Association of ACE1 I/D polymorphism and susceptibility to COVID-19 in Egyptian children and adolescents.

BACKGROUND: Given the sparse data on the renin-angiotensin system (RAS) and its biological effector molecules ACE1 and ACE2 in pediatric COVID-19 cases, we investigated whether the ACE1 insertion/deletion (I/D) polymorphism could be a genetic marker for susceptibility to COVID-19 in Egyptian children and adolescents. METHODS: This was a case-control study included four hundred sixty patients diagnosed with COVID-19, and 460 well-matched healthy control children and adolescents. The I/D polymorphism (rs1799752) in the ACE1 gene was genotyped by polymerase chain reaction (PCR), meanwhile the ACE serum concentrations were assessed by ELISA. RESULTS: The ACE1 D/D genotype and Deletion allele were significantly more represented in patients with COVID-19 compared to the control group (55% vs. 28%; OR = 2.4; [95% CI: 1.46-3.95]; for the DD genotype; P = 0.002) and (68% vs. 52.5%; OR: 1.93; [95% CI: 1.49-2.5] for the D allele; P = 0.032). The presence of ACE1 D/D genotype was an independent risk factor for severe COVID-19 among studied patients (adjusted OR: 2.6; [95% CI: 1.6-9.7]; P < 0.001. CONCLUSIONS: The ACE1 insertion/deletion polymorphism may confer susceptibility to SARS-CoV-2 infection in Egyptian children and adolescents. IMPACT: Recent studies suggested a crucial role of renin-angiotensin system and its biological effector molecules ACE1 and ACE2 in the pathogenesis and progression of COVID-19. To our knowledge, ours is the first study to investigate the association of ACE1 I/D polymorphism and susceptibility to COVID-19 in Caucasian children and adolescents. The presence of the ACE1 D/D genotype or ACE1 Deletion allele may confer susceptibility to SARS-CoV-2 infection and being associated with higher ACE serum levels; may constitute independent risk factors for severe COVID-19. The ACE1 I/D genotyping help design further clinical trials reconsidering RAS-pathway antagonists to achieve more efficient targeted therapies.

Vitamin D deficiency and vitamin D receptor FokI polymorphism as risk factors for COVID-19.

BACKGROUND: Given the sparse data on vitamin D status in pediatric COVID-19, we investigated whether vitamin D deficiency could be a risk factor for susceptibility to COVID-19 in Egyptian children and adolescents. We also investigated whether vitamin D receptor (VDR) FokI polymorphism could be a genetic marker for COVID-19 susceptibility. METHODS: One hundred and eighty patients diagnosed to have COVID-19 and 200 matched control children and adolescents were recruited. Patients were laboratory confirmed as SARS-CoV-2 positive by real-time RT-PCR. All participants were genotyped for VDR Fok1 polymorphism by RT-PCR. Vitamin D status was defined as sufficient for serum 25(OH) D at least 30 ng/mL, insufficient at 21-29 ng/mL, deficient at <20 ng/mL. RESULTS: Ninety-four patients (52%) had low vitamin D levels with 74 (41%) being deficient and 20 (11%) had vitamin D insufficiency. Vitamin D deficiency was associated with 2.6-fold increased risk for COVID-19 (OR = 2.6; [95% CI 1.96-4.9]; P = 0.002. The FokI FF genotype was significantly more represented in patients compared to control group (OR = 4.05; [95% CI: 1.95-8.55]; P < 0.001). CONCLUSIONS: Vitamin D deficiency and VDR Fok I polymorphism may constitute independent risk factors for susceptibility to COVID-19 in Egyptian children and adolescents. IMPACT: Vitamin D deficiency could be a modifiable risk factor for COVID-19 in children and adolescents because of its immune-modulatory action. To our knowledge, ours is the first such study to investigate the VDR Fok I polymorphism in Caucasian children and adolescents with COVID-19. Vitamin D deficiency and the VDR Fok I polymorphism may constitute independent risk factors for susceptibility to COVID-19 in Egyptian children and adolescents. Clinical trials should be urgently conducted to test for causality and to evaluate the efficacy of vitamin D supplementation for prophylaxis and treatment of COVID-19 taking into account the VDR polymorphisms.

