Aflatoxin B1 (AF) is an unavoidable environmental pollutant that contaminates food, feed, and grains, which seriously threatens human and animal health. Arabic gum (AG) has recently evoked much ...attention owing to its promising therapeutic potential. Thus, the current study was conducted to look into the possible mechanisms beyond the ameliorative activity of AG against AF-inflicted hepatic injury. Male Wistar rats were assigned into four groups: Control, AG (7.5 g/kg b.w/day, orally), AF (200 µg/kg b.w), and AG plus AF group. AF induced marked liver damage expounded by considerable changes in biochemical profile and histological architecture. The oxidative stress stimulated by AF boosted the production of plasma malondialdehyde (MDA) level along with decreases in the total antioxidant capacity (TAC) level and glutathione peroxidase (GPx) activity. Additionally, AF exposure was associated with down-regulation of the nuclear factor erythroid2–related factor2 (Nrf2) and superoxide dismutase1 (SOD1) protein expression in liver tissue. Apoptotic cascade has also been evoked following AF-exposure, as depicted in overexpression of cytochrome c (Cyto c), cleaved Caspase3 (Cl. Casp3), along with enhanced up-regulation of inflammatory mediators such as tumor necrosis factor-α (TNF-α), interleukin (IL)-6, inducible nitric oxide synthase (iNOS), and nuclear factor kappa-B transcription factor/p65 (NF-κB/p65) mRNA expression levels. Interestingly, the antioxidant and anti-inflammatory contents of AG may reverse the induced oxidative damage, inflammation, and apoptosis in AF-exposed animals.
Background: Hepatic and renal damage is a cisplatin (Cis)-induced deleterious effect that is a major limiting factor in clinical chemotherapy. Objectives: The current study was designed to ...investigate the influence of pretreatment with olive leaf extract (OLE), bone-marrow-derived mesenchymal stem cells (BM-MSC), and their conditioned media (CM-MSC) against genotoxicity, nephrotoxicity, hepatotoxicity, and immunotoxicity induced by cisplatin in rats. Methods: The rats were randomly divided into six groups (six rats each) as follows: Control; OLE group, treated with OLE; Cis group, treated with a single intraperitoneal dose of Cis (7 mg/kg bw); Cis + OLE group, treated with OLE and cisplatin; Cis + CM-MSC group, treated with BM-MSC conditioned media and Cis; and Cis + MSC group, treated with BM-MSC in addition to Cis. Results: Cis resulted in a significant deterioration in hepatic and renal functions and histological structures. Furthermore, it increased inflammatory markers (TNF-α, IL-6, and IL-1β) and malondialdehyde (MDA) levels and decreased glutathione (GSH) content, total antioxidant capacity (TAC), catalase (CAT), and superoxide dismutase (SOD) activity in hepatic and renal tissues. Furthermore, apoptosis was evident in rat tissues. A significant increase in serum 8-hydroxy-2-deoxyguanosine (8-OH-dG), nitric oxide (NO) and lactate dehydrogenase (LDH), and a decrease in lysozyme activity were detected in Cis-treated rats. OLE, CM-MSC, and BM-MSC have significantly ameliorated Cis-induced deterioration in hepatic and renal structure and function and improved oxidative stress and inflammatory markers, with preference to BM-MSC. Moreover, apoptosis was significantly inhibited, evident from the decreased expression of Bax and caspase-3 genes and upregulation of Bcl-2 proteins in protective groups as compared to Cis group. Conclusions: These findings indicate that BM-MSC, CM-MSC, and OLE have beneficial effects in ameliorating cisplatin-induced oxidative stress, inflammation, and apoptosis in the hepatotoxicity, nephrotoxicity, immunotoxicity, and genotoxicity in a rat model.
