Pancreatic cancer in Saudi Arabia (2005-2020): increasing trend.

Pancreatic cancer, a highly fatal malignancy, has shown a global rise in the incidence and mortality rates. However, these rates vary significantly across different regions worldwide. This study aims to assess the incidence and mortality of pancreatic cancer in Saudi Arabia. We collected the data from 16 annual cancer incidence reports in Saudi Arabia for the study period (2005-2020) and from the WHO's IARC Global Cancer Observatory website. Although the burden of pancreatic cancer in Saudi Arabia is relatively lower compared to global rates, the disease incidence has shown a steady increase over the study period, in addition to regional variations within the country. The disease predominantly affects the elderly population, aged 50 years and above in both genders, with males exhibiting higher rates than females. Further studies are required to identify the potential risk factors for pancreatic cancer in the Saudi population.

Treatment of sacroiliac joint laxity-induced coronal imbalance with the kickstand rod technique.

BACKGROUND: Considerations of the sacroiliac joint (SIJ) and its role in causing lower back and limb pain have taken a secondary role ever since Mixter and Barr's hallmark article in 1934 on the herniated nucleus pulposus. However, recent literature has highlighted the contribution of sacroiliac joint degeneration in the development of failed back surgery syndrome (FBSS), especially in patients undergoing lumbar or lumbosacral spinal fusion surgeries. Many reports have studied the anatomy, physiology, and clinical significance of the sacroiliac joint, but none have linked its dysfunction with other spinal deformities. CASE DESCRIPTION: A 63-year-old female with a history of multiple complex instrumented spinal fusions presented to our institution with progressive leftward coronal imbalance despite successful arthrodesis from T3 through S1. She was initially treated with decompression and reimplantation, but adjacent segment disease at the SIJ led to laxity, distal failure, and a worsening coronal deformity. A mechanical fall after her decompression surgery led to a dramatically increased coronal imbalance, which was ultimately treated using Lenke's kickstand rod technique. At 3.5 years follow up, the patient's coronal balance remains stable. CONCLUSION: Few studies have related SIJ degeneration and laxity with spinal deformity. Our case describes SIJ degeneration that evolved to joint laxity, which ultimately produced a leftward coronal imbalance according to the adjacent segment disease mechanism. Additionally, we describe the use of a kickstand rod to effectively correct the coronal imbalance, reduce pain levels, promote SIJ arthrodesis, and prevent further SIJ-related issues without significant complications over 3 years post-operation.

DRESS characteristics according to the causative medication.

BACKGROUND: To date, no study has identified a clear relationship between drug and a specific clinical presentation of DRESS. OBJECTIVES: To investigate the particularities of DRESS and analyze the variation of DRESS pattern according to culprit drugs. METHODS: We analyzed cases of DRESS notified to the Department of Clinical Pharmacology at the University Hospital of Monastir over a 15-year period. The statistical study was performed using the comparative and multivariate analysis. RESULTS: DRESS was mostly induced by anticonvulsive agents (27%) followed by allopurinol (26.3%) and antibiotics (24%): For anticonvulsive agents, the occurrence of lymphadenopathy was higher, renal involvement was rare and mild, and positive skin tests were more frequent. The allopurinol group was associated with the patient's older age and a lower incidence of lymphadenopathy and kidney injury. For antibiotics, eosinophilia rate was lower, time to recovery was shorter, and RegiSCAR score was low. The multivariate analysis showed a link of allopurinol with severe renal impairment, antibiotics with short latency period and low RegiSCAR score, and anticonvulsants with high propensity of positive skin test. CONCLUSION: We report the largest African and south Mediterranean cohort of DRESS and evaluated the usefulness of skin tests in identifying the culprit drug. The prominent finding was that latency period and renal involvement may independently differ according to culprit drugs.

A biological sub-sequences detection using integrated BA-PSO based on infection propagation mechanism: Case study COVID-19.

