Notification System for Overdue Radiology Recommendations Improves Rates of Follow-Up and Diagnosis.

OBJECTIVE. The purpose of this study was to quantify improved rates of follow-up and additional important diagnoses made after notification for overdue workups recommended by radiologists. MATERIALS AND METHODS. Standard reports from imaging studies performed at our institution from October through November 2016 were searched for the words "recommend" or "advised," yielding 9784 studies. Of these, 5245 were excluded, yielding 4539 studies; reports for 1599 of these 4539 consecutive studies were reviewed to identify firm or soft recommendations or findings requiring immediate management. If recommended follow-ups were incomplete within 1 month of the advised time, providers were notified. Compliance was calculated before and after notification and was compared using a one-sample test of proportion. RESULTS. Of 1599 patients, 92 were excluded because they had findings requiring immediate management, and 684 were excluded because of soft recommendations, yielding 823 patients. Of these patients, 125 were not yet overdue for follow-up and were excluded, and 18 were excluded because of death or transfer to another institution. Of the remaining 680 patients, follow-up was completed for 503 (74.0%). A total of 177 (26.0%) of the 680 patients were overdue for follow-up, and providers were notified. Of these 177 patients, 36 (20.3%) completed their follow-ups after notification, 34 (19.2%) had follow-up designated by the provider as nonindicated, and 107 (60.5%) were lost to follow-up, yielding four clinically important diagnoses: one biopsy-proven malignancy, one growing mass, and two thyroid nodules requiring biopsy. The rate of incomplete follow-ups after communication decreased from 26.0% (177/680) to 20.7% (141/680) (95% CI, 17.7-23.9%; p = .002), with a 20.4% reduction in relative risk of noncompliance, and 39.5% (70/177) of overdue cases were resolved when nonindicated studies were included. CONCLUSION. Notification of overdue imaging recommendations reduces incomplete follow-ups and yields clinically important diagnoses.

Enhancing treated wastewater effluent characteristics using hybrid biofilm/activated sludge process - a case study.

This paper documents the results of 12 months of monitoring of an upgraded hybrid moving bed biofilm reactor-conventional activated sludge wastewater treatment plant (MBBR-CAS WWTP). It also targets the assessment of the increment of the hydraulic load on existing treatment units with a zero construction and land cost. The influent flow to the plant was increased from 21,000 m3 d-1 to 30,000 m3 d-1, 40% of the existing CAS reactor volume was used for the MBBR zone with a carrier fill fraction of 47.62% and with Headworks Bio ActiveCell™ 515 used as media; no modifications were made for the primary and secondary tanks. The hybrid reactor showed high removal efficiencies for biochemical oxygen demand (BOD5), chemical oxygen demand (COD) and total suspended solids (TSS), with average effluent values recording 33.00 ± 8.87 mg L-1, 52.90 ± 9.65 mg L-1 and 29.50 ± 6.64 mg L-1 respectively. Nutrient removals in the hybrid modified biological reactor were moderate compared with carbon removal despite the high C/N ratio of 12.33. Findings in this study favor the application of MBBR in the upgrading of existing CAS plants with the plant BOD5 removal efficiency recording an increase of about 5% compared with the plant before upgrade and effluent values well within the legal requirements.

Voltammetric determination of cadmium(II), lead(II) and copper(II) with a glassy carbon electrode modified with silver nanoparticles deposited on poly(1,8-diaminonaphthalene).

