The use of recombinant tissue plasminogen activator in in acute ischemic stroke is associated with increased level of BDNF.

Much concern was directed towards the crucial role of recombinant tissue plasminogen activator (rt-PA) in improving neuroplasticity in patients with acute ischemic stroke. The aim of the work to investigate the effect of treating patients with acute ischemic stroke with rt-PA, on the level of brain derived neurotrophic factor (BDNF) as a marker of neuroplasticity. This study was conducted on 47 patients presenting with acute ischemic stroke (during the first 4.5 h from stroke onset); 26 patients of them eligible for receiving rt-PA (patient group) and 21 patients having contraindications for treatment with rt-PA (control group). Neurological, radiological and laboratory assessment (including BDNF serum level) were done for both groups at stroke onset (before receiving rt-PA) and at day 7. There was a statistically significant increase in BDNF serum level from day 1 to day 7 in rt-PA treated patients in comparison to control group (P-value˂ 0.001). Serum level of BDNF is significantly higher at the onset of stroke in female patients and non-smokers than males or smokers (P-value = 0.011, 0.01 respectively). There was no effect of either age, body mass index, hypertension, diabetes, drug abuse, past or family history of stroke, valvular heart diseases, atrial fibrillation, cardiomyopathy, ejection fraction, carotid atherosclerotic changes, lipid profile or uric acid, on BDNF serum level measured at the onset of stroke. Treatment of patients with acute ischemic stroke with rt-PA causes significant improvement in neuroplasticity through increasing BDNF serum level.

Imported and autochthonous malaria in West Saudi Arabia: results from a reference hospital.

BACKGROUND: The Kingdom of Saudi Arabia is seeking malaria eradication. Malaria transmission has been very low over the last few years. Discovered cases of Plasmodium falciparum infection are assigned a treatment protocol of artemisinin-based combination therapy, which consists of artesunate in addition to sulfadoxine-pyrimethamine rather than the traditional chloroquine, which has high resistance rates worldwide. This study aims to investigate the presence of different gene mutations concerning anti-malarial drug resistance (pfdhfr, pfdhps, pfmdr1, pfcrt, pfcytb, pfkelch13) to identify whether drug-resistant alleles are present in this area of the Kingdom and whether the country's treatment protocol is still suitable for Plasmodium bearing a resistance mutation [corrected]. METHODS: Blood samples were collected from patients suffering from symptoms suggesting malaria coming to King Faisal Hospital, Taif, from February to August 2016. Diagnosis was performed by Giemsa-stained thin and thick blood films, rapid diagnostic test and PCR. Positive P. falciparum samples were further subjected to series of PCR amplification reactions targeting genes related with drug resistance (pfdhfr, pfdhps, pfmdr1, pfcrt, pfcytb, pfketch13). RESULTS: Twenty-six cases were positives, 13 infected with P. falciparum, of those, 4 cases were autochthonous, and 13 with Plasmodium vivax. The results of the gene mutation detection confirmed that there was no mutation related to resistance to artemisinin or atovaquone, on the other hand chloroquine resistance alleles were detected in 31% of samples. Moreover, point mutations in the pfdhfr and pfdhps genes, related resistance to antifolate drugs, were detected in all characterized samples. CONCLUSIONS: Haplotypes of P. falciparum in the western region of the Kingdom of Saudi Arabia exhibit high resistance against antifolate drugs. These results should be extensively discussed when planning to modify anti-malarial drug protocols in the future.

Correction to: Imported and autochthonous malaria in West Saudi Arabia: results from a reference hospital.

Following publication of the original article [1], it was flagged by one of the authors that the name of the P. falciparum gene marker of artemisinin resistance 'pfkelch13' was (incorrectly) written as "pfketch13", which was repeated seven times in different parts of the published paper.

Consensus Guideline on the Management of Epilepsy in Egypt: A National Delphi Consensus Study.

