Outer Membrane Vesicles (OMVs) as Biomedical Tools and Their Relevance as Immune-Modulating Agents against H. pylori Infections: Current Status and Future Prospects.

Outer membrane vesicles (OMVs) are lipid-membrane-bounded nanoparticles that are released from Gram-negative bacteria via vesiculation of the outer membrane. They have vital roles in different biological processes and recently, they have received increasing attention as possible candidates for a broad variety of biomedical applications. In particular, OMVs have several characteristics that enable them to be promising candidates for immune modulation against pathogens, such as their ability to induce the host immune responses given their resemblance to the parental bacterial cell. Helicobacter pylori (H. pylori) is a common Gram-negative bacterium that infects half of the world's population and causes several gastrointestinal diseases such as peptic ulcer, gastritis, gastric lymphoma, and gastric carcinoma. The current H. pylori treatment/prevention regimens are poorly effective and have limited success. This review explores the current status and future prospects of OMVs in biomedicine with a special focus on their use as a potential candidate in immune modulation against H. pylori and its associated diseases. The emerging strategies that can be used to design OMVs as viable immunogenic candidates are discussed.

Perfusion index as an objective measure of postoperative pain in children undergoing adenotonsillectomy: a cohort study.

Postoperative pain in children is usually undertreated because of their inability to complain. While several pain assessment scales have been developed, they have shortcomings such as subjectivity and being observer-dependent. This study aimed to assess the validity of the perfusion index as an objective measure of postoperative pain in children undergoing adenotonsillectomy. Children aged 3-7 years were enrolled. The Children's Hospital of Eastern Ontario Scale (CHEOPS) was used to assess postoperative pain. The perfusion index was measured at the same time intervals as CHEOPS. The highest CHEOPS before rescue analgesia was administered and CHEOPS when the patients became pain-free were recorded with the corresponding perfusion index. The primary outcome was the correlation between the postoperative CHEOPS and the corresponding postoperative perfusion index. The secondary outcomes were the ability of perfusion index changes to predict the presence of postoperative pain and patients' response to analgesics. The postoperative perfusion index was negatively correlated with CHEOPS at 30 and 90 min postoperatively. The change in the preoperative baseline perfusion index (ΔPI-pre) was moderately correlated with the highest CHEOPS (CHEOPS-1) (r = 0.61, p = 0.001). The change in the postoperative perfusion index (ΔPI-po) was negatively correlated with the change in the CHEOPS (ΔCHEOPS) (r = - 0.53, P = 0.0001). The ΔPI-pre was an excellent predictor of postoperative pain (AUROC 0.83 with 71% sensitivity, 83% specificity, and a cut-off value of ≥ 0.26). The perfusion index is a good objective measure for predicting the presence of postoperative pain in children undergoing adenotonsillectomy under general anesthesia. Trial registration: ClinicalTrials.gov; ID: (NCT03854604) registered on February 2019.

Intraoperative MgSO4 infusion protects oxygenation and lung mechanics in COPD patients during general anesthesia. A randomized clinical trial.

BACKGROUND: The purpose of this study was to examine the effects of an intraoperative MgSO4 infusion on arterial oxygenation and lung mechanics in patients with moderate COPD undergoing cancer larynx surgery under general anesthesia (GA). Our primary outcome was arterial oxygenation determined by the PaO2 and PaO2 /FiO2 . The secondary outcomes were lung mechanics (peak airway pressure, airway plateau pressure, dead space, lung compliance, airway resistance) and postoperative complications. METHODS: In this randomized controlled double-blinded trial, 40 patients with an ASA classifications II and/or III who were diagnosed with moderate COPD and who were scheduled for cancer larynx surgery under GA were randomly allocated into two equal groups, the target (Mg group) and control group (C group). In the Mg group, 30 mg/kg of 10% MgSO4 solution was administered intravenously for over 20 minutes as the loading dose, followed by the continuous infusion of 10 mg/kg/hr In the C group, the same loading and maintenance infusion rates were administered using 0.9% saline. RESULTS: Unlike the C group (baseline "T0" to post-infusion "T1" interval 294 ± 97 vs 238 ± 71 mm Hg, respectively, P = .04 ± SD), the Mg group exhibited preserved intraoperative PaO2 (T0 to T1 interval 271 ± 89 vs 257 ± 53 mm Hg, respectively, P = .54 ± SD) and PaO2 /FiO2 (C group T0 to T1 interval 404 ± 81 vs 349 ± 84, P = .04 and Mg group 394 ± 91 vs 379 ± 95, P = .61, respectively), and these effects were modest. Further, compared to the C group, the Mg group exhibited lower airway resistance, dead space, airway plateau pressure, and peak airway pressure, and higher dynamic compliance. The postoperative PaO2 and PaO2 /FiO2 were higher in the Mg group compared to the C group. CONCLUSIONS: Intraoperative infusion of MgSO4 in patients with moderate COPD undergoing laryngectomy surgery under GA produces mild perioperative protective effects on both arterial oxygenation and lung mechanics. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03461328; registration date: 8 March 2018.

