Whole-genome sequencing of Egyptian multidrug-resistant Klebsiella pneumoniae isolates: a multi-center pilot study.

Multidrug-resistant (MDR) Klebsiella pneumoniae is a common infectious pathogen. We performed whole-genome sequencing (WGS) of 39 randomly selected, geographically diverse MDR K. pneumoniae from nine Egyptian hospitals. Clinical sources, phenotypic antibiotic resistance, and hyper-mucoviscosity were documented. WGS data were epidemiologically interpreted and tested for the presence of antibiotic resistance and virulence genes. Based on WGS data, we identified 18 classical multi-locus sequence types (MLST), the most common type being ST101 (23.1%) followed by ST147 (17.9%). Phylogenetic analyses identified small numbers of closely related isolates in a few of the centers, so we mostly documented independent nosocomial acquisition or import from public sources. The most common acquired resistance gene found was blaCTX-M-15, detected in 27 isolates (69.2%). Carbapenemase genes encountered were blaNDM-1 (n = 13), blaNDM-5 (n = 1), blaOXA-48 (n = 12), blaOXA-181 (n = 2), and blaKPC2 (n = 1). Seven strains (18%) contained more than a single carbapenemase gene. While searching for virulence-associated genes, sixteen wzi alleles were identified with wzi137, wzi64, and wzi50 most commonly found in ST101, ST147, and ST16, respectively. Yersiniabactin was the most common virulence factor (69.2%). Hyper-mucoviscosity was documented for 6 out of 39 isolates.This is the first genomic study of MDR K. pneumoniae from Egypt. The study revealed a clear spread of well-known international clones and their associated antimicrobial resistance and (hyper)virulence traits. The clinical situation in Egypt seems to reflect the scenario documented in many other countries and requires close attention.

Assessment of sexual functions in male patients with obstructive sleep apnea.

PURPOSE: Obstructive sleep apnea is characterized by repetitive cessation of breathing during sleep. It affects different aspects of sexuality. We aimed to assess male sexual function & risk factors in obstructive sleep apnea patients. METHODS: This case control study included 2 groups, 45 healthy volunteers as control group and 45 patients with confirmed diagnosis of obstructive sleep apnea. All the participants were subjected to measurement of Body Mass Index, Full night polysomnography (only for patients group) and serum total testosterone, FSH and LH. The International Index of Erectile Function-5 and Hamilton Depression Scale questionnaires were filed out for all participants. RESULTS: The mean scores for all sexual domains were significantly lower among the patients group compared to the control group (p<0.01). The Hamilton score was significantly higher among the patients group compared to the control group (p<0.0001). The mean levels of Testosterone and LH were significantly lower among the patients group compared to controls (p<0.0001), There were significant correlations between disease severity and age (r=0.48, p=0.001), Body mass index (r=0.48, p=0.001), Hamilton score (r=0.34, p=0.014) International Index of Erectile Function 5 domain score (r= -0.29, p=0.045)Testosterone level (r= -0.29, p=0.046) and LH levels (r= -0.104, p=0.049). CONCLUSION: We found that all domains of sexual function have been affected in patients group than controls. Their score was inversely related to the disease severity; which in turn has a complex interaction with other factors like age, obesity, hormones and psychological status. So when evaluating those patients, sexual dysfunction should be considered and assessed along with these factors.

Lens in Primary Congenital Glaucoma Eyes Treated by Combined Angle and Filtering Surgery.

PURPOSE: To report on the changes in the natural crystalline lens in primary congenital glaucoma (PCG) eyes that had undergone previous combined angle-filtering surgery with antimetabolites. SETTINGS: The pediatric ophthalmology unit of the ophthalmology department of Alexandria Main University Hospital. DESIGN: A retrospective chart review. METHODS: A retrospective chart review of patients presenting with and operated (by combined angle-filtering surgery with antimetabolites) for PCG in the period from 2005 to 2018. Any lens pathology was noted as well as the management and the outcome. RESULTS: The records of 422 children (613 eyes) were reviewed. Lens pathology was noted in 54 (8.8%) eyes. Abnormalities in lens clarity (cataract) were detected in 31 (56%) eyes, and abnormalities in lens position (subluxation) were detected in 24 (44%) eyes. Management options included observation (in 28 eyes), lensectomy for aphakia (in 14 eyes), lensectomy with in the bag intraocular lens (IOL) implantation (in 11 eyes), and lensectomy with iris-fixated IOL (in 1 eye). Elevation of intraocular pressure (IOP) occurred in only 4 eyes (of 26 operated eyes, 15.3%) after lens extraction. CONCLUSIONS: Changes in the natural crystalline lens clarity and/or position occurred in 8.8% (54 of 613) of PCG eyes operated by combined angle-filtering surgery with antimetabolites. Lens extraction was a relatively safe procedure with only 15% (4 of 26) of eyes suffering an elevation of IOP after lens extraction.

