High-dose Agomelatine Combined with Haloperidol Decanoate Improves Cognition, Downregulates MT2, Upregulates D5, and Maintains Krüppel-like Factor 9 But Alters Cardiac Electrophysiology.

Haloperidol decanoate (HD) has been implicated in cognitive impairment. Agomelatine (AGO) has been claimed to improve cognition. We aimed at investigating the effects of HD + low- or high-dose AGO on cognition, verifying the melatonergic/dopaminergic to the cholinergic hypothesis of cognition and exploring relevant cardiovascular issues in adult male Wistar albino rats. HD + high-dose AGO prolonged the step-through latency by +61.47% (P < 0.0001), increased the time spent in bright light by +439.49% (P < 0.0001), reduced the time spent in dim light by -66.25% (P < 0.0001), and increased the percent of alternations by +71.25% (P < 0.0001), despite the reductions in brain acetylcholine level by -10.67% (P < 0.0001). Neurodegeneration was minimal, while the mean power frequency of the source wave was reduced by -23.39% (P < 0.05). Concurrently, the relative expression of brain melatonin type 2 receptors was reduced by -18.75% (P < 0.05), against increased expressions of dopamine type 5 receptors by +22.22% (P < 0.0001) and angiopoietin-like 4 by +119.18% (P < 0.0001). Meanwhile, electrocardiogram (ECG) demonstrated inverted P wave, reduced P wave duration by -36.15% (P < 0.0001) and PR interval by -19.91% (P < 0.0001), prolonged RR interval by +27.97% (P < 0.05), increased R wave amplitude by +523.15% (P < 0.0001), and a depressed ST segment and inverted T wave. In rats administered AGO, HD, or HD+ low-dose AGO, Alzheimer's disease (AD)-like neuropathologic features were more evident, accompanied by extensive ECG and neurochemical alterations. HD + high-dose AGO enhances cognition but alters cardiac electrophysiology. SIGNIFICANCE STATEMENT: Given the issue of cognitive impairment associated with HD and the claimed cognitive-enhancing activity of AGO, combined high-dose AGO with HD improved cognition of adult male rats, who exhibited minimal neurodegenerative changes. HD+ high-dose AGO was relatively safe regarding triggering epileptogenesis, while it altered cardiac electrophysiology. In the presence of low acetylcholine, the melatonergic/dopaminergic hypothesis, added to angiopoietin-like 4 and Krüppel-like factor 9, could offer some clue, thus offering novel targets for pharmacologic manipulation of cognition.

Does the use of lactic acid as an antibiotic substitute in broiler diets affect growth, carcass traits, blood indices and intestinal microbiota?

The objective of the current study was to determine the impact of lactic acid (LAC) as an antibiotic alternative in broiler diets on growth performance, carcass traits, blood indices and intestinal microbial load. A total of 300 broiler chicks one day old (Ross 208) were allotted to five experimental groups in a complete randomized design experiment. Each group was subdivided into six replicates, each of ten unsexed chicks. The treatments were as follows: NC: negative control (basal diet); PC: positive control (basal diet + 0.5 g Colistin® antibiotic/kg diet); LAC2, LAC4, and LAC6: basal diet + 2, 4, and 6 cm3 lactic acid/kg diet, respectively. Results showed no significant effects of dietary treatments (antibiotic or lactic acid) on growth performance traits (body weight, BW; daily body weight gain, DBWG; feed intake, FI and feed conversion ratio, FCR) and carcass characteristics except for Thigh %. All blood biochemical traits were affected (p > 0.01) by dietary treatments. The highest values of blood total protein and albumin were found in birds of LAC2 group. Adding graded doses of LAC to broiler diets inhibited the activity of liver enzymes and reduced the concentration of blood urea. The positive effect of LAC supplementation excelled that of antibiotics regarding the antioxidant status parameters. The lowest pathogenic bacteria (E. coli and Salmonella) were recorded by LAC4 and LAC6 groups. It could be concluded that dietary supplementation of lactic acid did not significantly affect most growth performance traits. But its use could have beneficial impacts on blood parameters, oxidative status and intestinal microbial counts. Based on our results, the highest level (6 cm3 LAC/kg diet) is the recommended level for the best results.

Effect of Ramadan intermittent fasting on inflammatory markers, disease severity, depression, and quality of life in patients with inflammatory bowel diseases: A prospective cohort study.