Ultrasound-guided quadratus lumborum block for postoperative pain control in patients undergoing unilateral inguinal hernia repair, a comparative study between two approaches.

BACKGROUND: Early postoperative ambulation and reduction of hospital stay necessitate efficient postoperative analgesia. Quadrates Lumborum Block (QLB) has been described to provide adequate postoperative analgesia after abdominal surgery. This randomized comparative trial was designed to compare the duration of analgesia provided by two different QLB approaches; the posterior QLB (QLB-2) and transmuscular QLB (QLB-3) in patients undergoing surgical repair of unilateral inguinal hernia. METHODS: Forty patients, aged from 18 to 50 years, ASA physical status I or II, scheduled for unilateral inguinal hernia repair were enrolled. At the end of the surgical procedure and before recovery from general anesthesia, Patients were randomly assigned into two groups to receive either posterior QLB (Group QLB-2) or transmuscular QLB (Group QLB-3) using 20 ml 0.25% bupivacaine. Duration of analgesia, postoperative VAS and postoperative opioid consumption were recorded. RESULTS: Duration of block was significantly longer in QLB-3 group when compared to QLB-2 group (20.1 + 6.2 h versus 12.0 + 4.8 respectively) with P value of < 0.001. A statistically significant lower VAS score was recorded in QLB-3 group immediately and 12 h postoperative. QLB-3 group showed a statistically significant delayed time of first analgesic request and less postoperative morphine consumption with P value of < 0.001 and 0.001 respectively. CONCLUSIONS: Ultrasound guided postsurgical transmuscular approach of QLB (QLB-3) using 20 ml 0.25% bupivacaine produces more postoperative analgesic effect and less postoperative opioid consumption when compared to posterior QLB approach (QLB-2) in patients underwent unilateral inguinal hernia repair under general anesthesia. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03526731 - on 16 May 2018.

Psychological impact of female genital mutilation among adolescent Egyptian girls: a cross-sectional study.

OBJECTIVES: Worldwide, at least 200 million women and girls have undergone female genital mutilation (FGM). The medical and sexual consequences have been documented, but the psychological impact has not been studied to the same extent. The aim of this study was to explore the relationship between FGM and psychiatric problems among adolescent girls. METHODS: A total of 204 girls, aged 14-19 years, were included in a cross-sectional study conducted at Suez Canal University Hospitals. All participants completed an Arabic-validated, structured questionnaire covering nine symptom scales. Sociodemographic data were also collected. Main outcome measures were the prevalence of psychiatric problems among adolescent girls who had undergone FGM. RESULTS: Overall, 66.2% of girls had undergone FGM. The percentage in rural areas was 91.8%, compared with 43.0% in urban areas. There were no significant differences between the FGM and non-FGM groups as regards religion, educational and socioeconomic levels. FGM girls had a significantly higher level of psychological problems with regard to somatisation, depression, anxiety, phobic anxiety and hostility compared with non-FGM girls (p < .0001). CONCLUSIONS: FGM is a traumatic experience that may leave a lasting psychological mark and a negative impact on the psychological status of affected girls.

Comparative studies of four cumin landraces grown in Egypt.

