Subclavian steal syndrome: a case study of diagnosis, management, and successful surgical resolution.

Subclavian steal syndrome (SSS) is a rare vascular condition characterized by retrograde blood flow in the vertebral artery, often discovered incidentally in asymptomatic patients. We present a 65-year-old male with recurrent transient ischemic attacks (TIAs) attributed to 99% stenosis at the origin of the left subclavian artery, leading to SSS. Diagnostic modalities included duplex ultrasound, confirming inverted left vertebral artery flow, and multi-slice computed tomography angiography, confirming the diagnosis. Despite an unsuccessful attempt at balloon angioplasty, successful vascular surgery was performed, establishing a left carotid-vertebral artery bypass. The patient recovered well without complications. This case underscores the importance of considering SSS in TIA cases, utilizing non-invasive diagnostic tools, and highlighting the successful management of symptomatic SSS through surgical intervention.

Blastocystis hominis as a contributing risk factor for development of iron deficiency anemia in pregnant women.

Intestinal parasitic infection increases the risk of developing iron deficiency anemia (IDA) during pregnancy. The objective of this study was to assess Blastocystis hominis as a contributing risk factor for development of IDA in pregnant women. A total of 200 fecal specimens from 120 pregnant women with IDA (mean Hb = 9.6 g/dl), and 80 non-anemic controls were examined for Blastocystis. Fecal specimens were examined by the formalin/ethyl-acetate concentration technique, iron hematoxylin staining, modified Ziehl-Neelsen acid-fast staining, and by the in vitro cultivation technique for Blastocystis. Frequency of Blastocystis infection, detected microscopically and by the in vitro culture technique, was significantly higher in IDA study group (n = 48; 40%) compared to non-anemic controls (n = 5; 6.3%; P < 0.0001), and 26.5% (n = 53) in all study subjects. Among the 48 cases, Blastocystis without other intestinal parasitic infections was detected in 41 cases (34.2%), while seven cases (5.8%) with Blastocystis were coinfected with other intestinal parasites which included Giardia and Cryptosporidium (1.7% each), and Entamoeba sp., Ascaris, and Trichuris (0.8% each). The mean Hb level of the 48 Blastocystis-infected cases was 9.2 g/dl (mild anemia). While the other 72 IDA cases with no infection had mean Hb of 10.0 g/dl (mild anemia), with a significant difference in mean Hb level between Blastocystis-infected and the non-infected IDA cases (P < 0.0001). Furthermore, among the 48 Blastocystis-infected IDA cases, the mean Hb of the 41 Blastocystis-infected cases without other intestinal parasitic co-infection was 9.1 g/dl (mild anemia), while the mean Hb level of the 7 Blastocystis-infected cases with other intestinal parasitic co-infection was 8.7 g/dl (moderate anemia). Findings of the current study showed that B. hominis infection contributes to the development of IDA in pregnant women. Hence, parasitological diagnostic tests are recommended in routine examination at all antenatal clinics.

Inhibitory effect of Ferula asafoetida L. (Umbelliferae) on Blastocystis sp. subtype 3 growth in vitro.

Asafoetida is an oleo-gum-resin obtained from many Ferula species and frequently used in traditional medicine. The current study aimed to evaluate the activity of asafoetida against the in vitro growth of Blastocystis sp. Asafoetida as powder-form (Ap) and oil-form (Ao) extracts at concentrations of 2, 4, 8, 16, and 20 mg/ml and 5, 10, 25, 40, and 50 mg/ml, respectively were incubated with isolates of Blastocystis sp. subtype 3 for 24, 72, and 144 h and compared to the reference antiprotozoan drug metronidazole at concentrations of 10, 100, and 500 µg/ml. Asafoetida either as Ap or Ao decreased counts and viability of all tested isolates of Blastocystis sp. subtype 3 which was confirmed by microscopy. The degree of the inhibitory effect was dependent on the concentration, form, as well as the time of incubation with asafoetida extracts. The lowest concentrations of Ap and Ao that caused complete (100 %) inhibition of Blastocystis growth and highest (100 %) percentage inhibition of multiplication was 16 and 40 mg/ml, respectively; mean counts at these concentrations either did not differ or decreased significantly when compared to metronidazole control (p < 0.05). Also, the parasites did not resume growth after re-cultivation in asafoetida-free medium when examined further after 48, 72, and 144 h of cultivation. These findings demonstrate the potential of phytomedicine asafoetida as a potent natural alternative for treatment of Blastocystis sp.infection.

