MITOFUSIN 1 AS A MARKER FOR EMBRYO QUALITY AND DEVELOPMENT IN RELEVANCE TO ICSI OUTCOME IN INFERTILE FEMALES

Mitofusin-1 is one of the membrane profusion proteins that is present in the mitochondria wall. It has a role in mitochondrial fusion. Deletion of mitochondrial fusion proteins in oocytes leads to dynamic defects in mitochondria. Growth of implanted and after implantation embryo is an ATP-demanding step that involves a range of ATP-consuming events that require a small amount of ATP. The study aims to evaluate the mitofusin-1 in the serum and follicular fluid as a marker for the evaluation of embryo quality, in addition to the pregnancy rate in infertile females undergoing ICSI cycles. The cross-section study included 50 infertile couples who were prospectively recruited according to specific criteria at the" High Institute for Infertility Diagnosis and Assisted Reproductive Technologies" at AL-Nahrain University for one year. all participants have undergone oocyte pickup, ICSI, and embryo transfer. Mitofusin-1 levels were measured in serum on day 2 of the cycle and in follicular fluid on the day of ova pick-up. Showed important positive relations between follicular fluids mitofusin-1 with a total number of embryos (r=0.428 & p=0.002), GI embryos (r=0.335 & p=0.017) and GII embryos (r=0.295 & p=0.038). Out of 50 females, 14 (28.0 %) females became pregnant according to the results there were significantly higher follicular fluids mitofusin-1 levels in pregnant females (3.88±1.41 vs. 2.73±1.24 & p=0.007) compared to non-pregnant group. Also, the follicular fluids mitofusin-1 cut-off value was ≥2.89 ng/ml with sensitivity=71.4%, specificity=66.7%, positive predictive value 47.8%, negative predictive value 88.9%. Elevated MEN1 levels in the follicular fluid may affect positively IVF/ICSI outcomes (embryo quality, and pregnancy rate).

Withaferin A Increases the Effectiveness of Immune Checkpoint Blocker for the Treatment of Non-Small Cell Lung Cancer

Treatment of late-stage lung cancers remains challenging with a five-year survival rate of 8%. Immune checkpoint blockers (ICBs) revolutionized the treatment of non-small cell lung cancer (NSCLC) by reactivating anti-tumor immunity. Despite achieving durable responses, ICBs are effective in only 20% of patients due to immune resistance. Therefore, synergistic combinatorial approaches that overcome immune resistance are currently under investigation. Herein, we studied the immunomodulatory role of Withaferin A (WFA)-a herbal compound-and its effectiveness in combination with an ICB for the treatment of NSCLC. Our in vitro results show that WFA induces immunogenic cell death (ICD) in NSCLC cell lines and increases expression of the programmed death ligand-1 (PD-L1). The administration of N-acetyl cysteine (NAC), a reactive oxygen species (ROS) scavenger, abrogated WFA-induced ICD and PD-L1 upregulation, suggesting the involvement of ROS in this process. Further, we found that a combination of WFA and α-PD-L1 significantly reduced tumor growth in an immunocompetent tumor model. Our results showed that WFA increases CD-8 T-cells and reduces immunosuppressive cells infiltrating the tumor microenvironment. Administration of NAC partially inhibited the anti-tumor response of the combination regimen. In conclusion, our results demonstrate that WFA sensitizes NSCLC to α-PD-L1 in part via activation of ROS.

Role of Cannabidiol for Improvement of the Quality of Life in Cancer Patients: Potential and Challenges

There is currently a growing interest in the use of cannabidiol (CBD) to alleviate the symptoms caused by cancer, including pain, sleep disruption, and anxiety. CBD is often self-administered as an over-the-counter supplement, and patients have reported benefits from its use. However, despite the progress made, the mechanisms underlying CBD’s anti-cancer activity remain divergent and unclear. Herein, we provide a comprehensive review of molecular mechanisms to determine convergent anti-cancer actions of CBD from pre-clinical and clinical studies. In vitro studies have begun to elucidate the molecular targets of CBD and provide evidence of CBD’s anti-tumor properties in cell and mouse models of cancer. Furthermore, several clinical trials have been completed testing CBD’s efficacy in treating cancer-related pain. However, most use a mixture of CBD and the psychoactive, tetrahydrocannabinol (THC), and/or use variable dosing that is not consistent between individual patients. Despite these limitations, significant reductions in pain and opioid use have been reported in cancer patients using CBD or CBD+THC. Additionally, significant improvements in quality-of-life measures and patients’ overall satisfaction with their treatment have been reported. Thus, there is growing evidence suggesting that CBD might be useful to improve the overall quality of life of cancer patients by both alleviating cancer symptoms and by synergizing with cancer therapies to improve their efficacy. However, many questions remain unanswered regarding the use of CBD in cancer treatment, including the optimal dose, effective combinations with other drugs, and which biomarkers/clinical presentation of symptoms may guide its use.

