The effects of jujube (Ziziphus jujube) on metabolic and mental health outcomes in patients with metabolic syndrome: A randomized controlled trial.

OBJECTIVES: The effects of jujube (Ziziphus jujube) consumption on metabolic and mental health outcomes in subjects diagnosed with metabolic syndrome (MetS) is unknown and remains to be examined. Hence, we carried out a parallel-group, randomized controlled trial to investigate this issue. METHODS: Eligible participants were randomly assigned to the intervention (n = 30) or the control (n = 30) groups to receive either jujube or a placebo for eight weeks. Subjects were provided with 30 g dried jujube powder or placebo and were asked to consume half of the powder at 10 a.m. and the rest at 4 p.m. Lipid profile, fasting blood glucose (FBG), waist circumference (WC), and blood pressure were evaluated as primary outcomes. Secondary outcomes collected were mental health measures (e.g., depression, anxiety, and stress). RESULTS: Jujube consumption failed to decrease FBG, total cholesterol, low-density lipoprotein cholesterol, and blood pressure, as well as depression and anxiety scores (P > 0.05). However, the between-group comparison revealed a significant improvement in WC (- 3.98 vs. - 0.51, P = 0.01), triglyceride (TG) (- 24.96 vs. - 0.73, P = 0.03), and high-density lipoprotein cholesterol (HDL-C) (2.83 vs. 0.40, P = 0.01) in the jujube group compared to the placebo. In addition, compared to the control group, jujube consumption led to a significant improvement in the score of stress (- 5.80 vs. - 2.86, P = 0.01). CONCLUSION: Jujube consumption only had beneficial effects on WC, TG, and HDL-C in subjects with MetS. However, the current study has methodological weaknesses in blinding and herb purity/potency testing, which should be addressed in future studies.

Misoprostol and mid trimester termination of pregnancy in patients with two previous scars and more at Elwiya Maternity Teaching Hospital / Misoprostol e interrupção da gravidez no meio do trimestre em pacientes com duas cicatrizes anteriores e mais no Elwiya Maternity Teaching Hospital

Abstract Objectives: to determine efficiency and safety of three misoprostol regimens for 2nd trimester pregnancy termination in individuals with two or more cesarean section scars. Methods: a cross-sectional study included 100 pregnant ladies at 13th-26th weeks gestation with previous two cesarean sections (CSs) who were scheduled for pregnancy termination using misoprostol. Patients were conveniently assigned to 100µg/3h, 200µg/3h or 400 µg/3h regimens. Primary outcome was time to abortion, secondary outcomes were side effect and complications. Results: a significant association was found between number previous CSs and longer time to abortion (p=0.01). A highly significant association was identified between earlier gestational age and longer time to abortion (p<0.001). Lower side effects and complications were associated with 200 µg misoprostol every 3 hours of (p<0.001). Incomplete abortion was the most frequent recorded complication for the successive doses of misoprostol. Conclusions: misoprostol is an effective drug at low doses for pregnancy termination in women with prior two or more caesarean sections. However, its safety needs monitoring of the patient in the hospital to decrease morbidity and mortality behind its use.

Resumo Objetivos: determinar a eficiência e segurança de três regimes de misoprostol para interrupção da gravidez no segundo trimestre em indivíduos com duas ou mais cicatrizes de cesariana. Métodos: um estudo transversal incluiu 100 gestantes entre 13ª e 26ª semanas de gestação com duas cesarianas (CEs) anteriores que foram agendadas para interrupção da gravidez com uso de misoprostol. Os pacientes foram convenientemente designados para regimes de 100 µg/3 horas, 200 µg/3 horas ou 400 µg/3 horas. O desfecho primário foi o tempo para o aborto, os desfechos secundários foram efeitos colaterais e complicações. Resultados: foi encontrada associação significativa entre o número de cesáreas anteriores e o maior tempo até o aborto (p=0,01). Foi identificada associação altamente significativa entre idade gestacional mais precoce e maior tempo para abortar (p<0,001). Menores efeitos colaterais e complicações foram associados com 200 µg de misoprostol a cada 3 horas (p<0,001). O aborto incompleto foi a complicação mais frequente registrada para as doses sucessivas de misoprostol. Conclusões: o misoprostol é um medicamento eficaz em doses baixas para interrupção da gravidez em mulheres com duas ou mais cesarianas anteriores. Porém, sua segurança necessita de monitoramento do paciente no hospital para diminuir a morbimortalidade por trás de seu uso.

