The Mycetoma Research Center, University of Khartoum, Sudan's experience in community engagement initiatives spans 3 decades.

Mycetoma profoundly affects marginalised communities, especially in impoverished and remote areas with limited access to healthcare. This chronic and debilitating inflammatory disease highlights the typical issues of neglected tropical diseases (NTDs), such as insufficient attention, funding, and resources, which perpetuate neglect and suffering. Patients often delay seeking medical help, leading to advanced disease stages, severe complications, and lasting disabilities. The lack of medical infrastructure and skilled healthcare professionals worsens the situation, causing delays in diagnosis and inadequate treatment. Engaging affected communities in tailored interventions is essential to tackle these challenges, promote collaboration, raise awareness, and mobilise resources to improve healthcare access and enhance diagnostic and treatment capabilities. Since 1991, the Mycetoma Research Center (MRC) at the University of Khartoum, Sudan, has led community engagement initiatives aimed at improving the quality of life for mycetoma-affected individuals through education, advocacy, and local collaboration. In this communication, the MRC shares its extensive experience in community engagement to benefit mycetoma-affected communities.

Biodegradation of chemical contamination by lactic acid bacteria: A biological tool for food safety.

Chemical pollutants such as mycotoxins and pesticides exert harmful effects on human health such as inflammation, oxidative stress, and cancer. Several strategies were applied for food decontamination, including physicochemical and biological strategies. The present review comprehensively discussed the recent efforts related to the biodegradation of eight food chemical contaminants, including mycotoxins, acrylamide, biogenic amines, N-nitrosamines, polycyclic aromatic hydrocarbons, bisphenol A, pesticides, and heavy metals by lactic acid bacteria (LAB). Biological detoxification by LAB such as Lactobacillus is a promising approach to remove the risks related to the presence of chemical and environmental pollutants in foodstuffs. It is a safe, efficient, environmentally friendly, and low-cost strategy to remove hazardous compounds. LAB can directly decrease these chemical pollutants by degradation or adsorption. Also, it can indirectly reduce the content of these pollutants by reducing their precursors. Hence, LAB can contribute to reducing chemical pollutants in contaminated foods and enhance food safety.

A promising eco-friendly and cost-effective photocatalytic rolled graphene oxide/poly(m-methylaniline) core-shell nanocomposite for antimicrobial action.

A new and innovative rolled graphene oxide (roll-GO)/poly-m-methylaniline (PmMA) core-shell nanocomposite has been successfully synthesized using an in situ polymerization technique. This eco-friendly and cost-effective material shows great promise due to its antimicrobial properties. The characterization of the nanocomposite involved X-ray diffraction and Fourier transform infrared spectroscopy to analyze its structure and functional groups, whereas scanning electron microscopy and transmission electron microscopy (TEM) were utilized to examine its morphology. TEM analysis revealed the formation of roll-GO, forming multi-walled tubes with inner and outer diameters of 50 and 70 nm, respectively. Optical analysis demonstrated an enhanced bandgap in the nanocomposite, with bandgap values of 2.38 eV for PmMA, 2.67 eV for roll-GO, and 1.65 eV for roll-GO/PmMA. The antibacterial efficacy of the nanocomposite was tested against Gram-positive bacteria, including Bacillus subtilis and Staphylococcus aureus, as well as Gram-negative bacteria such as Escherichia coli and Salmonella sp. The well diffusion method was used to determine the inhibition zones, revealing that the nanocomposite demonstrated broad-spectrum antibacterial activity against all the pathogens tested. The largest inhibition zones were observed for B. subtilis, followed by S. aureus, E. coli, and Salmonella sp. Notably, the inhibition zones increased when the samples were exposed to light compared to dark conditions, with increases of 33 and 18 mm noted for B. subtilis. This enhanced activity under light exposure is attributed to the photocatalytic properties of the nanocomposite. The antibacterial mechanism is based on both adsorption and degradation processes. Moreover, antibacterial activity was found to increase with increasing concentrations of nanoparticles, ranging from 100 to 500 ppm. This suggests that the nanocomposite has potential as an alternative to antibiotics, especially considering the growing issue of bacterial resistance. The promising results obtained from the inhibition zones make these nanocomposites suitable for various applications. Currently, the research team is working on the development of a prototype utilizing these antimicrobial particles within commercial bottles for sterilization purposes in factories and companies.