Spilled gallstone mimicking right middle lobe pulmonary nodule

Laparoscopic cholecystectomy is the standard of care for the surgical management of symptomatic gallstone disease. Gallstone spillage at laparoscopic cholecystectomy is common, with a reported incidence of 0.2-20%. In the majority of cases there are no complications associated with this spillage, but a series of studies report patients with complications of free peritoneal gallstones. We present a case of migration of gallstone to the lung resulting in an inflammatory mass in the right middle lobe as a complication of spillage at laparoscopic cholecystectomy.

Spilled gallstone mimicking right middle lobe pulmonary nodule

Laparoscopic cholecystectomy is the standard of care for the surgical management of symptomatic gallstone disease. Gallstone spillage at laparoscopic cholecystectomy is common, with a reported incidence of 0.2-20%. In the majority of cases there are no complications associated with this spillage, but a series of studies report patients with complications of free peritoneal gallstones. We present a case of migration of gallstone to the lung resulting in an inflammatory mass in the right middle lobe as a complication of spillage at laparoscopic cholecystectomy.

Combination Therapy of Mithramycin A and Immune Checkpoint Inhibitor for the Treatment of Colorectal Cancer in an Orthotopic Murine Model

The axis of Programmed cell death-1 receptor (PD-1) with its ligand (PD-L1) plays a critical role in colorectal cancer (CRC) in escaping immune surveillance, and blocking this axis has been found to be effective in a subset of patients. Although blocking PD-L1 has been shown to be effective in 5–10% of patients, the majority of the cohorts show resistance to this checkpoint blockade (CB) therapy. Multiple factors assist in the growth of resistance to CB, among which T cell exhaustion and immunosuppressive effects of immune cells in the tumor microenvironment (TME) play a critical role along with other tumor intrinsic factors. We have previously shown the polyketide antibiotic, Mithramycin-A (Mit-A), an effective agent in killing cancer stem cells (CSCs) in vitro and in vivo in a subcutaneous murine model. Since TME plays a pivotal role in CB therapy, we tested the immunomodulatory efficacy of Mit-A with anti-PD-L1 mAb (αPD-L1) combination therapy in an immunocompetent MC38 syngeneic orthotopic CRC mouse model. Tumors and spleens were analyzed by flow cytometry for the distinct immune cell populations affected by the treatment, in addition to RT-PCR for tumor samples. We demonstrated the combination treatment decreases tumor growth, thus increasing the effectiveness of the CB. Mit-A in the presence of αPD-L1 significantly increased CD8⁺ T cell infiltration and decreased immunosuppressive granulocytic myeloid-derived suppressor cells and anti-inflammatory macrophages in the TME. Our results revealed Mit-A in combination with αPD-L1 has the potential for augmented CB therapy by turning an immunologically “cold” into “hot” TME in CRC.

Therapy-Resistant Hypercalcemia in a Patient with Inactivating CYP24A1 Mutation and Recurrent Nephrolithiasis: Beware of Concomitant Hyperparathyroidism

We describe a case harboring a homozygous CYP24A1 mutation with mild loss of function, first presenting with recurrent nephrolithiasis from the age of 22 onward, initially associated with hypercalcemia and low PTH concentrations. Over the years, hyperparathyroidism developed, resulting in more severe hypercalcemia. Also, kidney function deteriorated, most probably as a consequence of biopsy-proven nephrocalcinosis. Conventional treatment options for CYP24A1 mutation were not effective and/or tolerated (avoidance of sun exposure, diet, pamidronate, itraconazole). A total parathyroidectomy was performed resulting in a normocalcemic hypoparathyroidism without need for treatment with vitamin D analogs, a positive bone mineral balance and an improved kidney function.

