Palliative and Supportive Care for Patients with End-Stage Hepatocellular Carcinoma: Perspectives of Egyptian Domestic Caregivers

OBJECTIVES

Palliative care is a holistic, patient-centered approach to improving the quality of life for those with terminal diseases and their families. The main objective of the current study was to evaluate the Egyptian domestic caregivers' knowledge, attitudes, and competencies related to palliative and supportive care.

METHODS

Three hundred and thirty-five family caregivers in total were recruited. A descriptive research design was used. Four tools were used to collect data; structured interview questionnaire to collect demographic questions, palliative care knowledge questionnaire, Palliative Attitude Scale, and Competence Scale. The study was conducted in oncology outpatient and pain clinics located at the Damietta Cancer Institute in Damietta Governorate, Egypt.

RESULTS

Nearly two-thirds of the informal family caregivers are aged between 30-40 years old; 54% are female, and 83% are married. Also, sixty-seven point eight of the informal family caregivers were working (part-time). Furthermore, 65 % of them had insufficient knowledge, 68 % had a positive attitude, and 58% of the informal family caregivers had non-competency skills regarding palliative and supportive care.

CONCLUSION

Approximately two-thirds of informal care providers had insufficient total knowledge scores, more than half possessed a positive attitude, and more than half reported non-competency skills regarding palliative care of hepatocellular patients.

RECOMMENDATION

It is highly advisable to launch extensive health education programs and campaigns aimed at all of the unpaid informal family careers of patients with serious terminal illnesses, including hepatocellular carcinoma, at various governments with greater sample sizes.

Experimental evidence of the neurotoxic effect of monosodium glutamate in adult female Sprague Dawley rats: The potential protective role of Zingiber officinale Rosc. rhizomes

Strategies to prevent the health abnormalities associated with the extensive use of MSG (monosodium glutamate) as a flavoring booster are badly needed. The current study was conducted to investigate oxidative stress, inflammation, and abnormal lipid profile as the main risk factors of neurotoxicity in MSG-exposed female albino rats. Besides, the effect of concurrent consumption of Zingiber officinale rhizomes powder was studied at low doses. Twenty rats (total) were split into 4 separate groups. The 1st group was a negative control group (without any treatment), while the others received 6 mg MSG/kg. The 2nd group was left untreated, whereas the 3rd and 4th groups were given a regular laboratory diet that included ginger rhizome powder supplements (GRP, 0.5 & 1%, respectively) for six weeks. In brain tissue homogenates, exposure to MSG caused a significant depletion of gamma-aminobutyric acid (GABA) and total protein levels, while triglycerides and cholesterol contents were significantly elevated. Moreover, a noteworthy upsurge in oxidative load and inflammation markers was also noticed associated with a marked reduction of antioxidant levels, which histopathological staining verified further. The rat diet formulated with GRP, with a dose-dependent effect, resulted in increased GABA and total protein contents and attenuated inflammation, oxidative stress, abnormal lipid profile, and marked histological changes in cerebral cortical neurons of MSG-administered animals. Therefore, this study reveals that GRP shields rats against the neurotoxicity that MSG causes. The anti-inflammatory as well as antioxidant, and lipid-normalizing properties of rhizomes of ginger may be accountable for their observed neuroprotective action.

Ameliorative effect of vitamin E and selenium against bisphenol A-induced toxicity in spinal cord and submandibular salivary glands of adult male albino rats

Bisphenol A (BPA) used in plastic industry. This study evaluate ameliorative effect of vitamin E and selenium in combating BPA toxicity in spinal cord (SC) and submandibular glands (SMGs). Thirty rats divided into three groups [Group I, controls; Group II, BPA orally (25 mg/kg) three times a week, 60 days; Group III, BPA (25 mg/kg) plus vitamin E and selenium in water (1 ml/L/day)]. By histopathological, immunohistochemical, and biochemical investigations. Bisphenol A group showed degenerative alterations. SC gray matter showed pyknotic nuclei and white matter revealed neuropil degeneration. Myelinated fibers showed dispersed myelin. SMGs, exhibited vacuolated cytoplasm in acinar cells. Intense glial fibrillary acidic protein in SC and strong proliferating cell nuclear antigen in acinar and ductal cell nuclei of SMGs. Malondialdehyde elevated in SC and catalase decreased in SMG. Group III, SC and SMG revealed partial recovery. Vitamin E and selenium displayed protective effects against BPA toxicity in SC and SMGs.