Biochar applied to soil under wastewater irrigation remained environmentally viable for the second season of potato cultivation.

The environmental effectiveness of plantain peel biochar in the second season of its application to soil was studied using outdoor lysimeters (0.45 m diameter x 1.0 m height) packed with sandy soil, cultivated with potatoes (Solanum tuberosum) and irrigated with wastewater. Biochar (1% w/w) was amended in the soil one-time in the first season. For two seasons, the biochar improved the soil properties, immobilized the heavy metals in the soil, and reduced their uptake by the crop. The CEC of the biochar-amended soil (WW + B) for example, as compared to the unamended treatment (WW-B), was significantly higher (p<0.05; >65%) for both seasons due to higher pH which controls the availability of cations in soils, influencing their CECs. The soil sampled in the second season showed accumulation of all the heavy metals in the topsoil, while only Zn, Pb and Fe moved to the 0.1 m depth. The Fourier transform infra-red spectra of the soil and soil-biochar mix were similar and suggested that oxygen-containing functional groups were partly responsible for binding the heavy metals. The heavy metals translocated to all the potato parts (flesh, peel, root, stem and leaves). The concentrations of the heavy metals in potato parts under freshwater were lower than those under wastewater irrigated condition. After the second season of being in the soil, biochar significantly reduced (p < 0.05) the concentrations of Cd, Cu, Cr, Pb and Zn in the edible flesh suggesting that biochar immobilized wastewater-laden heavy metals in soil and reduced their uptake in potatoes for at least two seasons.

Corneal biomechanics in different age groups.

PURPOSE: To report on the corneal biomechanical characteristics, namely the corneal hysteresis (CH), corneal resistance factor (CRF), as well as the intraocular pressure (IOP) goldman compensated (IOPg), and the cornea compensated (IOPcc), using the ocular response analyzer (ORA) in different age groups in a cohort of normal individuals from the second decade to the seventh decade and beyond. PATIENTS AND METHODS: The study was a cross-sectional survey conducted on 997 eyes of 508 normal individuals presenting for a routine ophthalmic examination at Alexandria Main University Hospital in Alexandria University, Alexandria, Egypt. The study subjects were age stratified into decades (10-20, 21-30, 31-40, 41-50, > 50) and the ORA parameters (CH, CRF, IOPg, IOPcc) reported and stratified. Correlations were sought between the ORA parameters and the age, gender, and laterality. RESULTS: The study was conducted on 997 (502 right) eyes of 508 (234 males) normal individuals. The mean ± SD ages of the study groups were 14.7 ± 3.2, 25.9 ± 3.0, 35.3 ± 2.8, 44.6 ± 2.9, and 61.1 ± 7.7 years. The mean ± SD of the CH in the study groups were 10.9 ± 2.4, 9.8 ± 1.5, 9.8 ± 1.4, 9.7 ± 1.7, and 9.5 ± 1.6 mmHg and of the CRF were 10.9 ± 2.4, 9.5 ± 1.7, 9.4 ± 1.8, 9.6 ± 1.9, and 9.6 ± 1.8 mmHg. A statistically significant negative correlation was found between age and each of CH and CRF. IOPcc demonstrated a fairly constant trend in the different age groups whereas IOPg demonstrated an initial decline followed by a gradual rise over time. CONCLUSION: The corneal biomechanical properties CH and CRF decrease with age. IOPg and IOPcc change minimally with age.

The c.-190 C>A transversion in promoter region of protamine 1 gene as a genetic risk factor in Egyptian men with idiopathic infertility.