The emergency room is the most likely location where victims of violent crime would be encountered by the healthcare system, as the emergency staff is the first to evaluate the victim or culprit, ...exposing them to a range of forensic evidence. Forensic evidence can help exclude, identify, and prosecute a suspect and is classified as informational or physical evidence. Emergency staff must be proficient and knowledgeable in gathering, preserving, and documenting forensic evidence in their practice. To our knowledge, this is the first study that assesses the emergency staff's level of practice in managing forensic evidence. The aims of this study are to assess the level of practice of emergency staff in managing forensic evidence and observe an association between emergency experience and the level of practice in managing forensic evidence, study a connection between forensic education/training and the level of practice in the management of forensic evidence. This observational cross-sectional analytical study in Saudi Arabia was conducted from January 2022 to December 2022. Participants completed a self-administered online survey. Measuring the level of practice was implemented through a researcher-designed questionnaire based on a paper that provided guidelines for forensic evidence collection in the emergency department. Most emergency healthcare workers had a good level of practice in managing forensic evidence (64.7%). Those with excellent practice scored the lowest in documentation, whereas participants in the poor practice category scored the lowest in the trace evidence and clothes domains. Emergency workers who encountered less number of forensic cases per month, i.e. less than two or three to five cases, were found to be more likely to have poor management of forensic evidence. Emergency personnel with no prior education or training are more likely to engage in poor practice in forensic evidence collection. Furthermore, those who had acquired forensic education/training had higher percentages of excellent forensic practice (56.52%) compared to poor practice (7.14%). Those who claimed that their institution had issued guidelines were more likely to have excellent practice (75.36%), whilst those who did not receive guidelines were more likely to have poor forensic evidence management (85.71%). More research is required involving local hospitals and utilizing consistently validated methods in evaluating forensic evidence collection.
A national assessment of emergency staff level of practice in the management of forensic evidence was performed.Most emergency staff had a good level of practice in the management of forensic evidence.More training and education are needed for emergency staff in the field of forensics.National evidence-based guidelines for managing forensic evidence in the emergency setting should be established.
The postmortem diagnosis of death by drowning is one of the most difficult issues in forensic pathology. We investigated possible evidence differentiating saltwater drowning from freshwater drowning ...by histopathological changes in brain, heart, lungs, liver, and kidneys tissues. A cross section descriptive study was carried out on eighteen 12-week-old male Wistar rats; they were divided equally into 3 groups. Group 1: control group; Group 2: death by drowning in freshwater; Group 3: death by drowning in saltwater. Immediately after death, all tested organs were removed and fixed for histopathological examination. The brain of freshwater group depicted degenerated neurocytes with dystrophic changes in the form of shrunken cell, pyknotic nuclei and deeply eosinophilic cytoplasm. The heart showed clear evidence of myocyte injuries in saltwater drowning compared to the control and freshwater groups. The kidneys of rats drown in saltwater revealed more glomerular destruction with no differences in tubulo-interstitial changes in comparison with those drown in freshwater. In the lungs, the changes in freshwater were restricted to the alveoli, and the bronchial changes were more distinctive in saltwater. No disturbed liver architecture was seen in both test groups, however hydropic degeneration, congested vessels, and sinusoids were more distinct in saltwater group. In conclusion, diagnostic differentiation between fresh and saltwater drowning was reliable in rats’ lungs and heart with minimal differentiation in liver, kidneys, and brain. Further studies of drowning with different staining techniques will help to clarify the potential role of histopathological changes in body organs as indicator of drowning.
