Neuropsychiatric post-acute sequelae of COVID-19: prevalence, severity, and impact of vaccination

The potential long-term neuropsychiatric effects of COVID-19 are of global concern. This study aimed to determine the prevalence and predictors of neuropsychiatric post-acute sequelae of COVID-19 among Egyptian COVID-19 survivors and to study the impact of full vaccination before COVID-19 infection on the occurrence and severity of these manifestations. Three months after getting COVID-19 infection, 1638 COVID-19 survivors were screened by phone for possible neuropsychiatric sequelae. Subjects suspected to suffer from these sequelae were invited to a face-to-face interview for objective evaluation. They were requested to rate the severity of their symptoms using visual analogue scales (VAS). The mean age of participants was 38.28 ± 13 years. Only 18.6% were fully vaccinated before COVID-19 infection. Neuropsychiatric post-acute sequelae of COVID-19 were documented in 598 (36.5%) subjects, fatigue was the most frequent one (24.6%), followed by insomnia (16.4%), depression (15.3%), and anxiety (14.4%). Moderate and severe COVID-19 infection and non-vaccination increased the odds of developing post-COVID-19 neuropsychiatric manifestations by 2 times (OR 1.95, 95% CI = 1.415-2.683), 3.86 times (OR 3.86, 95% CI = 2.358-6.329), and 1.67 times (OR 1.67, 95% CI = 1.253-2.216), respectively. Fully vaccinated subjects before COVID-19 infection (n = 304) had significantly lesser severity of post-COVID-19 fatigue, ageusia/hypogeusia, dizziness, tinnitus, and insomnia (P value = 0.001, 0.008, < 0.001, 0.025, and 0.005, respectively) than non-vaccinated subjects. This report declared neuropsychiatric sequelae in 36.5% of Egyptian COVID-19 survivors, fatigue being the most prevalent. The effectiveness of COVID-19 vaccines in reducing the severity of some post-COVID-19 neuropsychiatric manifestations may improve general vaccine acceptance.

[Puncture access with a new atraumatic needle MG for mini-percutaneous nephrolithotomy]

INTRODUCTION

An important aspect of the prevention of complications in percutaneous nephrolithotomy (PCNL) is to reduce the likelihood of injury to the adjacent structures and perirenal tissues.

AIM

To determine the efficiency and safety of renal puncture during mini-PCNL with a new atraumatic needle MG.

MATERIALS AND METHODS

A total of 67 patients who underwent mini-percutaneous nephrolithotomy at the Institute of Urology and Human Reproductive Health of Sechenov University were included in the prospective study. For the purpose of homogeneity of the groups, those with staghorn nephrolithiasis, nephrostomy, a history of prior kidney surgery (including PCNL), renal and collecting system anomalies, acute pyelonephritis, and blood clotting disorders were not included. The main group consisted of 34 (50.7%) patients who underwent atraumatic kidney puncture with a new needle MG (MIT, Russia), while in the control group there were 33 (49.3%) patients, who underwent standard puncture with Chiba or Troakar needles (Coloplast A/S, Denmark). The outer diameter of all needles was 18 G.

RESULTS

In patients with a standard access, a hemoglobin decrease in the early postoperative period was more pronounced (p=0.024). The incidence of complications according to the Clavien-Dindo classification did not differ significantly (p=0.351), however, a JJ stent was placed in two patients from the control group due to impaired urine flow and the development of urinoma.

CONCLUSION

Together with a similar stone-free rate, atraumatic needle allows to reduce a hemoglobin drop, as well as less development of severe complications.

Can fluorescence-guided surgery improve optimal surgical treatment for ovarian cancer? A systematic scoping review of clinical studies

BACKGROUND

The predicament of achieving optimal surgical intervention faced by surgeons in treating ovarian cancer has driven research into improving intra-operative detection of cancer using fluorescent materials.

OBJECTIVE

To provide a literature overview on the clinical use of intra-operative fluorescence-guided surgery for ovarian cancer, either for cytoreductive surgery or sentinel lymph node (SLN) biopsy.

METHODS

The systematic review included studies from June 2002 until October 2021 from PubMed, Web of Science, and Scopus as well as those from a search of related literature. Studies were included if they investigated the use of fluorescence-guided surgery in patients with a diagnosis of ovarian cancer. Authors charted variables related to study characteristics, patient demographics, baseline clinical characteristics, fluorescence-guided surgery material, and treatment details, and surgical, oncological, and survival outcome variables. After screening 2817 potential studies, 24 studies were included.

RESULTS

Studies investigating the role of fluorescence-guided surgery to visualize tumor deposits or SLN biopsy included the data of 410 and 118 patients, respectively. Six studies used indocyanine green tracer with a mean SLN detection rate of 92.3% with a pelvic and para-aortic detection rate of 94.8% and 96.7%, respectively. The sensitivity, specificity, and positive predictive value for micrometastases detection of OTL38 and 5-aminolevulinc acid at time of cytoreduction were 92.2% vs 79.8%, 67.3% vs 94.8%, and 55.8% vs 95.8%, respectively.

