Hand palm sparganosis: morphologically and genetically confirmed Spirometra erinaceieuropaei in a fourteen-year-old girl, Egypt

Two spargana of 5 and 7 cm long were removed from the right-hand palm of 14-year-old girl at the General Hospital, Qalyubia, Egypt. Sparganum is the 2nd larval stage (pleurocercoid) of Diphyllobothrid cestode species develops in the vertebrate second intermediate host through ingestion of the crustacean first intermediate host.Dogs and cats are the final hosts get infected through predation of the second vertebrate host.Human attracts infection through drinking water contaminated with the infected crustacean host or consumption of the flesh of of vertebrate hosts such as frogs and reptilian species. The surgically removed specimens were parsitologically identified as a non-proliferative metacestodes of a spirometran species that then on molecular analysis proved to be Spirometra erinaceieuropaei. The present report has allocated Egypt on the world sparganosis map.Molecular characterization of 28 S rRNA of S. erinaceieuropae and correlation to other Spirometra spp. from the Nile countries, particularly Ethiopia and Lake Victoria countries where the Nile waters originate, and from China were dealt with. Drinking of contaminated fresh water is the only proposed mode of infection in Egypt.

Morphology and molecular phylogeny of trypanorhynchid metacestodes infecting commercial fish of the Mediterranean Sea

ABSTRACT Members of the order Trypanorhyncha are cestode parasites that are frequently found infecting the muscles of several marine fish species, affecting fish health, and resulting in consumers’ rejection of fish. Fifty-two specimens of marine fish were freshly caught throughout the year 2020 from boat landing sites at the Alexandria coast along the Mediterranean Sea in Egypt, including the grey trigger fish Balistes carolinensis (F: Balistidae); the mottled grouper Mycteroperca rubra (F: Serranidae) and the common sole Solea vulgaris (F: Soleidae). Blastocysts were isolated and ruptured; the generated pleurocerci were described morphologically and morphometrically by light and scanning electron microscopy. Also, multiple-sequence alignment was performed, and a phylogenetic tree was constructed following maximum likelihood analysis of the 18s and 28s ribosomal RNA sequences of the recovered worms. Thirty fish were infected; the infection was recorded as blastocysts embedded in fish flesh. Three different parasitic species were recovered and classified morphologically as Gymnorhynchus isuri, Pseudotobothrium dipsacum and Heteronybelinia estigmena. The taxonomic position of these parasites was justified by molecular analysis of their 18s and 28s rRNAs, which revealed high percentages of homology with species recovered from the GenBank. The accession numbers ON157059, ON139663 and ON139662 were respectively assigned to the recovered parasites after their deposition in GenBank. The results obtained from the molecular analyses confirmed the morphological records of the recovered parasites. Since metacestodes are found in the musculature of infected fish specimens, it is necessary to remove these areas in the commercialization of fish.

Cardiac remodeling in severe hypertension, does it respond to tight blood pressure control?

Funding Acknowledgements

Type of funding sources: None.

Background

Severe hypertension (HTN) may cause target organ damage (TOD). Kidney can tolerate severe HTN to very high levels. Cardiac remodeling as TOD could be detected by elevation of biomarker Troponin.

Aim

We aim to detect the response of organs (heart & kidney) to tight control of severe HTN.

Patients & Methods

Patients admitted due to severe hypertension (BP> 180/120) associated with any symptoms were enrolled. All patients were managed according to the European guidelines to the target BP. Cardiac biomarker Hs-Troponin T (hs-TNT) and serum creatinine (s.creat) were measured for all patients on admission and 24 hours later.

Results

Ninty five patients with hypertensive crisis were treated to target BP. Forty six patients had initially high hs-TNT (Group A) and 49 patients had initially normal hs-TNT (Group B). There was a highly significant difference between both groups regarding initial and follow-up s.creat with higher values in Group B (P= 0.03 and 0.004 respectively).There was high significant difference between initial and follow up s.creat values in Group B with higher values in the follow up measurements after BP control to the target (P= 0.03), while this difference is insignificant in Group A (P=0.26).  Five patients in Group B developed renal failure after tight BP control. There was a significant positive correlation between hs-TNT and the follow-up s.creat (P=0.018) with more deterioration of s.creat in those having initial high hs-TNT.