Characterization of Bacillus thuringiensis isolated from soils in the Jazan region of Saudi Arabia, and their efficacy against Spodoptera littoralis and Aedes aegypti larvae

Pest control in Saudi Arabia depends on applying chemical insecticides, which have many undesirable considerations and impacts on the environment. Therefore, the aim of this study was to isolate Bacillus thuringiensis from different rhizosphere soil samples in the Jazan region for the biological control of Spodoptera littoralis and Aedes aegypti larvae. The samples were collected from the rhizosphere of different plants located in eight agricultural areas in Jazan, Saudi Arabia. Out of 100 bacterial isolates, four bacterial isolates belonging to Bacillus species were selected namely JZ1, JZ2, JZ3, and JZ4, and identified using classical bacteriological and molecular identification using 16S rRNA. JZ1 and JZ2 isolates were identified as Bacillus thuringiensis. SDS-PAGE analysis and the detection of the Cry1 gene were used to describe the two isolates JZ1 and JZ2 in comparison to Bacillus thuringiensis reference strain Kurstaki HD1 (BTSK) were revealed that slightly different from each other due to the place of their isolation and namely Khlab JZ1 and Ayash JZ2. The EC₅₀ of JZ1 and JZ2 isolates, BTSK, and the commercial biopesticide DiPEL 6.4 DF against the second-instar larvae of Aedes aegypti were 207, 932, 400, and 500 ppm respectively, while EC₅₀ against first-instar larvae of Spodoptera littoralis were 193.93, 589.7, 265.108, and 342.9, ppm respectively. Isolate JZ1 recorded the highest mortality while JZ2 isolate gave the lowest mortality. It can be concluded that the local isolate of JZ1 and JZ2 can be developed for bio formulations to be used in Spodoptera littoralis and Aedes aegypti biological control programs.

Appraisal and characterization of candida load isolated from the oral cavity of smokers

Cigarette smoking is regarded as a major global health risk, therefore the aim of this work was to investigate the association of oral Candida spp. as one of the etiological agents of denture stomatitis with smokers of cigarette, hookah (shisha), and electronic smoking, also a dose-response relationship between the duration of smoking and the probability of denture stomatitis between volunteers. Oral rinse samples were collected from 47 male volunteers including 34 smokers and 13 non-smokers, also data of volunteers were collected via a questionnaire forum. Patterns of smoking were shown that smokers using tobacco cigarettes 17 (36.2 %), electronic cigarettes 16 (34.04 %), and hookah smokers 8 (17.02 %). A comparison of smokers and non-smokers regarding effects on oral health showed significantly finding (P < 0.05) indicating that smoking affects oral health in all evaluated parameters (an oral mucosal abnormality, mouth ulcers, bad breath, and feeling of dry mouth). Out of 19 Candida isolates, 18 (94.7 %) were identified as Candida albicans and 1 (5.3 %) as Candida tropicalis. Among the volunteers who presented with oral Candida (19 volunteers), 17 (89.5%) were smokers, while non-smoker volunteers were 2 (10.5 %), so it can be concluded that smoking was a significant positive correlation to the presence of Candida in the oral cavity. Five volunteers suffered from chronic diseases; 4 (8.5%) diabetes mellitus and 1 (2.1%) anemia as a systemic predisposing factor for oropharyngeal infection. Amphotericin and Nystatin had varying degrees of activity against isolated Candida isolates.