Protamines are considered the most important structure in the sperm nucleus, and they are proteins with a significantly large amount of amino acids carrying a positive charge, which allows the formation of the tight package of the genomic DNA in the spermatozoa. Many authors studied the abnormalities in the protamine 1 (PRM1) and/or protamine 2 (PRM2) genes and reported their possible association with male infertility. The chromosome 16 (16p13.2) carries these genes containing multiple undiscovered single nucleotide polymorphisms. The aim of the present study was to investigate the association of c.-190 C>A transversions that occur in PRM1 with idiopathic infertility in a sample of Egyptian men. It was a case-control study, and blood samples were collected from sixty male patients complaining of idiopathic infertility and forty healthy fertile males. The c.-190 C>A transversion in promotor region protamine 1 gene (rs2301365) was assessed by 5' nuclease assay, using Rotor-Gene Q real-time PCR system. The results of the present study revealed that CA and AA genotypes in PRM1 gene were associated significantly with low sperm concentration and decreased sperm motility (p = 0.001). Cases carrying A allele had a 6.05-fold increased risk for idiopathic infertility than cases carrying the C allele (OR: 6.05, 95% CI: 2.038-17.98 p statistically significant ≤0.05). Analysis of the results revealed that the c.-190 C>A transversion may be involved in the development of male infertility.

Effect of biochar on heavy metal accumulation in potatoes from wastewater irrigation.

In many developing countries water scarcity has led to the use of wastewater, often untreated, to irrigate a range of crops, including tuber crops such as potatoes (Solanum tuberosum L.). Untreated wastewater contains a wide range of contaminants, including heavy metals, which can find their way into the edible part of the crop, thereby posing a risk to human health. An experiment was undertaken to elucidate the fate and transport of six water-borne heavy metals (Cd, Cr, Cu, Fe, Pb and Zn), applied through irrigation water to a potato (cv. Russet Burbank) crop grown on sandy soil, having either received no biochar amendment or having top 0.10 m of soil amended with 1% (w/w) plantain peel biochar. A non-amended control, irrigated with tap water, along with the two contaminated water treatments were replicated three times in a completely randomized design carried out on nine outdoor PVC lysimeters of 1.0 m height and 0.45 m diameter. The potatoes were planted, irrigated at 10-day intervals, and leachate then collected. Soil samples collected two days after each irrigation showed that all heavy metals accumulated in the surface soil; Fe, Pb and Zn were detected at 0.1 m depth, while only Fe was detected at 0.3 m depth. Heavy metals were not detected in the leachate. Tested individually, all portions of the potato plant (tuber flesh, peel, leaf, stem and root) bore heavy metals. Biochar-amended soil significantly reduced only Cd and Zn concentrations in tuber flesh (69% and 33%, respectively) and peel compared to the non-amended wastewater control (p < 0.05). Heavy metal concentrations were significantly lower in the tuber flesh than in the peel, suggesting that when consuming potatoes grown under wastewater irrigation, the peel poses a higher health risk than the flesh.

Association of Tumor Necrosis Factor Alpha-Induced Protein 3 Interacting Protein 1 (TNIP1) Gene Polymorphism (rs7708392) with Lupus Nephritis in Egyptian Patients.

Lupus nephritis (LN) is a major cause of morbidity and mortality in systemic lupus erythematosus (SLE). Previous studies suggest that mutant A20 binding inhibitor of NF-κB 1 (ABIN1) protein encoded by tumor necrosis factor alpha-induced protein 3 interacting protein 1 (TNIP1) gene is associated with LN via NF-κB dysregulation. The aim of the current study was to evaluate the association of TNIP1 gene SNP rs7708392 with SLE and LN in Egyptian patients. 5' nuclease Allelic discrimination was used to evaluate the frequency of TNIP1 SNP rs7708392 in 53 patients with LN, 57 SLE patients without nephritis and 85 healthy controls. The genotyping analysis revealed that the CC genotype was more frequent in controls than SLE patients, while GC and GG genotypes were more common in SLE patients. Moreover, the GG genotype and the G allele were significantly more prevalent among LN patient than non-LN patients (P < 0.001). In LN patients, the most common genotype was GG (56.6%), while among the non-LN patients; the CG genotype was the most common (59.6%). Regression analysis demonstrated that SLE patients carrying only one G allele had a 3.4 folds increased risk for LN. Our results suggested that TNIP1 SNP (rs7708392) might be associated with the LN in Egyptian SLE patients. TNIP1 SNP (rs7708392) might be used to identify patients at risk of developing LN, which could help in early detection and treatment before progression to end-stage renal disease, improving patients' outcome and quality of life.

Effect of biochar on fate and transport of manure-borne estrogens in sandy soil.