Potential therapeutic biomolecules of hymenopteran venom against SARS-CoV-2 from Egyptian patients.

The therapeutic potential of insect-derived bioactive molecules as anti-SARS-CoV-2 agents has shown promising results. Hymenopteran venoms, notably from Apis mellifera (honeybee) and Vespa orientalis (oriental wasp), were examined for the first time in an in vitro setting for their potential anti-COVID-19 activity. This assessment utilized an immunodiagnostic system to detect the SARS-CoV-2 nucleocapsid antigen titer reduction. Further analyses, including cytotoxicity assays, plaque reduction assays, and in silico docking-based screening, were performed to evaluate the efficacy of the most potent venom. Results indicated that bee and wasp venoms contain bioactive molecules with potential therapeutic effects against SARS-CoV-2.Nevertheless, the wasp venom exhibited superior efficacy compared to bee venom, achieving a 90% maximal (EC90) concentration effect of antigen depletion at 0.184 mg/mL, in contrast to 2.23 mg/mL for bee venom. The cytotoxicity of the wasp venom was assessed on Vero E6 cells 48 h post-treatment using the MTT assay. The CC 50 of the cell growth was 0.16617 mg/mL for Vero E6 cells. The plaque reduction assay of wasp venom revealed 50% inhibition (IC50) at a 0.208 mg/mL concentration. The viral count at 50% inhibition was 2.5 × 104 PFU/mL compared to the initial viral count of 5 × 104 PFU/mL. In silico data for the wasp venom revealed a strong attraction to binding sites on the ACE2 protein, indicating ideal interactions. This substantiates the potential of wasp venom as a promising viral inhibitor against SARS-CoV-2, suggesting its consideration as a prospective natural preventive and curative antiviral drug. In conclusion, hymenopteran venoms, particularly wasp venom, hold promise as a source of potential therapeutic biomolecules against SARS-CoV-2. More research and clinical trials are needed to evaluate these results and investigate their potential for translation into innovative antiviral therapies.

Performance Evaluation of Sinusoidal Power Supplies for Ozone Generation in Water Purification Applications.

Ozone generation is a water disinfection method, superior to chlorine in terms of fewer byproducts and no residual taste. However, its high production cost limits its widespread adoption. This paper designs an ozone generation sinusoidal power supply for water treatment. Ozone generation requires a high-frequency and high-voltage power supply to produce ozone from oxygen molecules. The study evaluates two power supply topologies, one with a parallel LC filter and the other with an LCL filter, assessing their feasibility, effectiveness, and reliability. Theoretically, the LCL filter achieves higher gains than the parallel LC filter. The larger inductance in the parallel LC filter reduces gain, while the larger inductance in the LCL filter increases gain. Simulation and practical results validate these findings, achieving gains of 40 for the parallel LC filter and 150 for the LCL filter.

Proportion and risk factors of low birth weight among neonates delivered at Omdurman Maternity Hospital, Sudan.