The longest common consecutive subsequences (LCCS) play a vital role in revealing the biological relationships between DNA/RNA sequences especially the newly discovered ones such as COVID-19. FLAT is a Fragmented local aligner technique which is an accelerated version of the local pairwise sequence alignment algorithm based on meta-heuristic algorithms. The performance of FLAT needs to be enhanced since the huge length of biological sequences leads to trapping in local optima. This paper introduces a modified version of FLAT based on improving the performance of the BA algorithm by integration with particle swarm optimization (PSO) algorithm based on a novel infection mechanism. The proposed algorithm, named BPINF, depends on finding the best-explored solution using BA operators which can infect the agents during the exploitation phase using PSO operators to move toward it instead of moving toward the best-exploited solution. Hence, moving the solutions toward the two best solutions increase the diversity of generated solutions and avoids trapping in local optima. The infection can be propagated through the agents where each infected agent can transfer the infection to other non-infected agents which enhances the diversification of generated solutions. FLAT using the proposed technique (BPINF) was validated to detect LCCS between a set of real biological sequences with huge lengths besides COVID-19 and other well-known viruses. The performance of BPINF was compared to the enhanced versions of BA in the literature and the relevant studies of FLAT. It has a preponderance to find the LCCS with the highest percentage (88%) which is better than other state-of-the-art methods.

Utilization of random vector functional link integrated with manta ray foraging optimization for effluent prediction of wastewater treatment plant.

An innovative predictive model was employed to predict the key performance indicators of a full-scale wastewater treatment plant (WWTP) operated with an activated sludge treatment process. The data-driven model was obtained using data gathered from Cairo, Egypt. The proposed model consists of Random Vector Functional Link (RVFL) Networks incorporated with Manta Ray Foraging Optimizer (MRFO). RVFL is used as an advanced Artificial Neural Network (ANN) that avoids the common conventional ANN problems such as overfitting. MRFO is employed to determine the best RVFL parameters to maximize the prediction accuracy of the model. The developed MRFO-RVFL is compared with conventional RVFL to figure out the role of MRFO as an optimization tool to enhance model performance. Both models were trained and tested using experimental data measured during a long period of 222 days. This study aims to provide an accurate prediction of the most widely treated effluent indicators of BOD5 and TSS in the wastewater treatment plants. In this study, ten well-known influent wastewater parameters, BOD5, TSS, and VSS, influent flow rate, pH, ambient temperature, F/M ratio, SRT, WAS, and RAS, the output BOD5 and TSS were modeled and predicted using the integrated MRFO-RVFL algorithms and compared with the standalone RVFL model. The performance of the models was evaluated using different assessment measures such as R2, RMSE, and others. The obtained results of R2 and RMSE for the MRFO-RVFL model were 0.924 and 3.528 for BOD5 and 0.917 and 6.153 for TSS, which were much better than the results of conventional RVFL with 0.840 and 6.207 for BOD5 and 0.717 and 10.05 for TSS. Based on the obtained results, the selective model (MRFO-RVFL) exhibited a higher performance and validity to predict the TSS and optimal BOD5.

Boosting COVID-19 Image Classification Using MobileNetV3 and Aquila Optimizer Algorithm.

Currently, the world is still facing a COVID-19 (coronavirus disease 2019) classified as a highly infectious disease due to its rapid spreading. The shortage of X-ray machines may lead to critical situations and delay the diagnosis results, increasing the number of deaths. Therefore, the exploitation of deep learning (DL) and optimization algorithms can be advantageous in early diagnosis and COVID-19 detection. In this paper, we propose a framework for COVID-19 images classification using hybridization of DL and swarm-based algorithms. The MobileNetV3 is used as a backbone feature extraction to learn and extract relevant image representations as a DL model. As a swarm-based algorithm, the Aquila Optimizer (Aqu) is used as a feature selector to reduce the dimensionality of the image representations and improve the classification accuracy using only the most essential selected features. To validate the proposed framework, two datasets with X-ray and CT COVID-19 images are used. The obtained results from the experiments show a good performance of the proposed framework in terms of classification accuracy and dimensionality reduction during the feature extraction and selection phases. The Aqu feature selection algorithm achieves accuracy better than other methods in terms of performance metrics.

Cranial falling bullet injuries, a series of 30 cases in Iraq.

