The safety and efficacy of spray cryotherapy after endoscopic sinus surgery in chronic rhinosinusitis: A systematic review of randomized controlled trials.

Background: Chronic rhinosinusitis (CRS) is a condition that affects 5-12% of the general population. Endoscopic sinus surgery (ESS) is the preferred treatment because of its few adverse effects and highest success rates. The most common post-operative consequences include synechia, nasal blockage, and disease recurrence. Spray cryotherapy is a novel therapeutic approach with promising outcomes for the treatment of upper airway disorders.This review aimed to investigate the effects of spray cryotherapy (SCT) following ESS in patients with chronic rhinosinusitis. Methods: Six electronic databases were searched for randomized clinical trials (RCTs). The selected trials were evaluated for methodological quality, and data were extracted by two independent reviewers. The Cochrane risk-of-bias tool was used to assess the quality of evidence. Results: Three RCTs with 85 patients were included in the final analysis. SCT was related to -16 and -77 reductions in Lund-McKay and SNOT-22 scores after 36 weeks of follow-up, in contrast to a placebo, which showed -10.4, -65. Regarding the side effects of SCT, no adverse effects were reported, and visual assessments showed no pain, visual field loss, or any other ocular complications. Conclusions: SCT is a new treatment modality after endoscopic sinus surgery that shows an effective post-operative management strategy with better post-operative scales (Lund-McKay, SNOT-22, POSE, and Lund-Kennedy) and less edema, obstruction, crusting, and inflammation with minimal or no side effects. However, further research with longer follow-ups, a larger sample size, and subjective assessment is needed to assess any possible long-term side effects.

Spectrum of Disorders of Sex Development: A Single-Center Experience in the Southern Area of Iraq.

BACKGROUND: The most common presentation of disorders of sex development (DSD) is in the neonatal period when a baby is born with atypical ("ambiguous") genitalia, making it unclear whether the child is a boy or a girl. This study aims to provide an overview of the DSD spectrum, seen in Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), Basrah, southern area of Iraq. METHODS: A retrospective study on patients with DSD was referred to FDEMC, a tertiary center in Basrah, between January 2009 and December 2023. RESULTS: Out of the total 150 studied patients, individuals above 15 years old comprised the majority. Sex chromosomal DSD made up 37.3% of the cases, while 46, XY DSD comprised 34.7%, and 46, XX DSD accounted for 28% of the total. CONCLUSION: Many patients with DSD in Basrah were diagnosed late, beyond infancy. Increasing awareness among healthcare providers and families is essential for early diagnosis during infancy.

Effect of timing of casirivimab and imdevimab administration relative to mRNA-1273 COVID-19 vaccination on vaccine-induced SARS-CoV-2 neutralising antibody responses: a prospective, open-label, phase 2, randomised controlled trial.