A glassy carbon (GC) electrode was modified with poly(1,8-diaminonaphthalene) (p-1,8-DAN) that was coated with silver nanoparticles (Ag NPs) (size: 10.0-60.0 nm by TEM) by electrodeposition process using cyclic voltammetry (CV) technique. The resulting nanocomposite was characterized by FE-SEM, AFM, EDX, XPS, TEM and XRD. The surface area and the electrochemical characteristics of the electrode were investigated by CV and square wave voltammetry (SWV) techniques, and the probe preparation conditions were optimized. The electrode was used for individual and simultaneous determination of the heavy metal ions cadmium(II) (Cd2+), lead(II) (Pb2+) and copper(II) (Cu2+) in water samples by square wave anodic stripping voltammetry (ASV) using scan rate 0.005 V. s-1. The probe showed well separated anodic stripping peaks for Cd2+, Pb2+, and Cu2+. Attractive features of the method include (a) peak voltages of -1.02, -0.78 and - 0.32 V (vs. Ag/AgCl) for the three ions, and (b) low limits of detection (19, 30 and 6 ng.L-1, respectively. The electrode can also detect zinc(II) (Zn2+) and mercury(II) (Hg2+), typically at -1.36 V and + 0.9, respectively. Graphical abstract Schematic presentation of simultaneous electrochemical determination of Pb2+, Cd2+, and Cu2+ at a poly(1,8-diaminonaphthalene)-modified glassy carbon electrode coated with silver nanoparticles.

The prevalence of premature loss of primary teeth and its impact on malocclusion in the Eastern Province of Saudi Arabia.

OBJECTIVES: The present study was designed to determine the prevalence of premature loss of primary teeth and its effect on malocclusion in Eastern Province, Saudi Arabia. MATERIALS AND METHODS: This is an observational, cross-sectional study that included 307 male children aged 9-11 years old. Clinical examinations were performed using a disposable sharp explorer, a UNC periodontal probe and a dental mirror. The samples were examined clinically to detect the following traits: Angle's classification of malocclusion, overjet, overbite, anterior open-bite, lateral open-bite, midline shift and cross-bite. Additionally, a dental caries examination was performed using WHO methods. Questionnaires in Arabic were coded and sent to the students' parents. RESULTS: The mean DMFT was 5.61 (SD = 3.01). The d-component was the highest, with a mean of 4 (SD = 2.83). Of the 307 children, it was found that 204 (66.4%) had a high DMFT score, which is defined as a score above 4. It was found that 156/307 (51%) children had premature loss of deciduous teeth. CONCLUSION: A high prevalence of premature loss of teeth was found in this study. This finding emphasizes the importance of increasing awareness levels about this issue and focuses attention on the need for more preventive efforts to maintain healthy and normal dentitions that would improve the masticatory function and aesthetics of individuals and the whole population. In addition, the findings emphasize the importance of the early detection of premature loss of primary teeth to prevent future malocclusion.

Mandibular tori as bone grafts: an alternative treatment for periodontal osseous defects - clinical, radiographic and histologic morphology evaluation.

OBJECTIVES: The present study was designed to evaluate the clinical, radiographic and histochemical significance of using the mandibular tori as autogenous bone graft for treatment of intraosseous defects in patients with chronic periodontitis. MATERIALS AND METHODS: Twenty-eight sites from 14 patients with chronic periodontitis were included in this study. Each patient was treated with split mouth design; one site received torus mandibularis bone graft and the other site received a full-thickness fap alone. Histopathologic assessment was evaluated on removal of torus mandibularis to evaluate its histologic structure and by the end of the study 9 month later. Clinical and radiographic parameters were re-evaluated at 3 months interval for 1 year. RESULTS: The results of the present study revealed significant gain in the clinical attachment level (CAL) (88.4%, 4.53 ± 0.06 mm) for torus mandibularis sites compared to (39.7%, 2.01 ± 0.04 mm) for full-thickness fap. Moreover, there was a reduction in the probing pocket depth (PPD) of (75.4%, 5.75 ± 0.12 mm) for torus mandibularis sites and (49.6%, 3.73 ± 0.14 mm) for sites treated with a full-thickness fap only; CAL and PPD differences were significant at p-value ≤0.01. Concomitantly, significant radiographic increase in the bone height and density were recorded in the test group. CONCLUSION: The use of mandibular tori as autogenous bone graft could provide benefits as a periodontal therapeutic modality and enhance regenerative potential of periodontal intraosseous defects.

