Premarital screening of the viral hepatitis among Saudi nationals.

Blood borne sexually transmitted infections are among the most serious health problems worldwide. Many people possessing these infections do not have symptoms and may remain undiagnosed. The current study aimed to screen premaritally the incidence of blood borne viruses among Saudi nationals. A retrospective longitudinal study was conducted, using a total of 91,000 medical records, in the blood bank from a single center in the Western region of Saudi Arabia. All persons who underwent premarital examination during the period 2016-2021 for the presence of hepatitis B and C viruses as a part of the national screening program in Saudi Arabia were included in the study. Serological tests were used to screen the presence of HBc Ab and HBs Ag. Both anti-HCV antibodies and the presence of virus RNA using real-time reverse transcriptase polymerase chain reaction (RT-PCR) were also performed. The study reported the presence of 378/91000 (0.42%) infections with hepatitis B virus (HBV) as indicated by the presence of HBc Ab and HBs Ag. Meanwhile, 208 (0.23%) cases were found to be exposed to HCV including 49/91000 (0.05%) active HCV cases, positive for the HCV RNA, while 159/91000 (0.17%) persons were found to possess positive HCV antibodies in the absence of detectable HCV RNA. It was concluded that there is a low prevalence of HBV and HBV among Saudi citizens who were subjected to premarital screening.

Subcutaneous emphysema and pneumomediastinum in patients with COVID-19 disease; case series from a tertiary care hospital in Pakistan.

Since December 2019, the clinical symptoms of coronavirus disease 2019 (COVID-19) and its complications are evolving. As the number of COVID patients requiring positive pressure ventilation is increasing, so is the incidence of subcutaneous emphysema (SE). We report 10 patients of COVID-19, with SE and pneumomediastinum. The mean age of the patients was 59 ± 8 years (range, 23-75). Majority of them were men (80%), and common symptoms were dyspnoea (100%), fever (80%) and cough (80%). None of them had any underlying lung disorder. All patients had acute respiratory distress syndrome on admission, with a median PaO2/FiO2 ratio of 122.5. Eight out of ten patients had spontaneous pneumomediastinum on their initial chest x-ray in the emergency department. The median duration of assisted ventilation before the development of SE was 5.5 days (interquartile range, 5-10 days). The highest positive end-expiratory pressure (PEEP) was 10 cmH2O for patients recieving invasive mechanical ventilation, while 8 cmH2O was the average PEEP in patients who had developed subcutaneous emphysema on non-invasive ventilation. All patients received corticosteroids while six also received tocilizumab, and seven received convalescent plasma therapy, respectively. Seven patients died during their hospital stay. All patients either survivor or non-survivor had prolonged hospital stay with an average of 14 days (range 8-25 days). Our findings suggest that it is lung damage secondary to inflammatory response due to COVID-19 triggered by the use of positive pressure ventilation which resulted in this complication. We conclude that the development of spontaneous pneumomediastinum and SE whenever present, is associated with poor outcome in critically ill COVID-19 ARDS patients.

Hospitalization of Pediatric Enteric Fever Cases, Dhaka, Bangladesh, 2017-2019: Incidence and Risk Factors.