The feasibility of using two types of biochars to reduce steroid hormone pollution from poultry and swine manure application on agricultural land was evaluated. The sorption affinity and desorption resistance of softwood and hardwood biochars were also determined for two estrogen hormones, 17ß-estradiol (E2) and its primary metabolite estrone (E1). The softwood and hardwood biochars demonstrated high retention capacity for both estrogens. The effective distribution coefficient (Kdeff) of soil-softwood-derived biochar (SBS450) was significantly higher than soil-hardwood-derived biochar (SBH750), indicating the stronger sorption affinity of SBS450 for estrogens. To validate the laboratory results, a field lysimeter experiment was conducted to study the fate and transport of E2 and E1 in soil and leachate in the presence of 1% softwood-biochar (BS450) in topsoil and to compare it with soil without any amendments. The spatio-temporal distribution of both estrogens was monitored at four depths over a 46-day period. The lysimeters, in which the surface layer of soil was amended with biochar, retained significantly higher concentrations of both estrogen hormones. Although they leached through the soil and were detected in leachates, collected at 1.0m depth, the concentrations were significantly lower in the leachate collected from biochar-amended lysimeters. The result confirmed the efficacy of biochar amendment as a remediation technique to alleviate the manure-borne hormonal pollution of groundwater.

MicroRNA-200b Expression in the Vitreous Humor of Patients with Proliferative Diabetic Retinopathy.

BACKGROUND: The role of microRNA (miRNA)-200b in the pathogenesis of proliferative diabetic retinopathy (PDR) has been studied in diabetic animal models. The aim of this study was to assess miRNA-200b expression in the vitreous of patients with PDR and to determine its correlation with vascular endothelial growth factor (VEGF), one of the pathogenic mechanisms in PDR. METHODS: Quantitative reverse transcription polymerase chain reaction was used to measure miRNA-200b expression in the vitreous from 29 eyes with PDR and 30 eyes with idiopathic macular holes (IMH; control group). Vitreous VEGF was measured using an enzyme-linked immunosorbent assay. RESULTS: miRNA-200b expression was about 5-fold increased in the vitreous samples from eyes with PDR compared with the controls (p ≤ 0.001). Vitreous VEGF expression was also significantly higher in the PDR group than in the IMH group (p ≤ 0.001), but no significant correlation was found between miRNA-200b and VEGF. CONCLUSION: Both miRNA-200b and VEGF are increased in the vitreous of patients with PDR but in a noncorrelated pattern. miRNA-200b may be involved in the pathogenesis of PDR but through VEGF-independent mechanisms. Further studies are needed to identify the miRNA-200b-targeted genes involved in the pathogenesis of PDR and to examine the potential role of miRNA-200b as a target for PDR treatment.

Study of the role of tumor necrosis factor-α (-308 G/A) and interleukin-10 (-1082 G/A) polymorphisms as potential risk factors to acute kidney injury in patients with severe sepsis using high-resolution melting curve analysis.

RATIONAL: Septic acute kidney injury (AKI) is a prevalent complication in intensive care units with an increased incidence of complications. OBJECTIVE: The aim of the present study was to assess the use of high-resolution melting curve (HRM) analysis in investigating whether the genetic polymorphisms; -308 G/A of tumor necrosis factor-α (TNF-α), and -1082 G /A of Interleukin-10 (IL-10) genes may predispose patients diagnosed with severe sepsis to the development of AKI. METHODS: One hundred and fifty patients with severe sepsis participated in the present study; only sixty-six developed AKI. Both polymorphisms were studied using HRM analysis. MAIN FINDINGS: The low producer genotype of both studied polymorphism of TNF-α and IL-10 genes was associated with AKI. Using logistic regression analysis, the low producer genotypes remained an independent risk factor for AKI. A statistically significant difference was detected between both studied groups as regards the low producer genotype in both TNF-α (-308 G/A) and interleukin-10 (IL-10) (-1082 G/A) polymorphisms being prevalent in patients developing AKI. Principle conclusions: The low producer genotypes of both TNF-α (-308 G/A) and IL-10 (-1082 G/A) polymorphisms could be considered a risk factor for the development of AKI in critically ill patients with severe sepsis, thus management technique implemented for this category should be modulated rescuing this sector of patients from the grave deterioration to acute kidney injury. Using HRM for genotyping proved to be a highly efficient, simple, cost-effective genotyping technique that is most appropriate for the routine study of large-scale samples.

Poly-Gamma-Glutamic Acid Nanopolymer Effect against Bacterial Biofilms: In Vitro and In Vivo Study.