BACKGROUND: Intermittent fasting (IF) during the month of Ramadan is part of the religious rituals of Muslims. The effect of intermittent fasting on disease activity in inflammatory bowel diseases (IBD) is still unknown. This is the first study to assess the effect of IF during Ramadan on inflammatory markers in patients diagnosed with IBD. The effects on clinical disease activity, quality of life, and levels of depression were also assessed. METHODS: Patients diagnosed with ulcerative colitis (UC) or Crohn's disease (CD) who intended to observe Ramadan fasting were recruited. The following were assessed immediately before and at the end of Ramadan: Serum CRP and stool calprotectin, partial Mayo score, Harvey Bradshaw index (HBI), Simple IBD questionnaire (SIBDQ), and Hamilton depression scale questionnaire. RESULTS: 80 patients diagnosed with IBD were recruited (60 UC, 20 CD). Serum CRP and stool calprotectin did not show a significant change before vs after fasting (median CRP 0.53 vs 0.50, P value = 0.27, Calprotectin 163 vs 218 respectively, P value = 0.62). The partial Mayo score showed a significant rise after fasting (median 1 before vs 1 after fasting, mean: 1.79 vs 2.33 respectively, P value = 0.02). Harvey-Bradshaw index did not show a significant change after fasting (median 4 vs 5, P value = 0.4). Multiple linear regression revealed that older age and a higher baseline calprotectin were associated with a higher change in Mayo score after fasting (P value = 0.02 and P value = 0.01, respectively). No significant change was detected in SIBDQ or Hamilton depression scale scores. CONCLUSIONS: In patients diagnosed with UC, IF during Ramadan was associated with worsening of clinical parameters, the effect was more pronounced in older patients and those with higher baseline calprotectin levels. However, IF during Ramadan was not associated with an adverse effect on objective inflammatory markers (CRP and calprotectin).

Coupling hydrothermal carbonization and anaerobic digestion for sewage digestate management: Influence of hydrothermal treatment time on dewaterability and bio-methane production.

Hydrothermal carbonization (HTC) technology is addressed in the framework of sewage digestate management. HTC converts digestate into a stabilized and sterilized solid (the hydrochar) and a liquor (HTCL) rich in organic carbon. This study aims to optimize the HTC operating parameters, namely the treatment time, in terms of hydrochar production, HTC slurry dewaterability, HTCL bio-methane yields in anaerobic digestion (AD), and process energy consumption. Digestate slurry was processed through HTC at different treatment times (0.5, 1, 2 and 3 h) at 190 °C, and the dewaterability of the treated slurries was addressed through capillary suction time and centrifuge lab-testing. In addition, biochemical methane potential (BMP) tests were conducted for HTCL under mesophilic conditions. Results show that by increasing the HTC treatment time the dewaterability was further improved, ammonium concentration in HTCL increased, and methane potential of HTCL decreased. 0.5 h HTCL had the highest bio-methane potential of 142 ± 3 mL CH4/g COD yet the treatment time was not sufficient for improving the slurry's dewaterability. HTC treatment time of 1 h at 190 °C was identified as the optimum trade-off for improved dewaterability and utilisation of HTCL for biogas production. 1 h HTCL bio-methane potential can cover around 25% of the HTC and AD thermal and electrical energy needs without considering the eventual use of the hydrochar as a biofuel.

Impact of treatment with a Protein Tyrosine Kinase Inhibitor (Genistein) on acute and chronic experimental Schistosoma mansoni infection.

Schistosomiasis mansoni is considered one of the most common fibrotic diseases resulting from inflammation and deposition of fibrous tissue around parasitic eggs trapped in the liver, causing morbidity and mortality. Chemotherapy against schistosomiasis is largely dependent on Praziquantel (PZQ). Yet, the huge administration of it in endemic areas and its incompetence towards the immature stages have raised serious alarms against the development of drug resistance. Few drugs are directed to reverse schistosomal liver fibrosis, particularly at the chronic and advanced stages of the disease. Recently, protein tyrosine kinase (PTK) inhibitors have been identified as potent anti-schistosomal and anti-fibrotic drugs against schistosomes, that may suppress and reverse Schistosoma mansoni (S. mansoni) induced liver fibrosis. The present study was designed to assess the anti-schistosomal and antifibrotic activity of Genistein, a PTK inhibitor, in comparison to PZQ, on both acute and chronic S. mansoni-infected mice using different parasitological, histopathological and immunohistochemical studies. Genistein showed a significant reduction (P < .05) in total worm burden, tissue egg load, mean hepatic granulomas diameter and numbers, percentage of collagen and expression of transforming growth factor-beta 1 (TGF-ß 1) in the examined hepatocytes with elevation in percentage of degenerated ova, in comparison to the control groups, in both acute and chronic stages of infection. The best results were obtained when Genistein was combined with PZQ. Therefore, it was concluded that Genistein showed a promising anti-schistosomal and anti-fibrotic properties which could make it one of the new potential targets in chemotherapy against schistosomiasis.