Dietary polyphenol intake, body composition and components of metabolic syndrome in a sample overweight and obese adults: a cross-sectional study.

BACKGROUND: The health benefits of dietary polyphenol intake (DPI) including improved lipid profiles, blood pressure, insulin resistance, and reduced systemic inflammation has revealed previously. However, the results of numerous studies are not consistent and it seems that these health effects are attributed to some of DPI. In the current research, we evaluated the health benefits of DPI on metabolic markers and glycemic markers among overweight and obese individuals. METHODS: In this cross-sectional study, 487 individuals with overweight and obesity were participated. Dietary intake was assessed by a Food Frequency Questionnaire (FFQ) and the amount of dietary polyphenol intake were calculated based on the information derived from Phenol-Explorer database ( www.phenolexplorer.eu/contents ). Bioelectrical impedance analysis (BIA) was used to measure body composition. Systolic and diastolic blood pressures were measured by sphygmomanometer. Biochemical assays including fasting blood sugar, insulin and serum lipids' concentrations were measured by enzymatic methods. RESULTS: According to our results, males were more likely to be at the highest tertile of DPI (P = 0.04). Also, those at the highest tertile of DPI had higher fat free mass and physical activity level (P < 0.05). Lower TG level in highest tertile of DPI in crude model was also observed, but, it lost its significant threshold after adjustment for confounders. Subjects at the second tertile of DPI were more likely to have lower systolic blood pressure in the sex and age adjusted model [OR = 0.970; CI = 0.940-1.000; P = 0.049]. For other biochemical variables, no significant association was observed. CONCLUSION: In the current study, total dietary polyphenol intake was associated with lower SBP among overweight and obese individuals. Further studies are warranted to better elucidate the observed results.

Obstacles and Challenges Facing Iraqi Women Ophthalmologists.

PURPOSE: The purpose of this study was to address disparities between male and female Iraqi ophthalmologists in terms of personal circumstances, professional profiles, and attitudes toward work and family life. METHODS: A Google Form-based questionnaire was released on a social media platform including 500 ophthalmologists between September 1, and December 1, 2021. The survey included three domains: (1) demographic characteristics, (2) clinical practice profile, and (3) career satisfaction and work/family balance. RESULTS: The study included a total of 209 specialists, with a response rate of 45.5%. About 69.4% of them were 45 years and younger. The female-to-male ratio was 1:1.6, 188 (90%) were married and 186 (88.9%) had children. Women ophthalmologists worked fewer hours, days, and operations than male ophthalmologists (P = 0.091). Moreover, women ophthalmologists in private practice were considerably underrepresented. General ophthalmologists represented 77%. The number of women ophthalmologists with subspecialty degrees was far less 9 (11.5%) than males 38 (29.2%), P = 0.003, and they performed significantly fewer operations than male ophthalmologists (P = 0.001). Family duties were the biggest deterrent for female ophthalmologists. For males, the private clinic is an obstacle to acquiring a specialty degree in 45.6%, but for women, it is just 25.7%. Overall satisfaction was 65.1%. Women respondents were less satisfied with their practice (P = 0.009) and thought that they are facing more challenges (0.007). Men believed they had less time to spend with family, implying that women sacrifice working time/income to satisfy family obligations and expectations. Work-life balance is achieved by limiting work hours and including family members. CONCLUSION: Women ophthalmologists in Iraq might be facing greater obstacles to their professional advancement than their male counterparts. Female doctors were working fewer hours and doing fewer surgical procedures, and they were less likely to pursue subspecialty certification.