Conclusion

In severe HTN, hs-TNT may be elevated due to marked afterload. Renal affection and TOD occurs before cardiac remodeling and damage due to severe HTN. Renal autoregulation occurs in chronic elevation of BP. Acute control of severe HTN leads to disrruption of renal autoregulation and renal shut down. European guidelines regarding severe HTN control should be revised. In hypertensive patients with high hs-TNT, BP should not be well controlled on the short term not to disrupt renal autoregulation.

A qualitative exploration of pharmacist prescribing for patients with Chronic Kidney Disease in the United Kingdom

Introduction

Chronic Kidney Disease (CKD) has a high risk of mortality, frequent hospitalisation and reduced life expectancy. Clinical pharmacy services have potential to contribute significantly to the multidisciplinary team. In the UK Government policies prioritise development of pharmacist prescribing and the GPhC highlight changing health services that increasingly use pharmacist prescribers.

Aim

To explore the development, implementation and evaluation of pharmacist prescribing for patients with Chronic Kidney Disease (CKD) in the UK.

Method

This phase of a doctoral research programme used a phenomenological qualitative semi-structured interview approach. It involved 48 pharmacist prescriber members of the UK Renal Pharmacy Group (UKRPG) who had agreed to further research after an online survey. The development of the theory based semi-structured interview tool followed a rigorous iterative process using findings from a systematic review in the first phase [1] and results from a survey in the second phase.[2] The tool was designed using the Consolidated Framework for Implementation Research (CFIR) and reviewed independently for face and content validity by an expert panel. Think aloud testing and piloting completed the development process. A date / time for an audio-recorded telephone interview was arranged following receipt of signed consent. All interviews were transcribed verbatim naturalistically. NVivo® 11 was used for data management and analysis. Interview data were analysed thematically, guided by the CFIR, initially by two team members independently. The Francis method of checking for data saturation was used. Ethical approval was granted by RGU School of Pharmacy & Life Sciences Ethics committee.

Results

Fourteen pharmacists of the 48 agreed to participate. Demographic details included: 11 female, 7 had >16 year experience in profession, all had secondary care as main practice setting and 8 had > 11years as a prescriber. The interviewees were generally very positive about their prescribing practice and they articulated that they were prescribing in a variety of settings. They used mainly independent prescribing in both inpatient and/or outpatient settings and prescribing in clinic settings for CKD associated anaemia / epoetin clinics. CFIR helped identify themes related to facilitators and barriers to advancing prescribing practice (Table 1). There was enthusiasm for the future development of prescribing practice including further establishment of clinics and taking responsibility for groups of patients. Interviewees indicated awareness of systems for evaluating their prescribing activity.

Conclusion

This work provides valuable information relating to the current status of and needs for the development of pharmacist prescribing practice in the UK. It fills a gap shown from previous work [1] around availability of information on structures, process and monitoring of outcomes of this specific growing aspect of clinical pharmacy practice. Main strengths include consideration of aspects of trustworthiness throughout the research process aided by theoretical underpinning with CFIR and the focus on specialist pharmacist prescribers. Major limitations include low number of participants with consequent potential for recruitment and social desirability biases and lack of transferability of findings. Further ‘deep dive’ case study work will help explore the practice of leading edge advanced and consultant level practitioners to learn even more about practice development.

References

1. Al Raiisi F, Stewart D, Fernandez-Llimos F, Salgado TM, Fahmy Mohamed M, Cunningham S. 2019. Clinical pharmacy practice in the care of Chronic Kidney Disease patients: a systematic review. Int J Clin Pharm. 2019 41(3):630–666. doi: 10.1007/s11096-019-00816-4.