Effects of Aluminum Oxide Nanoparticles in the Cerebrum, Hippocampus, and Cerebellum of Male Wistar Rats and Potential Ameliorative Role of Melatonin

Aluminum oxide nanoparticles (Al₂O₃ NPs) have been widely used in vaccine manufacture, food additives, human care products, and cosmetics. However, they also have adverse effects on different organs, including the liver, kidneys, and testes. Melatonin is a potent antioxidant, particularly against metals by forming melatonin-metal complexes. The present study aimed to investigate the protective effects of melatonin against Al₂O₃ NP-induced toxicity in the rat brain. Forty adult male Wistar rats were allocated to four groups: the untreated control (received standard diet and distilled water), Al₂O₃ NP-treated (received 30 mg/kg body weight Al₂O₃ NPs), melatonin and Al₂O₃ NP-treated (received 30 mg/kg body weight Al₂O₃ NPs + 10 mg/kg body weight melatonin), and melatonin-treated (received 10 mg/kg body weight melatonin) groups. All treatments were by oral gavages and administered daily for 28 days. Afterward, the rats were sacrificed, and samples from various brain regions (cerebrum, cerebellum, and hippocampus) were subjected to biochemical, histopathological, and immunohistochemical analyses. Al₂O₃ NPs substantially increased malondialdehyde, β-amyloid 1-42 peptide, acetylcholinesterase, and β-secretase-1 expression, whereas they markedly decreased glutathione levels. Furthermore, Al₂O₃ NPs induced severe histopathological alterations, including vacuolation of the neuropil, enlarged pericellular and perivascular spaces, vascular congestion, neuronal degeneration, and pyknosis. Al₂O₃ NP treatment also resulted in an intense positive caspase-3 immunostaining. Conversely, the administration of melatonin alleviated the adverse effects induced by Al₂O₃ NPs. Therefore, melatonin can diminish the neurotoxic effects induced by Al₂O₃ NPs.

Oral Candidiasis of Tobacco Smokers: A Literature Review

The mouth is a vital point of entry into the human body, the health of the mouth entails mental, physical as well as social well-being. Studying diseases, microbiota and environmental conditions of the mouth is important to maintain oral health and all body. The smoke of tobacco cigarettes is one of the worst habits that affect the health of the mouth and the body. Therefore, this review has been conducted to study the effect of smoking on the balance of the oral microbiota and the opportunistic organisms, one of the most important of them &lt;i&gt;Candida&lt;/i&gt;. Although a few studies have found that cigarette smoking does not influence carriage by &lt;i&gt;Candida&lt;/i&gt; significantly. However, most of the studies had results completely contrary to that, smoking cigarettes affect &lt;i&gt;Candida&lt;/i&gt; pathogenic characteristics such as a transition from yeast to hyphal form, biofilm formation and, virulence-related gene expressions. Tobacco is not only an inducer of the transition process but it considers an excellent medium for this process. Furthermore, smoking was significantly associated with &lt;i&gt;Candida&lt;/i&gt; pathogenicity in patients with clinically suspected oral leukoplakia and smoking worsens oral candidiasis and dampens epithelial cell defense response. Nicotine significantly altered the composition and proportion of yeast cells, as well as the extracellular polysaccharide amounts which increase biofilm matrix and thickness which could promote oral candidiasis. Smoking has the potential to alter the oral condition and cause severe oxidative stress, thereby damaging the epithelial barrier of the mouth. These oxidative molecules during smoking activate epithelial cells proteins called oxidative stress-sensing proteins. If some of these proteins induced, widely thought to have anti-inflammatory properties, inhibit the secretion of pro-inflammatory cytokines and are linked to inflammation and oxidative stress is thought to be a possible therapeutic objective and a crucial regulator for smoking-related oral diseases and mouth candidiasis for instance leukoplakia. Also, it is transported into the cell nucleus in the existence of additional electrophilic chemicals to activate antioxidant enzyme gene expression. Therefore, smoking cigarettes destroys oral health and consequently destroys the health of the whole body.

