days of incubation and three passages. Viral genomic RNA titration in inactivated samples showed titres comparable to those in pre‐treatment samples.

Conclusion

Amotosalen and UVA light treatment of MERS‐CoV‐spiked platelet concentrates efficiently and completely inactivated MERS‐CoV infectivity (>4 logs), suggesting that such treatment could minimise the risk of transfusion‐related MERS‐CoV transmission.

Verification of atmospheric plasma irradiation as an alternative control method for Tribolium castaneum (Herbst)

Radio frequency plasma, RF plasma, has been applied to a number of industrial applications. Laboratory experiments were conducted to determine the RF plasma potential in Tribolium castaneum (Herbst) control. Three treatment variables: (1) helium or argon plasmas; (2) two power levels (50 and 100 watt); and (3) different RF plasma exposure times (0, 20, 40, 60 and 90 seconds) were examined in this study. The susceptibility of T. castaneum to treatment varies as gas, power level, and the exposure time varies. A positive correlation was found between insect mortality percent in treating larvae as well as treated pupae and exposure time to RF plasma and also the power level of irradiation. The results revealed that no live insects were found after a 90 second, 100 watt helium RF plasma treatment. The survival percents of the adults were developed from treated larvae and treated pupae were significantly reduced by increasing of the exposure time or power level. Obtained data indicated that the treatment with RF plasma might be considered as an environmentally compatible or alternative supplement to the other control methods for stored product-pests management.

First complete genome sequence of circulating dengue virus serotype 3 in Jeddah, Saudi Arabia

Here we report the first full-length genome sequence of dengue virus serotype 3 (DENV-3) from a strain isolated from a patient in Jeddah, Saudi Arabia, in 2014. The genome consists of 10 635 bp and shows close similarity to circulating genotype III isolates from Singapore, suggesting possible importation, most probably during religious pilgrimages to Saudi Arabia.

EVALUATION OF PACKING THE RESIDUAL CAVITY AFTER TOTAL OR PARTIAL CYST RESECTION IN MANAGEMENT OF HEPATIC HYDATID CYSTIC DISEASE

Hydatid disease is a worldwide zoonosis caused by the larval stage of the echinococcus tapeworm, that is endemic in many parts 6f the world (in Europe, Middle East, Mediterranean, South American and African countries). Hydatid disease is a relevant health problem in underdeveloped areas where veterinary control does not exist. The most frequent location of hydatid cystic lesions is the liver (up to 80% of cases), followed by the lung (about 20% of cases), and with a lower reported incidence in any other organ or tissue in the body. Currently, surgical operation remains the treatment of choice in hydatidosis. Many surgical options can be done for management of the cyst, ranging from unroofing of the cyst, pericystectomy, up to liver resection for the affected liver parenchyma site. The cyst cavity can be managed by different techniques, capitonnage, external drainage, introflexion or omentoplasty. The Omentoplasty (OP) filling technique was the method of choice for filling of the Residual -Cavity (RC). The omentoplasty filling was, done by two procedures Pedicle Omental Pack (POP), and Isolated Omental Pack (IOP); both techniques were applied for the filling of the residual cavity compared to non-filling of the re-sidual cavity after surgery, in our retrospective ,comparative multicenter study. Seventy six patients operated for hydatid cyst between January 2010 and February 2014 were analysed retrospectively. Either with or without filling of the cavity, and either the filling was with pedicle or isolated omentoplasty were used to treat the re-sidual cyst cavity. Patients were categorised into three groups to evaluate complications: without filling of the RC (GA), ouientoplasty filling with Pedicle Omental Pack (GB), and omentoplasty filling with Isolated Omental Pack (GC). The overall mortality rates were 0%. Overall morbidity rates were 57.1% for GA, and 10.3% for GB, and 7.7% for GC respectively. Mean hospital stay was 11.8 days for GA, and 8.1 days for GB, and 8.7 days for GC. The isolated omentoplasty filling technique is a safe management in the filling of the residual cavity after surgery with less operative time and same result as pedicle omentoplasty technique. Because of omentum has a high absorptive capacity and capable to fill the residual cavity, and omentoplasty was recommended (whether with pedicle or isolated omental flap) to manage patients with hydatid cyst of the liver.