2. Al Raiisi F, Stewart D, Ashley C, Fahmy M, Alnaamani H, Cunningham S. A theoretically based cross-sectional survey on the behaviors and experiences of clinical pharmacists caring for patients with chronic kidney disease. Res Social Adm Pharm. 2020 May. In press, https://doi.org/10.1016/j.sapharm.2020.05.005

A theoretically based cross-sectional survey on the behaviors and experiences of clinical pharmacists caring for patients with chronic kidney disease

The literature shows a lack of evidence on pharmacists contributing to chronic kidney disease services. The aim was to determine pharmacists' behaviors and experiences and perceptions of barriers and facilitators to implementation of models of care. A theoretically informed survey was developed and sent to pharmacist members of the United Kingdom renal pharmacy group. Sections included: demographics, clinical practice and prescribing practice. Questions were of various types; closed type and some open for comments. Attitudinal items on clinical/prescribing used 5-point Likert scale. Development/implementation items were derived from the Consolidated Framework for Implementation Research (CFIR). Analysis used descriptive statistics and open comments were analysed thematically. Ethical approval was granted by an academic institution. Response rate; 50% (n = 71), seven were incomplete and excluded. Respondents provided; inpatient general pharmaceutical care (n = 56, 87.5%), to those receiving dialysis (n = 54, 84.4%) and transplantation. Non-clinical roles; audits (n = 46, 71.9%), patient education (n = 31, 48.4%), only 7.8% (n = 5) doing academic research. For barrier/facilitators most strongly agreed/agreed with most CFIR items relating to clinical practice. A majority (n = 44, 68.7%) disagreed that they had sufficient time to practice clinically and 44 (68.7%) disagreed there was sufficient cover for services. For prescribing roles, 90.5% (n = 48) were currently actively prescribing. Although prescribing related CFIR items were largely positive, 39.6% (n = 19) disagreed about sufficient time to practice and 18.7% (n = 9) were neutral. Two thirds (n = 33, 68.7%) disagreed that there was sufficient cover for the prescribing. The majority of respondents provided general pharmaceutical care to dialysis and transplant patients, were confident in their abilities and tried new ways of working including independent prescribing. Many expressed that lack of resources was the main barrier to providing more advanced care. Further work is needed to explore these matters in more depth.

Cellulase Production by <i>Fusarium graminearum</i> and its Application in Ruminant's Diets Degradation

BACKGROUND AND OBJECTIVE

Cellulase as a fibrolytic enzyme is a highly effective tool for agricultural waste treatments. Production of cellulase enzyme on medium of agricultural wastes by Fusarium graminearum to be used in ruminant feeding was the main objective of this study.

MATERIALS AND METHODS

Impact of initial pH of growth medium, different nitrogen sources and variety of agriculture by products as a carbon sources on cellulase production have been studied. Electron microscope was used for investigate the impact of the resultant cellulase on corn stover degradation, while batch culture technique was used for investigate impact of different levels of the produced and commercial cellulases on total mixed ration digestibility by rumen microorganisms (in vitro).

RESULTS

Cellulase maximum production by F. graminearum was obtained at 20% corn stover, initial pH of growth medium 5.0 and peptone as a nitrogen source. All addition levels of the produced cellulase increased dry matter (DM), neutral detergent fiber (NDF), acid detergent fiber (ADF), cellulose and hemicellulose degradability of the treated diets, but the maximum produced cellulase efficiency% for dry matter degradability was obtained at 1200 IU kg-1 DM reached 23.19% over the control.

CONCLUSION

Utilization of the produced cellulase in enrichment of the feeding value of the agricultural by-products may help in overcome of the feed gap with good impact on environment and public health.

Rosuvastatin demonstrates greater reduction of low-density lipoprotein cholesterol compared with pravastatin and simvastatin in hypercholesterolaemic patients: a randomized, double-blind study

BACKGROUND

Rosuvastatin (Crestor), a new, highly efficacious statin, has demonstrated dose-dependent low-density lipoprotein cholesterol (LDL-C) reductions of up to 65% in a dose-ranging programme with doses of 1 to 80 mg.