Purpose: The purpose of this study is to highlight the importance of cranial falling bullet injuries and raise awareness about them. We studied the clinical and radiological findings, and their relation to the treatment and outcome. There are limited studies in this field.Materials and methods: Thirty patients, (aged 8-55 years) with cranial falling bullet injury were included in this study. They were followed during their hospitalization and up to 6 months thereafter. Post-resuscitation clinical findings, unenhanced brain CT scan findings, treatment and outcome (Glasgow Outcome Scale) were studied.Results: Male to female ratio was (1.73:1). Median age of all patients was: 17.5 years. 20(66.7%) patients had a GCS of 13-15, 3(10%) had 9-12, 2(6.7%) had 6-8, and 5(16.6%) had 3-5 at presentation. 23(76.7%) patients had normal pupillary reaction and symmetry whereas 7(23.3%) had poor reaction and/or asymmetry. On CT scan, 13 had a unilobar injury, six had multilobar or bihemispheric injuries, 10 had a bullet through the deep midline structures of the brain, seven had transventricular with IVH, four had SAH, none had large intracranial hematomas. All patients received medical treatment. Local wound care and/or extraction of extracranial subgaleal bullets were performed in 24 patients (80%). More extensive surgery was performed in six patients (20%). There was significant correlation (using Correlation Coefficient) between GCS, pupillary reaction/symmetry and CT imaging findings with the patient outcome. Low GCS, poor pupillary reaction and/or asymmetry, CT findings of central area injury, transventricular, IVH, or multilobar injury were associated with poor outcome.Conclusions: Cranial falling bullet injuries are uncommon, but they can cause significant morbidity and mortality. More studies are needed to document the impact of these injuries and to raise awareness among the society to support the efforts aiming at controlling the irrational use of guns in different countries of the world.

Hall technique crowns and children's masseter muscle activity: A surface electromyography pilot study.

BACKGROUND: Hall technique crowns (HTCs) alter the occlusion temporarily, potentially affecting jaw muscles, particularly the masseter - the primary jaw-closing muscle. AIM: To assess masseter muscle activity (MMA) in children treated with a unilateral HTC. DESIGN: In 12 children treated with a single HTC, bilateral MMA was recorded with surface electromyography (sEMG) for ten cycles of Rest Position (RP) and Maximum Voluntary Clenching (MVC) over 20 seconds immediately pre-HTC cementation (Pbase ), immediately post-HTC cementation (Pimmed ), at 2 weeks post-HTC cementation (P2w ) and at 6 weeks post-HTC cementation (P6w ). t test, ANOVA and post hoc statistics were used (P < .05). RESULTS: As expected, MMA was low at rest and increased during maximal jaw clenching (P < .0001). MMA (mean ± SD) increased significantly (P < .001) between RP and MVC at: Pbase [from 1.60 µV·s (±0.96) to 5.40(±2.30)]; Pimmed [1.57(±1.15) to 3.75(±1.87)]; P2w [1.39(±0.54) to 5.54(±1.45)] and finally P6w [1.46(±0.56) to 6.45(±2.56)]. Rest MMA at Pbase , Pimmed , P2w and P6w remained unchanged (P = .18) whereas Pbase clench MMA reduced by a third at Pimmed (P < .001), returned to and exceeded baseline levels at P2w (P = .822) and P6w (P < .001), respectively. CONCLUSIONS: This pilot study showed that Hall technique crowns may affect masseter muscle activity in children. Clench MMA was reduced immediately post-treatment but returned to and later exceeded baseline levels at 2 and 6 weeks, respectively. Rest MMA remained unchanged.

Removal of phenolic compounds from aqueous solution using MgCl2-impregnated activated carbons derived from olive husk: the effect of chemical structures.

Activated carbon (BC) prepared from olive oil solid waste (olive husk) by slow pyrolysis was chemically activated using MgCl2 (BC-MgCl2). The BC and BC-MgCl2 were used as adsorbents for removal of three phenolic compounds, namely, phenol (P), p-methoxyphenol (PMP) and p-nitrophenol (PNP), from aqueous solution. The uptake of these three phenolic compounds by the BC and BC-MgCl2 was better expressed by the Langmuir and Dubinin-Radushkevich (D-R) isotherm models than by the Freundlich isotherm, and the kinetics of the adsorption process followed the pseudo-second order kinetic model. The maximum monolayer adsorption capacity of P, PMP and PNP were increased from 24.938, 45.455 and 61.728 on BC to 43.860, 98.039 and 121.951 mg/g on BC-MgCl2 by factors of 1.76, 2.16 and 1.98, respectively. Therefore, the chemical activation of BC by MgCl2 is indeed of importance for improving its adsorption performances. For both adsorbents, the adsorption phenomenon for different substituted phenols is a strong function of solubility, polarity, molecule structure, and size. At the tested temperatures (25, 35 and 45 °C), the negative values of ΔG° and positive values of ΔH° and ΔS° for the adsorption of P, PMP and PNP on BC and BC-MgCl2 demonstrated that the adsorption was a spontaneous, endothermic and entropy-increasing process.