CONCLUSION

Fluorescence -guided surgery is a technique that may improve the detection rate of micrometastases and SLN identification in ovarian cancer. Further research is needed to establish whether this will lead to improved patient outcomes.

[Calico-venous fistulae: an intrarenal complication of percutaneous nephrolithotomy]

Bleeding is a serious complication of percutaneous nephrolithotomy (PCNL). A rare cause of gross hematuria is a calico-venous fistula. A clinical case of successful intraoperative diagnosis and treatment of calico-venous fistula during PCNL is presented in the article. Description of a clinical case. A patient J., 53 years old, underwent examination and treatment at the Institute of Urology and Reproductive Health, FGAOU VO I.M. Sechenov First Moscow State Medical University with a diagnosis of staghorn stone of the right kidney, a stone of the left kidney, chronic right-side pyelonephritis. On June 15, 2021, mini-PCNL was performed for the staghorn stone of the right kidney. The procedure seemed to be unremarkable, but during intraoperative antegrade pyelography, the inflow of contrast agent from the lower calyxes into the posterior segmental vein of the right kidney was detected, which was managed by creating sufficient traction of the nephrostomy drainage. Communication of the collecting and venous systems of the kidney is associated with a risk of both severe gross hematuria and urine flow into the venous bed. The urine flow into the bloodstream may result in hemodynamic disturbances, up to collapse followed by cardiac arrest. In order to prevent complications of PCNL it is necessary to analyze the kidney anatomy based on three-dimensional modeling of contrast- enhanced computed tomography. A calicovenous fistula can be a source of risk of bleeding and severe complications. To minimize intraoperative damage to parenchymal structures, an analysis of three-dimensional modeling of a kidney in patients with staghorn calculus based on computed tomography is required, which allows rational planning of surgical tactics.

Post-COVID-19 neuropsychiatric manifestations among COVID-19 survivors suffering from migraine: a case-control study

BACKGROUND

The burden of post-coronavirus disease (COVID)-19 symptoms has been increasing and is of great concern in patients with pre-existing chronic medical conditions.This study aimed to delineate the post-COVID-19 neuropsychiatric symptoms among migraine patients compared to the non-migraine control group.

METHODS

Two groups, each of 204 COVID-19 survivors, were enrolled in the study after 3 months of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, one group fulfilling the episodic migraine criteria and the other serving as a matching control group. Subjects were evaluated through an in-person interview for post-COVID-19 neuropsychiatric symptoms, including detailed headache patterns and severity, using the visual analogue scale.

RESULTS

The Frequency of headache during the acute phase of COVID-19 was more frequent in migraine patients (OR = 1.60, 95%CI = 1.04-2.45, P-value = 0.031). The reported significant post-COVID-19 neuropsychiatric symptoms in migraine patients compared to controls were fatigue (OR = 1.662, 95%CI = 1.064-2.596, P-value = 0.025), anosmia/hyposmia (OR = 2.06, 95%CI = 1.164- 3.645, P-value = 0.012), cacosmia (OR = 2.663, 95%CI = 1.145-6.195, P-value = 0.019), depression (OR = 2.259, 95%CI = 1.284- 3.975, P-value = 0.004), anxiety (OR = 3.267, 95%CI = 1.747- 6.108, P-value ≤ 0.001), insomnia (OR = 2.203, 95%CI = 1.298- 3.739, P-value = 0.003), and headache (OR = 3.148, 95%CI = 1.616-6.136, P-value =  ≤ 0.001).While there was no statistically significant difference between migraine patients and controls regarding the post-COVID-19 functional status score (P-value = 0.102). The pattern of post-COVID-19 headache was reported as chronic headache transformation in 17.6% of the migraine group, with the median intensity rate being 5.5 and IQR (3-7). In the control group, 14% experienced chronic headache attributed to systemic viral infection with a median intensity rate of 2 and IQR (2-5), while 12% experienced a new daily persistent headache with a median intensity of 5 and IQR (1-6).

CONCLUSION

The study highlighted the importance of follow-up migraine patients upon recovery from COVID-19 infection, being more vulnerable to post-COVID-19 symptoms.