Lung cancer cells survive epidermal growth factor receptor tyrosine kinase inhibitor exposure through upregulation of cholesterol synthesis

Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) provide clinical benefits over chemotherapy for lung cancer patients with EGFR activating mutations. Despite initial clinical responses, long-term efficacy is not possible because of acquired resistance to these therapies. We have developed EGFR TKI drug-tolerant (DT) human lung cancer cell lines as a model for de novo resistance. Mass spectroscopic analysis revealed that the cytochrome P450 protein, CYP51A1 (Lanosterol 14α-demethylase), which is directly involved with cholesterol synthesis, was significantly upregulated in the DT cells. Total cellular cholesterol, and more specifically, mitochondrial cholesterol, were found to be upregulated in DT cells. We then used the CYP51A1 inhibitor, ketoconazole, to downregulate cholesterol synthesis. In both parental and DT cells, ketoconazole and EGFR TKIs acted synergistically to induce apoptosis and overcome the development of EGFR tolerance. Lastly, this combination therapy was shown to shrink the growth of tumors in an in vivo mouse model of EGFR TKI resistance. Thus, our study demonstrates for the first time that ketoconazole treatment inhibits upregulation of mitochondrial cholesterol and thereby overcomes EGFR-TKI resistance in lung cancer cells.

Triage Into the Community for COVID-19 (TICC-19) Patients Pathway - Service evaluation of the virtual monitoring of patients with COVID pneumonia

INTRODUCTION

COVID-19 pneumonia presented a unique problem for healthcare systems with the potential to overwhelm hospitals and lead to unnecessary morbidity and mortality. Safe triage and follow up systems are required to manage this unprecedented demand.

METHODS

We designed a pathway for the triage and assessment of patients based on their resting oxygen saturations and response to a 30 metre rapid walking test. We admitted patients to a 'Virtual Ward' for remote oximetry monitoring from the Emergency Department, step down from inpatient wards and from the local Primary Care 'Hot Hub'. This allowed the safe and managed readmission of those patients who deteriorated at home.

RESULTS

During the first wave of COVID-19 we entered 273 onto the pathway for Virtual Ward follow up. Of these, 31 patients were readmitted to hospital, two were admitted to Intensive Care and one patient died. Median oxygen saturation at presentation was 97 % (IQR 96-98%) and following a 30 metre walk test 96% (IQR 94-97%). Median NEWS-2 score was 2 (IQR 1-3). On feedback 99.5% of patients were likely or extremely likely to recommend the service to their family and friends. There was a cost avoidance of £107,600 per month.

CONCLUSION

It is safe, feasible and cost effective to set up a triage system with remote oximetry monitoring for patients with COVID-19 and overwhelmingly patients find it a positive experience.

Actinomycin D and Telmisartan Combination Targets Lung Cancer Stem Cells Through the Wnt/Beta Catenin Pathway

The failure of lung cancer treatments has been attributed mostly to the development of drug resistance, however the underlying cellular and molecular mechanisms are poorly understood. Cancer initiating stem cells (CSCs), present in tumors in a small percentage, play critical roles in the development of drug resistance, metastasis, and cancer relapse. Hence, novel treatments targeting both bulk cancer cells and CSCs are under intense investigation. Herein, we report that lung cancer cells grown on a 3D fibrous scaffold form tumoroids that resemble in vivo tumors, expand CSCs, and provide a platform to identify anti-CSC drugs. The screening of an NCI library of FDA-approved drugs using tumoroid cultures led to identification of Actinomycin D (AD) as a top CSC inhibitor. Since CSCs are mostly resident in the tumor's inner core, AD was combined with an angiotensin receptor antagonist, Telmisartan (TS), which is known to increase drug permeability in tumors and was shown to have anti-CSC activity. Our results showed that AD + TS administered intra-tumorally was significantly more effective than either drug alone in both syngeneic and xenograft mouse models. The results of mechanistic studies revealed that CSC expansion in tumoroids was associated with activation of β catenin signaling and that AD + TS treatment reduced active β catenin levels in tumors. Together, these results establish the utility of the tumoroid culture system to expand CSCs ex vivo for targeted drug screening, to identify promising novel treatments with both anti-CSC and anti-cancer effects, and to individualize treatments for metastatic drug resistant lung cancer patients.