Low birth weight (LBW) is a major predictor of child mortality and morbidity. The objectives of this study are to determine the proportion and risk factors of LBW. A matched case-control study was conducted at Omdurman Maternity Hospital, Sudan. The study population consisted of all babies delivered in August 2016 excluding stillbirths, multiple births, and babies with insufficient data. All LBW neonates were selected using total coverage sampling as cases and matched on babies' gender with randomly selected normal birth weights as controls. The sample size was 350 babies; 175 test cases and 175 control cases. Data were collected from hospital records and six risk factors were tested: mother age, parity, gravidity, mode of delivery, hypertensive disorders, and diabetes mellitus. The proportion of LBW was 10.8% of the total number of delivered neonates which is 2,938. The bivariate analysis identified that younger mother age (p = 0.03) and hypertension (p = 0.02) were significantly associated with LBW while other factors were found statistically insignificant. Multivariable conditional logistic regression revealed that hypertensive disorders in pregnancy increase the risk for LBW almost three times [Adjusted OR = 2.98 (95% CI: 1.23-7.22), p = 0.02]. We found that hypertension is an independent risk factor for LBW. The proportion of LBWcan be reduced if hypertension is controlled by providing simple measures like proper antenatal care and health education for pregnant women.

Reduction of organic contaminants from industrial effluent using the advanced oxidation process, chemical coagulation, and green nanotechnology.

Municipal wastewater treatment systems use the chemical oxygen demand test (COD) to identify organic contaminants in industrial effluents that impede treatment due to their high concentration. This study reduced the COD levels in tannery wastewater using a multistage treatment process that included Fenton oxidation, chemical coagulation, and nanotechnology based on a synthetic soluble COD standard solution. At an acidic pH of 5, Fenton oxidation reduces the COD concentration by approximately 79%. It achieves this by combining 10 mL/L of H2O2 and 0.1 g/L of FeCl2. Furthermore, the author selected the FeCl3 coagulant for the coagulation process based on the best results of comparisons between different coagulants. At pH 8.5, the coagulation dose of 0.15 g/L achieved the maximum COD removal efficiency of approximately 56.7%. Finally, nano bimetallic Fe/Cu was used to complete the degradation and adsorption of the remaining organic pollutants. The XRD, SEM, and EDX analyses proved the formation of Fe/Cu nanoparticles. A dose of 0.09 g/L Fe/Cu NPs, 30 min of contact time, and a stirring rate of 200 rpm achieve a maximum removal efficiency of about 93% of COD at pH 7.5. The kinetics studies were analyzed using pseudo-first-order P.F.O., pseudo-second-order P.S.O., and intraparticle diffusion models. The P.S.O. showed the best fit among the kinetic models, with an R2 of 0.998. Finally, the authors recommended that technique for highly contaminated industrial effluents treatment for agriculture or industrial purposes.

Survival Patterns Based on First-site-specific Visceral Metastatic Prostate Cancer: Are Outcomes of Visceral Metastases the Same?

Background and objective: Visceral metastatic disease in prostate cancer patients conveys a poor prognosis. Using advanced imaging techniques, studies have demonstrated increasing detection rates of visceral metastasis. Visceral metastases are now seen in up to 30-60% of prostate cancer patients. Survival patterns of site-specific visceral metastasis are described poorly in the literature. Here, we sought to investigate survival patterns in prostate cancer patients according to their first detected site of visceral metastasis. Methods: Retrospectively, we identified 203 prostate cancer patients with visceral metastases from the Mayo Clinic Advanced Prostate Cancer Registry. Patients were divided into three groups according to the first site of visceral metastases detected: lung, brain, or liver. Visceral metastases were detected primarily on either metabolic imaging (C-11 choline) or prostate-specific membrane antigen positron emission tomography computed tomography (CT) scan. Confirmation of visceral metastasis diagnosis was established with either biopsy when feasible or focused conventional imaging, including focused CT or magnetic resonance imaging. Overall survival and cancer-specific survival were estimated using the Kaplan-Meier method. Univariate and multivariate Cox regression model was conducted to assess different variables that affect overall and cancer-specific survival. Key findings and limitations: Over a median (interquartile range) follow-up duration of 16.2 (3.9-49.8) mo, the overall and cancer-specific survival of the entire cohort suggests better survival patterns in patients with first-site lung metastases than in patients with first-site brain or liver metastases (p < 0.0001). In univariate and multivariate analyses of factors impacting patients' overall and cancer-specific survival, a high prostate-specific antigen level at diagnosis of visceral metastasis, concomitant bone and lymph node disease, and more than four visceral metastases were associated with poor overall and cancer-specific survival (p < 0.05). On the contrary, first-site lung metastasis was associated with improved overall and cancer-specific survival, compared with first-site liver and brain metastases (p < 0.001). Conclusions and clinical implications: These data suggest that prostate cancer patients with visceral metastatic disease have varying survival patterns according to first-site detected visceral metastasis. In our cohort, patients with first-site lung metastasis demonstrated better survival outcomes than patients with first-site brain or liver metastasis. Patient summary: Our study explored the survival outcomes among patients with visceral metastatic prostate cancer employing cutting-edge imaging methods. Prostate cancer patients with metastases to different organs have different survival rates. Patients with cancer spreading to the lungs first showed better survival than those with cancer spreading to the brain or liver first.