BACKGROUND: Enteric fever causes substantial morbidity and mortality in low- and middle-income countries. Here, we analyzed Surveillance for Enteric Fever in Asia Project (SEAP) data to estimate the burden of enteric fever hospitalization among children aged <15 years and identify risk factors for hospitalization in Bangladesh. METHODS: SEAP used hospital surveillance paired with a community-based health-care utilization assessment. In SEAP hospital surveillance, blood was obtained for culture from children aged <15 years with ≥3 days of fever. In the hospital catchment area, a health-care utilization survey (HCUS) was conducted to estimate the proportion of febrile children hospitalized at the study hospitals. We analyzed hospital surveillance and HCUS data to estimate the health care-adjusted incidence of enteric fever hospitalization, and conducted univariable and multivariable logistic regressions. RESULTS: From July 2017 through June 2019, 2243 laboratory-confirmed enteric fever cases were detected in 2 study hospitals; 673 (30%) were hospitalized. The health care-adjusted incidence of enteric fever hospitalization among children <15 years old was 303/100 000 children/year (95% confidence interval [CI], 293-313). Salmonella Typhi contributed most to the enteric fever hospitalization incidence (277/100 000 children/year; 95% CI, 267-287). The incidence was highest among children aged 2 to <5 years (552/100 000 children/year; 95% CI, 522-583), followed by those aged <2 years (316/100 000 children/year; 95% CI, 288-344). Factors independently associated with enteric fever hospitalization included fever duration, diarrhea, vomiting, abdominal pain, and leukocytopenia. CONCLUSIONS: We estimated a high burden of hospitalization due to enteric fever among children aged <5 years in Bangladesh. The introduction of a typhoid conjugate vaccine would protect children from typhoid and avert typhoid hospitalizations.

Agro-industrial wastes for production of paclitaxel by irradiated Aspergillus fumigatus under solid-state fermentation.

AIMS: Paclitaxel is the most profitable drug ever developed in cancer chemotherapy; however, the yield of paclitaxel from microbial platforms is still far from the commercial purpose. Thus, this study was conducted to explore the possibility of solid-state fermentation (SSF) for production of paclitaxel by fungal fermentation. METHODS AND RESULTS: Different agro-industrial wastes were screened as solid substrates for production of paclitaxel by the endophytic Aspergillus fumigatus TXD105 under SSF. Sugarcane bagasse followed by wheat bran, and rice bran were the most suitable substrates for maximum production of paclitaxel. In the effort to increase the paclitaxel production, selection of the most proper moistening agent that supports the production of paclitaxel by the fungal strain was investigated. The effect of varying inoculum concentrations on the production of paclitaxel was also studied. Moreover, optimization of SSF conditions (moisture level, substrate concentrations and nutrients concentration) was adopted using response surface methodology. SSF carried out under the optimum conditions of 20 g sugarcane bagasse, twofold nutrients concentration of the MM1D broth, 80% moisture level and inoculum concentration of 107 spores per ml intensified the paclitaxel concentration to 145·61 mg kg-1 which represents a 10-fold increase. The production of paclitaxel by the fungal strain was further improved via exposure to UV and gamma radiation at specific doses. The paclitaxel concentrations were intensified following UV and gamma radiation to 209·91 and 351·82 mg kg-1 . CONCLUSIONS: This is the first report on the production of paclitaxel using agro-industrial wastes as cheap source that may contribute in lowering the cost of producing paclitaxel. SIGNIFICANCE AND IMPACT OF THE STUDY: These findings offer new and alternate sources with excellent biotechnological potential for paclitaxel production by fungal fermentation.

A novel source of the cardiac glycoside digoxin from the endophytic fungus Epicoccum nigrum: isolation, characterization, production enhancement by gamma irradiation mutagenesis and anticancer activity evaluation.

AIMS: Different endophytic fungi were isolated and screened for their digoxin-producing ability. Strain improvement and different culture conditions were studied for more effective production of digoxin. METHODS AND RESULTS: Among the isolated fungi, an isolate produced digoxin in a concentration of 2·07 mg l-1 . The digoxin-producing fungal isolate was identified as Epicoccum nigrum Link according to the morphological features and phylogenetic analyses. The potentiality of the fungal strain for production enhancement of digoxin was performed by gamma radiation mutagenesis. Gamma irradiation dose of 1000 Gy intensified the digoxin yield by five-fold. Using this dose, a stable mutant strain with improved digoxin productivity was isolated and the stability for digoxin production was followed up across four successive generations. In the effort to increase digoxin magnitude, selection of the proper cultivation medium, addition of some elicitors to the most proper medium and several physical fermentation conditions were tested. Fermentation process carried out in malt extract autolysate medium (pH 6·5) supplemented by methyl jasmonate and inoculated with 2 ml of 6-day-old culture and incubated at 25°C for 10 days stimulated the highest production of digoxin to attain 50·14 mg l-1 . Moreover, cytotoxicity of digoxin separated from the fungal culture was tested against five different cancer cell lines. Based on the MTT assay, digoxin inhibited the proliferation of the five different cancer cell lines and the recorded 50% inhibitory concentration ranged from 10·76 to 35·14 µg ml-1 . CONCLUSIONS: This is the first report on the production and enhancement of digoxin using fungal fermentation as a new and alternate source with high productivity. SIGNIFICANCE AND IMPACT OF THE STUDY: These findings offer new and alternate sources with excellent biotechnological potential for digoxin production by fungal fermentation. Moreover, digoxin proved to be a promising anticancer agent whose anticancer potential should be assessed in prospective cancer therapy.