Controversies and evidence gaps in the early management of severe traumatic brain injury: back to the ABCs

Traumatic brain injury (TBI) accounts for around 30% of all trauma-related deaths. Over the past 40 years, TBI has remained a major cause of mortality after trauma. The primary injury caused by the injurious mechanical force leads to irreversible damage to brain tissue. The potentially preventable secondary injury can be accentuated by addressing systemic insults. Early recognition and prompt intervention are integral to achieve better outcomes. Consequently, surgeons still need to be aware of the basic yet integral emergency management strategies for severe TBI (sTBI). In this narrative review, we outlined some of the controversies in the early care of sTBI that have not been settled by the publication of the Brain Trauma Foundation’s 4th edition guidelines in 2017. The topics covered included the following: mode of prehospital transport, maintaining airway patency while securing the cervical spine, achieving adequate ventilation, and optimizing circulatory physiology. We discuss fluid resuscitation and blood product transfusion as components of improving circulatory mechanics and oxygen delivery to injured brain tissue. An outline of evidence-based antiplatelet and anticoagulant reversal strategies is discussed in the review. In addition, the current evidence as well as the evidence gaps for using tranexamic acid in sTBI are briefly reviewed. A brief note on the controversial emergency surgical interventions for sTBI is included. Clinicians should be aware of the latest evidence for sTBI. Periods between different editions of guidelines can have an abundance of new literature that can influence patient care. The recent advances included in this review should be considered both for formulating future guidelines for the management of sTBI and for designing future clinical studies in domains with clinical equipoise.

[Retrograde intrarenal surgery using a 1.94 m superpulsed thulium fiber laser]

INTRODUCTION

surgical treatment of urinary stone disease plays an important role in urological practice. Stone fragmentation can be performed using various lithotripters, from which Holmium fiber laser (Ho: YAG) has currently taken the main place. According to the current literature, a superpulsed thulium fiber laser with a wavelength of 1.94 m and a maximum power output of 40 W showed in vitro higher efficiency compared to Ho: YAG, while having the same safety profile. The use of a thulium fiber laser with a pulse energy of 0.025-6 J and a high repetition rate (up to 1600 Hz) allows to most effectively perform stone dusting during retrograde intrarenal surgery (RIRS).

AIM

to improve the performance of RIRS using the 1.94m superpulsed thulium fiber laser.

MATERIALS AND METHODS

a total of 152 patients with renal stones who were treated during the period from February 2018 to July 2019 were included in the study. The analysis of the laser settings, their effect on retropulsion and visibility when performing RIRS using a superpulsed thulium fiber laser with a wavelength of 1.94 m and a maximum power output of 40 W, a peak power of 500 W, as well as an assessment of the stone-free rate the first postoperative day and 3 months after the procedure was done.

RESULTS

The most frequently used settings were as following: 0.5 J, 30 Hz, 15 W (No. 1), 0.15 J, 200 Hz, 30 W (No. 2), 0.8 J, 31.25 Hz, 25 W (No. 3), 0.8 J, 37.5 Hz, 30 W (No. 4). The statistical analysis of the influence of the settings on the quality of endoscopic imaging and retropulsion was carried out. In addition, the features of each settings were analyzed. The stone-free rate on the first postoperative day was evaluated using low-dose CT.

CONCLUSION

A superpulsed thulium fiber laser with a wavelength of 1.94 m and a maximum power of 500 W has shown high efficiency in clinical practice when performing RIRS, since it allows to have good endoscopic imaging, minimal retropulsion, and to perform stone dusting, which had a positive effect on the stone-free rate. Optimization of the settings of thulium fiber lithotripsy may improve the results of surgical treatment of urinary stone disease.

[3D-technologies in planning and navigation for laparoscopic interventions in patients with renal and ureteric stones]

AIM

to evaluate the possibilities and efficiency of using 3D technologies for the laparoscopic interventions in patients with renal and ureteric stones.

MATERIALS AND METHODS

A retrospective analysis of the results of surgical treatment of patients with renal and ureteric stones performed in the urology clinic of the I.M. Sechenov First Moscow State Medical University of Minzdrav of Russia for the period from January 2012 to December 2017 was carried out. During this period a total of 4958 interventions were done. Among them, 98 laparoscopic (1.97%) surgeries were performed, including nephron-sparing interventions (n=47; 48%), pyelolithotomy (n=15; 15.3%), ureterolithotomy (n=32; 32.65%) and partial nephrectomy (n=4; 4.05 %). The average patients age was 55.76+/-10.5 (29-80) years. There were 51 men (52%) and 47 women (48%). The mean stone density was 1237.6+/-354.6 HU (from 500 to 1913 HU). In 14 (22.9%) cases, nephrostomy tube or ureteric stent had been put before surgery. In addition, 40 (40.8%) patients previously underwent one surgical intervention on the kidneys and 17 patients with urinary stone disease (17.3%) underwent surgery more or equal 2 times. 88 (89.8%) patients had severe concomitant diseases and the most common pathology in 51 (52.0%) patients with urinary stone disease was arterial hypertension. In 11 (11.2%) cases, the interventions were performed in patients with abnormal kidneys, including horseshoe kidney (n=6; 6.1%), duplicated collecting system (n=3; 3.1%) and pelvic kidney (n=2; 2%). In addition to standard preoperative diagnostic methods in 22 cases (22.4%) the 3D-planning and multivariate virtual performing of intervention based on the multidetector computer tomography scan was done using Amira 3D-modeling program. Among these patients, virtual interventions were performed prior to all pyelolithotomy and partial nephrectomy. Intraoperative data of virtual constructions were used by surgeons as navigation. The interventions were performed by seven urologists at the clinic with various experience in laparoscopic surgery.