A 12-month randomized controlled trial to assess the efficacy of revitalization of retreated mature incisors with periapical radiolucency in adolescents.

The use of regenrative endodontics is restoring the health status of the root canals of retreated mature teeth is a novel approach. Therefore, the current trial aimed to compare the effectiveness of regenerative endodontic procedures (REPs) to non-surgical root canal retreatment (NS-RCR) in reducing periapical radiolucency over one year for the retreatment of mature incisors with periapical periodontitis. The secondary purpose was to assess clinical success and regain pulp sensibility. A parallel randomized controlled trial, 66 mature incisors with periapical radiolucencies were randomly divided into two equal groups and retreated with either REPs or NS-RCR. At baseline and after 6 and 12 months, teeth were assessed clinically and radiographically using a periapical index (PAI). The Mann-Whitney test was used to analyze nonparametric PAI scores. The Electric pulp test readings were analyzed using the repeated measure analysis of variance (ANOVA). Over the follow-up intervals, there was no significant intergroup difference in the PAI medians, the majority of the teeth displayed a reduction in periapical radiolucency. At the end of the follow-up period, the clinical successes for the REP and NS-RCR groups were 93.9% and 97%, respectively (p = 0.555). Positive pulp sensibility was recorded in 54.54% of cases in the REPs after 12 months. Both approaches showed a comparable diminishing of periapical radiolucencies and equivalent clinical results. A conventional, non-surgical endodontic retreatment may not always be necessary.

Asymmetry in kinematics of dominant/nondominant lower limbs in central and lateral positioned college and sub-elite soccer players.

Change of direction, stops, and pivots are among the most common non-contact movements associated with anterior cruciate ligament (ACL) injuries in soccer. By observing these dynamic movements, clinicians recognize abnormal kinematic patterns that contribute to ACL tears such as increased knee valgus or reduced knee flexion. Different motions and physical demands are observed across playing positions, which may result in varied lower limb kinematic patterns. In the present study, 28 college and sub-elite soccer players performed four dynamic motions (change of direction with and without ball, header, and instep kick) with the goal of examining the effect of on-field positioning, leg dominance, and gender in lower body kinematics. Motion capture software monitored joint angles in the knee, hip, and ankle. A three-way ANOVA showed significant differences in each category. Remarkably, centrally positioned players displayed significantly greater knee adduction (5° difference, p = 0.013), hip flexion (9° difference, p = 0.034), hip adduction (7° difference, p = 0.016), and dorsiflexion (12° difference, p = 0.022) when performing the instep kick in comparison to their laterally positioned counterparts. These findings suggest that central players tend to exhibit a greater range of motion when performing an instep kicking task compared to laterally positioned players. At a competitive level, this discrepancy could potentially lead to differences in lower limb muscle development among on-field positions. Accordingly, it is suggested to implement position-specific prevention programs to address these asymmetries in lower limb kinematics, which can help mitigate dangerous kinematic patterns and consequently reduce the risk of ACL injury in soccer players.