Lipid Nanocarriers for Neurotherapeutics: Introduction, Challenges, Blood-brain Barrier, and Promises of Delivery Approaches.

Significant efforts have been made in research to discover newer neurotherapeutics, however, the rate of reported neurological disorders has been increasing at an alarming speed. Neurotherapeutics delivery in the brain is still posing a significant challenge, owing to the blood-brain barrier and blood-cerebrospinal fluid barrier. These physiological barriers restrict the passage of systemically available fractions of neurotherapeutics into the brain, owing to low permeability and drug localization factors. Neurotherapeutics encapsulating lipid carriers favor a significant increase in bioavailability of poorly water-soluble drugs by enhancing solubility in the gastrointestinal tract and favoring stability. Due to their small size and lipid-based composition, these carriers offer enhanced permeability across the semi-permeable blood-brain barrier to effectively transport encapsulated loads, such as synthetic drugs, nutraceuticals, phytoconstituents, herbal extracts, and peptides, thereby reducing incidences of off-target mediated adverse impacts and toxicity. The most significant advantage of such lipid-based delivery systems is non-invasive nature and targeting of neurotherapeutics to the central nervous system. Critical attributes of lipid-based carriers modulate release rates in rate-controlled manners, enable higher penetration through the blood-brain barrier, and bypass the hepatic first-pass metabolism leading to higher CNS bioavailability neurotherapeutics. The current review discusses a brief and introductory account of the limitations of neurotherapeutics, pharmacological barriers, challenges in brain-targeted delivery, and the potential of nanotechnology- processed lipid-based carriers in the clinical management of neuronal disorders.

The potential use of 29 kDa protein as a marker of pathogenicity and diagnosis of symptomatic infections with Blastocystis hominis.

The present study was performed to characterize the protein profiles of Blastocystis hominis isolates from symptomatic and asymptomatic individuals by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and immunoblotting using sera from symptomatic and asymptomatic patients. The presence of immunogenic bands associated with pathogenicity or of diagnostic potentials was also evaluated. The study comprised 80 individuals classified into four groups, 20 each: symptomatic blastocystosis (G1), asymptomatic blastocystosis (G2), other parasitic infections (G3), and healthy control subjects (G4). SDS-PAGE analysis of individual antigens form symptomatic and asymptomatic B. hominis isolates revealed similar and distinctive antigenic bands with significant differences in two high (123.5 and 112.3 kDa) and few low molecular weight bands (48.5, 38, 42.3, and 35.5 kDa). Immunoblotting was performed using symptomatic and asymptomatic antigen pools with sera of the four studied groups. It was found that anti-B. hominis IgG reacted with nine protein bands ranging from 100 to 18 kDa of the symptomatic antigen pool. There was a significant difference between G1 and G2 in the recognition of 64, 56, 38, and 29 kDa antigen bands. Also, anti-B. hominis IgG reacted with five protein bands ranging from 56 to 12 kDa of asymptomatic antigen pool. There was a significant difference between G1 and G2 in the recognition of 29 kDa antigen band. These findings suggest the potential use of the 29-kDa antigen as marker of pathogenicity and implicate its use in the diagnosis and differentiation between symptomatic and asymptomatic blastocystosis.

Withdrawal Notice: Lipid Carriers Mediated Targeted Delivery of Neurotherapeuticals: Challenges, Role of Blood Brain Barrier and Promises of Nanotechnology Based Approaches in Neuronal Disorders

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Hepatitis C Virus: Efficacy of New DAAs Regimens.