BACKGROUND: Deeper insight is needed on how monoclonal antibodies (mAbs) affect vaccine-mediated immune responses when targeting the same protein. We describe the first prospective randomised trial designed to understand mAb-mediated alterations in vaccine-induced immune responses to SARS-CoV-2 spike protein epitopes. METHODS: This randomised, open-label, parallel-group study assessed the potential interaction of a mAb combination, casirivimab and imdevimab, with a vaccine, Moderna's mRNA-1273, in healthy SARS-CoV-2 immunologically naive, seronegative adults at six centres in the USA. Participants were randomly assigned (per prespecified randomisation ratios within enrolment waves) according to a computer-generated randomisation scheme, stratified by age (<65 years and ≥65 years), to various intravenous or subcutaneous doses of casirivimab and imdevimab before, after, or at the same time as mRNA-1273 or to mRNA-1273 only. The doses of casirivimab and imdevimab were chosen to mimic various time intervals between receipt of 1200 mg of the mAb and the first dose of a primary series with mRNA-1273. The primary endpoint was vaccine-induced 50% inhibitory dilution neutralising antibody titres to SARS-CoV-2 spike protein, 56 days after the first vaccination. Secondary endpoints included vaccine-induced total antibodies to SARS-CoV-2 antigens and incidence of treatment-emergent adverse events. Exploratory endpoints included blood-derived T-cell and B-cell responses. The per-protocol set was used for the analysis of the primary endpoint and included all randomly assigned participants who received both doses of the vaccine and completed the injection or infusion of casirivimab and imdevimab per protocol, had no evidence of SARS-CoV-2 infection in the past or in the 56 days after the first dose of vaccine, and did not receive any intervention outside of the study that could alter the immune response. Safety was assessed in the safety analysis set, which included all randomly assigned participants who had received one or more doses of mRNA-1273 or any study drug, and analysed based on treatment received. The study is registered with ClinicalTrials.gov, NCT04852978, and is complete. FINDINGS: Between April 29, 2021, and Nov 21, 2022, 807 participants were assessed for eligibility and 295 were randomly assigned. 293 participants were included in the safety analysis set and 260 were included in the per-protocol set. All vaccinated participants developed neutralising antibodies to SARS-CoV-2, with median titres above the published protective threshold (100 IU/mL) against the SARS-CoV-2 D614G variant (considered a reference strain at the time the initial COVID-19 vaccines were developed). Titres were decreased up to 4-fold (median titres 280-450 IU/mL for casirivimab and imdevimab vs 1160 IU/mL for vaccine only on day 56) when casirivimab and imdevimab was given 85 days or less before vaccination (150-1200 mg intravenously) or co-administered subcutaneously (600 mg or 1200 mg) with vaccination. Minimal reduction in neutralisation titres was observed in the 48 mg and 12 mg intravenous groups, corresponding to receipt of casirivimab and imdevimab 113 days and 169 days, respectively, before vaccination, and when administering the vaccine 6 days before the mAb. Across all groups, mAbs had a minimal effect on vaccine-induced total antibodies and T-cell responses to the spike protein. Casirivimab and imdevimab plus mRNA-1273 was generally well tolerated; a slight increase in treatment-emergent adverse events was observed in the casirivimab and imdevimab plus vaccine groups versus the vaccine-only group. INTERPRETATION: Casirivimab and imdevimab administration before or at the time of COVID-19 vaccination reduced the elicitation of SARS-CoV-2 neutralising antibodies, but minimal effect was observed when vaccination occurred before mAb administration. Although the clinical significance of this decrease in neutralisation is unclear, this evidence suggests that further investigation of potential interactions could be warranted before concurrent clinical use of mAbs and vaccines targeting the same viral proteins as their main modes of action for the prevention or treatment of infectious diseases. FUNDING: Regeneron Pharmaceuticals and F Hoffmann-La Roche.

Quantitative analysis of loxoprofen sodium loaded microspheres comprising pectin and its thiolated conjugates: In-vivo evaluation of their sustained release behavior.

Continuous use of oral NSAIDs can damage mucosal membrane, which results in decreased bioavailability and non-compliance with the therapy. But the use of sustained release drug delivery systems might offer a solution. Objective was to synthesize mucoadhesive SR microspheres by using different combinations of pectin (PEC) and its thiolated derivative (T-PEC3100) for improved loxoprofen (LS) permeation. Thiolated pectin (T-PEC) was synthesized by the esterification method using thioglycolic acid. Thiolation was confirmed by thiol group quantification and charring point determination. Further characterization was done by Fourier Transform Infrared spectroscopy (FTIR), and Scanning electron microscopy (SEM). Ex-vivo mucoadhesion study was performed to confirm the improved characteristics. Microspheres (MS) were prepared using different ratios of PEC/T-PEC by solvent evaporation method and their particle size and surface morphology were evaluated. Mucus permeation study was carried out using the trans-well plate method. Sustained release behavior of prepared microspheres was investigated through the edema inhibition method in albino rats. T-PEC3100 was considered the optimum formulation for further evaluation and contained maximum thiol group content. FTIR spectra showed a characteristic peak of -SH and charring point was also changed considerably confirming the successful thiolation of PEC. SEM results showed spherical microspheres in the size range of 2-10 µm. Thiol-rich formulation of MS exhibited more than 80 % release after 12 h and maximum absorbable dose (MAD) was calculated as 400 µg % inhibition of edema in MS treated group was slowly attained initially but the reduction in inflammation was detected even after 24 h as compared to control group. Promising results from In-vivo edema inhibition study suggest the possible use of these thiolated MS in formulating sustained release formulation for arthritis.

Modeling and validation of purification of pharmaceutical compounds via hybrid processing of vacuum membrane distillation.