Aflatoxin Bsub.1 (AF) is an unavoidable environmental pollutant that contaminates food, feed, and grains, which seriously threatens human and animal health. Arabic gum (AG) has recently evoked much ...attention owing to its promising therapeutic potential. Thus, the current study was conducted to look into the possible mechanisms beyond the ameliorative activity of AG against AF-inflicted hepatic injury. Male Wistar rats were assigned into four groups: Control, AG (7.5 g/kg b.w/day, orally), AF (200 µg/kg b.w), and AG plus AF group. AF induced marked liver damage expounded by considerable changes in biochemical profile and histological architecture. The oxidative stress stimulated by AF boosted the production of plasma malondialdehyde (MDA) level along with decreases in the total antioxidant capacity (TAC) level and glutathione peroxidase (GPx) activity. Additionally, AF exposure was associated with down-regulation of the nuclear factor erythroid2–related factor2 (Nrf2) and superoxide dismutase1 (SOD1) protein expression in liver tissue. Apoptotic cascade has also been evoked following AF-exposure, as depicted in overexpression of cytochrome c (Cyto c), cleaved Caspase3 (Cl. Casp3), along with enhanced up-regulation of inflammatory mediators such as tumor necrosis factor-α (TNF-α), interleukin (IL)-6, inducible nitric oxide synthase (iNOS), and nuclear factor kappa-B transcription factor/p65 (NF-κB/p65) mRNA expression levels. Interestingly, the antioxidant and anti-inflammatory contents of AG may reverse the induced oxidative damage, inflammation, and apoptosis in AF-exposed animals.
To evaluate the Saudi campers' knowledge and the applied safety practices regarding carbon monoxide poisoning during camping activities.
The cross-sectional questionnaire-based study was conducted ...from December 1, 2018, to February 1, 2019, in Riyadh, Saudi Arabia, and comprised young male campers from recreational camps in the northern parts of the city. Data was collected from the participants regarding socio-demographic characteristics, knowledge regarding carbon monoxide poisoning, the applied safety measures to prevent carbon monoxide poisoning and the dealing with carbon monoxide poisoning during camping activities. Data was analysed using SPSS 22.
There were 235 male subjects with mean age 24.47±1.139 years (range: 21-32 years). Of the total, 50(21.3%) participants had received civil defence education or training. Overall, 137(58.3%) participants had a good mean knowledge score, and 157(66.8%) participants had a good mean practice score for applying healthy measures in preventing and managing carbon monoxide poisoning. As a preventive measure against carbon monoxide poisoning, the use of carbon monoxide detectors was valued by 107(45.5%) participants. Having civil defence training, having a monthly income >10,000 Saudi Riyals, and having a good knowledge score were the elements that had significant association with the choice related to carbon monoxide detector usage.
The campers had relatively high knowledge regarding carbon monoxide poisoning, but this knowledge was not fully translated into good health practice.
Heart failure (HF) is a common cause of cardiovascular mortality and morbidity. Despite advances in treatment, the prognosis remains poor. Sodium-glucose co-transporter 2 (SGLT-2) inhibitors decrease ...HF events by 27–39% in high-risk patients with type 2 diabetes mellitus (T2DM). Moreover, the DAPA-HF and EMPEROR-Reduced studies randomized patients with HF with reduced ejection fraction (HFrEF) with or without diabetes mellitus to receive guideline-directed medical therapy versus guideline-directed medical therapy plus an SGLT-2 inhibitor. Both studies showed the benefits of SGLT-2 inhibitors. In addition, SGLT-2 inhibitors have shown improvement according to the EMPEROR-Preserved study of HF with preserved ejection fraction (HFpEF)
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Therefore, a panel of cardiology experts from the Egyptian Atherosclerosis and Vascular Biology Association (EAVA) revised the literature for SGLT-2 inhibitors in HF, along with the recommended indications and contraindications, and this article presents their consensus on the topic. The panel concluded that SGLT-2 inhibitors have significantly benefited patients with chronic HFrEF, as indicated through the DAPA-HF and EMPEROR-Reduced trials. The panel recommended early use of dapagliflozin 10 mg or empagliflozin 10 mg in patients with symptomatic chronic HFrEF, whether diabetic or non-diabetic, to ameliorate HF hospitalization rate, mortality, symptoms, and decline in renal function.
The inflatable penile prosthesis (IPP) is typically the preferred implant for Peyronie’s disease (PD) and malleable penile prostheses (MPPs) have been discouraged.
To evaluate the effectiveness and ...patient satisfaction of the MPP vs IPP in patients with PD.