Comparison of the gut microbiota of people in France and Saudi Arabia

Background/Objectives:

The gut microbiota contributes to energy acquisition from food, and changes in the gut microbiome are associated with obesity. The eating habits of Saudis are much different than those of Europeans, and our objective was to compare the fecal microbiota of obese and normal weight Saudis and French.

Subjects/Methods:

Illumina MiSeq deep sequencing was used to test the gut microbiota of 9 normal weight and 9 obese individuals from Saudi Arabia and 16 normal weight and 12 obese individuals from France.

Results:

Obese French possessed significantly more relative Proteobacteria (P=0.002) and Bacteroidetes (P=0.05) and had lower richness and biodiversity at all the operational taxonomic unit (OTU) cutoffs (P<0.05) than normal weight French. Obese Saudis possessed significantly more Firmicutes (P=0.001) without a difference in richness (P=0.2) and biodiversity (P=0.3) compared with normal weight Saudis. We found a common bacterial species core of 23 species existing in ⩾50% of obese and normal weight Saudis and 29 species in ⩾50% of obese and normal weight French. Actinomyces odontolyticus, Escherichia coli and Ruminococcus obeum were present in at least 50% of all individuals tested. French individuals had significantly higher richness and biodiversity compared with Saudis at all the OTU cutoffs (P<0.05).

Conclusion:

Microbiota differences between obese and normal weight French were not similar to those between obese and normal weight Saudis. The studies of different populations can result in contrasting data regarding the associations of the gut microbiota and obesity.

Laparoscopic herniotomy in children: prospective assessment of tertiary center experience in a developing country

PURPOSE

We aimed to assess prospectively the feasibility and outcome of laparoscopic herniotomy (LH) in children in a tertiary center with limited resources.

METHODS

Fifty-six children with unilateral pediatric inguinal hernia (PIH) were treated for an 18-month period. All cases were subjected to LH in a way similar to the classic open technique following exploration of the contralateral patent processus vaginalis (CPPV) without ligation of the sac. Exclusion criteria included prematurity, age <6 months, irreducible or recurrent hernia, and cases with internal ring diameter >2 cm. Operative findings, postoperative results, and complications were assessed.

RESULTS

We have 56 cases presented with unilateral PIH, and they are aged between 6 months and 15 years. Thirty-two presented with Rt hernia including 12 associated with CPPV and 24 cases Lt hernia with 10 associated with CPPV. Two cases showed adhesions and 2 cases showed direct defects that were repaired in the same session. Hydrocele of the hernia sac was reported once. In the total of 78 hernias, the mean operative time was 20.5 min in unilateral cases and 42.5 min in bilateral cases. No conversion was reported. Postoperative pain lasts for a mean time of 11.2 h. Patients regained peristalsis by a mean of 7 h. Two cases developed wound infection and were treated conservatively. No case of recurrence, testicular atrophy, or hydrocele was reported in the mean follow-up period of 20.5 months.

CONCLUSIONS

Laparoscopic herniotomy is feasible and safe for PIH. It provides a superior tool to diagnose CPPV or rare hernias that can be managed in the same session with minimal postoperative complications reported even in developing countries. Laparoscopic herniotomy is proved to be beneficial for PIH since it provides an excellent view on the cord structures, and they can be guarded well during the procedure. Larger studies and longer follow-up are needed to support our encouraging results.

Synthesis, characterization and biological evaluation of Fe (III), Co (II), Ni(II), Cu(II), and Zn(II) complexes with tetradentate Schiff base ligand derived from protocatechualdehyde with 2-aminophenol

Schiff base ligand (H(3)L) was prepared from the condensation reaction of protochatechualdehyde (3,4-dihydroxybenzaldhyde)with 2-amino phenol. From the direct reaction of the ligand (H(3)L) with Co(II), Ni(II) and Cu(II) chlorides, and Fe(III)and Zn(II)nitrates in 2 M/1 L molar ratio, the five new neutral complexes were prepared. The characterization of the newly formed compounds was done by (1)H NMR, UV-Vis, and IR spectroscopy and elemental analysis. The in vitro antibacterial activity of the metal complexes was studied and compared with that of free ligand.

Association of cytokine gene polymorphism with susceptibility and clinical types of leprosy

BACKGROUND

Both pro- and anti-inflammatory cytokines are implicated in development and prognosis of leprosy so the genetic regulation of such cytokines could play an important role.