One of the significant aromatic plants applied in food and pharma is cumin. Despite its massive trading in Egypt, there are no comprehensive reports on cumin landraces profile screening. This study aimed to investigate the variation in seeds' physical and biochemical profiles and genetic diversity as well as assess the efficiency of seeds' germination under salinity stress. Consequently, during the 2020/2021 growing season, four common cumin seed landraces were gathered from various agro-climatic regions: El Gharbia, El Menia, Assiut, and Qena. Results showed a significant variation in physical profile among the four seeds of landraces. In addition, Assiut had the highest percentage of essential oil at 8.04%, whilst Qena had the largest amount of cumin aldehyde, the primary essential oil component, at 25.19%. Lauric acid was found to be the predominant fatty acid (54.78 to 62.73%). According to ISSR amplification, El Menia presented a negative unique band, whereas other landraces offered a positive band. Additionally, the cumin genotypes were separated into two clusters by the dendrogram, with El Gharbia being located in an entirely separate cluster. There were two sub-clusters within the other cluster: El Menia in one and Assiut and Qena in the other. Moreover, the germination sensitivity to the diverse salinity concentrations (control, 4, 8, 12, and 16 dS/m) findings showed that landraces exhibited varying responses to increased salinity when El Gharbia and El Menia showed a moderate response at four dS/m. Whilst, Qena landraces showed supreme values among other landraces under 12 and 16 dS/m. The majority of the examined features had strong positive associations over a range of salinity levels, according to phenotypic correlation coefficient analysis. To accomplish the aims of sustainable agriculture in Egypt, it would be imperative that the potential breeding program for cumin landraces consider this screening study.

Pigmented dentinogenic ghost cell tumor: a unique case report and a review of the literature.

Dentinogenic ghost cell tumors are rare tumors, and few cases of them were reported in the literature. The presence of pigment in odontogenic lesions is a rare unexplained histological finding. In this report, we describe a unique case of a 7-year-old girl that was referred to the Department of Oral and Maxillofacial Surgery complaining of a left mandibular swelling. Clinical examination revealed a huge, ulcerated mass. Both incisional and excisional biopsies revealed a benign infiltrative odontogenic tumor with admixed ameloblast-like cells and pigmented ghost cells, consistent with a pigmented dentinogenic ghost cell tumor. To the best of our knowledge, this is the youngest case of intraosseous dentinogenic ghost cell tumor reported in the English literature and the second report of a pigmented variant. This rare variant should be included in the differential of pigmented odontogenic lesions to avoid misinterpretation, especially in small biopsies.

Epidemiological and histopathological patterns of malignant salivary gland tumors in the Sudanese population.

Background: Malignant salivary gland tumors are rare. However, their morphological overlap and difficulty to differentiate benign from malignant makes diagnosing such diseases a challenging task. Geographical variation in distribution of these diseases is well documented in the literature. This study aims to review the histological and epidemiological variations of malignant salivary gland tumors in Sudanese patients considering the new WHO 2022 classification. Methodology: This retrospective study included malignant salivary gland tumours in our lab spanning from the period of 2014 to 2022. Information about clinical data, habits, geographical distribution, pathological diagnosis, duration and sites of tumors were retrieved from our archives. Equivocal cases were checked by a salivary gland expert. Data analysis was performed using IBM SPSS 29. Results: This study included 107 cases of malignant salivary gland tumours, representing 54 % of the total number of salivary gland tumours in the lab during that period. 47.7 % of the patients in this study were females and 52.3 % were males, the mean age of patients was 50 ± 15.7 years. (30 %) of the patients were from the central region of the country. The most common malignant salivary gland tumor was the Mucoepidermoid carcinoma accounting for 17 %. The palate was found to be the most common site as 38 % of malignant salivary gland tumors occurred in this site. Conclusion: The study found a high percentage of salivary gland tumours in the Sudan suggesting geographical differentiation.

Teicoplanin-Decorated Reduced Graphene Oxide Incorporated Silk Protein Hybrid Hydrogel for Accelerating Infectious Diabetic Wound Healing and Preventing Diabetic Foot Osteomyelitis.