BACKGROUND: HCV treatment showed dramatical change due to the introduction of potent, strong, direct antiviral drugs. Before the appearance of Direct-acting antivirals, multiple therapeutic interventions were used for hepatitis C, but none of these interventions were effective on patient-centered outcomes. Direct-acting antivirals cause disruption of viral replication because they target specific nonstructural viral proteins. AIM: To review the advantages of efficient HCV therapy and its long term drawbacks. METHODS: A search of the literature published in indexed databases (PubMed, Medline In-Process, and Embase) within the last 5 years was conducted. Any duplicated citations were excluded before first-pass screening. Citations (titles and abstracts) were screened for eligibility by a single reviewer. Full texts (including congress abstracts, posters and other congress communications) of citations deemed relevant during title and abstract screening were retrieved for second-pass review. RESULTS: Studies on the clinical effects of DAAs for hepatitis C show better tolerance, improved survival and fewer complications when compared to previous interferon therapy. CONCLUSION: HCV treatment has improved dramatically. Since that time, there are multiple approved oral therapies all with high efficacy. The most important factor which should be considered during choosing appropriate therapy is to ensure that it covers the viral genotype of the infected patients.

Brain Metastases From Differentiated Thyroid Carcinoma: Prevalence, Current Therapies, and Outcomes.

BACKGROUND AND OBJECTIVE: The brain is an unusual site for distant metastases of differentiated thyroid carcinoma (DTC). The aim of this study was to document the prevalence of brain metastases from DTC at our institutions and to analyze the current therapies and the outcomes of these patients. METHODS: We performed a retrospective chart review of patients with DTC and secondary neoplasia of the brain. RESULTS: From 2002 to 2016, 9514 cases of thyroid cancer were evaluated across our institutions and 24 patients met our inclusion criteria, corresponding to a prevalence of 0.3% of patients with DTC. Fourteen (58.3%) were female and 10 (41.7%) were male. Fifteen patients had papillary thyroid cancer (PTC) (62.5%). Brain metastases were diagnosed 0 to 37 years (mean ± SD, 10.6 ± 10.4 years) after the initial diagnosis of thyroid cancer. Patients undergoing surgery had a median survival time longer than those that did not undergo surgery (27.3 months vs 6.8 months; P = 0.15). Patients who underwent stereotactic radiosurgery (SRS) had a median survival time longer than those that did not receive SRS (52.5 months vs 6.7 months; P = 0.11). Twelve patients (50%) were treated with tyrosine kinase inhibitors (TKIs), and they had a better survival than those who have not used a TKI (median survival time, 27.2 months vs 4.7 months; P < 0.05). CONCLUSION: The prevalence of brain metastases of DTC in our institutions was 0.3% over 15 years. The median survival time after diagnosis of brain metastases was 19 months. In our study population, the use of TKI improved the survival rates.

Design, synthesis and evaluation of novel diaryl pyrrolopyrimidine and pyrrolothiazine derivatives as inhibitors of tumor necrosis factor stimulated gene-14 (TSG-14) production.

A novel series of pyrrolothiazines 2-4 and pyrrolopyrimidines 5-7 have been synthesized. The structures of these compounds were established by spectroscopic and element microanalytical data. The newly synthesized compounds were evaluated as inhibitors of TSG-14. The most effective results were obtained by the S-sec-butyl derivatives 6e (80%) and the N-ethyl derivatives 4e (70%).

Blastocystis spp.: frequency and subtype distribution in iron deficiency anemic versus non-anemic subjects from Egypt.