Anticandidal effect of Eucalyptus oil and three isolated compounds on cutaneous wound healing in rats

OBJECTIVE

Poor healing is one of the major complications of microbial contamination of wounds. When the skin is damaged, microorganisms can quickly invade the underlying tissues and cause infections that are potentially life-threatening. As a result, effective therapies are required to handle such pathological disorders. Several bioactivities, including fungicidal and antibacterial properties, have been noted for Eucalyptus essential oils. This study aimed to investigate the effect of Eucalyptus oil (EO) and mixed oils (MO) of Eucalyptus citriodora, citronellol acetate, linalool, and α-pinene on the healing of C. albicans infected wounds in rats.

MATERIALS AND METHODS

Essential oils were extracted from the fresh areal parts of Eucalyptus citriodora, Lavandula stricta, and Rosmarinus officinalis then their active compounds were chromatographically isolated and identified using GC/Ms. The in vitro antifungal activities of EO and MO were evaluated against Candida albicans using the Agar well diffusion method. Further, their effect on the healing of C. albicans infected wounds was evaluated via the excision wound rat's model. Percentages of wound contraction, epithelialization period, wound Candida load, and the histopathology of wounded tissues were evaluated to confirm the progression of wound healing.

RESULTS

Results of the in vitro tests showed that MO has a potent activity against C. albicans evaluated by an inhibitory zone (IZ) diameter of 23.4 mm and a MIC value of 0.24 g/mL, compared to EO's corresponding values of 13.4 mm and 15.63 g/mL. The beneficial impacts of MO creams in improving the percentage of contraction of C. albicans contaminated wounds were better than those of EO creams. MO 10% cream showed the greatest proportion of wound contraction and epithelialization rate. The beneficial effect of MO was further confirmed by a significant reduction of the fungal load of wounds in addition to histopathological improvement compared to the NC group.

CONCLUSIONS

This study suggested the potential of 10% MO cream in enhancing the healing of C. albicans infected wounds upon topical application.

The Knowledge of Palliative Care among Geriatric Home Staff in Jordan

Background

Palliative care in nursing homes (NHS) is a major challenge, because it gives the demands of the knowledge and skills of nursing staff to provide high-quality care.

Purpose

The purpose of this study was to assess the knowledge of palliative care among nursing home staff.

Methods

A descriptive study design was used, 124 nurses, aged over 30 years and most of them were male working in the nursing home in Jordan. Around 109 participants were responded to the questionnaire. All licensed nurses were included in the study, except of that will be excluded. The knowledge of palliative care was measured via the palliative care survey. knowledge scores were ranged 0-1, with higher scores indicate greater knowledge.

Results

Descriptive statistics was used. The Knowledge of palliative care issues is 0.21 in Jordan (95% confidence interval (CI) 0.19-0.24). Knowledge of physical aspects that can contribute to pain is 0.22 (95% CI 0.2-0.25), and knowledge of psychological aspects that can contribute to pain is 0.21 (95% CI 0.2-0.22).

Conclusion

Education for nursing staff needs to be enhanced to address the specific knowledge gaps. Additional studies with large sample size recommended to explore the effect of educational programs in regard of palliative care in nursing homes.

Ameliorative effect of Nigella sativa oil and vitamin C on the thyroid gland and cerebellum of adult male albino rats exposed to Monosodium glutamate (histological, immunohistochemical and biochemical studies)

Monosodium glutamate (MSG) is a major taste enhancer that is used as a food additive. Vitamin C (Vit C) and Nigella sativa oil (NSO) are known for their potent antioxidant activities.

OBJECTIVE

This study investigates the adverse effect of MSG on the thyroid gland and cerebellum of adult male albino rats and the protection against MSG-mediated toxicity provided by Vit C and NSO.