Developing hybrid hydrogel dressings with anti-inflammatory, antioxidant, angiogenetic, and antibiofilm activities with higher bone tissue penetrability to accelerate diabetic wound healing and prevent diabetic foot osteomyelitis (DFO) is highly desirable in managing diabetic wounds. Herein, the glycopeptide teicoplanin is used for the first time as a green reductant to chemically reduce graphene oxide (GO). The resulting teicoplanin-decorated reduced graphene oxide (rGO) is incorporated into a mixture of silk proteins (SP) and crosslinked with genipin to yield a physicochemically crosslinked rGO-SP hybrid hydrogel. This hybrid hydrogel exhibits high porosity, self-healing, shear-induced thinning, increased cell proliferation and migration, and mechanical properties suitable for tissue engineering. Moreover, the hybrid hydrogel eradicates bacterial biofilms with a high penetrability index in agar and hydroxyapatite disks covered with biofilms, mimicking bone tissue. In vivo, the hybrid hydrogel accelerates the healing of noninfected wounds in a diabetic rat and infected wounds in a diabetic mouse by upregulating anti-inflammatory cytokines and downregulating matrix metalloproteinase-9, promoting M2 macrophage polarization and angiogenesis. The implantation of hybrid hydrogel into the infected site of mouse tibia improves bone regeneration. Hence, the rGO-SP hybrid hydrogel can be a promising wound dressing for treating infectious diabetic wounds, providing a further advantage in preventing DFO.

Enhancing Women's Quality of Life: Exploring the Impact of Mastectomy with and without Breast Reconstruction among Breast Cancer Survivors in Iraq.

BACKGROUND AND AIMS: Mastectomy, a common intervention for breast cancer, has substantial implications for a woman's quality of life (QoL). However, the literature on QoL outcomes following mastectomy-with or without breast reconstruction (BR) is scant. This study aims to assess and compare the QoL among Iraqi women post-mastectomy, examining the impacts of undergoing BR. METHODS: We conducted a comprehensive cross-sectional study across multiple centers in Iraq from April to September 2021. Our cohort consisted of 404 women who had a mastectomy for breast cancer treatment, 154 of whom also chose to have BR. Utilizing the European Organisation for Research and Treatment of Cancer's (EORTC) tools specifically, select domains from EORTC QLQ-BR23, QLQ-C30, and QLQ-BRECON23-we evaluated various facets of their QoL. RESULTS: The mean QoL score was 54 out of 100, with patients who did not undergo BR reporting slightly higher scores (55) compared to those who did (52). Notably, social and sexual functioning scores were statistically superior in the non-BR group. Satisfaction with surgery, sexual function, and breast aesthetics were the lowest rated aspects among BR patients, indicating a considerable gap between expectations and outcomes. Marital status and the type of mastectomy notably influenced body image and sexual function. A significant portion of patients (100 out of 250) opted out of BR due to recurrence concerns, while 26.2% (106 out of 154) pursued BR to restore their pre-mastectomy physique. CONCLUSION: Contrary to the anticipated benefits of BR, our findings suggest that women who underwent the procedure reported a lower QoL compared to those who did not. The outcomes highlight the discrepancy between expected and actual benefits of BR, suggesting a pressing need for comprehensive rehabilitation programs. These programs should aim to enhance the QoL for post-mastectomy patients and provide in-depth counseling to align expectations with the potential realities of BR.

Antileishmanial activity, uptake, and biodistribution of an amphotericin B and poly(α-Glutamic Acid) complex.

A noncovalent, water-soluble complex of amphotericin B (AMB) and poly(α-glutamic acid) (PGA), with AMB loadings ranging from 25 to 55% (wt/wt) using PGA with a molecular weight range of 50,000 to 70,000, was prepared as a potential new treatment for visceral leishmaniasis (VL). The AMB-PGA complex was shown to be as active as Fungizone (AMB deoxycholate) against intracellular Leishmania donovani amastigotes in differentiated THP-1 cells. The in vitro uptake of the AMB-PGA complex by differentiated THP-1 cells was similar to that of Fungizone and higher than that of AmBisome (liposomal AMB). The AMB-PGA complex also displayed a dose-response profile similar to that of AmBisome in vivo in BALB/c mice against L. donovani, with 50% effective doses (ED50s) of 0.24 ± 0.03 mg/kg of body weight for the AMB-PGA complex and 0.24 ± 0.06 mg/kg for AmBisome. A biodistribution study with mice indicated that the AMB-PGA complex cleared more rapidly from plasma than AmBisome, with a comparable low level of distribution to the kidneys.