RESULTS

The mean duration of laparoscopic pyelolithotomy, laparoscopic partial nephrectomy, laparoscopic ureterolithotomy and laparoscopic nephrectomy was 183.2+/-69.6, 201.3+/-35.2 min, 97.6+/-43.7 and 165.4+/-92.3 min, respectively. The minimal blood loss was observed during laparoscopic ureterolithotomy (53.33+/-31.2 ml). During these interventions, in 8 cases (8.16%) a flexible endoscope was used for inspection and complete removal of stones. Intraoperative complications were noted in 6 patients (6.1%). There were 4 conversions to open surgery (4.1%). Postoperative surgical complications were observed in 1 (1%) patient, while non-surgical complications developed in 4 patients (4.1%). There was no mortality.

CONCLUSION

Laparoscopic access for the treatment of patients with urinary stone disease should be used for the treatment of patients with large, long-standing ureteral calculi and patients with kidney stones who have concomitant pathology of kidney or upper urinary tract (UPJ obstruction, kidney tumors) requiring surgical intervention. Laparoscopic access should be considered primarily for the planning of laparoscopic partial nephrectomy and laparoscopic nephrectomy in patients with urinary stone disease. The use of 3D computer-assisted technologies is advisable for patients with urinary stone disease and abnormal kidneys if laparoscopic pyelolithotomy, partial nephrectomy or ureterolithotomy is planned.

Abstract P3-03-40: A prospective two arm comparative study of indo-cyanine green (ICG) enhanced fluorescence imaging vs conventional methods (blue dye and radiocolloid/hand held gamma probe) for sentinel lymph node detection in breast cancer - Going beyond the horizon

Background:

The dual technique with radio colloid and blue dye is the gold standard in sentinel lymph node biopsy (SLNB) to stage axilla in breast cancer. However due to cost & infrastructural demands of nuclear medicine department most of the oncology centers are not doing slnb or are doing SLNB with blue dye which is not a standard of care. Indocyanine green (ICG) has recently been used as a method of identifying sentinel lymph nodes. Studies have shown that ICG fluorescence imaging alone or in combination with the blue dye method or the radionuclide method is a safe and easy technique. The objective of the present study was to assess the diagnostic performance of sentinel lymph node (SLN) biopsy using the indocyanine green (ICG) fluorescence method compared with that using the conventional method in detection of sentinel lymph nodes.

Material & Methods:

60 patients diagnosed with early breast cancer underwent the SLNB procedure using technetium-99m radio colloid (R), methylene blue dye (MB), and ICG. Fluorescence imaging was done using an indigenously designed , very economical fluorescence imaging system, Irilic.nm fluorescence imaging along with Indocyanine green. All SLNs that were removed during surgery were labelled as hot, blue or/and fluorescent and sent for pathological examination. The detection rate of SLNs and positive SLNs, and the number of SLNs of ICG, MB+ R, ICG + MB, ICG + R were compared. Injection safety of ICG and MB was evaluated.

Results:

Sentinel Lymph Node was identified in all 60 cases. Total Sentinel lymph nodes removed was 145 (Mean=2, Range 2-5), ICG was able to identify more nodes than the dual dye technique. The identification rate with the dual dye technique was 95%, with blue dye alone 93.6% and with radioisotope alone 96.8% whereas with ICG alone was 100%, with ICG + MB was 96.6% & ICG + R was 96.6 %. 28(46.6%) out of 60 patients had positive nodes which was identified by both dual dye & ICG. None of the patients had any local or systemic reaction with ICG, 3 patients with blue dye had tattooing & staining of skin.

Conclusion:

ICG is as effective as the dual dye for SLNB. ICG is safe & reliable. In addition, as a near-infrared dye, it has the advantages of real-time visualization, lower cost, and wider availability. It can be a boon for developing countries & second tier referral centers of developed country where there is limited access to nuclear medicine department & radiocolloid and even if its accesible the cost involved is too high which comes with added radiation exposure to medical personnel handling them. A combination of blue dye and ICG is useful dual approach when radioisotope is unavailable.

ICG verus Conventional Dye Clinical Profile ICGRadio-colloid+ B;ue DyeDetection Rate100%95%Sensitivity100% (CI 83.16% to 100.00%)100% (CI 83.16% to 100.00%)Positive Predictive Value100%100%Accuracy100%100%

Citation Format: Somashekhar S, Rohit Kumar C, Zaveri S, Rajgopal A, Rakshit S, Ali SH. A prospective two arm comparative study of indo-cyanine green (ICG) enhanced fluorescence imaging vs conventional methods (blue dye and radiocolloid/hand held gamma probe) for sentinel lymph node detection in breast cancer - Going beyond the horizon [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-03-40.