The Deepithelialized Dorsal Tongue Flap for Reconstruction of Anterior Palatal Fistulae: Literature Review and Presentation of Our Experience in Egypt.

OBJECTIVE: The purpose of this study was to present our experience with the closure of challenging palatal fistulae using the deepithelialized dorsal anterior tongue flap. We highlight the efficacy of suturing the tip of the tongue flap to the nasal septum for prevention of flap detachment. DESIGN: Prospective analysis of cleft patients with anterior palatal fistulae repaired by deepithelialized dorsal anterior tongue flap. SETTING: Institutional center. PATIENTS/PARTICIPANTS: A total of 30 patients with anterior palatal fistulae in the setting of previous cleft palate or fistula repair. INTERVENTIONS: Deepithelialized dorsal anterior tongue flap for treatment of anterior palatal fistulae. OUTCOME MEASURES: Patients had repair using deepithelialized dorsal anterior tongue flap between 2011 and 2014. Patients' photographs and clinical records were collected. The technique of flap harvesting and method of securing it in its position are described in this study. RESULTS: Patients were followed up over a mean period of 13.8 months to check flap viability, competent repair, and donor site function and aesthetics. All patients showed uneventful healing without complications. CONCLUSIONS: This technique offered a secure method of palatal fistulae reconstruction. Further research is needed to show this technique's advantages and drawbacks.

Arabic gum/chitosan/Zn-NPs composite film maintains the quality of Hass avocado fruit by delaying ripening and activating enzymatic defense mechanisms.

Avocado fruit is a climacteric fruit that has a short life after harvest. Chitosan (Ch) and Arabic gum (AG) have a pronounced effect on the storability of fruits. This investigation aimed to determine the effect of individual or combined use of Ch and AG as well as Ch/AG enriched with 2, 4, 8% Zn-NPs on physio-biochemical attributes and antioxidant capacity of Hass avocado fruit during cold storage (7 °C). The result showed that Ch or AG alone succeeded in maintaining fruit quality of Hass fruit during cold storage. Also, combined application of Ch/AG was more effective than individual application of Ch or AG in reducing fruit weight and polyphenol oxidase activity (PPO) as well as increasing total antioxidant capacity (TAC) and malondialdehyde (MDA). Moreover, Ch/AG coating enriched with 8% Zn-NPs recorded the lowest fruit weight loss, fruit decay %, TSS fruit content, fruit firmness and improved fruit skin and pulp color significantly compared to Ch/AG and control. Coating with Ch/AG/2%Zn NPs recorded the highest peroxidase (POD) activity, while Ch/AG/8% Zn-NPs recorded the highest TAC and the lowest PPO activity. Moreover, enriched Ch/GA with Zn-NPs recorded the highest CAT and POD activity compared to the control. This study shows the efficiency of Ch/AG enriched with Zn-NPs on preserving Hass avocado fruit quality during cold storage by delaying ripening process and activating enzymatic defense mechanisms.

Fifty years of Sudanese hospital-based obstetric outcomes and an international partnership.

OBJECTIVE: To present 50 years of hospital-based maternal and perinatal outcomes in Sudan, and the role of an international collaboration with an Irish maternity hospital, over the period 2002-2009, in recent health-indicator improvements. DESIGN: Retrospective descriptive study. SETTING: Omdurman Maternity Hospital, Sudan. POPULATION: All women who delivered at Omdurman Maternity Hospital, and their newborn infants, from July 1957 to October 2007, comprising 339 448 births. METHODS: The original logbook data was extracted. Infant and maternal health indicators were calculated according to World Health Organization definitions. MAIN OUTCOMES MEASURES: Total annual births, maternal mortality ratio and maternal complications, neonatal mortality and stillbirth rates, and rates of delivery methods. RESULTS: Total births increased 50-fold from 499 in 1958 to 24 913 in 2007. Significant reductions in morbidity and mortality began in the mid-1990s. From 2001 to 2007, maternal mortality fell from 329 to 36 per 100 000 live births: an 85% reduction. Stillbirth rates almost halved, from 35 to 19 per 1000 births in 2001 and 2007, respectively. Neonatal mortality rates remained largely static, at 24 per 1000 live births in 2007, but there is recent evidence of a decline. CONCLUSION: This hospital-based data offers a unique historical portrait of health outcomes in one of the largest maternity hospitals in Africa, and shows steady, sustained improvements in maternal, stillbirth and neonatal mortality rates since the 1990s. The partnership was associated with a number of positive infrastructural, educational, and staffing achievements. Whether it directly contributed to improved health outcomes has not been established.

