Improved analysis of folpet and captan in foods using liquid chromatography-triple quadrupole linear ion trap mass spectrometry: applying mass filtering, collision, and trapping conditions.

Accurate and highly sensitive analysis of folpet and captan was accomplished using liquid chromatography-triple quadrupole linear ion trap mass spectrometry (LC-QqQIT) with selective ion mode; mass filtering, collision, and trapping condition. Dimensional mass spectrometry (MS3) parameters were optimized for the residue detection of folpet and captan in six food commodities (apples, tomatoes, sweet pepper, wheat flour, sesame seeds, and fennel seeds). The sample preparation method was based on the known QuEChERS protocol, except a mixture of acetonitrile/acetone was used for the sample extraction from the sesame seeds. The robustness and reliability of the developed MS3 method were demonstrated by performing a full validation, according to SANTE/11312/2021, at 0.01-0.25 mg/kg. Recovery ranged from 83 to 118% with a relative standard deviation below 19% in all the tested commodities, and limits of quantifications (LOQs) were 0.01 mg/kg in apples and tomatoes; 0.03 mg/kg in sweet pepper; and 0.05 mg/kg in wheat flour, sesame seeds, and fennel seeds. Monitoring results showed that about 90% of apples contained captan residue, and in sweet pepper, concentrations of captan and folpet as high as 1.57 and 0.97 mg/kg were found, respectively. The novel developed MS3 method enabled more reliable identification of these commonly problematic fungicides at lower LOQs than previously reported methods.

Comparison of wire-guided localization (WGL) and radio-guided occult lesion localization (ROLL) in localization of non-palpable breast lesions.

BACKGROUND: The number of patients with non-palpable breast lesions has increased gradually. This is because of the technological development in imaging techniques and the screening programs that lead to early detection of breast lesions. The number of patients with non-palpable breast lesions has increased gradually. This is because of the technological development in imaging techniques and the screening programs that lead to early detection of breast lesions. The aim of marking the non-palpable breast lesions is to achieve accurate lesion localization, to obtain the better cosmetic result with less tissue loss and to provide negative surgical margin. AIM OF THE STUDY: In the current study, we aimed to compare the wire-guided localization (WGL) technique with the radio-guided occult lesion localization (ROLL) technique to assess their accuracy and efficacy in non-palpable breast lesions localization. METHODS: This is a retrospective study conducted at Baheya center for Early Detection and Treatment of Breast Cancer from January 2018 and June2022,where 670 patients with non-palpable breast lesions underwent an excision were enrolled randomly in ROLL group (n = 320) and WGL (n = 350). RESULTS: Both the localization time and the time of operation were significantly decreased with the ROLL in comparison to WGL(P < 0.001). Complete lesion excision with clear margins were reported in 119/135(88.2%) of ROLL group and in 130/159 (81.8%) of WGL group and the difference was significant (P < 0.001). Reoperations (re-lumpectomy or mastectomy) were done as a second procedure on 16(11.8%) of the ROLL patients compared with 29(18.2%) in the WGL patients(P < 0.001). CONCLUSION: This study shows that ROLL is as effective as WGL for non-palpable breast lesions excision. Also, ROLL improve the outcomes by decreasing the duration of surgery, localization time, achieving a higher percentage of clear margin in spite of lower specimen size and scar length.

The Association between Admission Procalcitonin Level and The Severity of COVID-19 Pneumonia: A Retrospective Cohort Study.