Atorvastatin repurposing for the treatment of cryptosporidiosis in experimentally immunosuppressed mice.

The present study was conducted on 200 male mice for the detection of the effect of Atorvastatin on Cryptosporidium spp. infection versus the commercially used drug Nitazoxanide in experimentally immunosuppressed mice. Atorvastatin was used alone at low dose (20 mg/kg), high dose (40 mg/kg), and combined with Nitazoxanide (1000 mg/kg) with either the low dose or high dose for five consecutive days. Parasitological assessment of the drug effect was done using Modified Z-N staining of stool samples collected from mice. Results revealed a reduction of the number of oocysts shed with percentage of reduction on the 21st day post infection by 53.7%, 67.2%, 70.1% &77.5%, respectively, compared to the infected untreated group. The Nitazoxanide treated group showed 52.7% reduction. In addition, examination of small and large intestinal contents after mice scarification revealed reduced numbers of oocysts by 56.2%-58.8%, 65.1%-65.3%, 70.6%-73.9% and 77.8%-79.9%, respectively, compared to 51.2%-54.1% in Nitazoxanide treated group. The histopathological examination of sections from duodenum, jejunum, ileum, colon, stomach and lungs also revealed a significant improvement of the histopathological changes in Atorvastatin treated groups and more remarkable improvement in the groups treated with combined drugs as compared to infected untreated group. Accordingly, the combination of Atorvastatin and Nitazoxanide showed a synergistic effect through reduction of the number of oocysts shed and improvement of the histopathological changes induced by Cryptosporidium spp. infection in the small intestine, colon, stomach and lungs of infected immunosuppressed mice in comparison to that induced by either Nitazoxanide or Atorvastatin alone.

Tamoxifen downregulates MxA expression by suppressing TLR7 expression in PBMCs of males infected with HCV.

Gender discrepancies in immune response to HCV infections and during HCV therapy exist and previous findings including those from this research team indicate the female sex hormone, 17ß-estradiol (E2), to be one probable cause of such inconsistencies. Also, it was recently demonstrated that estrogen receptor modulator Tamoxifen (TAM) exerts an upmodulating/enhancing effect on the TLR7 and JAK-STAT pathways in PBMCs of premenopausal females infected with HCV. Pursuing this work, a discrepancy was noticed in the results from male patients, therefore this study aimed to determine whether the effects of TAM previously observed in the PBMCs of women would hold true in PBMCs from males infected with HCV. Isolated PBMCs were pooled and relative expression of the TLR7 was quantified using RTqPCR. Sets of PBMCs were treated with exogenous interferon alpha (IFNα) or the TLR7 ligand, Imiquimod; these stimulations were performed with and without E2 and TAM pretreatment and the relative gene expressions of TLR7 and MxA were measured. Pretreatment with E2 and IFNα downregulated TLR7 (**P = 0.0080) and TAM further decreased this expression significantly (*P = 0.0284). TAM pretreatment also caused a significant downregulation in MxA expression in Imiquimod-stimulated PBMCs (*P = 0.0218). In conclusion, TAM displays several paradoxical effects in PBMCs of males infected with HCV compared to those of females. Contrary to the previous study involving premenopausal females, in PBMCs of infected males TAM may decrease IFNα release as indicated by reduced MxA expression possibly via the suppression of TLR7 expression.

Associates of school impairment in Egyptian patients with juvenile idiopathic arthritis: Sharkia Governorate.