Green tea influence on iron overload in thalassemia intermedia patients: a randomized controlled trial.

Background: Although iron chelation therapies have been available for many years for thalassemia intermedia patients, iron accumulation remains the major cause of death. Therefore, the need for additional chelation options is in demand. This randomized controlled study aimed to understand the effects of green tea on iron balance in thalassemia intermedia patients. Methods: Using a random selection method, 141 thalassemia intermedia patients were initially screened for inclusion in this trial; only 68 patients included after applying exclusion criteria. Two equal groups were generated (n=34/group): green tea (three cups/day after meals) + usual treatment (deferasirox iron chelator and on demand blood transfusion); and control (only usual treatment). The study lasted for a period of 12 months. Patients failing to comply to the trial methodology were excluded, leaving a final total of 29 patients in the green tea group and 28 patients in the control group. Liver iron concentration, and serum ferritin were assessed at baseline and 12 months, while hemoglobin levels were assessed monthly. Results: At baseline, both groups were matched regarding general demographics. At 12 months, the net drop of liver iron concentration in the green tea group (7.3 mg Fe/g dry weight) was significantly higher than the control group (4.6 mg Fe/g dry weight) (p<0.05). This was also seen with serum ferritin; net reduction in green tea and control groups were 1289 ng/ml and 871 ng/ml, respectively (p<0.05). Hemoglobin levels were slightly higher in the green tea group compared with the control group, but this was not significant. Conclusions: Regular green tea consumption had a significant capability to improve iron deposition in thalassemia intermedia patients who already undergo deferesirox iron chelation therapy. Trial registration: UMIN-CTR Clinical Trials Registry, UMIN000040841 (retrospectively registered June 21, 2020).

Prevalence of Montelukast Use as an Add-On Therapy among Iraqi Asthmatics on Treatment Attending Al-Kindy Teaching Hospital and Al-Zahraa Center of Asthma and Allergy.

BACKGROUND: Montelukast (Singulair) is a cysteinyl leukotriene receptor antagonist, used for the maintenance treatment of asthma and to relieve symptoms of seasonal allergic rhinitis and asthma, also used for exercise-induced bronchospasm. AIM: This study was performed to determine the prevalence of Montelukast use as an add-on therapy among Iraqi asthmatic patients on treatment. Comparing the effectiveness of regimens with and without montelukast. METHODS: This descriptive cross-sectional study was carried out on 73 Iraqi asthmatic patients on treatment of both sexes with age range (18-60) years old, attending Al-Kindy Teaching Hospital and Al-Zahraa Centre of Asthma and Allergy, Baghdad, for the period between February and March 2017. A questionnaire was specifically prepared to meet the objectives and was used to collect the data of the study. RESULTS: There was a significant statistical reduction of frequency in asthmatic attacks after Montelukast treatment (p-value < 0.05). Out of 73 patients, 39 were males, and 34 were females, 46 were jobless, 37 were married, 63 were urban residents, 63 were educated. Prevalence of exacerbation factors was as following: infection was found in 60.3% of the patients, exercise in 57.5%, dust in 72.6%, smoking in 60.6%, food in 24.7%, others (stress, perfumes) in 20.5%. The prevalence of Montelukast use in this study was 46% (34 patients). Out of 34 patients using Montelukast, 28 were using inhaled salbutamol, 5 were using oral salbutamol, 15 were using inhaled corticosteroids, 9 were using systematic corticosteroids, 2 were using xanthines, and 6 were using ketotifen. CONCLUSION: Montelukast was used as add-on therapy with the inhaled corticosteroids to reduce the required dose of inhaled corticosteroids also the use of Montelukast lead to reduced number of exacerbations which will be reflected on the use of inhaled salbutamol and systematic corticosteroids. Also, Montelukast was superior to xanthines and ketotifen as an add-on therapy.

The Protective Effect of Nitroglycerin, N-Acetyl Cysteine and Metoprolol in CCL4 Induced Animal Model of Acute Liver Injury.