DESIGN

Fifty rats were divided into five groups that were treated via oral gavage. Group I (control) rats received distilled water, Group II rats were treated with MSG (6 mg/gm body weight/day), Group III rats were treated with MSG and Vit C (100 mg/kg body weight /day), Group IV rats were treated with MSG and NSO (50 mg/kg body weight two times per week), and Group V rats were treated with MSG together with both Vit C and NSO with MSG. After 60 days of treatment, rats were euthanized and histological sections were prepared from the thyroid gland and the cerebellum for routine staining and immunohistochemical detection of glial fibrillar acidic protein (GFAP), Caspase-3 and proliferating cell nuclear antigen (PCNA), respectively. Cerebellar tissue was also evaluated to determine glutathione (GSH) and malondialdehyde (MDA) levels; GSH was also measured in thyroid tissue. Serum levels of fT3, fT4 and TSH (thyroid stimulating hormone) were also evaluated.

RESULTS

Microscopic examination of cerebellar tissues revealed significant cerebellar injury and cellular apoptosis among the rats in Group II. The thyroid glands of Group II rats were notable for degenerating follicles, loss of colloid, sloughed follicular cells and congested blood vessels. The cerebellar and thyroid tissues from rats in treatment Groups III, IV and V revealed significantly less pathology. Cerebellar and thyroid tissues from Group II rats that were treated with MSG alone revealed intense GFAP and caspase-3 (cerebellar) and PCNA (thyroid) immunoreactivity. Furthermore, cerebellar tissues from rats received MSG alone (Group II) were notable for decreased levels of GSH and increased levels of MDA; thyroid tissue from rats in Group II also demonstrated decreased levels of GSH. Likewise, serum fT3 and fT4 levels were significantly decreased, while serum TSH was significantly increased among rats in Group II. Combined administration of Vit C and NSO together with MSG (Group V) revealed some variations in oxidative parameters compared to those in the Group I control rats.

CONCLUSIONS

Oral intake of MSG resulted in degenerative changes in neurons and astrocytes in cerebellum and, also degeneration of the thyroid glands of albino rats. Concomitant administration of Vit C and NSO may limit MSG-induced damage to the cerebellum and thyroid glands and thereby provide significant protection against the oxidative damage induced by MSG.

Histological and immunohistochemical evaluation of the effect of tartrazine on the cerebellum, submandibular glands, and kidneys of adult male albino rats

Tartrazine is one of the most widely used food additives. The present investigation was carried out on 40 adult male albino rats. They were divided into four groups of ten animals for each. Group I was considered as a control group. Group II was treated with tartrazine daily in a dose 7.5 mg/kg body weight by oral gavage for 30 days. Group III was received 15 mg/kg body weight of tartrazine for the same period. Group IV was administered tartrazine in a dose 100 mg/kg body weight for the whole duration of the experiment. At the end of experiment, samples from the cerebellum, submandibular salivary glands, and kidneys were fixed in neutral buffered formalin 10% and prepared routinely for paraffin sectioning and staining for histopathological and immunohistochemical investigations of proliferating cell nuclear antigen "PCNA" and glial fibrillar acidic protein "GFAP". Tartrazine-treated groups revealed histopathological degenerative changes in the obtained organs. In group II, the cerebellum showed subcortical edema, congestion of the blood vessels, cytoplasmic vacuolations, and pyknosis of the nuclei in the gray matter neurons. Concerning the submandibular glands, they expressed cytoplasmic vacuolations and pyknosis of the nuclei of the acinar cells, congestion of the interacinar blood capillaries, and degenerative changes in the striated duct. The kidneys appeared with interstitial hemorrhage and dilatation of the glomerular capillaries. The PCT and DCT showed ill-defined cell boundaries. The collecting tubules in the renal medulla appeared with flattened epithelial cells. The severity of these changes increases by increasing the dose of tartrazine in group III and reach to the highest level in group IV. The immunoexpression of the GFAP in the cerebellum of the experimental groups was intense compared to the control group. The immunoreactivity of PCNA in the nuclei of the acinar and ductal cells of the submandibular gland and the cells of the renal cortex and medulla was strong in the tartrazine-treated groups compared to the control group. The current study concluded that the tartrazine had serious effect on the cerebellum, submandibular glands, and kidneys that adversely affect the functions of these organs.