OBJECTIVE

. This study was planned for testing the association of cytokine gene polymorphisms with susceptibility and clinical types of leprosy among Egyptian cases.

SUBJECTS

This study included 47 cases (29 men, 18 females, mean age = 46.3 years) with leprosy in addition to 98 healthy unrelated controls (52 males, 46 females, mean age = 44.9 years). Cases were recruited from Leprosy Clinics, Delta region of Egypt. Cases were classified into paucibacillary (PB) (n = 17; 10 males, 7 females; mean age 42.6 years) and multibacillary (MB) (n = 29; 19 males, 10 females; mean age 43.9 years).

METHODS

For all cases and controls, DNA was extracted and amplified using polymerase chain reaction with sequence specific primers (PCR-SSP) for detection of single nucleotide polymorphisms (SNPs) in the promoter regions of cytokine genes, TNF-α-308 (G/A), IL-10-1082(G/A), IL-6-174(G/C) as well as IL-1RaVNTR in intron 2 of the gene.

RESULTS

COMPARED TO CONTROLS, ALL CASES HAVE SHOWN INCREASED FREQUENCY OF HOMOZYGOUS GENOTYPES : IL-10-1082 (GG) (Odds ratio 6.6, P <0.05), homozygous TNF-α-308 (GG) (Odds ratio =3.23), and homozygous IL-1Ra (11) (Odds ratio = 3.6, P<0.05) with increased frequency of IL10 G and ILRa 1 alleles (P<0.05). BP subgroup showed increased frequency of homozygous IL-10-1082 (GG) (Odds ratio = 18.6, P<0.05) with increased frequency of IL10 G allele (P<0.05). On the other hand, MB subgroup showed increased frequency of homozygous TNF-α-308 (GG) (Odds ratio = 5.84, P<0.05) and homozygous IL-1Ra (11) (Odds ratio = 4, P<0.05) with increased frequency of IL-1Ra 1 allele (P<0.05). There is predominance for heterozygous IL-6-174 (G/C) polymorphism in all studies patient subgroups as well as controls with no significant difference among them.

CONCLUSION

Genetic polymorphisms related to TNF-α-308 and IL-10-1082 and IL-1Ra may be used as genetic markers for susceptibility and clinical outcome of leprosy among Egyptian cases from the Nile Delta.

Pyrimidines. Part II: Synthesis of novel pyrimidines, 1,2,4-triazolo[4,3-a]pyrimidin-7-ones and pyrimidino[2,1-c][1,2,4]triazin-8-ones for their antimicrobial and anticancer activities

Five main classes of novel pyrimidine derivatives have been synthesized; namely 6-substituted phenyl-5-cyano-3-methyl-2-phenacylhydrazino-3,4-dihydropyrimidin-4-ones 4a-e; 6-substituted phenyl-2-arylidene hydra-zino-5-cyano-3-methyl-3,4-dihydropyrimidin-4-ones 5a-i; 6-substituted phenyl-2-acylhydrazino-5-cyano-3-methyl-3,4-dihydropyrimidin-4-ones 7a-d, 8a-e and 9a-c; three novel series of 1,2,4-triazolo[4,3-a] pyrimidones 10a,b, 11a-d and 12a-d and 6-substituted phenyl-7-cyano-9-methyl-3-phenyl or 4-chlorophenyl-4,9-dihydropyrimido[2,1-c][1,2,4] triazin-8-ones 13a-c. Besides, the azide compound 2-azido-5-cyano-3-methyl-6-phenyl-3,4-dihydropyrimidin-4-one 6 was also synthesized. The prepared compounds were tested for antimicrobial and anticancer activity. Compounds 4b and 4d showed promising activity against Escherichia coli. Compounds 3c, 5c, 5e, 5g and 7b were active in the three cell line antitumor one dose primary assay and were evaluated in the 60 human tumor full panel cell line invitro screening. Compound 5c showed promising activity against all types of leukemia especially leukemia K-562 and leukemia SR with GI50 = 1.61 and 2.63 mmol/l respectively.