Background and Objectives: An elevated procalcitonin level has classically been linked to bacterial infections. Data on the association between elevated procalcitonin and the outcome of coronavirus disease 2019 (COVID-19) are conflicting. Some linked it to associated bacterial co-infections, while others correlated the elevation with disease severity without coexisting bacterial infections. We aimed to investigate the association between high procalcitonin and the severity of COVID-19. Materials and Methods: Hospitalized patients with confirmed COVID-19 pneumonia were divided into two groups: the normal-procalcitonin group and the high-procalcitonin group (>0.05 ng/mL). Patients with concomitant bacterial infections on admission were excluded. The primary outcomes were the need for intensive care unit (ICU) admission, progression to invasive mechanical ventilation (IMV), and in-hospital 28-day mortality. Results: We included 260 patients in the normal procalcitonin group and 397 patients in the high procalcitonin group. The mean age was 55 years and 49% were females. A higher number of patients in the elevated procalcitonin group required ICU admission (32.7% vs. 16.2%, p < 0.001) and IMV (27.2% vs. 13.5%, p < 0.001). In-hospital mortality was significantly higher in the elevated procalcitonin group (18.9% vs. 8.5%, p < 0.001). After adjusting for other covariates, procalcitonin > 0.05 ng/mL was an independent predictor of progression to IMV (OR, 1.71; 95% CI, 1.08−2.71; p = 0.022), ICU admission (OR, 1.73; 95% CI, 1.13−2.66; p = 0.011), and in-hospital mortality (OR, 1.99; 95% CI, 1.14−3.47; p = 0.015). An elevated procalcitonin level was the strongest predictor of in-hospital mortality. Conclusions: Measurement of procalcitonin can have a prognostic role among COVID-19 patients. The admission procalcitonin level can identify patients at risk of ICU admission, progression to IMV, and in-hospital mortality.

LICAP Versus TDAP for the Reconstruction of Partial Breast Defects.

Perforator flaps are the latest development in reconstructive surgery. Pedicled chest wall perforator flaps can be utilized in many cases of partial breast reconstruction. This research compares the outcome and technique of thoracodorsal artery perforator flap (TDAP) and the lateral intercostal artery perforator flap (LICAP) in the reconstruction of partial breast defects. Patient records were reviewed for the time period between 2011 and 2019 at the Breast Unit of the National Cancer Institute of Cairo University. Eighty three patients were accessible for the study. (46 cases of TDAP flap and 37 cases of LICAP flap). Relevant clinical data were extracted from patients' records. A special visit was organized for all 83 patients, where a digital photograph was taken in an antroposterior view. The photographs were later processed via BCCT.core software to obtain an objective cosmetic outcome assessment. Complication rates and cosmetic outcome were comparable for both techniques. TDAP flap proved to require more tedious dissection and preoperative Doppler mapping to localize perforator vessels. On the other hand, LICAP was technically easier with more consistent perforators. Pedicled chest wall perforator flaps constitute an excellent reconstructive option in partial breast defects. TDAP flap and LICAP are two reliable perforator flaps which can reconstruct outer breast defects with acceptable outcome.

The simultaneous degradation of prochloraz and tebuconazole in water with monitoring their degradation products using liquid chromatography-tandem mass spectrometry.

Prochloraz and tebuconazole are well-known fungicides for broad applications, including medical, industrial, and agricultural. They are frequently used simultaneously which increases the probability of their co-existing in various water sources. In this study, the analysis of PCZ or TBZ in water was performed by a direct analysis using the liquid chromatography-tandem mass spectrometry technique (LC-MS/MS). The optimized method was fully validated according to the European guidelines, SANTE/11312/2021. The complete degradation of these fungicides (each of 2 mg/L) in their single presence in the water was accomplished just after 15 min using 4.2 mM persulfate at 50 °C, while a lower concentration of persulfate (1.4 mM) leads to a degradation of prochloraz and tebuconazole, in their single existence in water, at percentages of 97 % and 98 %, respectively, after 30 min at 50 °C. On the other hand, it takes a complete hour to degrade a mixture of prochloraz and tebuconazole at percentages of 99 % and 94 %, respectively, using 1.4 mM persulfate at 50 °C. Degradation products (DPds) of prochloraz and tebuconazole, either in their single or simultaneous existing in water, were also identified and monitored during the whole degradation process by LC-MS/MS using at least two mass transitions for each DPd at both positive and negative ionization modes. It was elucidated that the persulfate degradation of prochloraz was conducted by the cleavage of the imidazole ring and the subsequent formation of a trichlorophenol, while persulfate degradation of tebuconazole was mainly accomplished by the formation of a hydroxyl structure, cleavage of the tert-butyl chain, and the subsequent formation of a ketone structure. Furthermore, a new DPd of tebuconazole (m/z = 263 Da) with a diketone structure was identified and confirmed.

Vitamin B12 (Cobalamin) Deficiency in Overt and Subclinical Primary Hypothyroidism.

