Biphasic calcium phosphate doped with zirconia nanoparticles for reconstruction of induced mandibular defects in dogs: cone-beam computed tomographic and histopathologic evaluation.

The present study aimed to evaluate osteogenic potential and biocompatibility of combining biphasic calcium phosphate with zirconia nanoparticles (4Zr TCP/HA) compared to biphasic calcium phosphate (TCP/HA) for reconstruction of induced mandibular defects in dog model. TCP/HA and 4Zr TCP/HA scaffolds were prepared. Morphological, physicochemical, antibacterial, cytocompatibility characterization were tested. In vivo application was performed in 12 dogs where three critical-sized mandibular defects were created in each dog. Bone defects were randomly allocated into: control, TCP/HA, and 4Zr TCP/HA groups. Bone density and bone area percentage were evaluated at 12 weeks using cone-beam computed tomographic, histopathologic, histomorphometric examination. Bone area density was statistically increased (p < 0.001) in TCP/HA and 4Zr TCP/HA groups compared to control group both in sagittal and coronal views. Comparing TCP/HA and 4Zr TCP/HA groups, the increase in bone area density was statistically significant in coronal view (p = 0.002) and sagittal view (p = 0.05). Histopathologic sections of TCP/HA group demonstrated incomplete filling of the defect with osteoid tissue. Doping with zirconia (4Zr TCP/HA group), resulted in statistically significant increase (p < 0.001) in bone formation (as indicated by bone area percentage) and maturation (as confirmed by Masson trichrome staining) compared to TCP/HA group. The newly formed bone was mature and organized with more trabecular thickness and less trabecular space in between. Physicochemical, morphological and bactericidal properties of combining zirconia and TCP/HA were improved. Combining zirconia and TCP/HA resulted in synergistic action with effective osteoinduction, osteoconduction and osteointegration suggesting its suitability to restore damaged bone in clinical practice.

Ultrasonographic and histopathologic features associated with common ocular diseases in donkeys (Equus asinus).

There is a lack of reports describing ultrasonographic and histopathologic features of ocular diseases in donkeys. The present study aimed to document ultrasonographic and histopathologic changes associated with common ocular diseases in donkeys. The study included 45 donkeys (64 eyes) with ocular diseases that had reached the end of their working lives and requested to be used for educational and research purposes. Complete clinical, ophthalmic, ultrasonographic, gross pathologic and histopathologic examinations were included. Ocular abnormalities were documented, tabulated, and analyzed. Seventy-five ocular abnormalities were diagnosed with multiple involvements within the same eye including anterior uveitis (n = 13; 22.8%), cataract (n = 57; 76%), retinal detachment (n = 3; 4%), lens and phthisis bulbi (n = 2; 2.6%). Descriptive ultrasonographic findings of ocular abnormalities were included. Gross pathologic and histopathology findings confirmed the ultrasonography findings. Ultrasonography provided a clinically useful tool offering insight into detailed intraocular structures especially with opacification of the dioptric structures of the eye.

Osteogenic potential of calcium silicate-doped iron oxide nanoparticles versus calcium silicate for reconstruction of critical-sized mandibular defects: An experimental study in dog model.

Objective: To evaluate bioactivity and osteogenic potential of calcium silicate (CS)-doped iron oxide (Fe2O3) nanoparticles versus pure CS in the reconstruction of induced critical-sized mandibular defects. Design: CS-doped Fe2O3 was prepared; morphological and microstructure identification of nanoparticles were made. An in vivo randomised design was developed on 24 adult male dogs where four critical-sized mandibular defects were created in each dog. Bone defects were allocated into control, CS, CS-3% Fe2O3 and CS-10% Fe2O3 group. Dogs were euthanized at 1 and 3 months (12 dog/time) for histopathologic and histomorphometric evaluation. Results: At three months, bone formation and maturation were evident where mean ± SD percent of mature bone was 2.66 ± 1.8, 9.9 ± 2.5, 22.9 ± 4.9, and 38.6 ± 8.1 in control, CS, CS-3% Fe2O3, and CS-10% Fe2O3 groups respectively. A high significant (P < 0.001) increase in area percent of mature bone was recorded in CS, CS-3% Fe2O3, and CS- 10% Fe2O3 groups compared to control group (73%, 88% and 93.3% respectively). Significant increase (P < 0.001) in area of mature bone was recorded in CS-3% Fe2O3 and CS-10% Fe2O3 groups compared to CS group. A significant increase (P < 0.001) in area of mature bone formation was detected in CS-10% Fe2O3 group compared to other groups. Conclusion: CS-doped Fe2O3 has good osteoconductive, biocompatible properties with promoted bone regeneration. Fe2O3 has synergistic effect in combination with CS to promote bone formation. Increasing concentration of Fe2O3 nanoparticles resulted in improved osteogenesis and maturation. Results suggests that the novel CS-Fe2O3 alloplasts could be used for reconstruction of critical-sized bone defects.