DESIGN

A randomized, double-blind multicentre trial compared rosuvastatin with commonly used starting doses of pravastatin and simvastatin to determine relative efficacy in LDL-C reduction and impact on other lipid parameters in primary hypercholesterolaemia.

METHODS AND RESULTS

A total of 502 patients (greater-than-or-equal 18 years; LDL-C greater-than-or-equal 4.14 mmol/l [160 mg/dl] and < 6.50 mmol/l [250 mg/dl] and triglycerides less-than-or-equal 4.52 mmol/l [400 mg/dl]) were randomized to 12 weeks of rosuvastatin 5 mg (n = 120) or 10 mg (n = 115), pravastatin 20 mg (n=]137) or simvastatin 20 mg (n = 130). Rosuvastatin 5 and 10 mg reduced LDL-C by 42 and 49%, respectively, compared with 28% for pravastatin (P < 0.001 versus both rosuvastatin doses) and 37% for simvastatin (P < 0.01 versus rosuvastatin 5 mg; P < 0.001 versus 10[?]mg). National Cholesterol Education Program Adult Treatment Panel II (NCEP ATP II) goals were achieved by 87% of rosuvastatin 10[?]mg patients, 71% of rosuvastatin 5[?]mg patients, 53% of pravastatin patients, and 64% of simvastatin patients; similar proportions of patients achieved NCEP ATP III goals. European Atherosclerosis Society (EAS) goals were achieved by 83, 63, 20 and 50% of patients, respectively. All study treatments were well tolerated.

CONCLUSIONS

Both doses of rosuvastatin were more effective than pravastatin and simvastatin in meeting NCEP ATP II and EAS LDL-C targets. Rosuvastatin 10 mg was more effective than pravastatin and simvastatin in meeting NCEP ATP III targets.

An unusual case of impacted esophageal foreign body

Incidental ingestion of foreign bodies in the pediatric age group is a recognized problem worldwide, however, it is unusual to have a neonate who presents with impacted esophageal foreign body. As such, this case is rare and considered a new form of child neglect.

Acute cerebrovascular accidents with severe ovarian hyperstimulation syndrome

Cerebrovascular complications are by far the most serious side-effects of ovarian hyperstimulation syndrome. We report a case in which the patient developed cerebral infarction with right sided hemiplegia as a result of severe hyperstimulation syndrome after using a gonadotrophin-releasing hormone agonist for intracytoplasmic sperm injection.

Ceruloplasmin, transferrin and apotransferrin facilitate iron release from human liver cells

The rate of iron release from HepG2 liver cells was increased not only by extracellular apotransferrin, but also by diferric transferrin, in a non-additive, concentration-dependent manner and to a similar magnitude. This suggests that rapid equilibration between receptor-mediated uptake and the release process determines net iron retention by the liver. Release was also accelerated by ceruloplasmin; most importantly, the effect of this protein was greatest when iron release was occurring rapidly, stimulated by apotransferrin, or under conditions of limited oxygen. Thus iron release involves both apotransferrin and ferrotransferrin, with ceruloplasmin playing a role in tissues with limited oxygen supply, as in the liver in vivo.

Parkinson's disease, cognition and aging. Clinical, neuropsychological, electrophysiological and cranial computerized tomographic assessment