Asiatic acid rescues intestinal tissue by suppressing molecular, biochemical, and histopathological changes associated with the development of ulcerative colitis.

Asiatic acid (AA) is a polyphenolic compound with potent antioxidative and anti-inflammatory activities that make it a potential choice to attenuate inflammation and oxidative insults associated with ulcerative colitis (UC). Hence, the present study aimed to evaluate if AA can attenuate molecular, biochemical, and histological alterations in the acetic acid-induced UC model in rats. To perform the study, five groups were applied, including the control, acetic acid-induced UC, UC-treated with 40 mg/kg aminosalicylate (5-ASA), UC-treated with 20 mg/kg AA, and UC-treated with 40 mg/kg AA. Levels of different markers of inflammation, oxidative stress, and apoptosis were studied along with histological approaches. The induction of UC increased the levels of lipid peroxidation (LPO) and nitric oxide (NO). Additionally, the nuclear factor erythroid 2-related factor 2 (Nrf2) and its downstream antioxidant proteins [catalase (CAT), superoxide dismutase (SOD), reduced glutathione (GSH), glutathione peroxidase (GPx), and glutathione reductase (GR)] were down-regulated in the colon tissue. Moreover, the inflammatory mediators [myeloperoxidase (MPO), monocyte chemotactic protein 1 (MCP1), prostaglandin E2 (PGE2), nuclear factor-kappa B (NF-κB), tumor necrosis factor-α (TNF-α), and interleukin-1ß (IL-1ß)] were increased in the colon tissue after the induction of UC. Notably, an apoptotic response was developed, as demonstrated by the increased caspase-3 and Bax and decreased Bcl2. Interestingly, AA administration at both doses lessened the molecular, biochemical, and histopathological changes following the induction in the colon tissue of UC. In conclusion, AA could improve the antioxidative status and attenuate the inflammatory and apoptotic challenges associated with UC.

Effectiveness of Haemophilus influenzae type b conjugate vaccine on radiologically-confirmed pneumonia in young children in Pakistan.

OBJECTIVE: The effectiveness of Haemophilus influenzae type b (Hib) vaccine in preventing severe pneumonia in Asian children has been questioned, and many large Asian countries yet to introduce Hib conjugate vaccine in immunization programs. The primary objective of this study was to assess Hib conjugate vaccine effectiveness (VE) on radiologically-confirmed pneumonia in children born after introduction of Hib conjugate vaccine in Pakistan. STUDY DESIGN: A matched case-control study enrolled cases of radiologically-confirmed pneumonia in several hospitals serving low-income populations during 2009-2011. Cases were matched by age and season with 3 hospital and 5 neighborhood controls. Pneumonia was diagnosed using standardized World Health Organization criteria for chest radiograph interpretation. Matched OR were estimated for VE. RESULTS: A total of 1027 children with radiologically-confirmed pneumonia were enrolled; 975 cases, 2925 hospital controls, and 4875 neighborhood controls were analyzed. The coverage for 3 doses of diphtheria-tetanus-pertussis-hepatitis B-Hib conjugate vaccine was 13.7%, 18%, and 22.7% in cases, hospital controls and neighborhood controls, respectively. Estimated Hib VE for radiologically-confirmed pneumonia was 62% with 3 doses of vaccine using hospital controls and 70% using neighborhood controls. CONCLUSIONS: Hib conjugate vaccine prevented a significant fraction of radiologically-confirmed pneumonia in children in Pakistan. Maximizing impact on child survival needs improved immunization coverage.

Risk factors of stroke patients admitted to a general hospital in Kuwait.