Causes and incidence of community-acquired serious infections among young children in south Asia (ANISA): an observational cohort study.

BACKGROUND: More than 500 000 neonatal deaths per year result from possible serious bacterial infections (pSBIs), but the causes are largely unknown. We investigated the incidence of community-acquired infections caused by specific organisms among neonates in south Asia. METHODS: From 2011 to 2014, we identified babies through population-based pregnancy surveillance at five sites in Bangladesh, India, and Pakistan. Babies were visited at home by community health workers up to ten times from age 0 to 59 days. Illness meeting the WHO definition of pSBI and randomly selected healthy babies were referred to study physicians. The primary objective was to estimate proportions of specific infectious causes by blood culture and Custom TaqMan Array Cards molecular assay (Thermo Fisher, Bartlesville, OK, USA) of blood and respiratory samples. FINDINGS: 6022 pSBI episodes were identified among 63 114 babies (95·4 per 1000 livebirths). Causes were attributed in 28% of episodes (16% bacterial and 12% viral). Mean incidence of bacterial infections was 13·2 (95% credible interval [CrI] 11·2-15·6) per 1000 livebirths and of viral infections was 10·1 (9·4-11·6) per 1000 livebirths. The leading pathogen was respiratory syncytial virus (5·4, 95% CrI 4·8-6·3 episodes per 1000 livebirths), followed by Ureaplasma spp (2·4, 1·6-3·2 episodes per 1000 livebirths). Among babies who died, causes were attributed to 46% of pSBI episodes, among which 92% were bacterial. 85 (83%) of 102 blood culture isolates were susceptible to penicillin, ampicillin, gentamicin, or a combination of these drugs. INTERPRETATION: Non-attribution of a cause in a high proportion of patients suggests that a substantial proportion of pSBI episodes might not have been due to infection. The predominance of bacterial causes among babies who died, however, indicates that appropriate prevention measures and management could substantially affect neonatal mortality. Susceptibility of bacterial isolates to first-line antibiotics emphasises the need for prudent and limited use of newer-generation antibiotics. Furthermore, the predominance of atypical bacteria we found and high incidence of respiratory syncytial virus indicated that changes in management strategies for treatment and prevention are needed. Given the burden of disease, prevention of respiratory syncytial virus would have a notable effect on the overall health system and achievement of Sustainable Development Goal. FUNDING: Bill & Melinda Gates Foundation.

Ultrastructure changes induced by the phloroglucinol derivative agrimol G isolated from Leucosidea sericea in Haemonchus contortus.