Noncovalent complexation of amphotericin-B with Poly(α-glutamic acid).

A noncovalent complex of amphotericin B (AmB) and poly(α-glutamic acid) (PGA) was prepared to develop a safe and stable formulation for the treatment of leishmaniasis. The loading of AmB in the complex was in the range of ∼20-50%. AmB was in a highly aggregated state with an aggregation ratio often above 2.0. This complex (AmB-PGA) was shown to be stable and to have reduced toxicity to human red blood cells and KB cells compared to the parent compound; cell viability was not affected at an AmB concentration as high as 50 and 200 µg/mL respectively. This AmB-PGA complex retained AmB activity against intracellular Leishmania major amastigotes in the differentiated THP-1 cells with an EC50 of 0.07 ± 0.03-0.08 ± 0.01 µg/mL, which is similar to Fungizone (EC50 of 0.06 ± 0.01 µg/mL). The in vitro antileishmanial activity of the complex against Leishmania donovani was retained after storage at 37 °C for 7 days in the form of a solution (EC50 of 0.27 ± 0.03 to 0.35 ± 0.04 µg/mL) and for 30 days as a solid (EC50 of 0.41 ± 0.07 to 0.63 ± 0.25 µg/mL). These encouraging results indicate that the AmB-PGA complex has the potential for further development.

Glycogen phosphorylase-a is a common target for anti-diabetic effect of iridoid and secoiridoid glycosides.

PURPOSE: Diabetes mellitus is characterized by hyperglycemia resulting from defects in insulin secretion, action or both. The use of medicinal plants for the treatment of diabetes mellitus dates back from the Ebers papyrus of about 1550 B.C. One of the major problems with herbal drugs is that the active ingredients are not well defined. It is important to know the active components and their molecular interactions which will help to analyze their therapeutic efficacy and also to standardize the product. There are a number of medicinal plants known for their anti-diabetic effect that possess similarities in their active chemical components, e.g. iridoid and secoiridoid glycosides. METHODS: In this study, we have compared the structure of various iridoid and secoiridoid glycosides to design a novel pharmacophore. We further developed a structure-activity relationship for the inhibition of glycogen phosphorylase-a. CONCLUSION: By using docking studies, we are proposing, for the first time, that inhibition of glycogen phosphorylase-a activity is a common target for iridoids and secoiridoids to elicit anti-diabetic effects. This article is open to POST-PUBLICATION REVIEW. Registered readers (see "For Readers") may comment by clicking on ABSTRACT on the issue's contents page.

Maternal serum leptin as a marker of preeclampsia.

PURPOSE: To assess maternal leptin levels as a marker for preeclampsia (PE) and to explore the possibility of leptin being a marker of severity of preeclampsia. PARTICIPANTS AND METHODS: Comparative prospective study was conducted among a total of 72 pregnant women at 28-38 weeks of gestation. They were divided into two groups (control and study) according to the absence or presence of clinical parameters of preeclampsia. Leptin was measured for both groups at the time of presentation, once weekly and at the termination of pregnancy. RESULTS: Leptin levels were found to be significantly higher among all preeclampsia patients when compared to the control group; whether at admission or at the time of delivery. Mean serum leptin level at admission in control group was 9.8 ng/ml versus 10.9 ng/ml in mild cases and 17.6 ng/ml in severe cases. At the time of delivery, mean serum leptin in control group decreased to 4.7 ng/ml while in preeclampsia patients it increased up to 22 ng/ml in mild cases and 42.6 ng/ml in severe cases. ROC curve analysis has shown that a cut off value >13.7 ng/ml can be used to detect presence of preeclampsia with a sensitivity of 91% and specificity 100% while a cut off value >22.5 ng/ml can be used to detect severity of preeclampsia with a sensitivity of 85% and specificity 100%. CONCLUSION: Maternal serum leptin is significantly elevated in preeclampsia, also it can be used as a marker for the presence of preeclampsia and to differentiate patients with mild preeclampsia from those with severe disease.