The influence of potassium nanoparticles as a foliar fertilizer on onion growth, production, chemical content, and DNA fingerprint.

Potassium is an important macro-fertilizer for plant growth but can be lost from the soil after application via irrigation. Slow-release nano-fertilizers can achieve sustainable crop cultivation and production, so this study evaluated the influence of potassium nanoparticles (K-NPs) with various concentrations (0, 50, 100, and 200 mg/l) on onion development, production, pigments, chemical content, and DNA fingerprint during two sequential agriculture seasons in 2021 and 2022 at a private farm in Zagazig, Sharkia Governorate, Egypt. Spraying onion plants with K-NPs (200 mg/l) significantly improved the vegetative characteristics of onion plant growth and production, as well as increasing the plant pigments and the content of carbohydrate, oil, total indole, and phosphorus in onion bulbs. Similarly, 50 mg/l of K-NPs considerably increased the content of nitrogen, potassium, protein, antioxidant activity, and phenols in the onion bulbs. The content of total flavonoids and anthocyanin was increased with 100 mg/l of K-NPs. In conclusion, the foliar application of K-NPs improves the onion plant yield and quality and can achieve agricultural sustainability.

Association between echocardiographic velocity time integral ratio of mitral valve and left ventricular outflow tract and clinical outcomes post transcatheter edge-to-edge mitral valve repair.

Background: Residual mitral regurgitation (MR) is frequent after transcatheter edge-to-edge repair (TEER). There is controversy regarding the clinical impact of residual MR and its quantitative assessment by transthoracic echocardiography (TTE), which is often challenging with multiple eccentric jets and artifact from the clip. The utility of the velocity time integral (VTI) ratio between the mitral valve (MV) and left ventricular outflow tract (LVOT), (VTIMV/LVOT), a simple Doppler measurement that increases with MR, has not been assessed post TEER. Methods: Baseline characteristics, clinical outcomes, and TTE data from patients who underwent TEER between 2014 and 2021 across three academic centers were retrospectively analyzed. Post-procedure TTEs were evaluated for VTIMV/LVOT in the first three months after TEER. One-year outcomes including all-cause and cardiac mortality, major adverse cardiac events, and MV reintervention were compared between patients with high VTIMV/LVOT (≥2.5) and low (<2.5). Results: In total, 372 patients were included (mean age 78.7 ± 8.8 years, 68 % male, mean pre-TEER ejection fraction of 50.5 ± 14.7 %). Follow up TTEs were performed at a median of 37.5 (IQR 30-48) days post-procedure. Patients with high VTIMV/LVOT had significantly higher all-cause mortality (HR 2.10, p = 0.003), cardiac mortality (HR 3.03, p = 0.004) and heart failure admissions (HR 2.28, p < 0.001) at one-year post-procedure. There was no association between raised VTIMV/LVOT and subsequent MV reintervention. Conclusion: High VTIMV/LVOT has clinically significant prognostic value at one year post TEER. This tool could be used to select patients for consideration of repeat intervention.

Role of H.pylori in Chronic Sore Throat by Using H.pylori Line.

Pharyngitis is an inflammation of the mucous membranes of the oropharynx. Pharyngitis may be caused by an infectious or noninfectious disease. Noninfectious diseases of pharynx include allergies, trauma, cancer, reflux and certain toxins. Infection with H. Pylori is associated with developing chronic sore throat, gastritis, gastric or duodenal ulcer, gastric cancer and MALT lymphoma. There are many different investigations to diagnose H pylori as H pylori antigen in blood and stool, urea breath test but, H. Pylori line is a new test for detection of the virulent strains. There are many lines of H pylori therapy in the form of PPIs and antibiotics for about two weeks. This study aimed to detect role of H pylori in chronic pharyngitis. 85 patients who had chronic pharyngitis with normal CBC, WBCS, lymphocyte, monocyte and eosinophils with negative ASO titer and throat swab. These patients did H pylori line to detect H pylori virulent antigen. 77 patients with chronic pharyngitis are positive H pylori and after medical treatment 68 patients became negative. H. Pylori line is a new test for detection of the virulent strains and screening H pylori carrier at risk of developing gastric and duodenal ulcers as well as cancer.