Plant extracts used for the treatment of helminth infections in sheep are an alternative to chemical anthelmintic drugs. Previous studies have reported the anthelmintic activity of acetone leaf extracts of Leucosidea sericea. For this study, we evaluate the ultrastructure changes induced by the acetone leaf extract of L. sericea and the component agrimol G (AG) that was isolated for the first time on adult haemonchus parasites. Adult haemonchus parasites harvested from sheep were incubated with the plant extract and AG for 3 h and evaluated by both scanning and transmission electron microscopy in comparison and in combination with albendazole or ivermectin. In all cases the method of evaluation shows ultrastructural changes, with albendazole inducing mitochondrial damage and ivermectin inducing muscle degeneration, both as previously described. Incubation with the plant extract and AG resulted in the formation of numerous non-membrane bound multi-vesicular like bodies and evenly spread disruptions/erosion in the epicuticle. Combining AG with ivermectin or albendazole resulted in an absence of effect of AG. Based on the structural changes induced by AG, together with the absence of an effect in combination with ivermectin and albendazole would suggest a disrupted microtubular network. The latter does however require biochemical confirmation.

Chondroma of the falx cerebri: A case report and review of literature.

Chondroma is a benign cartilage-forming tumor which usually occurs in small bones of extremities but occasionally occurs in the brain. Usually, intracranial chondromas originate from skull base; however, chondroma of the falx cerebri is a very rare condition. We here report a rare case of falcine chondroma in a 19-year-old man who had normal physical examination without signs of any syndromic disorder. The neuroimaging findings were inconclusive, and the diagnosis was based on histopathological examination. The purpose of this paper is to raise attention about intracranial chondromas and suggest that chondroma must be ruled out in any patient presenting with masses arising from the falx.

Phosphonium-based Ionic Liquid Modified Activated Carbon from Mixed Recyclable Waste for Mercury(II) Uptake.

The contamination of water surfaces by mercury is a dangerous environmental problem due to its toxicity, which leads kidney damage. Activated carbon from mixed recyclable waste modified by phosphonium-based ionic liquid (IL-ACMRW) was therefore prepared and evaluated for Hg(II) remediation. The activated carbon used in this study was prepared from mixed waste, including cardboard, papers and palm wastes as cheap raw materials. The mixed Recyclable Waste Activated Carbon was combined with trihexyl(tetradecyl)phosphonium Bis2,4,4-(trimethylpentyl)phosphinate (Cyphos® IL 104) ionic liquid to form an adsorbent with organic-inorganic content, in order to improve the Hg(II) uptake from aqueous solutions. FTIR confirms the presence of P, C=O and OH after this modification. The adsorption process was investigated and the evaluated results showed that the capacity was 124 mg/g at pH 4, with a contact time of 90 min, an adsorbent dose of 0.4 g/L, and a Hg(II) concentration of 50 mg/L. This Hg(II) adsorption capacity is superior than that reported in the literature for modified multiwall carbon nanotubes. The adsorption of Hg(II) on the modified activated carbon from mixed recyclable waste was found to follow the pseudo second-order kinetics model. Isotherms of adsorption were analyzed via Freundlich and Langmuir models. The results indicated that Freundlich is the best model to describe the process, suggesting multilayer adsorption.

Ultrasound as a Diagnostic Tool in Paediatric Distal Forearm Fractures

Aims To evaluate the accuracy of ultrasound in pediatric distal forearm fractures as well as the effect on the ED waiting time for these patients. Methods Convenience sample of 42 pediatric patients presented with wrist injury. All patients underwent US examination followed by 2-views radiographs of the wrist with recording the time to US. In addition, the time to X-ray were calculated, retrospectively, on 95 pediatric patients for comparison. Results Forty-two patients were examined, 25 males (60%) and 17 females (40%), mean age 7.2 years. On X-Ray, 30 patients (71%) were confirmed to have a distal forearm fractures, of which, 28 (93%) were diagnosed by US. The sensitivity of ultrasound diagnosis was 93.3% (95% CI, 83%-100%), and the specificity was 92% (95% CI, 76%-100%). The positive and negative likelihood ratios were 11.6 and 0.07, respectively. Conclusions Ultrasound is a reliable diagnostic tool in the diagnosis of distal forearm fractures in children. Ultrasound has radiation free and decreases the length of stay in ED.

MicroRNA-122 as a Novel Non-Invasive Marker of Liver Fibrosis in Hepatitis C Virus Patients.