In this study, a biodegradable poly-gamma-glutamic-acid nanopolymer (Ɣ-PGA NP) was investigated for its activity against clinical strains of Gram-positive (Staphylococcus aureus and Streptococcus pyogenes) and Gram-negative (Klebsiella pneumoniae and Escherichia coli), and reference strains of S. aureus ATCC 6538, S. pyogenes ATCC 19615 (Gram-positive), and Gram-negative E. coli ATCC 25922, and K. pneumoniae ATCC 13884 bacterial biofilms. The minimum inhibitory concentration (MIC) effect of Ɣ-PGA NP showed inhibitory effects of 0.2, 0.4, 1.6, and 3.2 µg/mL for S. pyogenes, S. aureus, E. coli, and K. pneumoniae, respectively. Also, MIC values were 1.6, 0.8, 0.2, and 0.2 µg/mL for K. pneumoniae ATCC 13884, E. coli ATCC 25922, S. aureus ATCC 6538, and S. pyogenes ATCC 19615, respectively. Afterwards, MBEC (minimum biofilm eradication concentration) and MBIC (minimum biofilm inhibitory concentration) were investigated to detect Ɣ-PGA NPs efficiency against the biofilms. MBEC and MBIC increased with increasing Ɣ-PGA NPs concentration or time of exposure. Interestingly, MBIC values were at lower concentrations of Ɣ-PGA NPs than those of MBEC. Moreover, MBEC values showed that K. pneumoniae was more resistant to Ɣ-PGA NPs than E. coli, S. aureus, and S. pyogenes, and the same pattern was observed in the reference strains. The most effective results for MBEC were after 48 h, which were 1.6, 0.8, 0.4, and 0.2 µg/mL for K. pneumoniae, E. coli, S. aureus, and S. pyogenes, respectively. Moreover, MBIC results were the most impactful after 24 h but some were the same after 48 h. MBIC values after 48 h were 0.2, 0.2, 0.2, and 0.1 µg/mL for K. pneumoniae, E. coli, S. aureus, and S. pyogenes, respectively. The most effective results for MBEC were after 24 h, which were 1.6, 0.8, 0.4, and 0.4 µg/mL for K. pneumoniae ATCC 13884, E. coli ATCC 25922, S. aureus ATCC 6538, and S. pyogenes ATCC 19615, respectively. Also, MBIC results were the most impactful after an exposure time of 12 h. MBIC values after exposure time of 12 h were 0.4, 0.4, 0.2, and 0.2 µg/mL for K. pneumoniae ATCC 13884, E. coli ATCC 25922, S. aureus ATCC 6538, and S. pyogenes ATCC 19615, respectively. Besides that, results were confirmed using confocal laser scanning microscopy (CLSM), which showed a decrease in the number of living cells to 80% and 60% for MBEC and MBIC, respectively, for all the clinical bacterial strains. Moreover, living bacterial cells decreased to 70% at MBEC while decreasing up to 50% at MBIC with all bacterial refence strains. These data justify the CFU quantification. After that, ImageJ software was used to count the attached cells after incubating with the NPs, which proved the variation in live cell count between the manual counting and image analysis methods. Also, a scanning electron microscope (SEM) was used to detect the biofilm architecture after incubation with the Ɣ-PGA NP. In in vivo wound healing experiments, treated wounds of mice showed faster healing (p < 0.00001) than both the untreated mice and those that were only wounded, as the bacterial count was eradicated. Briefly, the infected mice were treated faster (p < 0.0001) when infected with S. pyogenes > S. aureus > E. coli > K. pneumoniae. The same pattern was observed for mice infected with the reference strains. Wound lengths after 2 h showed slightly healing (p < 0.001) for the clinical strains, while treatment became more obvious after 72 h > 48 h > 24 h (p < 0.0001) as wounds began to heal after 24 h up to 72 h. For reference strains, wound lengths after 2 h started to heal up to 72 h.

Effect of nonionic surfactant Brij 35 on the fate and transport of oxytetracycline antibiotic in soil.