Association of high-sensitivity C-reactive protein with susceptibility to Schizophrenia in Tunisian population.

The pathogenic mechanisms underlying Schizophrenia (SZ), one of the most frequent mental disorders, are complex and poorly understood. Several evidences suggest that inflammatory processes may underpin some of its neurobiological correlates. The aim of this study was: (i) to analyze the potential association between circulating levels of the C-reactive protein (CRP), a crucial inflammatory marker, and Schizophrenia in Tunisian patients and healthy controls (HC) cohorts; (ii) to investigate the genetic diversity of three CRP variants (rs1417938, rs1130864 and rs1205) and; (iii) to analyze a potential relationship between expression and genetic data and clinical and socio demographical characteristics. CRP polymorphisms were exanimated for 155 patients and 203 HC by taqMan5'-nuclease. High-sensitivity CRP (hs-CRP) serum level was measured in 128 clinically stable out-patient SZ patients and 63 HC subjects via an automated biochemical analyzer. We found that hs-CRP levels were significantly higher in SZ patients as compared to HC. No significant differences were found when the proportions of CRP variants were compared in patients and HC. Further analysis according to clinical and socio demographical characteristics revealed a positive association with age and hypertension. Our data on an original Tunisian sample confirm the previous finding in others population groups.

SYNCHRONOUS OCCURRENCE OF THREE DIFFERENT THYROID TUMORS.

BACKGROUND: Thyroid nodules are common; however, the association of two or more different tumors in the thyroid gland is unusual. We present a first case with the association of three histological types of thryroid tumors. To the best of our knowledge, this association has not been reported in the literature before. We aim here to highlight the possible coexistence of many lesions in the thyroid gland and to discuss treatment options. CASE PRESENTATION: We report the case of a female patient who presented with a multinodular goiter. The final pathology after total thyroidectomy found the association of a multifocal papillary thyroid microcarcinoma arising within a Hurthle cells adenoma in a lobe and a noninvasive follicular thyroid neoplasm with papillary nuclear features in the other lobe. Due to the very low risk of recurrence, the patient was not treated with radioactive iodine. CONCLUSIONS: Many controversies remain about the management of Hurthle cells tumors and many variants of papillary thyroid carcinoma. Although the management of our case did not change, more studies are necessary to analyze the evolution of patients with multiple thyroid neoplasms. When discussing therapeutic options, the advantages and disadvantages should be considered case by case based on disease staging.

Hypolipidemic effect of novel 2,5-bis(4-hydroxybenzylidenamino)-1,3,4-thiadiazole as potential peroxisome proliferation-activated receptor-α agonist in acute hyperlipidemic rat model.

The development of new antihyperlipidemic agents with higher potency and lower side effects is of high priority. In this study, 1,3,4 thiadiazole Schiff base derivatives were synthesized as potential peroxisome proliferation-activated receptor-α (PPARα) agonists and characterized using elemental analysis, FTIR, 1H-NMR, 13C-NMR and mass spectroscopy and then tested for their hypolipidemic activity in Triton WR-1339-induced acute hyperlipidemic rat model in comparison with bezafibrate. The compounds showed significant hypolipidemic activity. Induced fit docking showed that the compounds are potential activators of PPARα with binding scores - 8.00 Kcal/mol for 2,5-bis(4-hydroxybenzylidenamino)-1,3,4-thiadiazole. PCR array analysis showed an increase in the expression of several genes involved in lipid metabolism through mitochondrial fatty acid ß oxidation and are part of PPARα signaling pathway including Acsm3, Fabp4 and Hmgcs1. Gene expression of Lrp12 and Lrp1b involved in LDL uptake by liver cells and Cyp7a1 involved in cholesterol catabolism were also found to be upregulated.

Phenol adsorption on biochar prepared from the pine fruit shells: Equilibrium, kinetic and thermodynamics studies.

