Safety and efficacy of lithium in patients with amyotrophic lateral sclerosis: a systematic review and meta-analysis of randomized controlled trials.

OBJECTIVES: This study provides a systematic review and meta-analysis of randomized controlled trials (RCTs) investigating the safety and efficacy of lithium in amyotrophic lateral sclerosis (ALS) patients. METHODS: PubMed, Web of Science, Cochrane CENTRAL, Scopus, and Your Journals@Ovid were searched up to 9 December 2022. RCTs investigating lithium, either alone or with any supplement, in ALS patients were included. Meta-analysis was performed using RevMan and results are presented in forest plot. RESULTS: Four RCTs with 469 patients met the inclusion criteria and were included in our study. Lithium doses varied among the included studies and one study used a combined therapy of lithium with valproate. Meta-analysis showed no difference between lithium and placebo regarding severe adverse events (odds ratio = 1.13, 95% confidence interval: 0.73 to 1.75, P = 0.58). No significant differences were observed with regard to survival rate between the two groups (hazard ratio = 0.95, 95% confidence interval: 0.65 to 1.37, P = 0.77). There were also no significant differences between the two groups with regard to average changes of revised amyotrophic lateral sclerosis functional rating scale (P = 0.35) and forced vital capacity percentage predicted (P = 0.73). Subgroup analysis showed no significant differences regarding all investigated outcomes either for lithium alone or lithium with valproate. CONCLUSION: Current evidence suggests a safety profile with no benefit of lithium for ALS. However, given the limited number of RCTs and the safety findings, we recommend further well-designed RCTs to investigate lithium and valproate in ALS patients.

Gut brain axis: an insight into microbiota role in Parkinson's disease.

Parkinson's disease (PD) is one of the most common progressive neurodegenerative diseases. It is characterized neuropathologically by the presence of alpha-synuclein containing Lewy Bodies in the substantia nigra of the brain with loss of dopaminergic neurons in the pars compacta of the substantia nigra. The presence of alpha-synuclein aggregates in the substantia nigra and the enteric nervous system (ENS) drew attention to the possibility of a correlation between the gut microbiota and Parkinson's disease. The gut-brain axis is a two-way communication system, which explains how through the vagus nerve, the gut microbiota can affect the central nervous system (CNS), including brain functions related to the ENS, as well as how CNS can alter various gut secretions and immune responses. As a result, this dysbiosis or alteration in gut microbiota can be an early sign of PD with reported changes in short chain fatty acids, bile acids, and lipids. This gave rise to the use of probiotics and faecal microbiota transplantation as alternative approaches to improve the symptoms of patients with PD. The aim of this review is to discuss investigations that have been done to explore the gastrointestinal involvement in Parkinson's disease, the effect of dysbiosis, and potential therapeutic strategies for PD.

First report of seroprevalence and genetic characterization of avian orthoreovirus in Egypt.

Recently, the Egyptian broiler industry has experienced an increased incidence of avian reovirus (ARV) infections. However, to date, no studies have been carried out to investigate the epidemiologic status of ARV infections as well as the genetic characteristics of the currently circulating ARV strains. The present study estimates the seroprevalence of ARV infections in Alexandria, El-Behera, Giza, Kafr El-Sheikh, and Gharbia governorates, Egypt, during the period 2017-2018. A total of 150 serum samples from 15 unvaccinated broiler flocks with suspicious ARV infection were screened using a commercial enzyme-linked immunosorbent assay kit. All the tested flocks were found to be positive for ARV-specific antibodies, and the overall seropositivity rate was 80.6%. Meanwhile, 5 (33.3%) flocks were confirmed for the presence of ARV through a reverse transcription-polymerase chain reaction (RT-PCR) assay based on the σA-encoding gene. Phylogenetic analysis based on the nucleotide sequences of the σA-encoding gene revealed that the obtained ARV isolate, designated EGY1, was grouped in the S1113-like cluster of ARV and displayed 100% and 98.7% nucleotide identity with the Chinese MSO1 isolate and the S1133 vaccine strain, respectively. In addition, amino acid alignments with the S1133 vaccine strain revealed that the σA protein of the EGY1 isolate carried the substitutions G81S and A118V. In conclusion, the present study provides the evidence for a ubiquitous distribution of ARV infection in Egypt as well as represents a starting point for genetic characterization of the currently circulating ARV strains.