[Vitamin D and urinary stone disease: the current state of problem]

Disturbances of vitamin D metabolism is one of the factors leading to the impairment of phosphate and calcium homeostasis which plays leading role in the development of urinary stone disease. Vitamin D is necessary for wide spectrum of physiologic processes and good health condition. Until now, in many guidelines on urolithiasis there is an advice to limit vitamin D intake due to concerns of an increase in the stone formation. In vivo studies have shown that 1,25()2D3 can both increase and decrease and not to influence on calcium excretion. The results of the studies assessing the relationship between vitamin D blood/plasma level and urinary stone disease are often inconsistent and even controversial. In patients with urinary stone disease the vitamin D deficiency is often found and currently there is still a lack of studies dedicated to problem of vitamin D deficiency in patients with urinary stone disease and the need for its correction.

Translational profiling of retinal ganglion cell optic nerve regeneration in Xenopus laevis

Unlike adult mammals, adult frogs regrow their optic nerve following a crush injury, making Xenopus laevis a compelling model for studying the molecular mechanisms that underlie neuronal regeneration. Using Translational Ribosome Affinity Purification (TRAP), a method to isolate ribosome-associated mRNAs from a target cell population, we have generated a transcriptional profile by RNA-Seq for retinal ganglion cells (RGC) during the period of recovery following an optic nerve injury. Based on bioinformatic analysis using the Xenopus laevis 9.1 genome assembly, our results reveal a profound shift in the composition of ribosome-associated mRNAs during the early stages of RGC regeneration. As factors involved in cell signaling are rapidly down-regulated, those involved in protein biosynthesis are up-regulated alongside key initiators of axon development. Using the new genome assembly, we were also able to analyze gene expression profiles of homeologous gene pairs arising from a whole-genome duplication in the Xenopus lineage. Here we see evidence of divergence in regulatory control among a significant proportion of pairs. Our data should provide a valuable resource for identifying genes involved in the regeneration process to target for future functional studies, in both naturally regenerative and non-regenerative vertebrates.

[Choosing a method of draining the upper urinary tract following percutaneous nephrolithotripsy]

PURPOSE

to compare various methods of upper urinary tract drainage in patients with urolithiasis.

PATIENTS AND METHODS

60 patients were included into a prospective study which ran from March 2013 through December 2014. All patients underwent PCNL with a nephrostomy tract diameter of (28-30 Ch.) at the I.M. Sechenov First Moscow State Medical University urology clinic. Patients were divided into 2 groups. Group 1 30 (patients) underwent nephrostomy after PCNL with nephrostomy tract placement, in group 2 (29 patients) internal drainage was performed. One patient withdrew from the study due to residual stone. Adequacy of urinary tract draining was assessed by operative time and blood loss. A comparative analysis was performed to outline difference in both groups by length of hospital stay, severity of flank pain in early postoperative period and 5 days after the procedure, day of drain removal.

RESULTS

the average operative time in group No1 was 104 minutes (+/-17 min.), and 71 minutes (+/- 19 minutes) in group No2 . The average hemoglobin level before surgery in both groups was roughly comparable and amounted to: 141.5g / l (+/-13) in group No1, in group No 2 143.6 g / l (+/-18). At the same time, hemoglobin level in the early postoperative period varied in both groups and was as follows: 121g / l (+/-13) in group No1, and 128g / l (+/-14) in group 2. Evaluation of pain severity by VAS score showed that severity of pain in an early postoperative period was roughly comparable in both groups and amounted to 6.29 and 6.05 points, respectively, but from the second day, and since the activation of the patients, the values of the intensity of pain in both groups became differ. Group No1: - 5.33 (+/-1.5) on day 2, 3.25 (+/-1.8) on day 3, - 2.5 (+/-1.6) on day 5. A more thorough elucidation of the cause of pain showed that in 56 (88%) patients the pain was due to the nephrostomy and pain in the nephrostomy stroke while driving and only 7 (11%) patients complained of a pain in the operated kidney. Group No2: - 3.5 (+/-1.2) on day 2, - 2.9 (+/-1.4) on day 3, 1.22 (+/-0.8) on day 5.

CONCLUSION

A detailed and thorough history, taking together with multislice computed tomography and multiplanar 3D modeling allows for better preoperative assessment regarding a size, a number and location of stones, vascular architecture of the kidney. This enebles an experienced endoscopic surgeon to plan an operation, and avoid the possible difficulties associated with lithotripsy and choose a more suitable method of pyelocaliceal system draining after the operation. In turn, tubeless PCNL, with proper intraoperative managamant and careful selection of patients appears to be safe and effective. Drainage of the upper urinary tract with internal drainage reduces intensity of postoperative pain, which improves the quality of life of patients in the postoperative period, and reduces the length of postoperative stay.