BACKGROUND: Noninvasive evaluation of hepatic fibrosis is a growing scientific effort in medicine and is of particular interest as early diagnosis is important for the timely prevention and treatment of liver fibrosis and cirrhosis. Non-invasive markers of liver fibrosis have recently been developed as an alternative to liver biopsy. Aim of the work: The aim of this study was to assess the diagnostic value of serum microRNA 122 in Egyptian chronic hepatitis C virus infected patients. This may be a useful tool as a non invasive diagnostic test to detect early stages of fibrosis in comparison to 4 non invasive indexes (APRI, Forns, FIB-4, and FI) vs. control and their ability to differentiate between mild and moderate fibrosis stages. METHODS: This study was conducted on 40 chronic hepatitis C patients diagnosed by liver biopsy and PCR and 20 apparently healthy volunteers who served as control group (III). Liver fibrosis was staged according to the METAVIR scoring system and consequently patients were classified in two groups of liver fibrosis: mild fibrosis (I) and moderate fibrosis (II). RESULTS: The mean expression level of microRNA-122 was significantly higher in both patient groups (I and II) as compared to the control group (III) (p < 0.001 for each). While there was no statistically significant difference in serum miR-122 expression level between group I compared to group II, microRNA 122 and 4 non invasive indexes (APRI, Forns, FIB-4, and FI) were statistically significant for prediction of fibrosis. MicroRNA 122 had the best performing ROC curve for prediction of fibrosis followed by APRI, FI, Forns, and FIB-4. The AUROCs ranged from 0.912 for FIB-4 to 1 for microRNA 122. While FIB-4 and Forns were statistically significant in differentiating mild and moderate fibrosis, FIB-4 had a better AUROC than Forns (0.75 and 0.71, respectively). CONCLUSIONS: The study concluded that there was increased expression of mcroiRNA-122 in Egyptian chronic hepatitis C virus (CHCV) infected patients. MicroRNA 122 has a strong potential to serve as one of the novel noninvasive markers of early liver fibrosis.

Implementation of enhanced recovery after surgery (ERAS) in gynaecological oncology.

OBJECTIVES: To evaluate the outcomes of enhanced recovery after surgery (ERAS) implementation in a gynaecological oncology centre. METHOD: Non-randomised control trial, evaluating morbidity outcomes, before and after implementation of ERAS programme. All consecutive major gynaecological oncology operations performed during two specified periods were included. Data were collected prospectively for a study group in the initial 7.5 months of ERAS implementation and compared with a consecutive historic control group from the exact same period, the year before. Patients' characteristics and perioperative outcomes were compared. Further analysis stratified abdominal and laparoscopic surgery. RESULTS: In total, 265 cases identified; 99 patients followed ERAS and 99 historic controls, managed with a traditional peri-operative approach, the exact same period the year before (vulval surgery excluded, 67 cases). Groups were comparable in demographics and co-morbidities (age, BMI, ASA, WHO), level of surgery and 30 days post-operative complication (grading Clavien-Dindo classification) and readmission rates (p > 0.05). Overall, the post-operative length of hospital stay (LOS) was significantly reduced for patients who followed ERAS (4.29 ± 2.78 days versus 7.23 ± 5.68 days, p < 0.001). Stratification to subgroups was based on the type of surgery, abdominal versus laparoscopic. Those who underwent abdominal surgery and followed ERAS benefited the maximum (LOS: 5.09 ± 2.74 days versus 8.70 ± 5.75, p < 0.001) CONCLUSIONS: ERAS programme is feasible and safe in Gynae-oncology. In this study, there was a reduction of 3.61 (SE: 0.78, CI 95 %) days in the total LOS, in major abdominal Gynae-oncology surgery (level 3 and 4) without affecting complication or readmission rates.

Immune and vascular dysfunction in diabetic wound healing.