This study provides an in-depth examination of forecasting the concentration of pharmaceutical compounds utilizing the input features (coordinates) r and z through a range of machine learning models. Purification of pharmaceuticals via vacuum membrane distillation process was carried out and the model was developed for prediction of separation efficiency based on hybrid approach. Dataset was collected from mass transfer analysis of process to obtain concentration distribution in the feed side of membrane distillation and used it for machine learning models. The dataset has undergone preprocessing, which includes outlier detection using the Isolation Forest algorithm. Three regression models were used including polynomial regression (PR), k-nearest neighbors (KNN), and Tweedie regression (TWR). These models were further enhanced using the Bagging ensemble technique to improve prediction accuracy and reduce variance. Hyper-parameter optimization was conducted using the Multi-Verse Optimizer algorithm, which draws inspiration from cosmological concepts. The Bagging-KNN model had the highest predictive accuracy (R2 = 0.99923) on the test set, indicating exceptional precision. The Bagging-PR model displayed satisfactory performance, with a slightly reduced level of accuracy. In contrast, the Bagging-TWR model showcased the least accuracy among the three models. This research illustrates the effectiveness of incorporating bagging and advanced optimization methods for precise and dependable predictive modeling in complex datasets.

Cubital tunnel syndrome and stroke coincide - adding insult to injury.

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Evaluation of clinical outcomes of anidulafungin for the treatment of candidemia in hospitalized critically ill patients with obesity: A multicenter, retrospective cohort study.

OBJECTIVES: To evaluate the clinical outcomes of anidulafungin for candidemia treatment in critically ill patients with obesity. METHODS: A multicenter, retrospective cohort study was conducted in Saudi Arabia for critically ill adults with candidemia who received anidulafungin. Patients with obesity have a body mass index ≥30 kg/m2. The primary outcome was the clinical cure rate. RESULTS: A total of 146 patients were included, 64 of whom were obese. There were no statistically significant differences in the clinical cure rate (P = 0.63), microbiological cure rate (P = 0.27), or the median time for a clinical cure (P = 0.13) for patients with obesity compared to non-obese patients. The median time for a microbiological cure was longer in non-obese patients than in patients with obesity (P = 0.04). The median hospital length of stay and the median mechanical ventilation durations were numerically longer in patients with obesity. CONCLUSIONS: Clinical and microbiological cure rates and time for clinical cure were statistically similar for both groups. Considering the study's limitations (especially with a small sample size), it is uncertain if patients with obesity have similar effectiveness to non-obese patients. Future studies with larger sample sizes are warranted to evaluate if obesity negatively impacts anidulafungin's clinical outcomes for candidemia.

Thiazine-derived compounds in inhibiting efflux pump in Staphylococcus aureus K2068, mepA gene expression, and membrane permeability alteration.

Staphylococcus aureus is a bacterium responsible for resistance to multiple drugs and the efflux system is widely studied among the resistance mechanisms developed by this species. The present study evaluates the inhibition of the MepA efflux pump by thiadiazine-derived compounds. For this purpose, thiadiazine-derived compounds (IJ-14 to IJ-20) were tested against S. aureus K2068 strains. Microdilution tests were initially conducted to assess the Minimum Inhibitory Concentration (MIC) of the compounds and their efflux pump inhibition activity. In addition, fluorimetry tests were performed using BrEt emission and tests were conducted to inhibit the expression of the mepA gene. This involved comparing the bacterial gene expression with the antibiotic alone to the gene expression after combining compounds (IJ-17 and IJ-20) with the antibiotic. Furthermore, membrane permeability assessment tests and in silico molecular docking tests were performed. It was observed that the IJ17 and IJ20 compounds exhibited direct activity against the tested strain. The IJ17 compound produced significant results in the gene inhibition tests, which was also evidenced through the membrane permeability alteration test. These findings suggest that thiadiazine-derived compounds have promising effects against one of the main resistance mechanisms, with the IJ17 compound presenting observable mechanisms of action.

Synthesis, Anticancer Activity, and Molecular Docking of New 1,2,3-Triazole Linked Tetrahydrocurcumin Derivatives.