OBJECTIVE: The current study was designed to determine the hepatoprotective effect of well-known drugs. Nitroglycerin, N-acetyl cysteine and Metoprolol in acute liver injury induced by CCL4. The antioxidant effects of b-blockers, especially carvedilol, have been described by several investigators. However, for metoprolol, the effect is a bit query as there is only one in-vitro study showing a little hepatoprotective effect. Thus, it is worthy to re-study the hepatoprotective effect of metoprolol. AIM: To explore the possible hepatoprotective effect of Nitroglycerin, N-acetyl cysteine and Metoprolol Tartrate. MATERIAL AND METHODS: The normal serum values of ALP, AST, ALT, TSB and TSP were determined in 35 healthy rabbits allocated to 5 groups before CCL4 induction and at three occasions 24, 72, 120 hrs after induction by CCL4 and treatment with the tested drugs: Nitroglycerin, N-acetyl cysteine and Metoprolol for five successive days. RESULTS: Showed significant decrease in serum levels of ALP, AST, ALT and TSB with a significant increase in TSP level of all the tested drugs measured at 120 hrs compared with the control and their levels measured at 24, 72 hrs. CONCLUSION: All the tested drugs proved in having a hepatoprotective effect when they are given orally to animals. The histopathological sections of the liver tissue supported the real effect of these drugs in the management of ALI.

Characterization of Healthy Donor-Derived T-Cell Responses Specific to Telaprevir Diastereomers.

Telaprevir, a protease inhibitor, was used alongside PEGylated interferon-α and ribavirin to treat hepatitis C viral infections. The triple regimen proved successful; however, the appearance of severe skin reactions alongside competition from newer drugs restricted its use. Skin reactions presented with a delayed onset indicative of a T-cell mediated reaction. Thus, the aim of this study was to investigate whether telaprevir and/or its diastereomer, which is generated in humans, activates T-cells. Telaprevir in its S-configured therapeutic form and the R-diastereomer were cultured directly with peripheral blood mononuclear cells from healthy donors prior to the generation of T-cell clones by serial dilution. Drug-specific CD4+ and CD8+ T-cell clones responsive to telaprevir and the R-diastereomer were generated and characterized in terms of phenotype and function. The clones proliferated with telaprevir and diastereomer concentrations of 5-20 µM and secreted IFN-γ, IL-13, and granzyme B. In contrast, the telaprevir M11 metabolite did not stimulate T-cells. The CD8+ T-cell response was MHC I-restricted and dependent on the presence of soluble drug. Flow cytometric analysis showed that clones expressed chemokine receptors CCR4 (skin homing) and CXCR3 (migration to peripheral tissue) and 1 of 3 distinct TCR Vßs; TCR Vß 2, 5.1, or 22. These data show the propensity of both R- and S-forms of telaprevir to generate skin-homing cytotoxic T-cells that may induce the adverse reactions observed in human patients.

Short Term Effectiveness of Gamma Knife Radiosurgery in the Management of Brain Arteriovenous Malformation.

AIM: To evaluate the short-term effectiveness of Gamma knife radiosurgery as a modality of treatment of brain arteriovenous malformation. METHODS: Sixty-three patients with arteriovenous brain malformations underwent Gamma knife radiosurgery included in this prospective study between April 2017 and September 2018 with clinical and radiological with MRI follow up was done at three months and six months post-Gamma knife radiosurgery. By the end of the 12th-month post-Gamma knife radiosurgery, the patients were re-evaluated using digital subtraction angiography co-registered with M.R.I. During the 12 months follow up, CT scan or MRI was done at any time if any one of the patients' condition deteriorated or developed signs and symptoms of complications. The mean volume of the arteriovenous malformations treated was 26.0 ± 5 cm3 (range 12.5-39.5 cm3) in The Neurosciences Hospital, Baghdad/Iraq. RESULTS: By the end of the 12th month of follow up, the overall obliteration of the arteriovenous malformations was seen in six patients only (9.5%), while shrinkage was noticed in 57 patients (90.5%). Improvement or clinical stability was found in 24 out of 39 patients (61.5%) presented with epilepsy as a chief complaint before Gamma knife radiosurgery and 21 out of 24 patients (87.0%) complained of a headache before Gamma knife radiosurgery. Post-Gamma knife radiosurgery bleeding was found in only three patients (5.0%). CONCLUSION: Even with the short term follow up, Gamma knife radiosurgery has an excellent clinical outcome in most patients with arteriovenous brain malformations. The clinical symptoms like headache and seizure were either diminished or controlled with the same medical treatment dose before Gamma knife radiosurgery. Long term clinical and radiological follow up is recommended.