Ischemia-modified Albumin as a Biomarker for Prediction of Poor Outcome in Patients With Traumatic Brain Injury: An Observational Cohort Study.

BACKGROUND: Biomarkers can assist in outcome prediction and therapeutic decision making after traumatic brain injury (TBI). The aim of this study was to evaluate the role of ischemia-modified albumin (IMA) in the prediction of mortality in patients with TBI. METHODS: In this observational study IMA was measured on admission to intensive care unit (D0) and 24 hours later (D1) in a cohort of patients with mixed TBI severity. The primary outcome was the correlation between IMA and 28-day mortality. Secondary outcomes included the incidence of elevated IMA, and the correlation between the severity of TBI and IMA, and between IMA and change in Glasgow coma score (GCS). The area under receiver operating characteristic curve analysis was performed to detect optimal IMA cut-off value for the detection of mortality. RESULTS: Fifty-four patients were included in the study; IMA was elevated in 49 (90.7%) on admission to the intensive care unit. Of the 49 patients with elevated IMA, 22 had a decrease in IMA while 27 had an increase by 24 hours. IMA levels were higher at D0 and D1 (P<0.001 for both) in patients who died compared with those who survived. Twenty-one patients died (mortality rate 38.9%); all had elevated IMA on D0 and D1 and higher IMA levels at D1 compared with D0. Optimal cut-off values for IMA predicted mortality with 76.2% sensitivity and 81.8% specificity at D0 and with 100% sensitivity and specificity at D1. IMA values at D0 and D1 were correlated with D0 and D1 GCS, respectively (both P<0.001). CONCLUSION: IMA levels were elevated in patients following TBI, and can predict mortality with high sensitivity and specificity.

Computer tomography imaging of an unusual cause of appendicitis: a case report.

Foreign body occlusion of appendices lumen is a quite rare cause of appendicitis due to foreign body. We present a case of a 63-year-old male who presented with right lower quadrant pain since 24 hours. Computed tomography (CT) demonstrated an acute appendicitis due to a metallic foreign body which was found to be a bullet.

Studies on the efficacy of combined immunostimulant-antibiotic therapy against experimental Mycoplasma gallisepticum infection in chickens.

Josamycin is an antibiotic known to become selectively concentrated intracellularly and in respiratory organs, the habitate of Mycoplasma gallisepticum. The aim of this present work was to evaluate the efficacy of josamycin when given alone or combined with an immunostimulant Cornebacterium cutis ultralysate. Groups of chickens were given josamycin alone or Corynebacterium ultralysate alone or both agents or nothing immediately before induction of Mycoplasma gallisepticum infection. Birds were subjected to pathological examination to evaluate the incidence and severity of air-sacculitis, bacteriological examination for re-isolation of Mycoplasma gallisepticum and for immunological examination to evaluate the humoral immune response to the infection (haemagglutination inhibiting titre determination). The effect of treatments used in this study was to decrease the incidence and severity of air sacculitis. The magnitude of rise in haemagglutination inhibiting titres were greater and faster in birds given Corynebacterium ultralysate. Treatments failed to achieve complete elimination of Mycoplasma. No special advantage was obtained from the use of josamycin, its effects were rather similar to previously used chemotherapy.

Chemical submission to commit robbery: a series of involuntary intoxications with flunitrazepam in Asian travellers in Brussels.