Barriers to mental health service utilisation in Sudan - perspectives of carers and psychiatrists

Background

In order to scale up mental health care nationally, barriers to health services utilisation need to be identified and addressed.

Aim: The aim of this study was to identify barriers to mental health services utilization in Sudan from the perspectives of carer’s of mentally ill patients and psychiatrists and to make recommendations to address the identified barriers.

Methods

Mixed research methods were used in this cross sectional survey. The quantitative part was conducted with carers of mentally ill patients who were staying in Tijani Elmahi psychiatric hospital in Sudan, and the qualitative part was conducted with the psychiatric consultants in the country.

Results

103 carers and six psychiatric consultants participated in the study. According to carers, the main barriers to utilisation of mental health services includes: the beliefs around mental illness, resorting to alternative treatments such as religious and traditional healers, centralization of mental health services, inadequate number of mental health staff, and mental health not being a priority by policy makers. In addition to these barriers, the psychiatric consultants identified stigma, cost of medications, and worries about medication’s side effects as barriers to the utilisation of mental health services. The carers and psychiatrists proposed several solutions to address the barriers to health services utilisation.

Conclusion

Carers and psychiatrists are aware of the barriers to mental health services utilisation in Sudan. Addressing these barriers require a health policy and political response.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-016-1280-2) contains supplementary material, which is available to authorized users.

Vitamin D supplementation in obese type 2 diabetes subjects in Ajman, UAE: a randomized controlled double-blinded clinical trial

OBJECTIVES

To study the effect of Vitamin D3 supplementation on metabolic control in an obese type 2 diabetes Emirati population.

METHODS

This randomized double-blind clinical trial was conducted with 87 vitamin D-deficient obese, type 2 diabetic participants. The vitamin D-group (n=45) and the placebo group (n=42) were matched for gender, age, HbA1c and 25-hydroxy vitamin D (25(OH) D) at the baseline. The study was divided into two phases of 3 months each; in phase 1, the vitamin D-group received 6000 IU vitamin D3/day followed by 3000 IU vitamin D3/day in phase 2, whereas the placebo group (n=42) received matching placebo.

RESULTS

After supplementation, serum 25(OH) D peaked in the vitamin D-group in phase 1 (77.2±30.1 nmol/l, P=0.003) followed by a decrease in the phase 2 (61.4±18.8 nmol/l, P=0.006), although this was higher compared with baseline. In the placebo group, no difference was observed in the serum 25(OH) D levels throughout the intervention. Relative to baseline serum, parathyroid hormone decreased 24% (P=0.003) in the vitamin D-group in phase 2, but remained unchanged in the placebo group. No significant changes were observed in blood pressure, fasting blood glucose, HbA1c, C-peptide, creatinine, phosphorous, alkaline phosphatase, lipids, C-reactive protein or thyroid stimulating hormone concentrations compared with baseline in either group.

CONCLUSIONS

Six months of vitamin D3 supplementation to vitamin D-deficient obese type 2 diabetes patients in the UAE normalized the vitamin D status and reduced the incidence of eucalcemic parathyroid hormone elevation but showed no effect on the metabolic control.

Effect of acid hydrolysis and fungal biotreatment on agro-industrial wastes for obtainment of free sugars for bioethanol production

This study was designed to evaluate selected chemical and microbiological treatments for the conversion of certain local agro-industrial wastes (rice straw, corn stalks, sawdust, sugar beet waste and sugarcane bagasse) to ethanol. The chemical composition of these feedstocks was determined. Conversion of wastes to free sugars by acid hydrolysis varied from one treatment to another. In single-stage dilute acid hydrolysis, increasing acid concentration from 1 % (v/v) to 5 % (v/v) decreased the conversion percentage of almost all treated agro-industrial wastes. Lower conversion percentages for some treatments were obtained when increasing the residence time from 90 to 120 min. The two-stage dilute acid hydrolysis by phosphoric acid (1.0 % v/v) followed by sulphuric acid (1.0 % v/v) resulted in the highest conversion percentage (41.3 % w/w) on treated sugar beet waste. This treatment when neutralized, amended with some nutrients and inoculated with baker’s yeast, achieved the highest ethanol concentration (1.0 % v/v). Formation of furfural and hydroxymethylfurfural (HMF) were functions of type of acid hydrolysis, acid concentration, residence time and feedstock type. The highest bioconversion of 5 % wastes (37.8 % w/w) was recorded on sugar beet waste by Trichoderma viride EMCC 107. This treatment when followed by baker’s yeast fermentation, 0.41 % (v/v) ethanol and 8.2 % (v/w) conversion coefficient were obtained.

Safe blood transfusion practices in blood banks of Karachi, Pakistan

BACKGROUND

Since 1997, legislations pertaining to safe blood transfusion (SBT) have evolved considerably in Pakistan. The objective of this study was to evaluate the SBT practices in the blood banks of Pakistan.