The diminished capacity for wound healing in patients with diabetes contributes to morbidity through ulceration and recurrent infections, loss of function and decreased workplace productivity, increased hospitalisation rates, and rising health-care costs. These are due to diabetes' effects on signalling molecules, cellular cascades, different cell populations, and the vasculature. The function of multiple immune system components including cellular response, blood factors, and vascular tone are all negatively impacted by diabetes. The purpose of this paper is to review the current understanding of immune and vascular dysfunction contributing to impaired wound healing mechanisms in the diabetic population. Normal wound healing mechanisms are reviewed followed by diabetic aberrations to immune and inflammatory function and atherogenesis and angiopathy. DECLARATION OF INTEREST: The authors have no financial or personal relationships to people or organisations that could potentially and inappropriately influence their work and conclusions.

Immobilization technique for enhanced production of the immunosuppressant mycophenolic acid by ultraviolet and gamma-irradiated Penicillium roqueforti.

AIMS: Different entrapment matrices were screened to immobilize two strains of Penicillium roqueforti (AG101 and LG109) for more effective production of mycophenolic acid (MPA). Further improvement in the MPA productivity from immobilization of spores and mycelia was adopted by UV and gamma irradiation. METHODS AND RESULTS: Penicillium roqueforti strains were immobilized in different entrapping carriers and used for MPA production in shake flask cultures. Maximum MPA production was achieved on using an alginate concentration of 3·0% (w/v) and a mycelial fresh weight of 10% (w/v). MPA produced by alginate-immobilized spores and mycelia was almost double in comparison to the free system. The MPA-producing ability of immobilized AG101 and LG109 strain was significantly enhanced by mutagenesis through irradiation by UV (254 nm) for 120 and 90 min, respectively and gamma rays at 0·75 KGy. The feasibility of MPA production in a semi-continuous form by immobilized cells as affected by irradiation was adopted. CONCLUSIONS: MPA production by immobilized spores and mycelia was more intensified by UV and gamma irradiation. Moreover, the immobilized cell culture was superior to free-cell culture. SIGNIFICANCE AND IMPACT OF THE STUDY: These findings indicate the future possibility to reduce the cost of producing fermentation-based drugs.

Generation of mice carrying a knockout-first and conditional-ready allele of transforming growth factor beta2 gene.

Transforming growth factor beta2 (TGFß2) is a multifunctional protein which is expressed in several embryonic and adult organs. TGFB2 mutations can cause Loeys Dietz syndrome, and its dysregulation is involved in cardiovascular, skeletal, ocular, and neuromuscular diseases, osteoarthritis, tissue fibrosis, and various forms of cancer. TGFß2 is involved in cell growth, apoptosis, cell migration, cell differentiation, cell-matrix remodeling, epithelial-mesenchymal transition, and wound healing in a highly context-dependent and tissue-specific manner. Tgfb2(-/-) mice die perinatally from congenital heart disease, precluding functional studies in adults. Here, we have generated mice harboring Tgfb2(ßgeo) (knockout-first lacZ-tagged insertion) gene-trap allele and Tgfb2(flox) conditional allele. Tgfb2(ßgeo/ßgeo) or Tgfb2(ßgeo/-) mice died at perinatal stage from the same congenital heart defects as Tgfb2(-/-) mice. ß-galactosidase staining successfully detected Tgfb2 expression in the heterozygous Tgfb2(ßgeo) fetal tissue sections. Tgfb2(flox) mice were produced by crossing the Tgfb2(+/ßgeo) mice with the FLPeR mice. Tgfb2(flox/-) mice were viable. Tgfb2 conditional knockout (Tgfb2(cko/-) ) fetuses were generated by crossing of Tgfb2(flox/-) mice with Tgfb2(+/-) ; EIIaCre mice. Systemic Tgfb2(cko/-) embryos developed cardiac defects which resembled the Tgfb2(ßgeo/ßgeo) , Tgfb2(ßgeo/-) , and Tgfb2(-/-) fetuses. In conclusion, Tgfb2(ßgeo) and Tgfb2(flox) mice are novel mouse strains which will be useful for investigating the tissue specific expression and function of TGFß2 in embryonic development, adult organs, and disease pathogenesis and cancer. genesis

Chewing gum in preventing postoperative ileus in women undergoing caesarean section: a systematic review and meta-analysis of randomised controlled trials.