Prostate Cancer Lung Metastasis: Clinical Insights and Therapeutic Strategies.

Prostate cancer lung metastasis represents a clinical conundrum due to its implications for advanced disease progression and the complexities it introduces in treatment planning. As the disease progresses to distant sites such as the lung, the clinical management becomes increasingly intricate, requiring tailored therapeutic strategies to address the unique characteristics of metastatic lesions. This review seeks to synthesize the current state of knowledge surrounding prostate cancer metastasis to the lung, shedding light on the diverse array of clinical presentations encountered, ranging from subtle radiological findings to overt symptomatic manifestations. By examining the diagnostic modalities utilized in identifying this metastasis, including advanced imaging techniques and histopathological analyses, this review aims to provide insights into the diagnostic landscape and the challenges associated with accurately characterizing lung metastatic lesions in prostate cancer patients. Moreover, this review delves into the nuances of therapeutic interventions employed in managing prostate cancer lung metastasis, encompassing systemic treatments such as hormonal therapies and chemotherapy, as well as metastasis-directed therapies including surgery and radiotherapy.

High-Performance Anion Exchange Membrane Water Electrolyzers Enabled by Highly Gas Permeable and Dimensionally Stable Anion Exchange Ionomers.

Designing suitable anion exchange ionomers is critical to improving the performance and in situ durability of anion exchange membrane water electrolyzers (AEMWEs) as one of the promising devices for producing green hydrogen. Herein, highly gas-permeable and dimensionally stable anion exchange ionomers (QC6xBA and QC6xPA) are developed, in which bulky cyclohexyl (C6) groups are introduced into the polymer backbones. QC650BA-2.1 containing 50 mol% C6 composition shows 16.6 times higher H2 permeability and 22.3 times higher O2 permeability than that of QC60BA-2.1 without C6 groups. Through-plane swelling of QC650BA-2.1 decreases to 12.5% from 31.1% (QC60BA-2.1) while OH- conductivity slightly decreases (64.9 and 56.2 mS cm-1 for QC60BA-2.1 and QC650BA-2.1, respectively, at 30 °C). The water electrolysis cell using the highly gas permeable QC650BA-2.1 ionomer and Ni0.8Co0.2O in the anode catalyst layer achieves two times higher performance (2.0 A cm-2 at 1.69 V, IR-included) than those of the previous cell using in-house ionomer (QPAF-4-2.0) (1.0 A cm-2 at 1.69 V, IR-included). During 1000 h operation at 1.0 A cm-2, the QC650BA-2.1 cell exhibits nearly constant cell voltage with a decay rate of 1.1 µV h-1 after the initial increase of the cell voltage, proving the effectiveness of the highly gas permeable and dimensionally stable ionomer in AEMWEs.

Lipoprotein(a) and Long-term In-stent Restenosis after Percutaneous Coronary Intervention.

AIM: Lipoprotein(a) [Lp(a)] has demonstrated its association with atherosclerosis and myocardial infarction. However, its role in the development of in-stent restenosis (ISR) after percutaneous coronary intervention (PCI) is not clearly established. The aim of this study is to investigate the association between Lp(a) and ISR. METHODS: A retrospective study of adult patients who underwent successful PCI between January 2006 and December 2017 at the three Mayo Clinic sites and had a preprocedural Lp(a) measurement was conducted. Patients were divided into two groups according to the serum Lp(a) concentration (high Lp(a) ≥50 mg/dl and low Lp(a) <50 mg/dl). Univariable and multivariable analyses were performed to compare risk of ISR between patients with high Lp(a) versus those with low Lp(a). RESULTS: A total of 1209 patients were included, with mean age 65.9 ±11.7 years and 71.8% were male. Median follow-up after baseline PCI was 8.8 (IQR 7.4) years. Restenosis was observed in 162 (13.4%) patients. Median serum levels of Lp(a) were significantly higher in patients affected by ISR versus non-affected cases: 27 (IQR 73.8) vs. 20 (IQR 57.5) mg/dL, p=0.008. The rate of ISR was significantly higher among patients with high Lp(a) versus patients with low Lp(a) values (17.0% vs 11.6%, p=0.010). High Lp(a) values were independently associated with ISR events (HR 1.67, 95%CI 1.18 to 2.37, p=0.004), and this association was more prominent after the first year following the PCI. CONCLUSION: Lipoprotein(a) is an independent predictor for long-term in-stent restenosis and should be considered in the evaluation of patients undergoing PCI.