Background: B12 (cobalamin) deficiency has been reported in hypothyroid patients with variable prevalence rates thus routine screening of hypothyroid patients was recommended by some and discouraged by others. We aimed to assess the prevalence of B12 deficiency among hypothyroid patients and to evaluate for pernicious anemia and celiac disease as etiologies. Methods: A total 133 patients were included. Thyroid hormones and thyroid peroxidase (TPO) autoantibodies were measured. Serum B12 was measured and if deficient, intrinsic factor antibodies (IFAB) and tissue transglutaminase (tTG) antibodies were evaluated. Results: Our study included 45 patients with overt hypothyroidism (OH), 48 patients with subclinical hypothyroidism (SCH), and 40 patients as controls. Mean age was 34.3 years and 82% were females. TPO antibodies were positive in 73.5% of OH and 51.1% of SCH patients. B12 deficiency was detected in 33.3%, 47.9%, and 37.5% of OH, SCH, and controls, respectively with no significant difference (P = .334). Borderline-to-low B12 level was more prevalent in the OH and the SCH groups compared to controls (68.9%, 85.4%, and 57.5%, respectively; P = .014). Among B12-deficient hypothyroid patients, 7.5% had positive IFAB and 13.3% had positive tTG antibodies. We did not find a significant association of TPO positivity and B12 deficiency (OR, 0.69; 95% CI 0.3-1.57; P = .147). Conclusion: We did not find a higher prevalence of B12 deficiency among hypothyroid patients nor an association with TPO positivity. Borderline B12 levels were more prevalent among hypothyroid patients.

Stress Hyperglycemia Ratio as a Prognostic Marker in Diabetic Patients Hospitalized with COVID-19.

Evidence is conflicting about the diabetes characteristics associated with worse outcome among hospitalized COVID-19 patients. We aimed to assess the role of stress hyperglycemia ratio (SHR) as a prognostic marker among them. In our retrospective cohort study, patients were stratified according to SHR, admission glucose, and glycated hemoglobin tertiles. The primary outcome was a composite endpoint of invasive mechanical ventilation, intensive care unit admission, and in-hospital mortality. The study included 395 patients with a mean age of 59 years, and 50.1% were males. Patients in the third tertile of SHR developed more primary events, and the difference was significant compared to the first tertile (p = 0.038) and close to significance compared to the second tertile (p = 0.054). There was no significant difference in the outcomes across admission glucose and glycated hemoglobin tertiles. A higher SHR tertile was an independent risk factor for the primary outcome (OR, 1.364; 95% CI: 1.014-1.836; p = 0.040) after adjustment for other covariables. In hospitalized COVID-19 diabetic patients, SHR third tertile was significantly associated with worse outcome and death. SHR can be a better prognostic marker compared to admission glucose and glycated hemoglobin. A higher SHR was an independent risk factor for worse outcome and in-hospital mortality.

Acetonitrile-Ethyl acetate based method for the residue analysis of 373 pesticides in beeswax using LC-MS/MS and GC-MS/MS.

In the current study, Pesticide residue extraction in beeswax was carried out using a mixture of acetonitrile-ethyl acetate (1:3, v/v). This mixture of solvents not only enables the melting of beeswax sample at a lower temperature than when using acetonitrile only but also introduces one phase solution. The sample extract was directly injected into both GC-MS/MS, of the commonly used split-less inlets, and into LC-MS/MS. Sample preparation and clean-up were also optimized. The developed method was validated according to SANTE/11813/2017 European Union guidelines. Three spiking levels of low concentrations 20, 50, 100 µg/kg were studied for the analysis of a total of 373 pesticides. Most of the studied pesticides have acceptable recovery between 80 and 110% with good reproducibility <10. There are 265 and 139 pesticides having a lower limit of quantifications equal 20 µg/kg using LC-MS/MS and GC-MS/MS, respectively. Finally, the developed method was successfully applied for the analysis of real beeswax samples.

Supercritical fluid chromatography coupled to tandem mass spectrometry for the analysis of pesticide residues in dried spices. Benefits and drawbacks.