There are limited data on stroke incidence in the Middle East, and only one study from Kuwait. The aim of this study was to establish a baseline status of stroke in Kuwait. We performed a retrospective chart review of all patients admitted from January 1st to December 31st, 2008 to the Amiri Hospital, Kuwait, who either were discharged or passed away with a diagnosis of stroke. Documented risk factors for stroke were analyzed for the total cohort and for male and female subgroups. Stroke subtypes were defined in accordance with the Trial of Org 10172 in acute stroke treatment (TOAST) criteria. There were 151 cases of stroke, of which 90.1% were ischemic. Eighty-five (56.3%) of the patients had diabetes mellitus, 86 (57.0%) had hyperlipidemia, and 104 (68.9%) had hypertension. Statins were used by 42.4% of the 86 hyperlipidemic patients prior to their presentation, and only 66 hypertensive patients (63.5%) were receiving treatment for hypertension prior to their presentation. Atrial fibrillation was diagnosed in 4% of the patients prior to their presentation, and 4% more were diagnosed afterward. History of ischemic heart disease was present in 28.5% of the subjects. This study shows similar rates of risk factors to regionally published reports and provides an updated picture of stroke in Kuwait.

Insulin resistance in non-diabetic patients of chronic Hepatitis C.

OBJECTIVE: To determine insulin resistance in non-diabetic chronic hepatitis C patients using Homeostatic Model Assessment of Insulin Resistance (HOMA-IR). METHODOLOGY: Patients having anti-HCV positive were included in this study. Patients with diabetes mellitus, thyroid disease, hyperlipidemias, hypercortisolism and infective diseases other than hepatitis C were excluded. Age, weight, height and absence of diabetes were documented. Fasting blood glucose and fasting insulin levels were done. Body mass index and insulin resistance was calculated using the formulas. Patients having insulin resistance using formula HOMA-IR>2.5 were labeled as insulin resistant. Data was analyzed using SPSS-18. RESULTS: One hundred and fifty five patients according to sample size estimation were enrolled, in whom HOMA-IR was calculated, the mean value was found to be 2.47 ±1.30. A total of 79 (51%) of patients had HOMA-IR more than 2.5 showing insulin resistance. CONCLUSION: In a third world country like Pakistan, where there is a high prevalence of hepatitis C infection, the consequences of the disease are also very common. Insulin resistance was found in 51% of patients with chronic hepatitis C.

Prevalence and Characteristics of Needle Stick and Sharp Injuries Among King Salman Armed Forces Hospital Personnel in Tabuk City: A Retrospective Hospital-Based Study.

BACKGROUND: This study aimed to determine the prevalence and associated characteristics of needle stick and sharp injuries (NSSIs) among King Salman Armed Forces Hospital (KSAFH) personnel. METHODS: Data was collected by reviewing all reported NSSIs among KSAFH personnel between January 2020 to December 2022. RESULTS: The prevalence of NSSIs was 2.05%, with nurses being the most commonly affected. Most injuries occurred in patients' rooms/wards and among health care workers (HCWs) aged < 40 years. Of the injured workers, 93.8% were immunized against hepatitis B virus (HBV). CONCLUSION: Educational and training programs targeting high-risk age groups and professions should be developed. Policies related to locations and situations where injuries occur frequently should be reviewed regularly to reduce the risk of NSSIs.

Silver Nanoparticles Enhance Oxidative Stress, Inflammation, and Apoptosis in Liver and Kidney Tissues: Potential Protective Role of Thymoquinone.