Cancer is one of the deadliest diseases to humanity. There is significant progress in treating this disease, but developing some drugs that can fight this disease remains a challenge in the field of medical research. Thirteen new 1,2,3-triazole linked tetrahydrocurcumin derivatives were synthesized by click reaction, including a 1,3-dipolar cycloaddition reaction of tetrahydrocurcumin baring mono-alkyne with azides in good yields, and their in vitro anticancer activity against four cancer cell lines, including human cervical carcinoma (HeLa), human lung adenocarcinoma (A549), human hepatoma carcinoma (HepG2), and human colon carcinoma (HCT-116) were investigated using MTT(3-(4,5-dimethylthiazole-2-yl)-2,5-diphenyltetraz-olium bromide) assay. The newly synthesized compounds had their structures identified using NMR HRMS and IR techniques. Some of prepared compounds, including compounds 4g and 4k, showed potent cytotoxic activity against four cancer cell lines compared to the positive control of cisplatin and tetrahydrocurcumin. Compound 4g exhibited anticancer activity with a IC50 value of 1.09 ± 0.17 µM against human colon carcinoma HCT-116 and 45.16 ± 0.92 µM against A549 cell lines compared to the positive controls of tetrahydrocurcumin and cisplatin. Moreover, further biological examination in HCT-116 cells showed that compound 4g can arrest the cell cycle at the G1 phase. A docking study revealed that the potential mechanism by which 4g exerts its anti-colon cancer effect may be through inhabiting the binding of APC-Asef. Compound 4g can be used as a promising lead for further exploration of potential anticancer agents.

Discovery of new 1,3-diphenylurea appended aryl pyridine derivatives as apoptosis inducers through c-MET and VEGFR-2 inhibition: design, synthesis, in vivo and in silico studies.

Interest has been generated in VEGFR-2 and c-MET as potential receptors for the treatment of different malignancies. Using aryl pyridine derivatives with 1,3-diphenylurea attached, a number of promising dual VEGFR-2 and c-MET inhibitors were developed and synthesized. Regarding the molecular target, compounds 2d, 2f, 2j, 2k, and 2n had potent IC50 values of 65, 24, 150, 170, and 18 nM against c-MET, respectively. Additionally, they had potent IC50 values of 310, 35, 290, 320, and 24 nM against VEGFR-2, respectively. Regarding cytotoxicity, compounds 2d, 2f, 2j, 2k and 2n exhibited potent cytotoxicity against MCF-7 with IC50 values in the range 0.76-21.5 µM, and they showed promising cytotoxic activity against PC-3 with IC50 values in the range 1.85-3.42 µM compared to cabozantinib (IC50 = 1.06 µM against MCF-7 and 2.01 µM against PC-3). Regarding cell death, compound 2n caused cell death in MCF-7 cells by 87.34-fold; it induced total apoptosis by 33.19% (8.04% for late apoptosis, 25.15% for early apoptosis), stopping their growth in the G2/M phase, affecting the expression of apoptosis-related genes P53, Bax, caspases 3 and 9 and the anti-apoptotic gene, Bcl-2. In vivo study illustrated the anticancer activity of compound 2n by reduction of tumor mass and volume, and the tumor inhibition ratio reached 56.1% with an improvement of hematological parameters. Accordingly, compound 2n can be further developed as a selective target-oriented chemotherapeutic against breast cancer.

Strong association between sarcopenic obesity and non-alcoholic fatty liver disease: An observational study with ISarcoPRM algorithm.

BACKGROUND: In recent times, sarcopenia and non-alcoholic fatty liver disease (NAFLD) have garnered widespread attention in public health. Nevertheless, the relationship between sarcopenia and NAFLD remains uncertain. This study investigated the association between NAFLD and sarcopenia in the elderly population. METHODS: In this cross-sectional study, 1099 adults aged 60 and older participated. The participants were classified based on their body composition, and the International Society of Physical and Rehabilitation Medicine's diagnostic algorithm (ISarcoPRM) was utilized to diagnose sarcopenia, while the fatty liver index was utilized to diagnose NAFLD. Binary logistic regression analysis determined the correlation between NAFLD and sarcopenia. RESULTS: Of the 1099 participants, 213 (58.2 %) males and 480 (65.5 %) females were afflicted with NAFLD. After adjusting for other clinical factors, exercise was found to decrease the likelihood of NAFLD in females (but not in males) by approximately 70 % [relative risk (RR): 0.312, 95 % confidence interval (CI): 0.182-0.547]. In addition, sarcopenia was not discerned as a risk factor for NAFLD in either gender (both p > 0.05). However, obesity increased the likelihood of NAFLD in males by 27.5 (95 % CI: 10.4-73.1) and in females by 28.1 (95 % CI: 17.1-46.4), and sarcopenic obesity increased the likelihood of NAFLD by 49.5 (95 % CI: 11.1-219.1) in males and 35.5 (95 % CI: 18.5-68.2) in females (all p < 0.001). CONCLUSION: Our study suggests that sarcopenia is not a risk factor for NAFLD in non-obese elderly subjects. However, a strong association was observed between obesity, especially sarcopenic obesity, and NAFLD. Regular physical activity seems protective for NAFLD in older females.