The aim of this study was to investigate the factors associated with school absenteeism and poor school functioning in Egyptian children and adolescents with juvenile idiopathic arthritis (JIA). We studied 52 consecutive patients of JIA with age ≥ 7 years and duration of disease ≥ 1 year. All of the patients underwent assessment of socioeconomic and demographic characteristics, disease activity (JIDAS-27), functional ability (CHAQ), depressive symptoms (CDI score), and school functioning (PedsQL™ 4.0). Multivariate modeling was applied to determine the factors that associated with school absenteeism and poor school functioning. A total of 69% of the sample missed 3 weeks or more of school during past academic year. The mean percentage of missed school days was 12.5% (equivalent to 25 absent days). A total of 46% of the patients had poor school functioning (school functioning subscale score of HRQOL ≥ 1 SD below the mean of healthy children). In multiple regression analyses, high CHAQ scores, disease activity, and depressive symptoms were independent predictors for both of school absenteeism and of poor school functioning. However, living in rural regions was independently associated only with high school absenteeism in patients with JIA. Disease activity, functional disability, and high depressive symptoms are predictors of school absenteeism and poor school functioning. These findings underscore the critical need for treatment strategies that have the ability to better control disease activity, to minimize functional disability, and depressive symptoms. More attention should be given to JIA patients who live in rural regions.

Biology, predation, and life table of Cydnoseius negevi and Neoseiulus barkeri (Acari: Phytoseiidae) on the old world date mite, Oligonychus afrasiaticus (Acari: Tetranychidae).

The old world date mite, Oligonychus afrasiaticus (McGregor) (Acari: Tetranychidae) is a severe spider mite pest of date palm in most of the Middle East and North Africa. Considering that nothing is known about the performance of phytoseiid predators against O. afrasiaticus, biology, predation, and life table parameters of Cydnoseius negevi (Swirski and Amitai) and Neoseiulus barkeri Hughes (Acari: Phytoseiidae), collected from date palm orchards, were studied under laboratory conditions (25, 35°C and 35 ± 10% RH) as a first step to understand their effectiveness against all mobile life stages of O. afrasiaticus. For both predators, oviposition period was significantly shorter at 35°C than at 25°C. The following parameters were obtained for C. negevi and N. barkeri at 25 and 35°C, respectively: female longevity, 31.8, 20.1, 35.7, 27.4 d; fecundity, 21.6, 38.0, 18.8, 34.8 eggs per female; oviposition period, 23.9, 13.7, 25.9, 18.1 d. Total predation of C. negevi and N. barkeri female was 246.0, 270.0, 227.6, 205.3 prey at 25 and 35°C, respectively. Rectal plugs were observed attached to the opisthosoma of some adult females of N. barkeri, which often cause the mite to stick to the surface. Life table parameters were estimated as net reproductive rate (R0) 10.44, 17.35, 10.19, 13.84, intrinsic rate of increase (rm) 0.14, 0.19, 0.13, 0.16 d(-1), finite rate of increase (λ) 1.15, 1.21, 1.12, 1.17 d(-1), generation time (T) 17.03, 15.17, 17.83, 16.61 d, doubling time (DT) 04.95, 03.64, 05.33, 04.33 d for C. negevi and N. barkeri at 25 and 35°C, respectively. The values of intrinsic rate of increase and net reproductive rate were higher in C. negevi than N. barkeri at both temperature regimes. Therefore, it could be concluded that C. negevi performance was better than N. barkeri against O. afrasiaticus and can be considered as a valuable addition to the existing methods for spider mites control.

Unidirectional barbed sutures vs. interrupted intracorporeal knots in thoracoscopic repair of congenital diaphragmatic hernia in pediatrics.

Background: Intracorporeal suturing knots continue to be one of the most challenging and time-consuming steps in the thoracoscopic repair of congenital diaphragmatic hernia (CDH). Barbed unidirectional knotless sutures are designed to shorten surgical procedures by eliminating the need to tie knots. This work aimed to compare unidirectional barbed sutures and interrupted intracorporeal knots in the thoracoscopic repair of CDH in pediatrics regarding the time required to suture, operative time and complications. Methods: This retrospective study included 139 patients presented with Bochdalek CDH. Patients were classified into early (neonatal) and late presentations. The hernia defect was repaired by unidirectional Barbed sutures (V-LocTM and StratafixTM sutures) in group B or by Conventional interrupted intracorporeal knots in group C. Results: In both early and delayed presentations, the time required to suture (15 and 13 min in group B, 33 and 28 min in group C for neonatal and delayed presentation respectively) was significantly shorter in group B. Complications (visceral perforation, wound infection, and recurrence) insignificantly differed between group B and group C of early presentation. No patients suffered from major complications in both groups. Conclusions: Both unidirectional barbed sutures and intracorporeal knots were safe and effective. However, unidirectional barbed sutures are a time-saving choices for CDH thoracoscopic repair in early and late presentations.