Forty-three patients with Parkinson's disease (PD) and thirty-seven normal volunteers were subjected to clinical, neuropsychological, neurophysiological (P300 component of the event-related potentials ERP) and radiological (cranial computerized tomographic scanning CCT) evaluation. Intentional memory was more impaired in PD than in normal controls, more so in the demented group of patients, and was related to enlargement of third ventricular size in CCT. While intentional memory was age related in PD patients, perception was age-related in normal controls. Neither global nor specific cognitive functions were related to duration, severity of parkinsonian motor disability, or depression. However, depression in PD was significantly related to parkinsonian motor disability. P300 latency was more prolonged in PD patients than normal controls. P300 parameters of PD patients were not influenced by age, cognitive functions, duration or severity of motor disability, or depression. The reaction time was the only P300 parameter that was age-related in normal controls. Subcortical atrophy as indicated by CCT was more marked in PD and correlated with age in both patients and controls. Subcortical atrophy was significantly related to cognitive functions in PD but not in normal controls. It was concluded that cognitive impairment in PD could be attributed to complex cognitive changes rather than age. It is a disease process, though not directly related to parkinsonian motor disability or depression. PD differed from normal aging as regards the effect of age on the specific cognitive functions, where in PD patients, age was related to intentional memory, yet in normal controls, it was related to perception. Intentional memory deterioration was found to be specific of PD, being related to subcortical atrophy as well as being more pronounced in the demented group of patients.

Use of biplane transesophageal echocardiography as the only imaging technique for percutaneous balloon mitral commissurotomy

Percutaneous balloon mitral commissurotomy with the Inoue technique was attempted in 9 patients with rheumatic mitral stenosis under the sole guidance of biplane transesophageal echocardiography and was completed in 8 patients. This preliminary experience points to the feasibility and relative safety of performing percutaneous balloon mitral commissurotomy under the sole guidance of biplane transesophageal echocardiography.

Brain aging in normal Egyptians: neuropsychological, electrophysiological and cranial tomographic assessment

Eighty-eight normal Egyptian volunteers above the age of 40 years were studied for brain aging and subjected to neuropsychological (the Paced Auditory Serial Addition Test; the Trailmaking test A, B; the Digit Symbol Substitution Test; sensory and secondary memory tests), electrophysiological (computerized EEG, P300 and reaction time measures), and Computerized Cranial Tomography (CCT) assessment. A significant correlation was found between age and both perception (Digit Symbol Substitution Test (DDST) and psychomotor performance (Trailmaking B test (TMb)), reaction time (RT) and the size of the third ventricle. Whereas females were worse in attention (Paced Auditory Serial Addition Test (PASAT)), males had worse performance in secondary memory test. Elderly subjects with vascular risk factors did worse in psychomotor performance (TMa) than subjects with no risk factors. Non-educated subjects showed worse perception (DSST) than educated subjects. A significant decrease in upper and lower limit percent power of the alpha band was found in subjects above 60 years, males, and non-educated subjects. A significant increase in theta activity was found only in non-educated subjects. It is concluded that decline in specific cognitive functions occurs with advancing age. Vascular risk factors and lack of education early in life enhance these changes. Moreover, the EEG slowing in the elderly was linked to lack of education early in life.

Modulation of iron metabolism in monocyte cell line U937 by inflammatory cytokines: changes in transferrin uptake, iron handling and ferritin mRNA

We have investigated the effects of the pro-inflammatory cytokines interleukin 1 beta (IL-1 beta), tumour necrosis factor alpha (TNF alpha) and interferon gamma (IFN gamma) on the iron metabolism of the human monocytic cell line U937. Cells were treated with each cytokine for up to 24 h, and then iron uptake from diferric transferrin was determined. The intracellular distribution of this iron, the expression of the transferrin receptor and levels of mRNA for the two ferritin subunits were also studied. IL-1 beta, TNF alpha and IFN gamma all decreased transferrin-iron uptake into cells, and all three cytokines had effects on the proportion of iron associated with ferritin. With TNF alpha there was a marked enhancement of the fraction incorporated into ferritin. Transferrin-receptor expression was diminished by TNF alpha and IL-1 beta, but not IFN gamma, suggesting different effector mechanisms. Both TNF alpha and IFN gamma increased the amount of cellular mRNA for ferritin H-chain, but not the L-chain; IL-1 beta affected mRNA for neither ferritin. These data demonstrate that cytokines, which can be present at high concentrations in inflammation, have the capacity to affect macrophage iron uptake, transferrin receptor expression, intracellular iron handling and the relative abundance of ferritin-subunit mRNA, and may therefore be important mediators in the observed perturbations of iron metabolism in inflammatory diseases.