In many parts of the world, river water is used for irrigation. Treated, partially treated, and even untreated water from wastewater treatment plants is discharged directly into rivers, thereby degrading the quality of the water. Consequently, irrigation water may contain surfactants which may affect the fate and transport of chemicals such as pesticides and antibiotics in agricultural soils. A field lysimeter study was undertaken to investigate the effect of the nonionic surfactant, Brij 35, on the fate and transport of an antibiotic, Oxytetracycline, commonly used in cattle farms. Nine PVC lysimeters, 1.0 m long × 0.45 m diameter, were packed with a sandy soil to a bulk density of 1.35 Mg m(-3). Cattle manure, containing Oxytetracycline, was applied at the surface of the lysimeters at the recommended rate of 10 t/ha. Each of three aqueous Brij 35 solutions, 0, 0.5 and 5 g L(-1) (i.e., 'good,' 'poor' and 'very poor' quality irrigation water) were each applied to the lysimeters in triplicate. Over a 90 day period, soil and leachate samples were collected and analyzed. Batch experiment results showed that the presence of the nonionic surfactant Brij 35 significantly reduced the sorption coefficient of OTC from 23.55 mL g(-1) in the aqueous medium to 19.49, 12.49 and 14.53 in the presence of Brij 35 at concentrations of 0.25, 2.5 and 5 g L(-1), respectively. Lysimeter results indicted the significant downward movement of OTC at depths of 60 cm into soil profile and leachate in the presence of surfactant. Thus, the reuse of wastewater containing surfactants might enhance the mobility of contaminants and increase ground water pollution.

Combined trabeculotomy-trabeculectomy for glaucoma after congenital cataract surgery: long-term results.

OBJECTIVE: The aim of this study was to report on the long-term (>5 years) results of surgery for glaucoma after congenital cataract surgery. DESIGN: Retrospective. METHODS: A chart review was conducted of all children operated on for glaucoma after congenital cataract surgery in the Pediatric Ophthalmology Service of the Ophthalmology Department of Alexandria main University Hospital in Alexandria, Egypt, between 2005 and 2014 who completed 5 years of follow-up. Demographic, clinical, and operative data were retrieved from the medical records. Success was defined by stability and (or) reversal of optic nerve cupping in relation to presentation and, if this information was not available, by an intraocular pressure (IOP) less than the presenting IOP and less than 16 mm Hg with (true) or without (qualified) IOP-lowering therapy. RESULTS: The records of 48 children were reviewed. Thirty-two eyes of 24 children had completed at least 5 years of follow-up and were included in the study. The mean age (±SD) of the study children was 11.6 ± 11.3 months (range, 3.2-52.0 months) at presentation, and the mean (±SD) follow-up was 105.5 ± 31.4 months (range, 60-156 months). Of 47 glaucoma surgical procedures in total, combined angle and filtering surgery with antimetabolite was the most common procedure performed (n = 30;63.8%). Annual success percentages from the fifth year onward to the thirteenth year were 69.6%, 68.8%, 77.8%, 50.0%, 71.4%, 60.0%, 50.0%, 83.3%, and 50.0%, respectively. CONCLUSIONS: Surgery for glaucoma after congenital cataract surgery remains safe and successful for 13 years after surgery.

Pediatric glaucoma in aniridia in a population of Egyptian children.

PURPOSE: To report on the incidence, characteristics, and treatment of glaucoma in association with aniridia in a population of Egyptian children. METHODS: A retrospective chart review was conducted of children (<18 years of age) presenting with aniridia between 2007 and 2022. Diagnosis of glaucoma was based on cup:disk ratio (>0.3) and IOP (>16 mm Hg). Success of glaucoma surgery was defined as IOP ≤16 mm Hg and stable or regressing cup:disk ratio. RESULTS: A total of 93 eyes of 47 children were included. The mean patient age at presentation was 41.2 ± 44.7 months. The mean intraocular pressure (IOP), corneal diameter, cup:disk ratio, and axial length on presentation were 16.4 ± 10.3 mm Hg, 11.4 ± 1.3 mm, 0.4 ± 0.3, and 22.43 ± 2.6 mm Hg. Of eyes with IOP and cup:disk ratio data at presentation, 23 (30%) were diagnosed with glaucoma. Fourteen eyes underwent surgery after presentation; follow-up data were available for half the remaining eyes. At the final follow-up, glaucoma was present in 20 eyes (49%). Glaucoma surgery was performed in 17 eyes, with a complete or qualified success rate of 82.4% at final follow-up, with 15 eyes having at least 12 months' follow-up. CONCLUSIONS: In this study cohort, children with aniridia presented at around 3 years of age, with glaucoma at presentation in almost one-third of the cases.

GDF-15 and hepcidin as a therapeutic target for anemia in chronic kidney disease.