Posterior Sinuplasty: A New Strategy for Managing Hydrocolpos in Cloaca-Case Series.

We present a simple surgical technique aiming to improve urine outflow through the common urogenital sinus in cloaca and facilitate drainage of existing hydrocolpos. The study included three cases of cloaca with associated hydrocolpos that were operated during the period 2022 through 2023. The patient is placed in the prone position for a standard posterior sagittal anorectoplasty. The distal rectal fistula is severed flush with the vagina/sinus leaving an open defect in the posterior wall of the vagina/sinus. The defect is then widened distally via a vertical incision (∼1 cm) through the posterior wall of the common urogenital sinus toward but not reaching the perineum. This vertical defect is then closed horizontally displacing the posterior vaginal wall downwards toward the perineum (posterior sinuplasty). The postoperative recovery was uneventful in the three cases. Adequate drainage of hydrocolpos was confirmed by imaging at follow-up, as well as improvement of upper urinary tract dilatation. In selected cases of cloaca, posterior sinuplasty is a simple procedure that can be applied during anorectoplasty to provide effective drainage of associated hydrocolpos.

Nematocidal activity of chitosan nanoparticles conjugated with albendazole against the enteral and parenteral phases of trichinosis in experimentally infected mice.

Trichinosis is a serious parasitic zoonotic disease caused mainly by Trichinella spiralis. The used drugs for treatment of trichinosis showed limited bioavailability and high degree of resistance. Moreover, they have a very poor effect in treatment of encysted larvae. Therefore, there is a need for development of new agents which help in improving the bioavailability of the used drugs and enable them to reach different tissues. This study was designed to assess the use of chitosan nanoparticles (CSNPs) in conjugation with full and half dose albendazole (ABZ) in treatment of intestinal and muscular trichinosis. Albino mice (84 mice) were used to evaluate the efficacy of drugs and divided into seven groups; I: control, II: ABZ (50 mg/kg) treated, III: ABZ (25 mg/kg) treated, IV: ABZ (50 mg/kg) conjugated CSNPs treated, V: ABZ (25 mg/kg) conjugated CSNPs treated, VI: CS treated and VII: CSNPs treated. Parasitological and histopathological examinations were used to evaluate the therapeutic efficacy of the used drugs. Results showed significant reduction of adult Trichinella extracted from intestine of all ABZ treated groups either conjugated or not with the highest reduction rate in group IV followed by group V with percentage of reduction of 99.33% and 98.11%, respectively and marked improvement of histopathological examination. Also, results showed significant reduction of Trichinella larvae extracted from muscles of group IV, V and VII with the highest reduction rate in group IV with percentage of reduction of 100% in muscle larvae and marked improvement of histopathological examination. It was concluded that albendazole full dose conjugated chitosan nanoparticles can be a good candidate drug for treating both intestinal and muscular trichinosis.

FABP4, GINS2 and CBX7 Expression in Cancer Cervix Tissues: Clinical, Pathological and Prognostic Implications.

Background & Objective: Cervical cancer spreads to the pelvic lymph nodes, leading to a high incidence of cancer recurrence and unfavorable survival rates. Therefore, there is an urgent need to detect new predictive biomarkers for the early assessment of pelvic lymph node status in patients with cervical cancer. The current study aimed to assess the expression of FABP4, GINS2, and CBX7 in cervical cancer tissue to detect their prognostic and predictive roles in developing lymph node metastases in patients with that cancer type. Methods: We collected the tissues from patients with cervical cancer and evaluated the expression of FABP4, GINS2, and CBX7 using immunohistochemistry. We evaluated the association between their expression and clinicopathological and prognostic parameters. Results: A high expression of FABP4 and GINS2 and a low expression of CBX7 were found to be positively associated with the old age group, large tumor size, high grade and lymphovascular involvement, para-uterine organ infiltration, advanced FIGO stage, chemotherapeutic resistance, and tumor recurrence. Conclusion: We demonstrated the oncogenic roles of FABP4 and GISN2 in addition to the on-co-suppressive roles of CBX7 in cervical cancer and their association with poor clinicopathological criteria and poor survival. Our results may indicate that FABP4, GISN2, and CBX7 could be considered predictive biomarkers of the occurrence of lymph node metastases in the cancer of the cervix preoperatively, which could be beneficial in the accurate preoperative design therapy.