METHODS

Twenty-three blood banks were randomly selected from a list of registered 40 in Karachi, the largest city in Pakistan. To evaluate the SBT practices in the selected blood banks, a questionnaire and a checklist were administered during 2007-2008.

RESULTS

Of the 23 blood banks surveyed, 4 (17%) were affiliated with government or a semi-government institution; 16 (70%) blood banks had a healthy donor recruitment program and 2 (9%) of the blood banks agreed that they recruited remunerated (paid) blood donors. Donors were screened for HIV, Hepatitis B, Hepatitis C and syphilis by all 23 blood banks, whereas malaria was screened by all blood banks but one.

CONCLUSION

SBT practices in Karachi have improved since 1995; an active role by the government in policy-making has proven effective.

Asthma prevalence and severity among primary-school children in Baghdad

To measure asthma prevalence and severity among children in Baghdad, we randomly sampled 3360 primary-school children and had their parents complete standardized questionnaires. The response rate was 86%, male to female ratio was 0.75:1 and age range was 6-12 years. Prevalence of wheezing ever was 25.0%. Wheezing during the last 12 months was 19.9% and 2.9% of the children had more than 12 attacks. Parents reported nocturnal wheezing for 16.3% of the children and severe attacks that limited speech for 10.5%. Prevalence of asthma ever was 22.3%. Asthma was detected in 81.9% of those with wheezing in the last 12 months. Males were predominant among children with wheezing ever, whereas females were predominant among children with asthma ever. Prevalence rates of asthma and of severe asthma symptoms decreased with increasing age.

A new approach to modelling substrate inhibition

Substrate inhibition, which is one of the most frequently observed phenomena in the biological treatment of industrial wastewaters, has been the subject of numerous studies. Yet there are still cases which cannot be adequately described by the existing models. In this paper, a review of substrate inhibition approaches was made. A new model is proposed that assumes a common mechanism for substrate and product inhibition. The model is a continuous function having a maximum growth rate at the critical substrate concentration, beyond which the growth rate decreases as the substrate concentration is increased. The model also predicts the maximum substrate concentration where the growth ceases. The model was tested using existing data in the literature to assess the model response and predictability of critical points. The literature datahave been selected from the studies conducted on pure and mixed cultures in batch and continuous reactors for phenol and several phenolics as well as from the studies which employed the Haldane model. A curve fitting method was used to determine the model parameters. The fit of the model to the data was satisfactory, particularly for the substrate concentrations exceeding maximum growth rate.

High levels of oestrogen receptor-alpha in tumorigenesis: inhibition of cell growth and angiogenic factors

We previously found that the stable overexpression of oestrogen receptor-alpha in the human endothelial cell line ECV304* inhibits its growth in vitro, and that this inhibition is possibly mediated through a down-regulation of the vasoactive agents endothelin-1 and vascular endothelial growth factor. Here we show an in vivo growth-inhibitory effect of oestrogen receptor-alpha overexpression in tumours initiated in nude mice from the same clone of ECV304. In addition, we show that this growth inhibition is accompanied by an alphavbeta3-mediated inhibition of cell migration in vitro, and a down-regulation of the integrin alphavbeta3, vascular endothelial growth factor and vascularization in vivo. The levels of vascular endothelial growth factor and integrin alphavbeta3, through their effect on cell growth and migration, contribute to the process of angiogenesis and to the pathogenesis of atherosclerosis and cancer. The results shown here demonstrate that a higher level of oestrogen receptor-alpha in the cell, through its effect on certain angiogenic factors, may play a role in the control of angiogenesis.

Cellular transformation by SV40 large T antigen: interaction with host proteins

SV40 large T antigen (TAg) is a powerful oncoprotein capable of transforming a variety of cell types. The transforming activity of TAg is due in large part to its perturbation of the retinoblastoma (pRB) and p53 tumor suppressor proteins. In addition, TAg binds to several other cellular factors, including the transcriptional co-activators p300 and CBP, which may contribute to its transformation function. Several other features of TAg that appear to contribute to its full transformation potential are yet to be completely understood. Study of TAg therefore continues to provide new insights into the mechanism of cellular transformation.

Estrogen receptor-alpha in the inhibition of cancer growth and angiogenesis

A high level of estrogen receptor-alpha (ER-alpha) is believed to be favorable in the prognosis and treatment of certain female cancers. ER-alpha expression in the ER-negative breast cancer cell lines inhibits their proliferation and invasive, metastatic potential in vitro. We stably overexpressed the ER-alpha in the human endometrial cancer cell line Ishikawa and showed that, unlike estradiol, high levels of ER-alpha significantly inhibit the growth of tumors xenografted from the Ishikawa cells. Subsequent to ER-alpha overexpression, in vivo down-regulation of vascular endothelial growth factor was observed in tumor xenografts. In addition, these tumors showed an inhibition of vascularization and of the angiogenic agent, integrin alphavbeta3. Involvement of a switch in the angiogenic pathways during tumorigenesis has been a recent focus of interest. Our results indicate that a high level of ER-alpha may be beneficial in the control of female cancers because of its inhibitory effect on such angiogenic pathways.