BACKGROUND: Anaemia is a common presenting feature among patients with chronic kidney disease (CKD) and associated with poor clinical outcomes. We evaluated the diagnostic validity of growth differentiation factor-15 (GDF-15) and hepcidin as it is not clear if they are useful as a biomarkers of anaemia among non-dialysis CKD egyptian patients. METHOD: An analytical cross-sectional study was conducted among non-dialysis CKD patients (n = 60) and apparently healthy controls (n = 28) at Minia University maternity & children Hospital. Serum levels of GDF-15 and hepcidin were determined. Predictive logistic regression models were built and post estimation receiver operator characteristics were determined to evaluate diagnostic validity of hepcidin and GDF-15 for iron deficiency anaemia. RESULTS: Hepcidin and GDF-15 are significantly higher in cases than control p value (0.047 < 0.0001) respectively. The predictive value of diagnosing anaemia among CKD patients using hepcidin and GDF-15 was 72.0%, 70.0%. There was a weak negative correlation between hepcidin levels and glomerular filtration rate GFR (r = -.175, p = 0.105) in CKD patients, and significant correlation between serum GDF-15 and haemoglobin (r = -0.897, p < 0.0001), ferritin (r = 0.489, P < 0.000), Iron (r = -0.314, P = 0.002), CRP (r = 0.409, P < 0.0001). CONCLUSION: Hepcidin and GDF-15 is a potential biomarker for predicting anaemia connected with inflammation among CKD Egyptian patients.

How many children with large clear cornea do not have glaucoma?

PURPOSE: A horizontal corneal diameter greater than 2 standard deviations from the mean (9.8 mm) or greater than 11 mm in term infants defines megalocornea (herein referred to as a large clear cornea). The aim of the current study was to report on the incidence and clinical characteristics of children presenting with large clear cornea that do not suffer glaucoma. METHODS: A retrospective chart review of children presenting with large clear cornea to the pediatric ophthalmology unit of the ophthalmology department of Alexandria Main University Hospital in the period from March 2011 to December 2020 was conducted. A large clear cornea was defined as a horizontal white-to-white corneal diameter (as measured by calipers) greater than 12 mm. Glaucoma was diagnosed according to the childhood glaucoma research network (CGRN) criteria and the axial length was used to filter out eyes with large clear corneas due to congenital high myopia. RESULTS: Out of 120 eyes of 91 (58 males) children a total of 76 eyes of 67 (41 males) children were diagnosed with glaucoma and 44 eyes of 24 (17 males) children (36.7%) did not suffer glaucoma. Out of these, 30 eyes were classified as myopia and 14 eyes as congenital megalocornea. CONCLUSIONS: More than one third of eyes presenting with large clear corneas may not have glaucoma, and almost two thirds of these eyes (that are not suffering from glaucoma) demonstrate axial myopia.

Synthesis, characterization, DNA binding interactions, DFT calculations, and Covid-19 molecular docking of novel bioactive copper(I) complexes developed via unexpected reduction of azo-hydrazo ligands.

In this work, we focused on the 3rd goal of the sustainable development plan: achieving good health and supporting well-being. Two redox-active hydrazo ligands namely, phenylcarbonohydrazonoyldicyanide (PCHD) and pyridin-4-ylcarbonohydrazonoyl-dicyanide (PyCHD), and their copper(I) complexes have been synthesized and characterized. The analytical data indicates the formation of copper(I) complexes despite starting with copper(II) perchlorate salt. The 1H-NMR and UV-visible spectral studies in DMSO revealed that PyCHD mainly exists in its azo-form, while PCHD exists in azo ↔ hydrazo equilibrium form, and confirmed the copper(I) oxidation state. XPS, spectral and electrochemistry data indicated the existence of copper(I) valence of both complexes. Cyclic voltammetry of PCHD and its copper(I) complex supported the reduction power of the ligand. The antimicrobial activity, cytotoxicity against the mammalian breast carcinoma cell line (MCF7), and DNA interaction of the compounds are investigated. All compounds showed high antimicrobial, and cytotoxic activities, relative to the standard drugs. Upon studying the wheat DNA binding, PCHD and PyCHD were found to bind through external contacts, while both [Cu(PCHD)2]ClO4.H2O and [Cu(PyCHD)2]ClO4.H2O were intercalated binding. In-silico molecular docking simulations against Estrogen Receptor Alpha Ligand Binding Domain (ID: 6CBZ) were performed on all produced compounds and confirmed the invitro experimentally best anticancer activity of [Cu(PyCHD)2]ClO4.H2O. The molecular docking tests against SARS-CoV-2 main protease (ID: 6 WTT) showed promising activity in the order of total binding energy values: [Cu(PCHD)2]ClO4.H2O > [Cu(PyCHD)2]ClO4.H2O > PCHD > PyCHD.