Withania Somnifera (Ashwagandha) and Withaferin A: Potential in Integrative Oncology

Ashwagandha (Withania Somnifera, WS), belonging to the family Solanaceae, is an Ayurvedic herb known worldwide for its numerous beneficial health activities since ancient times. This medicinal plant provides benefits against many human illnesses such as epilepsy, depression, arthritis, diabetes, and palliative effects such as analgesic, rejuvenating, regenerating, and growth-promoting effects. Several clinical trials of the different parts of the herb have demonstrated safety in patients suffering from these diseases. In the last two decades, an active component of Withaferin A (WFA) has shown tremendous cytotoxic activity suggesting its potential as an anti-carcinogenic agent in treatment of several cancers. In spite of enormous progress, a thorough elaboration of the proposed mechanism and mode of action is absent. Herein, we provide a comprehensive review of the properties of WS extracts (WSE) containing complex mixtures of diverse components including WFA, which have shown inhibitory properties against many cancers, (breast, colon, prostate, colon, ovarian, lung, brain), along with their mechanism of actions and pathways involved.

The Association between Fibrinogen, von Willebrand Factor, Antithrombin III, and D-dimer Levels and Survival Outcome by 36 Months from Ovarian Cancer

Thirty-five patients diagnosed to have ovarian cancer (early FIGO stage I/II n = 11, advanced FIGO stage III/IV, n = 24) were evaluated for hemostatic parameters relating to survival outcome by 36 months of disease. Systemic plasminogen activators and inhibitors were evaluated and we found no significant association with survival outcome and eventually only fibrinogen, von Willebrand Factor (vWF), antithrombin III (ATIII), and D-dimer levels were determined for their association with disease outcome by 12 months, 24 months, and 36 months. Twenty-four patients succumbed to the disease by 36 months (early n = 2, advanced n = 22). The 11 surviving patients (advanced n = 3, including one deceased at 52 months) is still living past 36 months and 82 months at the time of analysis. Elevated fibrinogen, vWF, and D-dimer together with reduced ATIII levels were found to be associated with poor survival outcome by 12 months of disease. Moreover, elevated vWF and D-dimer with reduced ATIII levels was strongly implicated with poor survival outcome by 36 months from ovarian cancer. The overall survival rate at 36 months from ovarian cancer was 31.4%. It is therefore suggested that fibrinogen, vWF, ATIII, and D-dimer levels be used together as prognostic markers for disease outcome especially in patients with advanced ovarian cancer within 36 months of disease. An expanded study is required to confirm these findings.

Injection practices among practitioners in private medical clinics of Karachi, Pakistan

The aim of this study was to determine the frequency and determinants of sharps injuries among private health practitioners in slum areas of Karachi, Pakistan. All practitioners with at least 1 year of experience in a private medical clinic were asked to complete a self-administered, structured questionnaire (317/397 responded). Only 7.9% of practitioners were qualified from medical school, 12.3% were registered nurses and 8.8% lacked any professional qualifications. At least 1 sharps injury in the previous 12 months was reported by 26.7%, mostly due to needle recapping. Only 25.2% reported using a new syringe for each patient. In multivariate regression analysis shorter work experience, < 14 years of schooling, > 20 patients per day, administering > or = 30 injections per day, reuse of syringes and needle recapping after use were significantly associated with sharps injury in the past year. Better awareness and training on standard precautions is needed for private practitioners in slum areas of Karachi.

Dose reduction in multidetector CT of the urinary tract. Studies in a phantom model

A novel ureter phantom was developed for investigations of image quality and dose in CT urography. The ureter phantom consisted of a water box (14 cm x 32 cm x 42 cm) with five parallel plastic tubes (diameter 2.7 mm) filled with different concentrations of contrast media (1.88-30 mg iodine/ml). CT density of the tubes and noise of the surrounding water were determined using two multidetector scanners (Philips MX8000 with four rows, Siemens Sensation 16 with 16 rows) with varying tube current-time product (15-100 mAs per slice), voltage (90 kV, 100 kV, 120 kV), pitch (0.875-1.75), and slice thickness (1 mm, 2 mm, 3.2 mm). Contrast-to-noise ratio as a parameter of image quality was correlated with dose (CTDI) and was compared with image evaluation by two radiologists. The CT densities of different concentrations of contrast media and contrast-to-noise ratio were significantly higher when low voltages (90 kV versus 120 kV, 100 kV versus 120 kV) were applied. Smaller slice thickness (1 mm versus 2 mm) did not change CT density but decreased contrast-to-noise ratio due to increased noise. Contrast phantom studies showed favourable effects of low tube voltage on image quality in the low dose range. This may facilitate substantial dose reduction in CT urography.