PYCR1, BANF1, and STARD8 Expression in Gastric Carcinoma: A Clinicopathologic, Prognostic, and Immunohistochemical Study.

BACKGROUND: It will be important to understand the molecular pathways of gastric cancer (GC) occurrence and progression, thus detecting predictive and prognostic biomarkers of GC. Pyrroline-5-carboxylate reductase 1 (PYCR1) was upregulated in many cancers, suggesting its possible roles in carcinogenesis and tumor metastases. Barrier-of-autointegration factor 1 (BANF1) is a protein family that plays essential roles in maintaining the integrity of an intact cellular genome. Rho-GTPs are molecular switches that control many signal transduction pathways in normal cells, including 3 subgroups from 1 to 3 (DLC1-3). DLC-3, known as StAR-related lipid transfer domain protein 8 (STARD8), and its role in cancers were not sufficiently studied. The study aimed to investigate the significance of PYCR1, BANF1, and STARD8 protein expression in GC tissues and normal gastric mucosa retrieved from patients with GC to detect prognostic roles of expression. PATIENTS AND METHODS: Specimens were collected from 100 patients with gastric carcinoma. After the application of the inclusion criteria of the study, we prepared 100 paraffin blocks from samples of the 100 included patients; each block included samples from gastric carcinoma and adjacent non-neoplastic gastric mucosa. We assessed the expression of PYCR1, BANF1, and STARD8 using immunohistochemistry in all studied samples. We followed patients for the detection of disease progression and survival rates. We correlate PYCR1, BANF1, and STARD8 expression with clinical, pathologic, and prognostic parameters. RESULTS: Overexpression of PYCR1 and BANF1 and decreased expression of STARD8 was found in gastric carcinoma tissues than adjacent non-neoplastic gastric mucosa ( P <0.001), and was positively associated with high grade ( P =0.006), depth of tumor invasion, presence of lymph nodes metastases and advanced stage ( P =0.001), high incidence of GC progression, recurrence, unfavorable disease-free survival ( P =0.003) and unfavorable overall survival rates ( P <0.001). Thus, it was revealed that; in univariate and multivariate analyses, levels of PYCR1, BANF1, and STARD8 are associated with the overall survival rate of GC patients. CONCLUSIONS: We showed that overexpression of PYCR1 and BANF1 and decreased expression of STARD8 in GC tissues was associated with poor prognosis and GC progression.

Feather mites of the genus Zachvatkinia Dubinin, 1949 (Astigmata: Analgoidea: Avenzoariidae) from Saudi Arabia: A new species and two new records.

Feather mites of the family Avenzoariidae (Acari: Astigmata: Analgoidea) are recorded for the first time in Saudi Arabia. A new avenzoariid species, Zachvatkinia (Zachvatkinia) repressae sp. n. (Avenzoariidae: Bonnetellinae), is described from the White-cheeked Tern, Sterna repressa Hartert, 1916 (Charadriiformes: Stemidae). The new species belongs to the sternae group and is closely related to Z (Z.) chlidoniae Mironov, 1989a. Two more species, Z. (Z.) dromae Mironov, 1992 and Z. (Z.) sternae (Canestrini & Fanzago, 1876), were collected from the Crab Plover Dromas ardeola Paykull, 1805 (Charadriiformes: Dromadidae) and the Sooty Gull Ichthyaetus hemprichii (Bruch, 1853) (Charadriiformes: Laridae), respectively. Among the 18 described species of Zachvatkinia Dubinin, 1949, including the new species, this is the fifth species recorded from a sternid host. The remaining 13 nominal species are associated with birds of the families Diomedeidae, Dromadidae, Hydrobatidae, Laridae, Pelecanoididae, Procellariidae and Stercorariidae. A checklist of world species of Zachvatkinia with data on their distribution and type hosts is also provided.

Post-circumcision penile skin loss: reporting the outcome of one-stage anterolateral scrotal based flaps in children.