Role of dexmedetomidine in modifying immune paralysis in patients with septic shock: randomized controlled trial.

BACKGROUND: Immune paralysis can be defined as a hypoinflammatory state associated with the incapacity of the immune system to release proinflammatory mediators despite the clearance of pathogens by antimicrobials. Persistent immune paralysis leads to failure to eradicate primary infections with a substantial increase in the risk of multiorgan dysfunction and mortality. The state of immune paralysis is caused mainly by the diminished ability of monocytes to release proinflammatory cytokines in response to endotoxin. This phenomenon is known as endotoxin tolerance. This study aimed to assess the role of dexmedetomidine in modifying immune paralysis in septic shock patients. METHODS: Twenty-four patients with septic shock were randomized into two groups of 12 patients. A continuous intravenous infusion of dexmedetomidine started at 0.15 µg kg-1 hr-1 and adjusted by 0.15 µg kg-1 h-1 to a maximum of 0.75 µg kg-1 h-1 (10 ml h-1), while midazolam was started at 1 mg h-1 (2 mL hr-1) and adjusted by 1 mg h-1 to a maximum of 5 mg h-1 (10 mL h-1). All infusions were adjusted by increments of 2 mL/hr-1 to maintain blinding. Serum levels of CD42a+/CD14+, HLADR+/CD14+, CRP, IL-6, IL-10 and TNF-α were measured at baseline (T1), 12 h (T2), and 24 h (T3). RESULTS: Treatment with dexmedetomidine yielded no significant difference in CD42a+/CD14+, HLADR+/CD14, CD24b-MFI, HLADR-MFI, IL6 and TREM1 at all time points when compared with midazolam treatment. There was no significant difference in TLR levels between the two groups. Cardiac output in the dexmedetomidine group showed a significant decrease at 6, 12 and 24 h (P = 0.033, 0.021, and 0.005, respectively) compared with that in the midazolam group. CONCLUSION: Our results indicated that dexmedetomidine did not affect CD42a+/CD14+ and HLA-DR+/CD14+ expression in septic patients. Furthermore, cytokine production and inflammatory biomarkers did not change with dexmedetomidine infusion. Trial registration Clinical trial.gov registry (NCT03989609) on June 14, 2019, https://register. CLINICALTRIALS: gov .

Subclinical Hypothyroidism in Patients with Diabetic Retinopathy: Role of Vascular Endothelial Growth Factor.

BACKGROUND: This study was conducted by considering the vital role of Vascular Endothelial Growth Factor (VEGF) in the development of Diabetic Retinopathy (DR) on the one hand and the frequent association between Subclinical Hypothyroidism (SCH) and DR on the other hand. OBJECTIVE: The present study was proposed to explore the possible role of VEGF in the relation between SCH and DR; thus, we investigated the relationship between SCH and VEGF levels in patients with DR. METHODS: Two hundred patients with DR were recruited in this study [100 patients with Proliferative Diabetic Retinopathy (PDR) and 100 patients with Non-Proliferative Diabetic Retinopathy (NPDR)]. Patients with DR were divided into 2 groups according to thyroid function, patients with SCH or those with euthyroidism. Patients were subjected to careful history taking and underwent clinical and ophthalmological examination. Fasting blood glucose, glycosylated hemoglobin, fasting insulin, Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), TSH, FT4, FT3, VEGF, and thyroid volume were assessed. RESULTS: Among all the studied patients, 21.5% (43/200) had SCH. DR patients with SCH had older age, longer diabetes duration, and higher HbA1c, HOMA-IR, and VEGF than those with euthyroidism. The frequency of PDR in patients with SCH was 72.1% (31/43) and 43.9% (69/157) in those with euthyroidism, whereas the frequency of NPDR in patients with SCH was 27.9 (12/43) and 56.1% (88/157) in those with euthyroidism (P 0.003). In multivariate analysis, PDR, HOMA- IR, and VEGF levels were the significant predictor variables of SCH. CONCLUSION: Increased VEGF levels may be implicated in the relationship between SCH and DR.