BACKGROUND: The incidence of postoperative ileus (POI) after gynaecological surgery is 10-15% Chewing gum following general surgery improves outcomes, including early flatus, early bowel sounds, and shortening of hospitalisation periods. There is currently no guideline that supports the use of chewing gum after caesarean sections. OBJECTIVES: To systematically analyse the published randomised controlled trials regarding the effectiveness of chewing gum in preventing POI in women undergoing caesarean sections. SEARCH STRATEGY: Systematic search of medical databases up to March 2013. SELECTION CRITERIA: Randomised controlled trials that reported the role of chewing gum in preventing POI in women undergoing caesarean sections. DATA COLLECTION AND ANALYSIS: Two authors independently identified the relevant studies for inclusion, extracted outcome-related data, and analysed it systematically using REVMAN(®). The combined outcome was expressed as an odds ratio and standardised mean difference. MAIN RESULTS: Seven randomised controlled trials involving 1462 women (728 in the chewing gum group, 734 controls) were systematically analysed. There was significant heterogeneity (χ(2) = 29.02, df = 7; P < 0.0001; I(2) = 76%) among the included trials. Among women undergoing caesarean sections, chewing gum reduced the risk of POI (odds ratio 0.36; 95% confidence interval 0.19-0.69; z = 3.08; P < 0.002) but did not affect duration of hospitalisation (P = 0.32). CONCLUSIONS: Chewing gum for 30-60 minutes at least three times a day appears to be effective in reducing the incidence and consequences of POI following caesarean sections.

Sustained hypophosphatemia after denosumab in a patient on hemodialysis.

An 81-year-old Caucasian man who had commenced thrice weekly hemodialysis (HD) three months earlier, presented with a hip fracture, two vertebral fractures and a bone mineral density T-score of -3.6. He had received weekly iron sucrose infusions for 6 weeks and alphacalcidol on dialysis days. Although he suffered from coeliac disease and cirrhosis, he was fully ambulatory and well-nourished. He was normocalcaemic with a marginally low plasma phosphate and the PTH was 11.8 pmol/L (<2-times the upper range of the assay). In view of his severe osteoporosis, it was decided to treat him with denosumab (dmab). Laboratory assessment 2 weeks post dmab showed severe hypophosphatemia and hypocalcemia; phosphate 0.11 mmol/L and ionized calcium 0.83 mmol/L, and he was admitted for intravenous phosphate infusion. Three months later he remained on a phosphate supplement. The case illustrates that, in addition to the risks of hypocalcemia in patients with kidney failure and high bone turnover, kidney failure patients without evidence of high bone turnover, can also be at risk of hypocalcemia and severe hypophosphatemia requiring acute hospitalization and phosphate infusion. The potential role of compromised phosphate absorption versus increased deposition will be discussed. We recommend a cautious approach to dmab therapy in patients on dialysis, with evaluation of bone turnover and serum phosphate levels prior to initiation of treatment.

Bioaccumulation and sources of metal(loid)s in fish species from a subtropical river in Bangladesh: a public health concern.