How well do GP's and Hospital Consultants in Qatar Interacts? A Survey of the Professional Relationship

The study involved 196 participants, 83 (42.3%) of which were consultants and 113 (57.7%) were General Practitioners (GP's).

Background: The way that GP's and hospital consultants or specialists interact has important implications for any health care system in which a GP is the first contact health professional person for patients and the point of access to relatively scarce and expensive hospital services, for this reason, the relationship between the two main branches of the medical profession has received a considerable amount of interest.

Objectives: To test out some professional issues on a random sample of both parties to determine their ability to work together productively.

Methods: We conducted a lickert-style survey based upon statements made in qualitative questionnaire sent to GP's and specialists working at Hamad Medical Corporation and health centers in state of Qatar. The questionnaire was modified and validated during a multistage pilot and was distributed to a stratified random sample of 196 clinicians.

Results: GP's and consultants demonstrated a good level of agreement, mutual understanding and respect (Significant difference in opinion only in four statements out of 13).

Conclusion: The ability of GP's and specialists to work together has been tested out and confirmed with acceptable significance and it may be repeated to assess the relationship which is central to an efficient and effective operation of health care delivery.

[History of Parkinson's disease]

History of Parkinson's disease includes four periods: clinical, neuropathological, neurosurgical and biochemical. An "Essay on the shaking Palsy" by James Parkinson introduces the clinical period in 1817. Tretiakoff thesis defines pathology of the substantia nigra in 1919. Surgical treatment are various neurophysiological approachs, and biochemical discoveries open the way to medical treatment.

T-helper subsets cytokine production in kidney transplant recipients: diverting influences and impact on graft outcome

A large body of evidence suggests the existence of functionally polarized human T-helper responses based on their profile of cytokine secretion. Human T-helper cell clones can be divided into two mutually exclusive subsets, T-helper cell 1 (Th1) and T-helper cell 2 (Th2). Substantial work in several animal models has demonstrated that allograft rejection is associated with enhanced Th1 activity and tolerance with enhanced Th2. Some studies have not been consistent with this association. In this study, gamma interferon (INF-y) and interleukin 4 (IL-4) levels (as indicators of Th1 and Th2 activity, respectively) were assayed in supernatant of cultured peripheral lymphocytes. The levels of these cytokines were compared between a study group of 26 stable kidney transplant recipients immunosuppressed with cyclosporine A, corticosteroids and azathioprine or mycophenolate mofetil, and a control group of 10 healthy blood donors. The mean INF-gamma and IL-4 levels in the control group were considered as the cutoff levels for comparison. Our results showed that 25/26 of the study patients (96%) had low levels of INF-gamma compared to 4/10 of the control subjects (40%), (P< 0.05). However, the IL-4 level was high in 10/26 of the study patients (38%) and 3/10 of the control subjects (30%), not a statistically significant difference, (P>0.05).

IN CONCLUSION

These results suggest that well-established graft tolerance may be mediated via depressed Th1 activity rather than enhanced Th2 activity.

[Divergent asymmetries of the temporo-parietal cortical areas: anatomo-functional correlations and evolutionary and developmental implications]

Human brains present a clear asymmetry of the postero-lateral cortical area, so called "planum temporale" (Geschwind and Levitsky). This asymmetry is on favour of the left brain. A similar asymmetry is observed on the parietal operculum. MRI studies of 37 healthy volunteers have shown a clear difference between individuals. Mixing the index of temporal and parietal asymmetry, the authors consider four types: the most frequent pattern concerns 90% of right handed. For the others, 10% there are left handed as right handed. On conclusion, planum as many asymmetry and opercular asymmetry can be divergent, and both canan to determines handedness.