Stable over-expression of estrogen receptor-alpha in ECV304 cells inhibits proliferation and levels of secreted endothelin-1 and vascular endothelial growth factor

Studies with mammalian vascular cells have suggested growth inhibitory effects of estrogen on the vascular wall. To investigate the involvement of estrogen receptor-alpha (ER) in the control of endothelial cell proliferation, we have stably transfected human estrogen receptor-alpha cDNA into the endothelial cell line ECV304. The clone ECV-ER, thus obtained, over-expresses estrogen receptor to a level approximately 10-fold higher than the parent cell line. Effects of this over-expression were studied on the cell growth rate, and on the levels of secreted endothelin-1 and vascular endothelial growth factor (VEGF). Similar to the previously reported data in other cell types, we found the transfection of ER in ECV304 cells to be inhibitory to their growth. Our ER-over-expressing clone of ECV304 also showed an inhibition of secreted endothelin-1 and VEGF levels. Moreover, the growth inhibition of this ER-over-expressing clone was reversed by the addition of endothelin-1 or VEGF to the medium. In view of the growth-stimulatory effect of endothelin-1 and VEGF on vascular cells, our results indicate that estrogen receptor-alpha may bring about its growth inhibition partly by suppressing endothelin-1 and/or VEGF production in ECV304 cells.

Biochemical studies on proteins from cheese whey and blood plasma by-products

Efforts have been done to recover proteins from waste liquors rich in protein in a soluble form. Cheese whey and animal bloods are by-products from the manufacture of cheese and meat. It contains a variety of proteins which can be reclaimed. The efficiency of protein precipitation from the sweet-cheese whey by the use of hydroxyethyl cellulose (HEC) was similar to that precipitated by the use of carboxymethyl cellulose (CMC). Both are greater than that precipitated by trichloro acetic acid. The same results of the efficiency of precipitation were attained when the plasma was precipitated. It was found that cheese-whey protein-HEC-complex and plasma protein-HEC-complex contain a large amount of essential amino acids. Electrophoretic separation of whey protein complex showed that beta-Lactoglobulin forms the major fraction while in case of plasma protein complex albumin forms the major fraction. The fractionation patterns of different complexes with HEC, CMC or TCA gave the same components and about the same ratio. It appears from these results that HEC-protein complexes are preferable than CMC-protein complexes or proteins precipitated by TCA. Chemical analysis of whey protein complexes revealed that lactose content of whey protein-HEC-complex was higher than that of CMC-complex or protein precipitated by TCA. Elemental analysis of protein complexes showed that the level of sodium, phosphorus, and potassium was increased while that of copper or zinc decreased. Cellulose derivative protein complexes showed no significant effects on the liver or kidney function of albino rat and these results indicted that no toxic effect was observed from the uses of these protein complexes in feeding.

Sleep quality and nocturnal respiratory function with once-daily theophylline (Uniphyl) and inhaled salbutamol in patients with COPD

We compared the effects of evening administration of sustained-release theophylline (Uniphyl) and qid inhaled beta 2-agonist (salbutamol, two 100-micrograms puffs) on sleep quality and nocturnal oxygen saturation in 20 patients with COPD. Patients with FEV1 less than 70% predicted and FEV1/FVC ratio less than 70% were eligible to participate in this double-blind, crossover study, with 2-week treatment arms. Patients recorded morning and evening peak flow and symptoms in a daily diary. On the last day of each treatment period, overnight polysomnography was done. Spirometric indexes were measured before retiring and on awakening. Patients spent less time at less than 90% oxygen saturation (51 +/- 92 min vs 72 +/- 105 min; p = 0.03) during theophylline treatments than during salbutamol treatment. There was a smaller overnight decrease in FEV1 (0.04 L vs 0.13 L; p = 0.04) after theophylline than after sallbutamol treatment. FEV1/FVC ratio and maximum expiratory flow at 50% of vital capacity (V50) increased overnight with theophylline and decreased with salbutamol (p = 0.014, 0.025). Morning peak expiratory flow rate was higher with theophylline (4.0 +/- 1.7 L/s) than with salbutamol (3.6 +/- 1.8 L/s; p = 0.004). The duration of patient-reported nocturnal wheezing was lower with theophylline than with salbutamol (p = 0.006). There were no differences between treatments in sleep quantity, efficiency, staging, or subjective quality. We conclude that, compared with salbutamol, evening administration of once-daily theophylline results in better nocturnal oxygen saturation and an improvement in the overnight change in pulmonary function, without affecting sleep architecture, in patients with COPD.