The role of Lp(a) in the development of in-stent restenosis is not clearly established. In this study including 1209 patients who underwent successful percutaneous coronary intervention and had a preprocedural Lp(a) measurement between 2006 and 2017, the rates of restenosis were significantly higher among patients with high Lp(a) versus patients with low Lp(a) values and high Lp(a) concentrations were independently associated with restenosis events. Lp(a) should be considered as a risk factor for long term in-stent restenosis in the evaluation of patients undergoing percutaneous coronary intervention and assessed as a potential therapeutic target for reducing residual cardiovascular risk in this population.

Rapidly Progressive Apical Hypertrophic Cardiomyopathy: Not Everything is What It Seems.

Apical hypertrophic cardiomyopathy (HCM) is a rare variant of HCM. A 43-year-old female with a past medical history significant for hypertension and kidney transplantation presented with recurrent syncopal episodes and dyspnea on exertion. Electrocardiogram showed characteristic diffuse giant T-waves inversion, and cardiac magnetic resonance showed HCM with circumferential apical thickening. This case highlights the rapid development of apical HCM and its challenging diagnostic characteristics.

Arthroscopic Anatomic Reconstruction of the Anterior Talofibular and Calcaneofibular Ligaments Through a 2-Portal Technique.

Arthroscopic anatomic lateral ligament reconstruction of the ankle joint has proven to be a safe option in the treatment of chronic ankle instability (CAI), with good functional results as well as allowing simultaneous management of associated lesions. We described an arthroscopic technique for anatomic reconstruction of the anterior talofibular ligament and calcaneofibular ligament using only 2 arthroscopic portals. This surgical technique to treat CAI is technically less demanding than other described techniques that use 3 or 4 arthroscopic portals. Moreover, as an anatomic technique, it has the advantage of preserving the biomechanics and kinematics of the ankle joint.

Salivary toxicity from PSMA-targeted radiopharmaceuticals: What we have learned and where we are going.

Clinical trials of prostate-specific membrane antigen (PSMA) targeted radiopharmaceuticals have shown encouraging results. Some agents, like lutetium-177 [177Lu]Lu-PSMA-617 ([177Lu]Lu-PSMA-617), are already approved for late line treatment of metastatic castration-resistant prostate cancer (mCRPC). Projections are for continued growth of this treatment modality; [177Lu]Lu-PSMA-617 is being studied both in earlier stages of disease and in combination with other anti-cancer therapies. Further, the drug development pipeline is deep with variations of PSMA-targeting radionuclides, including higher energy alpha particles conjugated to PSMA-honing vectors. It is safe to assume that an increasing number of patients will be exposed to PSMA-targeted radiopharmaceuticals during the course of their cancer treatment. In this setting, it is important to better understand and mitigate the most commonly encountered toxicities. One particularly vexing side effect is xerostomia. In this review, we discuss the scope of the problem, inventories to better characterize and monitor this troublesome side effect, and approaches to preserve salivary function and effectively palliate symptoms. This article aims to serve as a useful reference for prescribers of PSMA-targeted radiopharmaceuticals, while also commenting on areas of missing data and opportunities for future research.