Many helminthic and protozoal infections have been implicated in iron deficiency anemia (IDA) but few reports have suggested a link between Blastocystis sp. infection and IDA. Herein, we investigated the frequency and the association of the Blastocystis sp. genotype with IDA. Two-hundred and six stool samples were examined for Blastocystis sp. Samples were obtained from 96 cases with a confirmed diagnosis of IDA and 110 matched non-anemic controls. The prevalence of the parasite was significantly higher in the IDA group (54.2%) when compared to controls (17.3%) and was 34.5% in all study subjects. Thus, a relationship between Blastocystis sp. infection and IDA was confirmed. PCR amplification of isolates from cases with IDA and controls using subtype-specific sequenced-tagged site primers found that subtype 3 was the most common (83.3%), followed by subtype 1 (16.7%), and both had similar prevalence in both groups. Therefore, there was no correlation found between the Blastocystis sp. genotype and the occurrence of IDA.

Prevalence of Toxoplasma gondii infection in antenatal population in Menoufia governorate, Egypt.

Knowledge of the prevalence of Toxoplasma gondii infection in pregnant women would be a valuable approach for planning appropriate preventive strategies. However, no enough data currently exist as to the magnitude of T. gondii infection among pregnant women in Egypt. In view of paucity of reports on this issue, the current cross-sectional study aimed to determine the rate of T. gondii infection and maternal-fetal transmission in antenatal population in Menoufia governorate, Egypt. Out of 323 pregnant women who were screened for Toxoplasma-specific IgG and IgM antibodies with ELFA, 218 samples were IgG seropositive, of which, 9 samples were IgM seropositive. Therefore, seropositivity rates of 67.5% (95% CI: 62.39%, 72.61%), and 2.8% (95% CI: 1%, 4.6%) for IgG and IgM, respectively were found. Analysis of serological patterns revealed that a large proportion of subjects were immune to Toxoplasma infection (IgG+/IgM-), as prevalence of chronic infection was 64.7% (209 cases), and 32.5% of cases were susceptible to primary infection (IgG-/IgM-). Meanwhile, the rate of probable acute Toxoplasma infection (IgG+/IgM+) was 2.8%, with one case (0.3%) confirmed for recent infection, as she had low avidity index with positive amniotic fluid analysis with both PCR and mouse inoculation. Significant relations were seen between Toxoplasma-specific IgG and knowledge about transmission modes, consumption of milk/milk products and unwashed raw vegetable/fruit, hand hygiene, contact with soil and farm animals. In conclusion, we reported high prevalence for T. gondii infection among antenatal population in Menoufia governorate. Thus, the susceptibility for toxoplasmosis is relatively low. Sources of infection revealed herein might represent potential threats for primary infection in seronegative women. Accordingly, there is urgent need for implementation of health education programs as an appropriate approach for prevention.

Effect of Ferula assafoetida on experimental murine Schistosoma mansoni infection.

Ferula assafoetida is a hard, resinous, oily herbaceous gum belonging to plant family Umbelliferae. It is used as a traditional medicine in many parts of the world and its wide use in medicine was listed by many authors. In the current study, the effect of F. assafoetida on Schistosoma mansoni in experimentally infected mice is investigated. F. assafoetida was given orally via intragastric tube in an oil-form and a powder-form in different concentrations. Four test groups of 30 mice each were studied. Gs I & II mice were given F. assafoetida in an oil-form in different concentrations at 4 and 6 weeks post infection (PI) respectively. Mice in Gs III & IV were given re-constituted F. assafoetida powder in different concentrations (conc.) at 4 & 6 weeks PI. respectively like the previous groups. Oil-form F. assafoetida was given at conc. of 50, 25 & 15 mg/ml. Powder-form was given at conc. of 32, 16 & 8 mg/ml. A highly significant statistical difference between the test Gs (I, II, III & IV) was recorded in comparison to the infection control G with p value < 0.0001 and also between powder and oil forms of F. assafoetida (p < 0.0001) as regards the mean worm burden and tissue egg count. The highest reduction in worm burden and egg counts was found with powder form of F. assafoetida (Gs III & IV) when compared to oil form (Gs I & II), as confirmed histopathologically and by ultrastructural profile alteration.