Glutathione peroxidase activity in blood cells from aspirin-induced asthma patients

Aspirin and other inhibitors of cyclo-oxygenase precipitate acute bronchospasm in about 10% of adult asthmatics. It has been assumed that cyclo-oxygenase is involved in the pathogenesis of bronchospasm, but the precise mechanism remains poorly understood. The oxygenation products of arachidonic acid include hydroperoxyeicosatetraenoic acid and cyclic endoperoxides. Glutathione peroxidase (GPX) reduces semi-stable hydroperoxides to less reactive alcohols and removes H(2)O(2) involved in inflammation. GPX could, therefore, modulate oxidation of arachidonic acid in the cyclo-oxygenase and lipoxygenase pathways, but the involvement of GPX in the pathogenesis of asthma has received little attention. We measured GPX activity in platelets, peripheral blood lymphocytes (PBL), red blood cells (RBC) and plasma from 13 patients with aspirin-induced asthma (AIA). Age- and sex-matched healthy individuals served as the comparison group. The patients had significantly higher GPX activity in platelets (P = 0.05) and tended to have high GPX activity (P = 0.08) in plasma but not in RBC or PBL. The results suggest that the increased GPX activity may be an adaptive advantage in AIA to protect against increased free radical production by inflammatory cells. That the higher GPX activity was not evident in all cell types studied may indicate a differential role played by them as effector cells in the pathogenesis of AIA.

Therapeutic efficacy of chloroquine and sulfadoxine/pyrimethamine against Plasmodium falciparum infection in Somalia

OBJECTIVE

To assess the efficacy of chloroquine and sulfadoxine/pyrimethamine in the treatment of uncomplicated Plasmodium falciparum infections in Somalia.

METHODS

Patients with clinical malaria in Merca, an area of high transmission of the disease, were treated with the standard regimens of chloroquine (25 mg/kg) or sulfadoxine/pyrimethamine (25 mg sulfadoxine and 1.25 mg pyrimethamine per kg). Similar patients in Gabiley, an area of low transmission, received the standard regimen of chloroquine. The clinical and parasitological responses were monitored for 14 days.

FINDINGS

Chloroquine treatment resulted in clinical failure in 33% (n = 60) and 51% (n = 49) of the patients in Merca and Gabiley respectively. There were corresponding parasitological failures of 77% RII/RIII and 35% RII/RIII. Patients who experienced clinical failure had significantly higher initial parasitaemia than those in whom there was an adequate clinical response, both in Merca (t = 2.2; P t = 2.8; P n = 50) of the patients achieved an adequate clinical response despite a parasitological failure rate of 76% RII/RIII.

CONCLUSION

Chloroquine should no longer be considered adequate for treating clinical falciparum malaria in vulnerable groups in the areas studied. Doubts about the therapeutic life of sulfadoxine/pyrimethamine in relation to malaria are raised by the high levels of resistance in the Merca area and underline the need to identify suitable alternatives.

Acylated flavonol glycosides from Eugenia jambolana leaves

Two acylated flavonol glycosides and 15 known polyphenols have been isolated and identified from the leaves of Eugenca jambolana Lam. The structures of the new compounds were identified as 3-O-(4"-O-acetyl)-alpha-L-rhamnopyranoside of mearnsetin (myricetin 4'-methyl ether) and myricetin 3-O-(4"-O-acetyl-2"-O-galloyl)-alpha-L-rhamnopyranoside. The complete structure elucidation of all isolated metabolites based on chemical and spectroscopic methods of analysis (UV, 1D and 2D NMR) as well as negative ESI-MS with and without CID in-source fragmentation.

Elemental investigation of some Egyptian vehicle motor alloys using neutron activation analysis

Six samples of different Egyptian motor vehicle alloys have been investigated by neutron activation analysis to estimate the concentrations of their elemental constituents, which affect their quality. A single high resolution hyper-pure germanium HPGe gamma-ray detector and a multichannel analyzer are used to collect the gamma-ray spectra. A HPGe-HPGe coincidence spectrometer was also used to confirm the identity of certain peaks. Thirteen trace elements (Sc, Cr, Fe, Co, Zn, Sn, Sb, La, Sm, Eu, Hf, Pt and Au) were observed in the spectra and their concentrations were determined. A comparative study on the element concentrations for the six samples is given.