Silver nanoparticles (AgNPs) are the most common nanomaterials in consumer products. Therefore, it has been crucial to control AgNPs toxicological effects to improve their safety and increase the outcome of their applications. This work investigated the possible protective effect of thymoquinone (TQ) against AgNPs-induced hepatic and renal cytotoxicity in rats. Serum markers of liver and kidney functions as well as liver and kidney oxidative stress status, pro-inflammatory cytokines, apoptosis markers, and histopathology were assessed. TQ reversed AgNPs-induced elevation in serum liver and kidney function markers, including aspartate transaminase, alanine transaminase, urea, and creatinine. Moreover, TQ co-administration with AgNPs alleviates hepatic and renal oxidative insults by decreasing MDA and NO levels with a significant increase in the activity of antioxidant enzymes (superoxide dismutase, catalase, and glutathione recycling enzymes peroxidase and reductase) compared to AgNPs-treated rats. Besides, TQ upregulated hepatic and renal Nrf2 gene expression in AgNPs-intoxicated rats. Furthermore, TQ co-administration decreased the hepatic and renal pro-inflammatory mediators represented by IL-1ß, TNF-α, TGF-ß, and NF-κB levels. Besides, TQ co-administration decreased apoptotic protein (Bax) levels and increased the anti-apoptotic protein (Bcl-2) levels. These findings were confirmed by the histopathological examination of hepatic and renal tissues. Our data affirmed the protective effect of TQ against AgNPs cytotoxicity and proposed a possible mechanism of TQ antioxidant, anti-inflammatory, and anti-apoptotic effects. Consequently, we could conclude that using TQ might control AgNPs toxicological effects, improve their safety, and increase the outcome of their applications.

Therapeutic antischizophrenic activity of prodigiosin and selenium co-supplementation against amphetamine hydrochloride-induced behavioural changes and oxidative, inflammatory, and apoptotic challenges in rats.

Schizophrenia (SCZ), a multifactorial neuropsychiatric disorder, is treated with inefficient antipsychotics and linked to poor treatment outcomes. This study, therefore, investigated the combined administration of prodigiosin (PDG) and selenium (Na2SeO3) against SCZ induced by amphetamine (AMPH) in rats. Animals were allocated into four groups corresponding to their respective 7-day treatments: control, AMPH (2 mg/kg), PDG (300 mg/kg) + Na2SeO3 (2 mg/kg), and AMPH + PDG + Na2SeO3. The model group exhibited biochemical, molecular, and histopathological changes similar to those of the SCZ group. Contrastingly, co-administration of PDG and Na2SeO3 significantly increased the time for social interaction and decreased AChE and dopamine. It also downregulated the gene expression of NMDAR1 and restored neurotrophin (BDNF and NGF) levels. Further, PDG combined with Na2SeO3 improved the antioxidant defence of the hippocampus by boosting the activities of SOD, CAT, GPx, and GR. These findings were accompanied by an increased GSH, alongside decreased MDA and NO levels. Furthermore, schizophrenic rats having received PDG and Na2SeO3 displayed markedly lower IL-1ß and TNF-α levels compared to the model group. Interestingly, remarkable declines in the Bax (pro-apoptotic) and increases in Bcl-2 (anti-apoptotic) levels were observed in the SCZ group that received PDG and Na2SeO3. The hippocampal histological examination confirmed these changes. Collectively, these findings show that the co-administration of PDG and Na2SeO3 may have a promising therapeutic effect for SCZ. This is mediated by mechanisms related to the modulation of cholinergic, dopaminergic, and glutaric neurotransmission and neurotrophic factors, alongside the suppression of oxidative damage, neuroinflammation, and apoptosis machinery.

Does grafting of third molar extraction sockets enhance periodontal measures in 30- to 35-year-old patients?