Between January 17, 2003 and August 29, 2003, the Emergency Department admitted a patient who had been surreptitiously intoxicated and robbed of his valuables every Friday. The first cases were considered anecdotal, but criminal activity was rapidly suspected. The cohort includes 16 male Asian patients aged 28-50 years. All the victims had just arrived in Brussels through one of the main rail station of the town and were admitted via the emergency ambulance service from different locations in the centre of Brussels around the CHU Saint-Pierre Hospital. Haemodynamic parameters upon admission were within normal limits. The Glasgow Coma Scale was equal or higher than 9/15 in 14 of the 16 victims. Toxicology screening obtained in 12 patients revealed the presence of flunitrazepam, which was further quantified at levels ranging from 21 to 75 µg/l. One of the Japanese patients, who returned to Belgium afterwards for professional reasons, was approached by the police and accepted to press charges. This allowed the police to investigate and send undercover agents to the railway station on Friday afternoons and evenings. They found a person who was offering welcome cookies to Asian travellers. He arrived from Amsterdam and returned once his crime was committed. Flunitrazepam is well known as a rape drug. We report a series of victims in whom flunitrazepam was used to facilitate robbery.

Left tilt position for easy extracorporeal membrane oxygenation cannula insertion in late pregnancy patients.

The aim was to describe how to avoid technical difficulties during venous femoral cannula insertion for extracorporeal membrane oxygenation (ECMO) in a woman in late pregnancy. A 28-year old pregnant woman presented at 32 weeks of gestation after developing an acute respiratory distress syndrome (ARDS) of an unknown origin that required venovenous ECMO insertion via the femoral vein. A cannula insertion by the Seldinger visual control technique was impossible in the supine position. A left lateral tilt between 15° and 30° was performed by placing a wedge-shaped cushion under the right hip permitting the cannula insertion. We proposed a systematic 15°-30° left lateral tilt position during the ECMO femoral cannula insertion in late pregnancy cases needing ECMO. This precaution should avoid an injury to the vessels due to multiple insertion attempts.

Five years follow-up after Y-graft arterial revascularization: on pump versus off pump; prospective clinical trial.

OBJECTIVES: We report our comparative experience of on-pump and off-pump full arterial coronary artery bypass grafting (CABG) using both internal mammary arteries (IMAs) anastomosed as a Y-graft. METHODS: A single-center clinical study was conducted prospectively between January 2003 and May 2008. It compared the short- and mid-term clinical outcomes of on- and off-pump arterial revascularization where the left internal mammary artery (LIMA) was anastomosed to the left anterior descending (LAD) artery while the free right internal mammary artery (RIMA) graft taking off from the LIMA was used to bypass different coronary targets. RESULTS: One hundred and ninety-two patients were divided into 77 on-pump and 115 off-pump procedures based on the intention to treat. The mean age in both groups was 60.2+/-11.7 and 68.1+/-10.6 years, respectively (P<0.05). Mean predictive logistic EuroSCORE was 3.5+/-6.7% for the on-pump group and 7.3+/-8.6% for the off-pump group (P<0.0001). Mean number of distal anastomoses were 2.7+/-0.6 (group ON) and 2.5+/-0.6 (group OFF) (P=NS). Postoperative mortality was two patients (2.6%) in the on-pump group and four patients (3.4%) in the off-pump group (P=0.63). No major adverse cardiac event, no stroke and no late death were reported during the follow-up that averaged 36.5+/-18.6 months. Angina recurrence was three patients (2.6%) in off-pump and two patients (3.5%) in on-pump group (P=NS). CONCLUSIONS: The use of a free RIMA as Y-graft from the LIMA performed off pump eradicates aortic manipulations and provides complete revascularization to high-risk patients with mortality similar to the one of a lower risk population operated on pump. The morbidity and cost was lower in the off-pump group. This advocates for the widespread usage of the technique in high-risk patients.

Recurrent endocarditis of a bicuspid aortic valve due to Q fever.

A 46-year-old man was referred to our institution for a recurrent endocarditis with negative blood culture. Clinical examination and complementary investigations confirmed the diagnosis of aortic valve endocarditis with left ventricular fistula. Blood culture was negative but serological tests were positive for Coxiella burnetti. Aortic valve replacement and fistula repair were done. A combination of Doxycycline and Chloroquine antibiotics was given postoperatively with a clinical improvement. Coxiella burnetti should be systemically searched for in all cases of endocarditis even with negative blood cultures. This case is interesting because of its rarity, diagnosis, therapeutic problems and its severe complication.