Elemental analysis of two Egyptian iron ores and produced industrial iron samples by neutron activation analysis

Elemental analysis of two iron ores and initial industrial iron production prepared by the Egyptian Iron and Steel Company of Helwan near Cairo were performed by the instrumental neutron activation analysis technique. Five samples of each type were irradiated for 48 h in a thermal neutron flux of 4 x 10(12) n/cm2 s in the first Egyptian research reactor ET-RR-1. Also, the Pneumatic Irradiation Rabbit System (PIRS), attached to the reactor ET-RR-1 in Inshass, was used to measure short-life elements. The gamma-ray spectra were obtained with a hyper pure germanium detection system. The concentration percentage values of major, minor and trace elements are presented. Implications of the elemental concentration values obtained are presented.

Elemental analysis of some Egyptian ores and industrial iron samples by neutron activation analysis

Elemental analysis of iron ore samples and first industrial iron production prepared by the Egyptian Iron and Steel Company of Helwan near Cairo were determined by instrumental neutron activation analysis technique. Five samples from each kind were irradiated for a 48 hours at a thermal neutron flux of 4 x 10(12) n/(cm2.s) in the first Egyptian research reactor ET-RR-1. Also the Pneumatic irradiation Rabbit system (PIRS) attached to the reactor in Inshass, was used to measure the elements of short-life time. The gamma-ray spectra were recorded by means of the hyper pure germanium detection system. The concentration percentage values of major, minor and trace elements are presented. The long and short lived isotopes were considered. A comparative study and a discussion on the elemental concentration values are given.

Age and gender effects on injury outcome for restrained occupants in frontal crashes: a comparison of UK and US data bases

Field accident data from NASS/CDS in the US and CCIS in the UK are compared. The UK sample is deliberately weighted to conform to the same AIS proportions (within AIS 2-6) as the weighted NASS data so that crash severity distributions can be compared for various selected outcomes. Age and gender have a significant effect on the delta V distributions and median delta V values. These differences are documented both for overall AIS 2-6, 3-6, and 4-6, and also for body regions of the head, neck, chest, abdomen and upper and lower extremities. Anomalies between the two samples are profound which raises doubts about the recording of belt use in NASS and the calculation of delta V at lower crash severities.

Ketogenic diet in the treatment of refractory epilepsy in childhood

There has been renewed interest in the ketogenic diet in the treatment of medically refractory seizure disorders in childhood. This article reports the results of a retrospective chart review of 52 patients who were treated with the ketogenic diet. The vast majority (49 of 52) were treated with the classic 4:1 diet. Seizure control improved in 67.3% of patients with complete abolition of seizures in six. Adverse reactions were uncommon and included the development of renal stones, gall bladder stones, and hypoproteinemia in one patient each. Routine biochemical screening during the diet did not identify or prevent adverse events. The authors' experiences with the diet emphasize the need for close ongoing medical and dietary supervision.

Serodiagnosis of cutaneous leishmaniasis: assessment of an enzyme-linked immunosorbent assay using a peptide sequence from gene B protein

An enzyme-linked immunosorbent assay (ELISA) using a 28 amino acid sequence of the repetitive element of gene B protein (GBP) from Leishmania major was developed for serodiagnosis of cutaneous leishmaniasis (CL). The assay was compared to ELISAs using crude amastigote and promastigote antigens from L. donovani and the major surface glycoprotein (Gp63) from either L. donovani or L. major as a solid-phase ligand. The sensitivity of the assays was tested in 33 patients suffering from CL caused by L. major. The sensitivity of the GBP peptide (GBPP) ELISA was 82%. This was higher than in the assays using crude amastigote (67%) or promastigote (67%) antigens, but the difference was not statistically significant. The sensitivity in the assays using Gp63 from L. donovani (52%) or L. major (39%) was significantly lower than in the assay using GBPP (P = 0.019 and P < 0.001, respectively). Plasma samples from healthy Sudanese individuals living in an area endemic for malaria but free of leish-maniasis were negative in all the assays. Significantly higher levels of antibodies were found in the patients who had suffered from the disease for more than eight weeks than in patients with a shorter clinical history (GBPP ELISA; P = 0.038; amastigote ELISA; P = 0.004; and promastigote ELISA; P = 0.017). In the former group, the sensitivities of the five ELISAs were 100% (GBPP), 87% (amastigote), 93% (promastigote), 67% (L. donovani), and 53% (L. major), respectively.