Men with PD and erectile dysfunction who elected for penile implant surgery constituted the study population. Preoperatively, demographic and comorbidity parameters were recorded. Curvature was measured with a goniometer at maximum rigidity after intracavernosal injection of a vasoactive agent. Postoperatively, overall satisfaction was measured at 3, 6, 12, and 24 months on 5-point Likert scale from 1 (dissatisfied) to 5 (very satisfied).
166 men with a mean age of 59 ± 10 years were analyzed. The mean preoperative curvature in the entire cohort was 65° (range = 30–130°). 94% of patients with MPP had total resolution of their curvature at the end of the operation, whereas 8 patients (6%) had residual curvature (25–40°). In the IPP group 25 of 30 (83.3%) had a straight penis at the end of surgery, whereas 5 of 30 (16.7%) had residual curvature, with the mean magnitude being 33° in the MPP group and 30° in the IPP group. 86% of all patients had diabetes. There were no differences between the 2 implant groups in age, hemoglobin A1c, body mass index, or smoking status. The mean patient satisfaction was 4.42 ± 0.70 (range = 2–5) and there was no difference between the 2 groups. The mean follow-up period was 23.4 months (range = 6–29 months).
We found that the MPP is as effective as the IPP in curvature correction in patients with PD, with similar patient satisfaction for the 2 groups.
Habous M, Farag M, Tealab A, et al. Malleable Penile Implant Is an Effective Therapeutic Option in Men With Peyronie’s Disease and Erectile Dysfunction. Sex Med 2018;6:24–29.
Background
The current expert view of the PCSK9 inhibitors’ use in Egypt is still ambiguous.
Main body
Hyperlipidemia is an important, if not the most important, risk factor for the occurrence of ...atherosclerosis worldwide. Egypt is the most populous country in the Middle East and North Africa and has > 15% of the cardiovascular deaths in the region. The burden of dyslipidemia as seen in the recently published CardioRisk project conducted throughout Egypt shows a high prevalence of dyslipidemia as a risk factor that is still reaching up to 71% in female participants. Reaching the targets for LDL lowering, and thus control of hyperlipidemia, is quite often very difficult especially with the update of the last ESC guidelines. With the advent of PCSK9 inhibitors, the control rate of patients, reduction of cardiac major adverse events, and mortality have been improved. However, Egypt is not considered a rich country on the grounds of annual income, and this raises a concern on which patients would benefit from these expensive medications. Revising the randomized control trials, we analyzed the data that would enable us to control LDL in those patients, at risk, to obtain simple clear indications for the use of these rather expensive medications.
Conclusion
We recommend the use of PCSK9 inhibitors in addition to statins ± ezetimibe in patients with ASCVD, by definition at very high risk; patients with ASCVD at very high risk who do not tolerate appropriate doses of at least three statins; and familial hypercholesterolaemia patients with clinically diagnosed ASCVD, at very high cardiovascular risk.
Background
Elevation of low-density lipoprotein cholesterol (LDL-c) is still a hugely unmet need in the reduction of atherosclerotic cardiovascular disease. In the published CardioRisk project in ...Egypt, up to 71% of female participants had dyslipidemia. Control of LDL-c levels and thus improvement of hyperlipidemia is quite often very difficult. With the introduction of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, the decrease of significant cardiac adverse events, the patient control rate, and the death rate have all been improved. Inhibition of the formation of PCSK9 through inclisiran, which is a novel method of reducing LDL-c and is only given twice per year, seems alluring. After revision of published data, we analyzed the potential advantages of the use of inclisiran.
Conclusion
The Egyptian Association for Vascular Biology and Atherosclerosis (EAVA) analyzed the data necessary for obtaining clear indications for the usage of inclisiran. We propose the addition of inclisiran to statins with or without ezetimibe for patients with documented atherosclerotic cardiovascular disease (ASCVD) or similar risk, familial hypercholesterolemia (FH) with another major risk factor, and very high and high risk diabetes mellitus, who did not reach LDL-c goals and/or with true statin intolerance. Inclisiran is also recommended as upfront therapy, with triple combination, in extreme risk subjects such as those with post acute coronary syndromes (ACS).
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