This study describes the high sensitivity and the reduced ion suppression and matrix effect that can be achieved by supercritical fluid chromatography (SFC) in the analysis of dried spices as complex matrices. Samples selected for the evaluation were cayenne and black pepper, which are representative of complex dried spices. To carry out the evaluation of this technique, blank samples were fortified with a solution containing 162 pesticides at two concentration levels (50 and 200 µg kg-1). During the modified QuEChERS method, EMR sorbent was used as dispersive SPE in the clean-up step. The samples were analysed by supercritical fluid chromatography coupled to tandem mass spectrometry. The validation parameters studied were recovery, inter and intraday precision, linearity and matrix effect. Recoveries for the majority of compounds were in the 70-120% range recommended by DG-SANTE guidelines and showed a precision lower than 20% in terms of RSD. Matrix effect was low (0-20% signal suppression) for 132 pesticides in cayenne and 91 in black pepper. The method was used to analyse 47 real samples of spices from different countries. A high number of these samples presented one or more pesticides (81%). Some of these detected pesticides are not approved in the European Union and, in many cases, the positive findings exposed concentrations that exceed the EU MRLs.

Development of an efficient method for multi residue analysis of 160 pesticides in herbal plant by ethyl acetate hexane mixture with direct injection to GC-MS/MS.

A simple and efficient multi residue method was developed, for the analysis of 160 pesticides by GC-MS/MS in herbal plants. The developed method employs pesticide residue extraction by EtAC/ n. hexane (6:4) with a cleanup step using florisil/ PSA mixture. The optimized conditions have resulted in lower co-extracted matrix components than those extracted using EtAC or MeCN (QuEChERS method), according to FTIR and full scan GC/MS analyses. In addition, the developed method (EtAC/ Hexane) eliminates the evaporation step that is usually performed when using MeCN as an extraction solvent prior to the GC-MS/MS injection. The developed method was fully validated on chamomile, based on SANTE/11945/2015 guidelines. Where, intraday recoveries were estimated at three concentration levels of 10, 50 and 250µgkg-1. However, interday recoveries have also been carried out, at 250µgkg-1. In addition, intraday recoveries were estimated for two other herbal plants (thyme and marjoram), at 250µgkg-1. Three point calibration mixtures were prepared in ethyl acetate solvent and in the blank extracts of chamomile, thyme, and marjoram, in order to check the linearity and matrix effect. The average recoveries for most of the studied pesticides ranged from 70% to 100% at 50 and 250µgkg-1 with relative standard deviations below 20%. The validated method was successfully applied for determination of pesticide residues in 20 herb samples, collected from the Egyptian market.

Vascular endothelial growth factor G1612A (rs10434) gene polymorphism and neuropsychiatric manifestations in systemic lupus erythematosus patients.

AIM: To investigate the relation between vascular endothelial growth factor (VEGF) gene polymorphism in systemic lupus erythematosus (SLE) patients and lupus related neuropsychiatric manifestations. PATIENTS AND METHODS: Sixty adult SLE patients recruited from the Rheumatology and Neurology departments of Cairo University hospitals were classified into two groups; Group A: 30 patients with neuropsychiatric manifestations (NPSLE) and Group B: 30 patients without. For both groups the SNP G1612A (rs10434) of the VEGF gene was genotyped by real time polymerase chain reaction (RT-PCR). RESULTS: Statistically significant difference was found in genotype and allele frequencies between both groups (AA [70% vs 13.3%, p<0.001] and GG [10% vs 66.7%, p<0.001]). CONCLUSION: Polymorphism in the gene coding for VEGF may be associated with increased incidence of neuropsychiatric lupus in SLE patients.

Superior Mesenteric Artery Syndrome: Clinical and Radiological Considerations.

Background. Superior mesenteric artery (SMA) syndrome is a rare condition of duodenal obstruction, caused by the overlying SMA. Aim. To report on our experience with the management of SMA syndrome, drawing the attention to its existence. Material and Methods. We reviewed our records to identify cases diagnosed with SMA syndrome, in the period from October 1995 to January 2012. Results. Seven patients were identified, one male and six females. Their mean age was 17.1 years. Vomiting and abdominal pain were the presenting complaints in all patients and history of weight loss was present in six of them. In no patient was the diagnosis suspected initially on clinical grounds. Only after radiological investigations was the diagnosis declared. Radiology took the form of gastrografin/barium meal only in four patients and both gastrografin/barium meal and computerized tomography scan in the remaining three. Four patients responded to medical treatment and surgery was performed in the remaining three, with open duodenojejunostomy in two patients and laparoscopic dissection of the ligament of Treitz in the third. Long lasting improvement was sustained in all patients except one in the surgery group who, despite initial improvement, still has infrequent attacks of abdominal pain. Conclusion. Although the clinical manifestations of SMA syndrome are shared with many other disease entities, it has unique radiological as well as endoscopic features, which enables a confident diagnosis to be made. Once diagnosed, conservative treatment with nutritional support and positioning should be tried first. In case of unresponsiveness, surgery may give a lasting cure.