Calreticulin is the major Ca2+ storage protein in the endoplasmic reticulum of the pea plant (Pisum sativum)

A 56kDa protein with high similarity in its N-terminal amino acid sequence to animal calreticulin and 100% homology with the N-terminal amino acids of spinach calreticulin has been identified in seeds of the pea plant (Pisum sativum). A new purification procedure is described by which the calreticulin-like protein was selectively solubilized by incubation with deoxycholate and HgCl2 from microsomes enriched for endoplasmic reticulum. Following Mono Q ion exchange chromatography of the deoxycholate extract by fast protein liquid chromatography, the calreticulin-like protein was obtained in nearly pure form. This purified protein is similar to animal calreticulin in apparent mass, characteristic blue staining with Stains-all dye and calcium-binding ability. In addition, this protein is recognized only by affinity purified antibodies against rabbit calreticulin and is not recognized by anti-calsequestrin antibodies. Our data suggested that calreticulin rather than calsequestrin functions as the Ca(2+)-storage protein in the endoplasmic reticulum of pea plants.

Metabolic inter-organ relations by exercise of fed rat: carbohydrates, ketone body, and nitrogen compounds in splanchnic vessels

Fed rats were exercised until exhaustion by almost 65% VO2max on a treadmill. In 2.5 min after the exercise, blood was collected from various vessels of the splanchnic bed. Metabolites, glucose, lactate, ketone body, and nitrogencompounds in the plasma, were measured. Glucose excretion from the liver was increased by exercise, but was not significant. The absorption by the kidney decreased to 30% by exercise. Lactate was highly absorbed by the kidney, lower limbs, and digestive tract by exercise. Exercise caused a 200-300% increase of the plasma beta-hydroxybutyrate, but the absorption by the kidney and the lower limbs was decreased. These data suggest that glucose is a good carbon source for the recovery, and that lactate is more useful than glucose, but ketone body is less effective at a very early recovery phase under fed condition. Amino acid balances in each organ except digestive tract were positive showing anabolic conditions of these organs even after exhaustive exercise at fed condition. Most amino acid concentrations in the plasma tended to decrease to 60-90% by exercise. Amino acids were excreted from the digestive tract, and were eventually absorbed by the liver in both rested and exercised rat. The digestive tract, therefore, seems to be a primary amino acids pool to supply them to the liver during the inter meal. Urea excretion from the liver was more than the absorbed ammonia showing that active deamination from amino acids was carrying on. The resulted carbon skeletons of the amino acids might be used for the gluconeogenesis in the liver.

Effect of toxoplasmosis on experimental schistosomiasis

One hundred and twenty Swiss albino mice were infected with avirulent strain of Toxoplasma gondii (Czechoslovakian strain) challenged with Schistosoma mansoni at different intervals of one week, one month, and two months. Worm load, egg count, oogram pattern and liver and spleen weight were assessed for each mouse. Toxoplasmosis induced a significant resistance to Schistosoma mansoni challenge infection as evidenced by the reduction in worm load, egg count and changes in oogram pattern. The mean liver weights of concomitantly infected mice was increased which was not significantly different from their corresponding Schistosoma infected controls but the increase in spleen weight was significant.

Immunological and histopathological studies on the effect of toxoplasmosis in experimental schistosomiasis

One hundred and twenty Swiss albino mice were infected with avirulent strain of Toxoplasma gondii. Then challenged with Schistosoma mansoni at different time intervals of one week, one month and two months. The immunological and histopathological changes were assessed for each mouse. The results showed that toxoplasmosis caused specific humoral and cellular immunosuppression to Schistosoma mansoni infection.

Synthesis of new benzimidazole derivatives as potential antimicrobial agents

Barbiturates 3 as possible antimicrobial agents were obtained by reacting the N,N'-disubstituted urea 1a or the thiourea analogues 1b,c with the magic malonates 2a,b. On the other hand, reaction of 1a with ethoxycarbonyl isocyanate (4) yielded the substituted s-triazine-2,4,6(1H,3H,5H)-trione 5. The reaction of 4 with 2-aminomethyl-benzimidazole (6) gave the allophanate 7 which upon treatment with Na2CO3 yielded N-(1H-benzimidazol-2-yl)urea 8.