PURPOSE: This study was designed to evaluate the use of xenograft plus a membrane as grafting material for periodontal osseous defects distal to the mandibular second molar compared with nongrafted extraction sites after removal of impacted mandibular third molars. MATERIALS AND METHODS: We performed a single-blind, randomized, controlled clinical trial, and the sample comprised of subjects at high risk for the development of periodontal osseous defects distal to the second molar after third molar extraction (aged 30-35 years), pre-existing osseous defects distal to the second molar, and horizontal third molar impaction. The predictor variable was the treatment status of the second molar osseous defects. The third molar extraction sites were grafted with an anorganic xenograft plus a membrane. The other sites received a full-thickness flap and extraction of the third molar without placement of the grafting materials. The outcome variables were the change in gingival index, pocket probing depth, and clinical attachment level on the distobuccal aspect of the second molar preoperatively and at 3, 6, 9, and 12 months after surgery. Data were statistically analyzed by multivariate analysis of variance, and the statistical significance was set at P < .05. RESULTS: The study was composed of 28 sites that were selected by use of a split-mouth design for each patient, and this was randomly determined through a biased coin randomization. Twelve months after third molar removal, there was a statistically significant gain in the clinical attachment level and a reduction in the probing pocket depth in the grafted sites compared with the nongrafted sites (P < .001). Moreover, there was a significant difference in the alveolar bone height during the monitoring periods for the grafted sites compared with the nongrafted sites (P < .001). CONCLUSIONS: Grafting of osseous defects distal to mandibular second molars with an anorganic xenograft plus a membrane predictably resulted in a significant reduction in the probing pocket depth, clinical attachment level gain, and bone fill, which suggests that grafting the extraction sites with an anorganic xenograft plus a membrane could prevent periodontal disease in the future.

Occurrence, human exposure, and risk of microplastics in the indoor environment.

Microplastics (MPs) are a group of emerging contaminants that have attracted increasing scientific and societal attention over the past decade due to their ubiquitous detection in all environmental compartments. So far, most studies on MPs focus on characterizing their occurrence, fate, and impact in the aquatic environment. Therefore, very little is known about the magnitude, patterns, and associated risks of human exposure to MPs, particularly indoors. This is a significant research gap given that people spend most of their time (up to 90%) indoors, which is exacerbated over the past year by COVID-19 lockdown measures. Critical evaluation of the existing literature revealed the presence of MPs at higher concentrations in indoor air and dust (from homes and offices) compared to outdoors. This was attributed to several factors including: indoor MPs sources (e.g. furniture, textiles), increased deposition of atmospheric MPs indoors, and less atmospheric mixing and dilution compared to outdoor air. Current understanding is that indoor human exposure to MPs occurs via a combination of inhalation, ingestion, and dermal contact. Dietary intake was considered the major pathway of human exposure to MPs until recent studies revealed potential high exposure via inhalation. Moreover, exposure via inadvertent dust ingestion and dermal contact cannot be neglected, particularly for young children. This is alarming due to the potential toxic implications of MPs exposure. Early toxicological evidence indicates that small MPs (<20 µm) can cause oxidative stress and inflammation, while particles <5 µm can be engulfed by cells and translocated to accumulate in different organs. Also, there is increasing concern over potential leaching of toxic chemicals used as plastic additives (e.g. plasticizers and flame retardants) upon exposure to MPs due to their large surface area. However, MPs exposure and risk assessment in humans is still in its infancy and more research is necessary to provide the knowledge base required for regulations to protect human health and environment against MPs.

Participatory health research under COVID-19 restrictions in Bauchi State, Nigeria: Feasibility of cellular teleconferencing for virtual discussions with community groups in a low-resource setting.

INTRODUCTION: During the COVID-19 pandemic, researchers have used Internet-based applications to conduct virtual group meetings, but this is not feasible in low-resource settings. In a community health research project in Bauchi State, Nigeria, COVID-19 restrictions precluded planned face-to-face meetings with community groups. We tested the feasibility of using cellular teleconferencing for these meetings. METHODS: In an initial exercise, we used cellular teleconferencing to conduct six male and six female community focus group discussions. Informed by this experience, we conducted cellular teleconferences with 10 male and 10 female groups of community leaders, in different communities, to discuss progress with previously formulated action plans. Ahead of each teleconference call, a call coordinator contacted individual participants to seek consent and confirm availability. The coordinator connected the facilitator, the reporter, and the participants on each conference call, and audio-recorded the call. Each call lasted less than 1 h. Field notes and debriefing meetings with field teams supported the assessment of feasibility of the teleconference meetings. RESULTS: Cellular teleconferencing was feasible and inexpensive. Using multiple handsets at the base allowed more participants in a call. Guidelines for facilitators and participants developed after the initial meetings were helpful, as were reminder calls ahead of the meeting. Connecting women participants was challenging. Facilitators needed extra practice to support group interactions without eye contact and body language signals. CONCLUSIONS: With careful preparation and training, cellular teleconferencing can be a feasible and inexpensive method of conducting group discussions in a low-resource setting.