Biochar samples were prepared from pine fruit shell (PFS) biomass using slow pyrolysis for 1 h at three different temperatures (350, 450 and 550°C). Batch experiments were carried out for the biosorption of phenol onto these biochars. The effect of biosorption experimental parameters such as adsorbent dosage, ionic strength, initial solution pH, contact time and temperatures has been investigated. Experimental equilibrium data were fitted to Langmuir, Freundlich, and Dubinin-Radushkevich (D-R) isotherms by non-linear regression method. The experimental kinetic data were also fitted to Lagergren pseudo-first order, pseudo-second order, Elovich and intraparticle diffusion models by non-linear regression method. Determination coefficient (R2), chi-squared (χ2) and error function (Ferror%) were used to determine the optimum isotherm and kinetic by non-linear regression method. Kinetics results were best described by pseudo-second order model for phenol onto three biochars. Thermodynamic parameters were estimated and implied that the adsorption process is spontaneous and exothermic in nature.

FODMAPs alter symptoms and the metabolome of patients with IBS: a randomised controlled trial.

OBJECTIVE: To gain mechanistic insights, we compared effects of low fermentable oligosaccharides, disaccharides and monosaccharides and polyols (FODMAP) and high FODMAP diets on symptoms, the metabolome and the microbiome of patients with IBS. DESIGN: We performed a controlled, single blind study of patients with IBS (Rome III criteria) randomised to a low (n=20) or high (n=20) FODMAP diet for 3 weeks. Symptoms were assessed using the IBS symptom severity scoring (IBS-SSS). The metabolome was evaluated using the lactulose breath test (LBT) and metabolic profiling in urine using mass spectrometry. Stool microbiota composition was analysed by 16S rRNA gene profiling. RESULTS: Thirty-seven patients (19 low FODMAP; 18 high FODMAP) completed the 3-week diet. The IBS-SSS was reduced in the low FODMAP diet group (p<0.001) but not the high FODMAP group. LBTs showed a minor decrease in H2 production in the low FODMAP compared with the high FODMAP group. Metabolic profiling of urine showed groups of patients with IBS differed significantly after the diet (p<0.01), with three metabolites (histamine, p-hydroxybenzoic acid, azelaic acid) being primarily responsible for discrimination between the two groups. Histamine, a measure of immune activation, was reduced eightfold in the low FODMAP group (p<0.05). Low FODMAP diet increased Actinobacteria richness and diversity, and high FODMAP diet decreased the relative abundance of bacteria involved in gas consumption. CONCLUSIONS: IBS symptoms are linked to FODMAP content and associated with alterations in the metabolome. In subsets of patients, FODMAPs modulate histamine levels and the microbiota, both of which could alter symptoms. TRIAL REGISTRATION NUMBER: NCT01829932.

The structure of InAlGaN layers grown by metal organic vapour phase epitaxy: effects of threading dislocations and inversion domains from the GaN template.

Defects in quaternary InAlGaN barriers and their effects on crystalline quality and surface morphology have been studied. In addition to growth conditions, the quality of the GaN template may play an important role in the formation of defects in the barrier. Therefore, this work is focused on effects caused by threading dislocations (TDs) and inversion domains (IDs) originating from the underlying GaN. The effects are observed on the crystalline quality of the barrier and characteristic surface morphologies. Each type of TDs is shown to affect the surface morphology in a different way. Depending on the size of the corresponding hillock for a given pinhole, it was possible to determine the dislocation type. It is pointed out that the smallest pinholes are not connected to TDs whereas the large ones terminate either mixed type or edge type TDs. At sufficiently large layer thickness, the IDs originating from the GaN template lead to the formation of concentric trenches at the layer surface, and this is related to the change in growth kinetics on top and at the immediate surroundings of the ID.

MRI-Guided Interstitial Laser Ablation for Intracranial Lesions: A Large Single-Institution Experience of 133 Cases.