A case of African histoplasmosis from Sudan

The first authentic case of African histoplasmosis from the Sudan is reported. The patient came from Dindir, along the southern part of the Blue Nile River. He had cutaneous and visceral leishmaniasis as well as the cutaneous form of African histoplasmosis. The latter was proved by culture and histopathology to be due to Histoplasma duboisii. The fungus was confined to the skin. H. duboisii may be more prevalent, and further studies in Dindir area are needed.

Synthesis and pharmacological evaluation of indanpropionic acids as uterine relaxants

The PGF2 alpha antagonist 5,6-bis(benzyloxy)-1-oxo-2-propyl-2-indanpropionic acid (1) had previously been shown to provide significant protection against the abortifacient actions of PGF2 alpha in mice. To explore further structural concepts in drug design employed for the development of 1, several mono(benzyloxy) ketones (3-10) and alcohols (11-15) as well as a diacid (22) were prepared. None of these structural modifications resulted in compounds of greater superiority to 1 as uterine relaxants and 22 was void of any antagonistic properties, suggesting that the original rationale requiring one carboxyl group and two benzyloxy functions appropriately placed for maximum PGF2 alpha antagonism in this series was a good assumption. A carbonyl rather than hydroxyl group at position C-1 of the indan is most beneficial for reversible antagonism. Reduction of the ketone to the alcohol is of synthetic interest and discussed in some detail.

Uterine relaxant effects of mono- and dibenzyloxyindanpropionic acids

DIPA [5,6-bis(dibenzyloxy)-1-oxo-2-propyl-2-indanpropionic acid] and MIPA (5-benzyloxy-1-oxo-2-butyl-2-indanpropionic acid) were evaluated for relaxant effects on the estrogenized isolated rat uterus. In a concentration-dependent and reversible manner DIPA (10(-5)-3x10(-4)M) inhibited uterine contractions induced by PGF2 alpha, KCl and BaCl2, and MIPA (10(-5)-3x10(-4)M) inhibited the oxytocic effects of PGF2 alpha, PGE2, acetylcholine and BaCl2. Further evaluation of DIPA demonstrated its selectivity for uterine smooth muscle since it did not interfere with carbachol-induced increased tone nor isoproterenol-induced decreased tone of the isolated guinea pig trachea, nor did it inhibit the positive inotropic effects of isoproterenol on the isolated guinea pig atrium.

New biphenyl derivatives i: 1-(4-biphenylyl)-2-phenylethylamines as potential antispasmodic and cardiovascular agents

A series of 1-(4-biphenylyl)-2-phenylethylamine derivatives was synthesized as potential antispasmodic and cardiovascular agents related to papaverine. Preliminary pharmacological tests, on isolated guinea pig ileum and anesthetized cat blood pressure, showed that the new compounds possess nonspecific inhibitory action on smooth muscles.

The pathology of schistosomiasis in Sudan

The pathology of schistosomiasis in an autopsy material consisting of medico-legal cases and unclaimed bodies in the Sudan is described. The limitations of this type of study are pointed out. S. mansoni-infection and S. haematobium-infection occurred with a frequency of 14.3 per cent and 4.5 per cent of autopsies respectively. There was a geographical difference in the severity of S. mansoni-infection in two endemic areas in the country; it was particularly severe in patients coming from Bor area in the Southern Sudan. In autopsies with S. mansomi-infection intestinal polyposis and cor pulmonale were rarely encountered. The distribution of eggs in the tissues, using digestion studies, and the relationship of tissue egg load to pathology are reported and discussed.

Studies on the antibody response to E. Coli O-antigens in children with urinary tract infections

A passive haemagglutination technique was used to measure the E. coli antibody response in children with acute and chronic urinary tract infections with or without renal involvement. The E. coli antibody titre was also determined in sera of control normal children. In acute infections with renal involvement there was markedly high antibody response whereas in acute infections without renal involvement the rise in the antibody response to E. coli was only slight. In patients with chronic pyelonephritis the titres were also markedly high. E. coli antigens from 3 different sources were used in an attempt to find a substitute antigen for cases with negative urinary cultures. The 3 antigens used were urinary strains (only in patients with positive urinary cultures), patient's faecal strain and a polyvalent standard E. coli antigen. The faecal antigens gave results similar to the urinary ones in only 52% while the polyvalent antigen was found to be a more valuable substitute antigen giving equal titres to those with the urinary antigens in about 63% of the cases.