Drug-related hospitalization at a tertiary teaching center in Lebanon: incidence, associations, and relation to self-medicating behavior

OBJECTIVE

In Lebanon there is very limited restriction on drug use. Accordingly, self-medication is highly prevalent. This study examined the influence of these factors on the development of drug-related illnesses that lead to hospitalization.

METHODS

Patients admitted to the medical and pediatric wards of a tertiary teaching center in Beirut, Lebanon, over a period of 6 months were interviewed and their charts were reviewed. Admissions attributable to adverse drug reactions or therapeutic failures were identified and characterized with respect to demographic factors, medical history, drug intake, and self-medicating behavior. The influence of these variables on the development of drug-related illnesses was examined by logistic regression.

RESULTS

Of 1745 adults and 457 children, there were 177 (10.2%) and 36 (7.9%) drug-related illnesses, respectively. Adverse drug reactions accounted for 7.0% and 5.7% and therapeutic failures for 3.2% and 2.2% of adult and pediatric admissions, respectively. Self-medication was commonly practiced (52.6% of adults and 41.6% of children). Logistic regression analysis revealed that female sex increased the risk of adverse drug reaction in adults, whereas self-medication decreased the risk. In children, the risk of adverse drug reaction was increased in lower socioeconomic groups, whereas the risk of therapeutic failure was increased by a positive history of atopy or drug reaction.

CONCLUSIONS

These results provide the first detailed analysis of the problem of drug-related illnesses in a developing country and identify a number of related or risk factors. Despite the lack of regulation of drug dispensing and the unchecked access to drugs in Lebanon, the incidence of drug-related illnesses is not different from that in Western nations. This finding may have relevance to policies of drug regulation in other countries.

Case report of ruptured endometriotic cyst in pregnancy treated by laparoscopic ovarian cystectomy

Pregnancy is thought to have an ameliorating effect on endometriosis, inducing a state of quiescence. We report a case of ruptured endometriotic cyst in pregnancy successfully treated by laparoscopic ovarian cystectomy. Our patient subsequently progressed uneventfully to deliver a healthy baby girl at term. Laparoscopic ovarian cystectomy in pregnancy, even with ruptured cysts, appeared to be safe in trained hands with similar benefits of reduced post-operative morbidity.

[Acute myelopathies in young patients and multiple sclerosis. prospective study of 20 cases]

The risk of progression to multiple sclerosis (MS) after an episode of acute non compressive episode involving the spinal cord remains uncertain. A follow-up study was performed to determine the risk of early progression to MS in 20 patients presenting with clinically isolated lesions of the spinal cord, combined clinical evaluation, spinal and brain magnetic resonance imaging (MRI), visual, brainstem auditory and somatosensory evoked potentials (VEPs, BAEPs, SEPs), and cerebrospinal fluid (CSF) electrophoresis analysis. Spinal cord MRI demonstrated more lesions in cervical region (74 p. 100) than thoracic or lumbar regions (26 p. 100). Six patients (30 p. 100) had an initial brain MRI that was strongly suggestive of MS and 5 patients (25 p. 100) had only one MS-like abnormality. Eight patients (40 p. 100) had abnormal VEPs, 3 (15 p. 100) abnormal BAEPSs and only 44 p. 100 (8/18) abnormal SEPs. In contrast, CSF analysis showed oligoclonal bands (CSFOB) in 15/19 patients (79 p. 100). The diagnosis of MS was performed initially in 13 cases (65 p. 100) (clinically definite MS (CDMS) in 30 p. 100, laboratory-supported definite MS (LSDMS) in 61 p. 100 and clinically probable (CPMS) in one case). During the follow-up period (18 +/- 7 months), 8 patients (40 p. 100) presented one or more exacerbations and time to the first recurrence was 8 +/- 5 months. Seven of these 8 patients were initially treated by infusion of methylprednisolone. Among these patients, all of them had CSF OB and initial brain MRI was strongly suggestive of MS in 3 of them. During this follow-up period, brain MRI showed emergence of lesions in 4 cases with normal initial examination and 3 of them presented exacerbations. At the follow-up term, the diagnosis of MS was performed in 15 cases (75 p. 100) CDMs in 66 p. 100, LSDMS in 26 p. 100 and CPMS in one case). This confirms the predictive value of brain MRI and CSF OB for the diagnosis of MS in patients who present with clinically isolated acute syndrome of the spinal cord.