BACKGROUND: Managing difficult-to-access lesions or surgically accessible lesions in fragile patients is a central problem in neurosurgery. MRI-guided interstitial laser ablation (ILA) is a minimally invasive option that may provide a safe means of treating these challenging patients. OBJECTIVE: We aim to (1) evaluate safety, efficacy, and preliminary outcomes within a diverse and large series of ILA treatments; and (2) report technical details and operative trends that proved useful over time in the authors' experience and that may be of use to neurosurgeons who perform ILA. METHODS: A retrospective evaluation of ILA patients was performed in terms of demographics, surgical techniques, and clinical outcomes. RESULTS: A total of 133 intracranial lesions in 120 patients were treated with ILA, including glioblastomas (GBM), other gliomas, metastases, epilepsy foci, and radionecrosis. The rate of complications/unexpected readmission was 6.0%, and the mortality rate was 2.2%. With high-grade tumors, tumor volumes >3 cm in diameter trended toward a higher rate of complication (p = 0.056). Median progression-free survival (PFS) and overall survival (OS) for recurrent GBM were 7.4 and 11.6 months, respectively. As a frontline treatment for newly diagnosed GBM, median PFS and OS were 5.9 and 11.4 months, respectively. For metastases, median PFS was not yet reached, and OS was 17.2 months. CONCLUSION: Our series suggests that ILA is a safe and efficacious treatment for a variety of intracranial pathologies, can be tailored to treat difficult-to-access lesions, and may offer a novel alternative to open craniotomy in properly selected patients.

Minimally invasive transforaminal lumbar interbody fusion with expandable versus static interbody devices: radiographic assessment of sagittal segmental and pelvic parameters.

OBJECTIVE Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) has been adopted as an alternative technique to hasten recovery and minimize postoperative morbidity. Advances in instrumentation technologies and operative techniques have evolved to maximize patient outcomes as well as radiographic results. The development of expandable interbody devices allows a surgeon to perform MIS-TLIF with minimal tissue disruption. However, sagittal segmental and pelvic radiographic outcomes after MIS-TLIF with expandable interbody devices are not well characterized. The object of this study is to evaluate the radiographic sagittal lumbar segmental and pelvic parameter outcomes of MIS-TLIF performed using an expandable interbody device. METHODS A retrospective review of MIS-TLIFs performed between 2014 and 2016 at a high-volume center was performed. Radiographic measurements were performed on lateral radiographs before and after MIS-TLIF with static or expandable interbody devices. Radiographic measurements included disc height, foraminal height, fused disc angle, lumbar lordosis, pelvic incidence, sacral slope, and pelvic tilt. Mismatch between pelvic incidence and lumbar lordosis were calculated for each radiograph. RESULTS A total of 48 MIS-TLIFs were performed, predominantly at the L4-5 level, in 44 patients. MIS-TLIF with an expandable interbody device led to a greater and more sustained increase in disc height when compared with static interbody devices. Foraminal height increased after MIS-TLIF with expandable but not with static interbody devices. MIS-TLIF with expandable interbody devices increased index-level segmental lordosis more than with static interbody devices. The increase in segmental lordosis was sustained in the patients with expandable interbody devices but not in patients with static interbody devices. For patients with a collapsed disc space, MIS-TLIF with an expandable interbody device provided superior and longer-lasting increases in disc height, foraminal height, and index-level segmental lordosis than in comparison with patients with static interbody devices. Using an expandable interbody device improved the Oswestry Disability Index scores more than using a static interbody device, and both disc height and segmental lordosis were correlated with improved clinical outcome. Lumbar MIS-TLIF with expandable or static interbody devices had no effect on overall lumbar lordosis, pelvic parameters, or pelvic incidence-lumbar lordosis mismatch. CONCLUSIONS Performing MIS-TLIF with an expandable interbody device led to a greater and longer-lasting restoration of disc height, foraminal height, and index-level segmental lordosis than MIS-TLIF with a static interbody device, especially for patients with a collapsed disc space. However, neither technique had any effect on radiographic pelvic parameters.

Predictors of Early Failure After Fecal Microbiota Transplantation for the Therapy of Clostridium Difficile Infection: A Multicenter Study.