OBJECTIVE: In epilepsy, early diagnosis, accurate determination of epilepsy type, proper selection of antiseizure medication, and monitoring are all essential. However, despite recent therapeutic advances and conceptual reconsiderations in the classification and management of epilepsy, serious gaps are still encountered in day-to-day practice in Egypt as well as several other resource-limited countries. Premature mortality, poor quality of life, socio-economic burden, cognitive problems, poor treatment outcomes, and comorbidities are major challenges that require urgent actions to be implemented at all levels. In recognition of this, a group of Egyptian epilepsy experts met through a series of consecutive meetings to specify the main concepts concerning the diagnosis and management of epilepsy, with the ultimate goal of establishing a nationwide Egyptian consensus. METHODS: The consensus was developed through a modified Delphi methodology. A thorough review of the most recent relevant literature and international guidelines was performed to evaluate their applicability to the Egyptian situation. Afterward, several remote and live rounds were scheduled to reach a final agreement for all listed statements. RESULTS: Of 278 statements reviewed in the first round, 256 achieved ≥80% agreement. Live discussion and refinement of the 22 statements that did not reach consensus during the first round took place, followed by final live voting then consensus was achieved for all remaining statements. SIGNIFICANCE: With the implementation of these unified recommendations, we believe this will bring about substantial improvements in both the quality of care and treatment outcomes for persons with epilepsy in Egypt. PLAIN LANGUAGE SUMMARY: This work represents the efforts of a group of medical experts to reach an agreement on the best medical practice related to people with epilepsy based on previously published recommendations while taking into consideration applicable options in resource-limited countries. The publication of this document is expected to minimize many malpractice issues and pave the way for better healthcare services on both individual and governmental levels.

Kinetics of Foxp3-expressing regulatory cells in experimental Toxocara canis infection.

Foxp3-expressing cells have recently been recognized as a cornerstone for the homeostasis of the immune system, and as key cells in many infectious diseases. Moreover, they have been found to contribute to the regulation of parasite-induced immunopathology in many parasitic infections. However, their role in Toxocara-induced immunopathology has not yet been investigated. The aim of this study is to assess the kinetics of Foxp3-expressing regulatory cells during the course of experimental infection by Toxocara canis (T. canis). Foxp3+ cells were identified in the liver by immunohistochemistry, and splenic Foxp3 gene expression was evaluated. We found significantly progressive increase in Foxp3-expressing cell counts in the liver starting from 5 weeks p.i. These cells were detected within and around Toxocara-induced granulomas as well as in isolated inflammatory foci in the portal tracts or within the hepatic parenchyma. Likewise, expression of Foxp3 mRNA in the spleen significantly increased at 5 and 16 weeks p.i. Furthermore, immunization of mice with Toxocara excretory-secretory antigen prior to experimental infection caused earlier mobilization and recruitment of Foxp3+ cells to the liver and enhanced splenic expression of Foxp3 transcripts. These results suggest a potential role of Foxp3-expressing regulatory cells in the evolution of the immunopathological events during infection by T. canis.

Risk factors of acute ischemic stroke in patients presented to Beni-Suef University Hospital: prevalence and relation to stroke severity at presentation.

BACKGROUND: Acute ischemic stroke is one of the major causes of disability and death worldwide. Effective prevention remains the best approach for reducing the burden of stroke. The aim of this work was to study the prevalence of stroke risk factors and the possible relation between such risk factors and the disease severity at presentation in a sample of stroke patients presented to Beni-Suef University Hospital, north Upper Egypt. METHODS: A sample of 167 patients of acute ischemic stroke recruited from Beni-Suef University Hospital was included in this cross-sectional descriptive study. All subjects were subjected to history taking, clinical, laboratory, and radiological evaluation. Stroke severity and disability were evaluated by National Institute of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS) respectively. RESULTS: Hypertension was detected in 104 patients (62.3%), dyslipidemia was detected in 79 patients (58.1%), and 69 patients (41.3%) were smokers. Diabetes mellitus was detected in 58 patients (34.7%) with high prevalence of cardio-embolic risk factor, 36 patients (21.6%) had rheumatic heart, and 44 patients (26.3%) had atrial fibrillation.NIHSS score was significantly higher in hypertensive patients (P value = 0.023) and in patients who had carotid stenosis ≥ 50% (P value = 0.011), whereas there was no significant relation between NIHSS score and diabetes mellitus (P = 0.221), dyslipidemia (P = 0.834), patients with history of cardio-embolic stroke (P = 0.085), previous ischemic stroke (P = 0.316), or sex (P = 0.343).mRS score was significantly higher in patients with age > 45 years old (P < 0.001), hypertension (P < 0.001), cardio-embolic risk factor (P = 0.044), and carotid stenosis ≥ 50% (P = 0.017), whereas there was no significant relation between mRS score and diabetes mellitus, previous ischemic stroke, or sex. CONCLUSIONS: The most common risk factor for stroke was hypertension followed by dyslipidemia and then smoking with higher incidence of rheumatic heart diseases due to lowered living conditions. Age, hypertension, cardio-embolic risk factors, and carotid stenosis ≥ 50% have negative impact on stroke severity and disability.