Identifying Immunological and Clinical Predictors of COVID-19 Severity and Sequelae by Mathematical Modeling.

Since its emergence as a pandemic in March 2020, coronavirus disease (COVID-19) outcome has been explored via several predictive models, using specific clinical or biochemical parameters. In the current study, we developed an integrative non-linear predictive model of COVID-19 outcome, using clinical, biochemical, immunological, and radiological data of patients with different disease severities. Initially, the immunological signature of the disease was investigated through transcriptomics analysis of nasopharyngeal swab samples of patients with different COVID-19 severity versus control subjects (exploratory cohort, n=61), identifying significant differential expression of several cytokines. Accordingly, 24 cytokines were validated using a multiplex assay in the serum of COVID-19 patients and control subjects (validation cohort, n=77). Predictors of severity were Interleukin (IL)-10, Programmed Death-Ligand-1 (PDL-1), Tumor necrosis factors-α, absolute neutrophil count, C-reactive protein, lactate dehydrogenase, blood urea nitrogen, and ferritin; with high predictive efficacy (AUC=0.93 and 0.98 using ROC analysis of the predictive capacity of cytokines and biochemical markers, respectively). Increased IL-6 and granzyme B were found to predict liver injury in COVID-19 patients, whereas interferon-gamma (IFN-γ), IL-1 receptor-a (IL-1Ra) and PD-L1 were predictors of remarkable radiological findings. The model revealed consistent elevation of IL-15 and IL-10 in severe cases. Combining basic biochemical and radiological investigations with a limited number of curated cytokines will likely attain accurate predictive value in COVID-19. The model-derived cytokines highlight critical pathways in the pathophysiology of the COVID-19 with insight towards potential therapeutic targets. Our modeling methodology can be implemented using new datasets to identify key players and predict outcomes in new variants of COVID-19.

Antiulcer activity of proanthocyanidins is mediated via suppression of oxidative, inflammatory, and apoptotic machineries.

Gastric ulcer (GU) is a lesion in the gastric mucosa associated with excessive oxidative damage, inflammatory response, apoptotic events, and irritation which may develop into cancer. However, medications commonly used in GU treatment cannot normalize gastric mucosa, while causing several adverse effects. Proanthocyanidins (PAs) are dietary flavonoids with numerous biological and pharmacological activities. In the current investigation, we studied the potential anti-ulcerative activity of PAs against acidified ethanol (HCl/ethanol)-caused gastric ulceration. Fifty male albino Wistar rats were allocated into five equal groups: control, HCl/ethanol (3 mL/kg), lansoprazole (LPZ, 30 mg/kg) + HCl/ethanol, and PAs (100 and 250 mg/kg) + HCl/ethanol. LPZ and PAs were applied one week before gastric ulcer induction. PAs pretreatment notably reduced gastric mucosal macroscopic and microscopic pathological changes in a dose-dependent manner. Additionally, PAs activated the innate antioxidant molecules including glutathione and its derived antioxidants (glutathione peroxidase and glutathione reductase), along with superoxide dismutase and catalase, while attenuating pro-oxidant formation, including malondialdehyde and nitric oxide. Interestingly, PAs supplementation at a higher dose suppressed gastric inflammatory and apoptotic responses, as demonstrated by the reduced levels of interleukin-1ß, interleukin-6, tumor necrosis factor alpha, high-mobility group box 1, cyclooxygenase 2, prostaglandin E2, nuclear factor kappa-B, Bcl-2-associated X protein, and caspase-3, while B cell lymphoma 2 was elevated. Hence, PAs could exhibit antiulcer activity by protecting gastric tissue from the development of oxidative damage, inflammatory responses, and apoptosis events associated with ulceration. PRACTICAL IMPLICATIONS: Gastric ulcer is a lesion in the gastric mucosal layer associated with excessive inflammatory response, apoptotic events, oxidative damage, and irritation, and may develop into cancer with about 5%-10% morbidity rate. However, medications commonly used in GU treatment cannot normalize gastric mucosa, while causing several adverse effects. Therefore, new therapeutic approaches are needed to treat or prevent gastric ulceration. Proanthocyanidins (PAs, condensed tannins) are dietary flavonoids found in abundance in different plant species, including their fruits, bark, and seeds. Due to their potent antioxidative activity, PAs have been applied to prevent or treat oxidative stress-related diseases, including cancer, as well as metabolic, neurodegenerative, cardiovascular, and inflammatory disorders. Here, we examine the potential therapeutic role of proanthocyanidins (PAs) against acidified ethanol-induced gastric ulcer in rats through evaluating oxidative challenge, inflammatory response, apoptotic events, and histopathological changes in the gastric tissue.