OBJECTIVES: Fecal microbiota transplant (FMT) is a highly efficacious treatment for recurrent or refractory Clostridium difficile infection (CDI); however, 10-20% of patients fail to achieve cure after a single FMT. The aim of this study was to identify risk factors associated with FMT failure and to develop and validate a prediction model for FMT failure. METHODS: Patient characteristics, CDI history, FMT characteristics, and outcomes data for patients treated between 2011 and 2015 at three academic tertiary referral centers were prospectively collected. Early FMT failure was defined as non-response or recurrence of diarrhea associated with positive stool C. difficile toxin or PCR within 1 month of FMT. Late FMT failure was defined as recurrence of diarrhea associated with positive stool C. difficile toxin or PCR between 1 and 3 months of the FMT. Patient data from two centers were used to determine independent predictors of FMT failure and to build a prediction model. A risk index was constructed based on coefficients of final predictors. The patient cohort from the third center was used to validate the prediction model. RESULTS: Of 328 patients in the developmental cohort, 73.5% (N=241) were females with a mean age of 61.4±19.3 years; 19.2% (N=63) had inflammatory bowel disease (IBD), and 23.5% (N=77) were immunocompromised. The indication for FMT was recurrent CDI in 87.2% (N=286) and severe or severe-complicated in 12.8% (N=42). FMT was performed as an inpatient in 16.7% (N=54). The stool source was patient-directed donors in 40% (N=130) of cases. The early FMT failure rate was 18.6%, and the late failure rate was 2.7%. In the multivariable analysis, predictors of early FMT failure included severe or severe-complicated CDI (odds ratio (OR) 5.95, 95% confidence interval (CI): 2.26-15.62), inpatient status during FMT (OR 3.78, 95% CI: 1.55-9.24), and previous CDI-related hospitalization (OR 1.43, 95% CI: 1.18-1.75); with each additional hospitalization, the odds of failure increased by 43%. Risk scores ranged from 0 to 13, with 0 indicating low risk, 1-2 indicating moderate risk, and ≥3 indicating high risk. In the developmental cohort, early FMT failure rates were 5.6% for low risk, 12.7% for moderate risk, and 41% for high-risk patients. Of 134 patients in the validation cohort, 57% (N=77) were females with a mean age of 66±18.1 years; 9.7% (N=13) had IBD, and 17.9% (N=24) were immunocompromised. The early FMT failure rate at 1 month was 19.4%, with an additional 3% failing by 3 months. In the validation cohort, FMT failure rates were 2.1% for low risk, 16.1% for moderate risk, and 35.7% for high risk patients. The area under the receiver operating characteristic curve (AUROC) for FMT failure was 0.81 in the developmental cohort and 0.84 in the validation cohort. CONCLUSIONS: Severe and severe-complicated indication, inpatient status during FMT, and the number of previous CDI-related hospitalizations are strongly associated with early failure of a single FMT for CDI. The novel prediction model has good discriminative power at identifying individuals who are at high risk of failure after FMT therapy and may assist the treating physician in subsequent management plans.

Green synthesis of nanosilver particles by Aspergillus terreus HA1N and Penicillium expansum HA2N and its antifungal activity against mycotoxigenic fungi.

AIMS: The aim of this study was to synthesize silver nanoparticles (AgNPs) by an eco-friendly and low-cost method using the fungi Aspergillus terreus HA1N and Penicillium expansum HA2N as an alternative to chemical procedures mostly requiring drastic experimental conditions emitting toxic chemical byproducts. Also, this study has been extended to evaluate the effect of AgNPs on the growth of some mycotoxigenic fungi and ochratoxin A (OTA) produced by Aspergillus ochraceus. METHODS AND RESULTS: The AgNPs have been characterized by UV-Visible Spectrophotometer, Dynamic Light Scattering (DLS), Fourier Transform Infrared Spectroscopy (FTIR) and Transmission Electron Microscope (TEM). The TEM analysis has revealed that the size of AgNPs ranged between 14 and 25 nm in the case of P. expansum and 10-18 nm in the case of A. terreus. The antifungal activity of AgNP colloids has indicated that the highest inhibition zone was detected with AgNPs synthesized by A. terreus HA1N against all tested fungi. The highest inhibition zone was detected with Aspergillus niger at concentrations 3 and 6 µg of AgNP solution (7·56 ± 0·38 and 11·3 ± 1·8 mm, respectively) while, A. ochraceus showed the maximum inhibition zone (16·33 ± 0·96 mm) at the concentration 9 µg of AgNPs synthesized by A. terreus. The results have also indicated that the AgNPs synthesized by A. terreus and P. expansum at the concentration 220 µg/100 ml media gave the highest reduction of OTA, where the percentages of reduction were 58·87 and 52·18% respectively. CONCLUSIONS: The smallest size AgNPs synthesized by A. terreus HA1N are better in their antifungal activity against all tested mycotoxigenic fungi than the largest one synthesized by P. expansum HA2N. SIGNIFICANCE AND IMPACT OF THE STUDY: This is the first study focused on using AgNPs in control of OTA production.