LAPAROSCOPIC ASSISTED PER-CUTANEOUS RADIO-FREQUENCY ABLATION (LAPRFA) AS A NEW MODALITY FOR TREATMENT OF HCC IN CIRRHOTIC LIVER.

Laparoscopic assisted percutaneous radiofrequency ablation (LAPRFA) for hepatocellular carcinoma (HCC) under guidance of intra-operative laparoscopic ultrasound (IOLUS) is a new modality for obtaining additional assessment of the liver situation, better tumor staging and effective treatment for the hepatic focal lesion (HFL), in patients with a difficult percutaneous approach. Between September 2010 and July 2014, 1150 patients with HCC on top of liver cirrhosis were referred to HCC clinic (MDT clinic) at National Hepatology and Tropical Medicine Research Institute (NHTMRI). Fourty nine patients were submitted to LAPRFA under IOLUS guidanceby the Multidiscipplinary team decision. Operation time, hospital stay, post procedure complications were recorded. A routine spiral CT scan one month postoperative and laporatory investigations with AFP were mandatory during follow up. The results showed that LAPRFA was completed in all patients. The IOLUS examination identified new HFL in three patients. A total of 52 lesions were treated. The mean operative time was 92 minutes; eight procedures were associated in six patients: cholecystectomy (6) and adhesiolysis (2). A complete tumor ablation was observed in all patients during the procedure by the U/S assessment intra-operatively, and was documented via spiral computed tomography (CT scan) one mopth after treatment.

Vascular endothelial growth factor G1612A (rs10434) gene polymorphism and neuropsychiatric manifestations in systemic lupus erythematosus patients / Polimorfismo genético do fator de crescimento vascular endotelial G1612A (rs10434) e manifestações neuropsiquiátricas em pacientes com lúpus eritematoso sistêmico

Abstract Aim: To investigate the relation between vascular endothelial growth factor (VEGF) gene polymorphism in systemic lupus erythematosus (SLE) patients and lupus related neuropsychiatric manifestations. Patients and methods: Sixty adult SLE patients recruited from the Rheumatology and Neurology departments of Cairo University hospitals were classified into two groups; Group A: 30 patients with neuropsychiatric manifestations (NPSLE) and Group B: 30 patients without. For both groups the SNP G1612A (rs10434) of the VEGF gene was genotyped by real time polymerase chain reaction (RT-PCR). Results: Statistically significant difference was found in genotype and allele frequencies between both groups (AA [70% vs 13.3%, p < 0.001] and GG [10% vs 66.7%, p < 0.001]). Conclusion: Polymorphism in the gene coding for VEGF may be associated with increased incidence of neuropsychiatric lupus in SLE patients.

Resumo Objetivo: Investigar a relação entre o polimorfismo genético do fator de crescimento vascular endotelial (VEGF) em pacientes com lúpus eritematoso sistêmico (LES) e manifestações neuropsiquiátricas relacionadas com o lúpus. Pacientes e métodos: Foram recrutados 60 pacientes adultos com LES nos departamentos de Reumatologia e Neurologia de hospitais universitários do Cairo e classificados em dois grupos; grupo A: 30 pacientes com manifestações neuropsiquiátricas (LESNP) e grupo B: 30 pacientes sem manifestações neuropsiquiátricas. Genotipou-se o SNP G1612A (rs10434) do gene VEGF em ambos os grupos por reação em cadeia da polimerase em tempo real (RT-PCR). Resultados: Foi encontrada diferença estatisticamente significativa nas frequências genotípicas e alélicas entre os dois grupos (AA [70% vs. 13,3%, p < 0,001] e GG [10% vs. 66,7%, p < 0,001]). Conclusão: O polimorfismo no gene que codifica o VEGF pode estar associado ao aumento na incidência de lúpus neuropsiquiátrico em pacientes com LES.