Introduction: Improper penile assessment, together with carrying out circumcision by an inexperienced person, results in major complications. One of the complex complications is the complete or sub-complete penile skin loss, which in many cases, necessitates one or staged repair. Purpose: To evaluate modified one-stage bilateral anterolateral scrotal-based flaps to compensate for penile skin loss after circumcision. Methods: This study was performed on patients with almost penile skin loss after circumcision from February 2013 to July 2021. In all cases, one-stage modified bilateral anterolateral scrotal skin flaps were used to compensate for penile skin loss. The modification includes scrotal skin flap fashioning in a novel way, in addition to the use of penodermal fixation sutures at the penoscrotal junction, to create a stable penoscrotal junction and new penile skin coverage. Patients were discharged from the hospital on the same day of surgery. The dressing was left for 5 days. Follow-up visits were scheduled weekly in the first month, 3 and 6 months later, then annually. Results: Forty-six children were included in this study. Their mean age was 4.5 ± 1.5 years. The mean operative time was 139.6 ± 11.5 min. No flap ischemia or necrosis was reported. One case (2.2%) developed a scrotal hematoma managed conservatively. Three (6.5%) cases presented with wound dehiscence at the penoscrotal angle. Three (6.5%) cases had self-limited penile edema. Two (4.3%) cases had dorsal midline hypertrophic scar; one improved after treatment with triamcinolone acetonide ointment, and the other needed scar revision. The mean follows up was 23.33 ± 9.13 months. Conclusion: The modified scrotal skin flap technique provides a good substitution for stable penile skin coverage and a one-stage reconstruction of penile skin loss. It results in good parents' satisfaction with acceptable complications.

Evaluating the Effect of Lactobacillus casei FEGY 9973 and Curcumin on Experimental Giardiasis.

BACKGROUND AND OBJECTIVE: Giardia is a parasitic hard protozoan that causes a variety of parasitological and pathological changes in gastrointestinal epithelial cells and is resistant to a variety of disinfectants and treatments. This study used experimental animals infected with Giardia Lamblia to assess the potential therapeutic effect of Lactobacillus casei, Lactobacillus bulgaricus (Lactobacillus in yoghurt) and curcumin in comparison to one of the commonly used drugs (metronidazole). METHODS: The study included 54 Syrian hamsters (Mesocricetus auratus) that ranged in weight from 80 to 100 g and were divided into six groups: The effect of the used preparations was assessed in terms of parasitological and histopathological aspects in Group I non-infected healthy control, Group II infected non-treated, Group III infected treated with metronidazole MTZ, Group IV infected treated with Lactobacillus casei, Group V infected treated with curcumin, and Group VI infected treated with, Lactobacillus bulgaricus (Lactobacillus in yoghurt). The number of G. lamblia cysts per gram of stool was counted during the parasitological examination. RESULTS: The difference between the infected non-treated group and all the treated groups was statistically significant (P0.05). When compared to the infected untreated group, Lactobacillus casei and, Lactobacillus bulgaricus (Lactobacillus in yoghurt) produced a 100% reduction in G. lamblia cyst shedding, curcumin produced an 87.80% reduction in number of cysts, and metronidazole produced a 78.4% reduction in number of cysts. CONCLUSION: Our results highlight the potentially effective therapeutic effect of different preparations of probiotics and curcumin against Giardiasis.

Protein Expression of NEK2, JMJD4, and REST in Clear Cell Renal Cell Carcinoma (ccRCC): Clinical, Pathological, and Prognostic Findings.

Background & Objective: Cells of renal cell carcinoma (RCC) are resistant to the most currently used chemotherapeutic agents and targeted therapies; hence, we evaluated the expression of NEK2, JMJD4, and REST in cases of clear cell renal cell carcinoma (ccRCC) and benign adjacent tissues of kidney to detect associations between their expression and clinicopathological features, prognostic data, tumor recurrence, and survival rates. Methods: We collected 200 samples including tumoral and adjacent non-neoplastic tissues related to 100 ccRCC patients. All samples were evaluated for the expression of NEK2, JMJD4, and REST, and the patients were followed up for about 5 years. Tumor recurrence and survival data were documented and analyzed. Results: NEK2 and JMJD4 expression showed increase in ccRCC tissues (P=0.002 and 0.006), while REST was downregulated (P<0.001). The elevated expression of NEK2 was positively related ro the tumor size (P=0.015), higher grades (P=0.002), higher stages (P=0.013), distant spread (P=0.004), tumor recurrence, shorter progression-free survival (PFS) rate, and overall survival (OS) rate (P<0.001). Likewise, the high expression of JMJD4 showed positive correlation with the tumor size (P=0.047), higher grades (P=0.003), higher stages (P=0.043), distant spread (P=0.001), tumor recurrence, shorter PFS rate, and OS rate (P<0.001). Conversely, low expression of REST demonstrated positive relationship with the tumor size, higher grades, higher stages, distant spread, tumor recurrence, and shorter PFS and OS rates (P<0.001). Conclusion: Overexpression of NEK2 and JMJD4 and downregulation of REST may be noted in malignant renal tissues compared to benign renal tissues and may be correlated with unfavorable pathological findings, poor clinical parameters, and poor patient outcomes.