Protocatechuic acid abrogates oxidative insults, inflammation, and apoptosis in liver and kidney associated with monosodium glutamate intoxication in rats.

Monosodium glutamate (MSG), a commonly used flavor enhancer, has been reported to induce hepatic and renal dysfunctions. In this study, the palliative role of protocatechuic acid (PCA) in MSG-administered rats was elucidated. Adult male rats were assigned to four groups, namely control, MSG (4 g/kg), PCA (100 mg/kg), and the last group was co-administered MSG and PCA at aforementioned doses for 7 days. Results showed that MSG augmented the hepatic and renal functions markers as well as glucose, triglycerides, total cholesterol, and low-density lipoprotein levels. Moreover, marked increases in malondialdehyde levels accompanied by declines in glutathione levels and notable decreases in the activities of superoxide dismutase, catalase, glutathione peroxidase, and glutathione reductase were observed in MSG-treated group. The MSG-mediated oxidative stress was further confirmed by downregulation of nuclear factor erythroid 2-related factor 2 (Nrf2) gene expression levels in both tissues. In addition, MSG enhanced the hepatorenal inflammation as witnessed by increased inflammatory cytokines (interleukin-1b and tumor necrosis factor-α) and elevated nuclear factor-κB (NF-κB) levels. Further, significant increases in Bcl-2-associated X protein (Bax) levels together with decreases in B-cell lymphoma 2 (Bcl-2) levels were observed in MSG administration. Histopathological screening supported the biochemical and molecular findings. In contrast, co-treatment of rats with PCA resulted in remarkable enhancement of the antioxidant cellular capacity, suppression of inflammatory mediators, and apoptosis. These effects are possibly endorsed for activation of Nrf-2 and suppression of NF-kB signaling pathways. Collectively, addition of PCA counteracted MSG-induced hepatorenal injuries through modulation of oxidative, inflammatory and apoptotic alterations.

Case of Resistance to Thyroid Hormones With a Relatively Rare Mutation in Thyroid Hormones Receptor.

Normal thyroid hormone level is essential to maintain the normal physiologic function of the human body. Disturbances of these hormone levels have variable clinical manifestations ranging from asymptomatic to severe illness. Resistance to thyroid hormone (RTH) is a syndrome characterized by reduced intracellular action of T3, the active thyroid hormone. It is a rare autosomal dominant condition and occurs mostly due to heterogeneous mutations in the thyroid hormone receptor. Other causes of RTH include thyroid hormone cell membrane transport defect and thyroid hormone metabolism defect. Affected individuals present with symptoms of both increased and decreased thyroid hormone action, depending on the tissue's predominant receptor isoform expression, the magnitude of hormonal resistance, and the effectiveness of compensatory mechanisms. Here, we share our experience in diagnosing a case of RTH confirmed with a genetic test and found to have sequence variant mutation that is not well described in the literature previously due to the absence of genetic conclusive evidence.