Esophageal stents for iatrogenic esophageal perforations during cardiac surgery.

The usefulness and safety of transesophageal echocardiography during cardiac surgery have been well described in the literature. However, rare complications of this procedure can occur and should be familiar to surgeons and anesthesiologists. A series of two cases of esophageal perforation by echoprobe during cardiac surgery treated successfully by endoscopic stenting are reported.

Studies on the helminth parasites of birds from Egypt: 1-trematoda and cestoda.

A total number of 1019 wild birds were examined, of which 486 (49%) were found infected with one or more species of helminth parasites. Digeneans were recovered from 151 (15%) and cestodes from 249 (24%) birds. Out of 20 helminth species recovered, 10 were found new (7 trematodes and 3 cestodes). The prevalence and the effect of concurrent infection on the most frequently occurring helminth parasites were recorded and discussed. A review of all the trematode and cestode parasites previously described from the Egyptian birds was also given.

Two new species of Eumegacetes Looss, 1900 (Digenea: Eumegacetidae) from Egyptian birds.

Two new species of the genus Eumegacetes Looss, 1900 are described from avian hosts in Sharkia province, Egypt and these include Eumegacetes (Anterovitellum) pycnonotus n. sp. from the bulbul, Pycnonotus barbatus, and E. (Posthovitellum) hirundus n. sp. from the barn swallow Hirundo rustica saviginii. The descriptions are based primarily on differences in the shape and elevation of the intestinal caeca, the position of the genital opening and the shape and distribution of the vitelline follicles, testes, ovary and uterine loops.

A new species of Neyraia Joyeux et Timon-David, 1934 (Cestoda: Dilepididae) from the Egyptian wild birds.

A new species of the genus Neyraia Joyeux et Timon-David, 1934 is described from Egyptian wild birds; Neyraia epops from the hoopoe Upupa epops. The new species is compared and with the other related species of the genus. The erection of the new species was based primarily on differences in the number of testes and number of the rostellar hooks.

Studies on samh seeds (Mesembryanthemum forsskalei Hochst) growing in Saudi Arabia: 3. Utilization of samh seeds in bakery products.

Samh seeds obtained from Al-Jouf area were ground into flour analyzed and used as a replacement for wheat in the ratio of 10, 20 and 30% for bread and 30, 60 100% for cookies. The rheological effect of the Samh flour on Saudi wheat flour was also studied. The bread and cookies obtained were evaluated physically and by sensory evaluation. The results obtained indicated that samh flour has high protein content and could be used as a replacement for wheat flour upto 30% without adversely affecting the bread specific volume much. Samh flour has improved the cookies appearance specially the colour (chocolate colour) and spreading ratio. The results also revealed that it is possible to make cookies from 100% samh flour. Due to the high protein content of the samh seeds the nutritional value of the bread and cookies made with samh flour will be improved. The results of the sensory evaluation of the bread and cookies indicated that the bread made with samh flour upto 30% has similar characters except for the crumb color and the overall acceptability which were rated as significantly inferior. The sensory evaluation of the cookies showed that the cookies made with samh flour upto 100% were significantly superior (p < 0.05) to the cookies made with 100% wheat flour (control).

Scanning electron microscopy of Boreostrongylus seurati (Nematoda: Heligmosomidae) from the Egyptian desert gerbil Gerbillus gerbillus with notes on its phylogeny.

A heligmosomid nematode Boreostrongylus seurati, belonging to the subfamily Nippostrongylinae, is described and figured based on specimens collected from duodenum of Egyptian gerbil Gerbillus gerbillus (Olivier) collected in Giza and Sinai Peninsula, Egypt. Both light and scanning electron microscopy were used to describe adult worms and their bursa and the synlophe. The ultrastructural morphology of some features of the worms is also described including mouth opening, cuticular surface, spicules, cephalic and bursal papillae.