Schistosomiasis in Egypt: A never-ending story?

Schistosomiasis has plagued the Egyptian population since the antiquity. The disease is still a public health problem in Egypt, despite the tendency of being overlooked. In the first part of this review, the past and current trends of schistosomiasis in Egypt are reviewed, including history, epidemiology, morbidity, therapy, and control of the disease. Most of these aspects are more or less relevant to other schistosome-endemic regions all over the world. As only one drug is currently available for individual treatment and preventive mass chemotherapy, the quest for complementary measures is urgently warranted. Indeed, one promising approach is the discovery of a vaccine. Herein, we point out the efforts of the Egyptian scientists to develop an efficacious and affordable vaccine against schistosomiasis - a step forward in the battle of elimination of Schistosoma infection. Based on the candidate vaccine antigens, four types of vaccine formulations are discussed: purified antigen vaccines, DNA constructs, attenuated cercariae, and excretory-secretory antigen vaccines. Finally, this review provides insights into this ancient seemingly long-lasting parasitic disease.

Biochemical and Parasitological Studies on the Effect of hUCB-Selected CD34(+) Progenitor/Stem Cells in Mice Infected with Schistosoma mansoni.

BACKGROUND AND OBJECTIVES: Placenta and blood that remained in the umbilical cord is routinely available as a discarded tissue after deliveries and it is free of any legal, moral, ethical or religious objections, providing a high number of multipotent CD34(+) progenitor and stem cells. Using ex vivo isolated CD34(+) cells from human umbilical cord blood (hUCB) have emerged as promising candidates to treat various diseases, including exogenous pathogenic infections. We have expanded to build a rational approach to study the effect of CD34(+) cells after damaged liver tissues by the devastating human parasitic flatworm Schistosoma mansoni. METHODS AND RESULTS: Experimental studies were conducted in the Department of Zoology, Faculty of Science and Departments of Parasitology and Physiology, Faculty of Medicine, SCU, Egypt. We have studied the impact of ex vivo preparation of CD34(+) cells from hUCB on S. mansoni-induced liver fibrosis de novo, and treated for shorter and longer periods in vivo. Ova count, ALT and albumin were measured at specific time interval and histopathological examination of liver was conducted to confirm the biochemical results. The data obtained were statistically analyzed by ANOVA between groups. It was found that the administration of CD34(+) cells have modestly reduced liver damage; reduced the S. mansoni infection associated elevation in serum levels of ALT; significantly improved serum levels of albumin and reduced egg granuloma diameter in the livers. CONCLUSIONS: We demonstrated that CD34(+) cells can markedly ameliorated liver fibrosis in vivo and may be beneficial for therapy to recover organ structure and/or function of S. mansoni-infected mice.

Congenital exposure to Schistosoma mansoni infection: impact on the future immune response and the disease outcome.

Schistosomiasis mansoni is a widespread parasitic infection that may lead to several serious complications, such as hepatic periportal fibrosis and portal hypertension, mainly due to deposition of schistosome eggs in the tissues. However, people in endemic areas infrequently exhibit severe pathology and complications; this may be explained, in part, by modulation of the disease in indigenous populations by in utero exposure to the parasite. This study investigated the differences between mice born to Schistosoma mansoni-infected mothers and those born to non-infected ones in subsequent postnatal schistosomal infections. We found that the intensity of infection, evidenced by hepatic egg load, was much reduced in mice born to infected mothers. No difference was found as regards total and Schistosoma-specific immunoglobulin levels except for total IgG. The levels of gene expression of two regulatory cytokines, namely interleukin-12 (IL-12) and transforming growth factor beta (TGF-beta) were found to be significantly increased in prenatally exposed animals. Moreover, liver fibrosis was significantly decreased in animals born to infected mothers as revealed by histopathological and histochemical examination as well as by immunohistochemical identification of activated hepatic stellate cells (HSCs) using antibody against glial fibrillary acidic protein (GFAP). In conclusion, congenital exposure to S. mansoni seems to ameliorate the immunopathological changes in future postnatal infections.