The Effect of Inhibitory Signals on the Priming of Drug Hapten-Specific T Cells That Express Distinct Vß Receptors.

Drug hypersensitivity involves the activation of T cells in an HLA allele-restricted manner. Because the majority of individuals who carry HLA risk alleles do not develop hypersensitivity, other parameters must control development of the drug-specific T cell response. Thus, we have used a T cell-priming assay and nitroso sulfamethoxazole (SMX-NO) as a model Ag to investigate the activation of specific TCR Vß subtypes, the impact of programmed death -1 (PD-1), CTL-associated protein 4 (CTLA4), and T cell Ig and mucin domain protein-3 (TIM-3) coinhibitory signaling on activation of naive and memory T cells, and the ability of regulatory T cells (Tregs) to prevent responses. An expansion of the TCR repertoire was observed for nine Vß subtypes, whereas spectratyping revealed that SMX-NO-specific T cell responses are controlled by public TCRs present in all individuals alongside private TCR repertoires specific to each individual. We proceeded to evaluate the extent to which the activation of these TCR Vß-restricted Ag-specific T cell responses is governed by regulatory signals. Blockade of PD-L1/CTLA4 signaling dampened activation of SMX-NO-specific naive and memory T cells, whereas blockade of TIM-3 produced no effect. Programmed death-1, CTLA4, and TIM-3 displayed discrete expression profiles during drug-induced T cell activation, and expression of each receptor was enhanced on dividing T cells. Because these receptors are also expressed on Tregs, Treg-mediated suppression of SMX-NO-induced T cell activation was investigated. Tregs significantly dampened the priming of T cells. In conclusion, our findings demonstrate that distinct TCR Vß subtypes, dysregulation of coinhibitory signaling pathways, and dysfunctional Tregs may influence predisposition to hypersensitivity.

Definition of the Nature and Hapten Threshold of the ß-Lactam Antigen Required for T Cell Activation In Vitro and in Patients.

Covalent modification of protein by drugs may disrupt self-tolerance, leading to lymphocyte activation. Until now, determination of the threshold required for this process has not been possible. Therefore, we performed quantitative mass spectrometric analyses to define the epitopes formed in tolerant and hypersensitive patients taking the ß-lactam antibiotic piperacillin and the threshold required for T cell activation. A hydrolyzed piperacillin hapten was detected on four lysine residues of human serum albumin (HSA) isolated from tolerant patients. The level of modified Lys541 ranged from 2.6 to 4.8%. Analysis of plasma from hypersensitive patients revealed the same pattern and levels of modification 1-10 d after the commencement of therapy. Piperacillin-responsive skin-homing CD4+ clones expressing an array of Vß receptors were activated in a dose-, time-, and processing-dependent manner; analysis of incubation medium revealed that 2.6% of Lys541 in HSA was modified when T cells were activated. Piperacillin-HSA conjugates that had levels and epitopes identical to those detected in patients were shown to selectively stimulate additional CD4+ clones, which expressed a more restricted Vß repertoire. To conclude, the levels of piperacillin-HSA modification that activated T cells are equivalent to the ones formed in hypersensitive and tolerant patients, which indicates that threshold levels of drug Ag are formed in all patients. Thus, the propensity to develop hypersensitivity is dependent on other factors, such as the presence of T cells within an individual's repertoire that can be activated with the ß-lactam hapten and/or an imbalance in immune regulation.