Intraoperative endomanometric laparoscopic Nissen fundoplication improves postoperative outcomes in large sliding hiatus hernias with severe gastroesophageal reflux disease: a retrospective cohort study.

BACKGROUND: Laparoscopic Nissen fundoplication (LNF) is the gold standard surgical intervention for gastroesophageal reflux disease (GERD). LNF can be followed by recurrent symptoms or complications affecting patient satisfaction. The aim of this study is to assess the value of the intraoperative endomanometric evaluation of esophagogastric competence and pressure combined with LNF in patients with large sliding hiatus hernia (>5 cm) with severe GERD (DeMeester score >100). MATERIALS AND METHODS: This is a retrospective, multicenter cohort study. Baseline characteristics, postoperative dysphagia and gas bloat syndrome, recurrent symptoms, and satisfaction were collected from a prospectively maintained database. Outcomes analyzed included recurrent reflux symptoms, postoperative side effects, and satisfaction with surgery. RESULTS: Three hundred sixty patients were stratified into endomanometric LNF (180 patients, LNF+) and LNF alone (180 patients, LNF). Recurrent heartburn (3.9 vs. 8.3%) and recurrent regurgitation (2.2 vs. 5%) showed a lower incidence in the LNF+ group ( P =0.012). Postoperative score III recurrent heartburn and score III regurgitations occurred in 0 vs. 3.3% and 0 vs. 2.8% cases in the LNF+ and LNF groups, respectively ( P =0.005). Postoperative persistent dysphagia and gas bloat syndrome occurred in 1.75 vs. 5.6% and 0 vs. 3.9% of patients ( P =0.001). Score III postoperative persistent dysphagia was 0 vs. 2.8% in the two groups ( P =0.007). There was no redo surgery for dysphagia after LNF+. Patient satisfaction at the end of the study was 93.3 vs. 86.7% in both cohorts, respectively ( P =0.05). CONCLUSIONS: Intraoperative high-resolution manometry and endoscopic were feasible in all patients, and the outcomes were favorable from an effectiveness and safety standpoint.

Biliary fistula and late recurrence of liver hydatid cyst: Role of cysto-biliary communication: A prospective multicenter study.

BACKGROUND: Hydatid cyst disease (HCD) is common in certain locations. Surgery is associated with postoperative biliary fistula (POBF) and recurrence. The primary aim of this study was to identify whether occult cysto-biliary communication (CBC) can predict recurrent HCD. The secondary aim was to assess the role of cystic fluid bilirubin and alkaline phosphatase (ALP) levels in predicting POBF and recurrent HCD. AIM: To identify whether occult CBC can predict recurrent HCD. The secondary aim was to assess the role of cystic fluid bilirubin and ALP levels in predicting POBF and recurrent HCD. METHODS: From September 2010 to September 2016, a prospective multicenter study was undertaken involving 244 patients with solitary primary superficial stage cystic echinococcosis 2 and cystic echinococcosis 3b HCD who underwent laparoscopic partial cystectomy with omentoplasty. Univariable logistic regression analysis assessed independent factors determining biliary complications and recurrence. RESULTS: There was a highly statistically significant association (P ≤ 0.001) between cystic fluid biochemical indices and the development of biliary complications (of 16 patients with POBF, 15 patients had high cyst fluid bilirubin and ALP levels), where patients with high bilirubin-ALP levels were 3405 times more likely to have biliary complications. There was a highly statistically significant association (P ≤ 0.001) between biliary complications, biochemical indices, and the occurrence of recurrent HCD (of 30 patients with recurrent HCD, 15 patients had high cyst fluid bilirubin and ALP; all 16 patients who had POBF later developed recurrent HCD), where patients who developed biliary complications and high bilirubin-ALP were 244.6 and 214 times more likely to have recurrent hydatid cysts, respectively. CONCLUSION: Occult CBC can predict recurrent HCD. Elevated cyst fluid bilirubin and ALP levels predicted POBF and recurrent HCD.