Toxic metals and freshwater fish's metalloid contamination are significant environmental concerns for overall public health. However, the bioaccumulation and sources of metal(loids) in freshwater fishes from Bangladesh still remain unknown. Thus, the As, Pb, Cd, and Cr concentrations in various freshwater fish species from the Rupsha River basin were measured, including Tenualosa ilisha, Gudusia chapra, Otolithoides pama, Setipinna phasa, Mystus vittatus, Glossogobius giuris, and Pseudeutropius atherinoides. An atomic absorption spectrophotometer was used to determine metal concentrations. The mean concentrations of metal(loids) in the fish muscle (mg/kg) were found to be As (1.53) > Pb (1.25) > Cr (0.51) > Cd (0.39) in summer and As (1.72) > Pb (1.51) > Cr (0.65) > Cd (0.49) in winter. The analyzed fish species had considerably different metal(loid) concentrations with seasonal variation, and the distribution of the metals (loids) was consistent with the normal distribution. The demersal species, M. vittatus, displayed the highest bio-accumulative value over the summer. However, in both seasons, none of the species were bio-accumulative. According to multivariate statistical findings, the research area's potential sources of metal(loid) were anthropogenic activities linked to geogenic processes. Estimated daily intake, target hazard quotient (THQ), and carcinogenic risk (CR) were used to assess the influence of the risk on human health. The consumers' THQs values were < 1, indicating that there were no non-carcinogenic concerns for local consumers. Both categories of customers had CRs that fell below the permissible range of 1E - 6 to 1E - 4, meaning they were not at any increased risk of developing cancer. The children's group was more vulnerable to both carcinogenic and non-carcinogenic hazards. Therefore, the entry of metal(loids) must be regulated, and appropriate laws must be used by policymakers.

Surgical Outcomes of Laparoscopic-assisted Distal Gastrectomy Versus Totally Laparoscopic Distal Gastrectomy Billroth I for Gastric Cancer.

OBJECTIVE: The present study aimed to compare intraoperative and postoperative outcomes of laparoscopic-assisted distal gastrectomy versus totally laparoscopic distal gastrectomy (TLDG) Billroth I (BI) for gastric cancer and to assess the impact of the initial introduction phase of TLDG BI anastomosis. PATIENTS AND METHODS: The study analyzed the prospectively collected data of patients who underwent laparoscopic distal gastrectomy BI from 2014 to 2021 at Seoul National University Hospital. RESULTS: Among 1116 patients, laparoscopic-assisted distal gastrectomy BI was performed in 566 patients and TLDG BI was performed in 550 patients. The total laparoscopic arm had a faster mean operative time (190 vs 208 min; P < 0.001) and a shorter postoperative hospital stay (7.4 vs 7.9 d; P < 0.001). Local complications were higher in the total laparoscopic group (17.6% vs 9.9%; P = 0.008) during the early introduction phase. CONCLUSION: The total laparoscopic approach for BI reconstruction is safe and effective with faster operative time, shorter hospital stays, and less wound infection, but it may be associated with an increase in postoperative surgical complications and hospital stay in the early introduction phase.

Evaluation of the remineralizing effect of the chicken eggshell paste after removal of the fixed orthodontic appliance: An in vitro study.

BACKGROUND: Demineralization of the enamel surface, which appears as white spot lesions during and after removal of the fixed orthodontic appliance, is the most common disadvantage of the orthodontic treatment course. Using the remineralizing agents during and after orthodontic treatment helps to avoid those enamel defects. OBJECTIVE: The present study aims to assess the remineralizing effect of the chicken eggshell powder on the demineralized enamel surfaces after debonding the orthodontic bracket system. MATERIALS AND METHODS: The current study was performed on 80 prepared premolar crowns embedded into acrylic molds. The samples were prepared to receive routine steps of the bonding process for the bracket system. The paste of the chicken eggshell powder was added to the samples after the debonding process. Scanning electron microscopy (SEM) and energy-dispersive X-ray (EDX) were used to evaluate the remineralization effect of the chicken eggshell powder. Also, the Vickers microhardness tester was used to assess the enamel surface microhardness. RESULTS: It was found that the mean value of the Ca/P ratio for the samples before bonding of the orthodontic bracket system was (4.17 ± 2.2). This value significantly decreased to (2 ± 1.3) after debonding of the orthodontic bracket system and then showed a significant increase to (4.79 ± 2.65) after remineralization. These results were assured by the values of the Vickers microhardness tester. CONCLUSION: The chicken eggshell powder has an excellent remineralization effect for the demineralized enamel surface after debonding the orthodontic enamel surface.