COVID-19 Infection in Patients with Comorbidities: Clinical and Immunological Insight.

AIM: Our study's objectives were to study the clinical and laboratory characteristics that may serve as biomarkers for predicting disease severity, IL-10 levels, and frequencies of different T cell subsets in comorbid COVID-19 patients. METHODS: Sixty-two hospitalized COVID-19 patients with comorbidities were assessed clinically and radiologically. Blood samples were collected to assess the T lymphocyte subsets by flow cytometry and IL-10 levels by ELISA. RESULTS: The most common comorbidities observed in COVID-19 patients were diabetes mellitus (DM), hypertension, and malignancies. Common symptoms and signs included fever, cough, dyspnea, fatigue, myalgia, and sore throat. CRP, ferritin, D dimer, LDH, urea, creatinine, and direct bilirubin were significantly increased in patients than controls. Lymphocyte count and CD4+ and CD8+ T-cells were significantly decreased in comorbid COVID-19 patients, and CD25 and CD45RA expression were increased. CD4+ and CD8+ regulatory T cells (Tregs) and IL-10 levels were significantly decreased in patients. CONCLUSIONS: Many parameters were found to be predictive of severity in the comorbid patients in our study. Significant reductions in the levels and activation of CD4+ and CD8+ T-cells were found. In addition, CD4+ and CD8+ Tregs were significant decreased in patients, probably pointing to a prominent role of CD8+ Tregs in dampening CD4+ T-cell activation.

Evaluation of tripartite motif 59 and its diagnostic utility in benign bowel diseases and colorectal cancer.

Colorectal cancer (CRC) is the second leading cause of cancer-related mortality in developing countries. Tripartite motif-59 (TRIM59) a member of the TRIM ubiquitin ligase family, is a surface molecule that regulates biological processes such as cell proliferation, apoptosis, and tumorigenesis. Previous studies reported that TRIM59 expression was upregulated in human CRC, however, the expression pattern and role of TRIM59 in benign colorectal lesions remain unclear. Sixty patients diagnosed with CRC and 60 patients with benign lesions (Crohn's disease, ulcerative colitis, adenoma, and familial adenomatous polyposis) were recruited to the present study. TRIM59 gene expression was assessed by real-time quantitative polymerase chain reaction. Expression of TRIM59 protein and p-AKT were determined using, enzyme-linked immunoassay while p53 expression was detected by immunohistochemistry. Antioxidant/oxidant role of glutathione (GSH)/malondialdehyde (MDA) were evaluated by colorimetric methods in all of the studied groups. Our results showed upregulated expressions of TRIM59 gene and protein levels in CRC tissues and benign colonic lesions compared to nontumor tissues. Their levels were higher in inflammatory compared to noninflammatory bowel lesions. There were significant interrelations among TRIM59 gene expression, protein levels, tumor, node, metastasis staging, and the presence of metastasis (p < 0.0001). Receiver-operator characteristic curve analyses showed that at the cutoff point of 2.5 TRIM59 mRNA expression can discriminate between CRC cases and benign bowel group (area under the curve [AUC]: 0.639, sensitivity: 86.7%, specificity: 41.7%), and between CRC and controls (AUC: 0.962, sensitivity: 90%, specificity: 91.7%). TRIM59 could be a potential biomarker in the early detection, diagnosis, and treatment of benign colonic lesions and CRC.

An in vitro / in vivo release test of risedronate drug loaded nano-bioactive glass composite scaffolds.

Three-dimensional (3D) matrices scaffolds play a noteworthy role in promoting cell generation and propagation. In this study, scaffolds prepared from chitosan/polyvinyl alcohol loaded with/without an osteoporotic drug (risedronate) and nano-bioactive glass (nBG) have been developed to promote healing of bone defects. The scaffolds were characterized by scanning electron microscopy (SEM), porosity test as well as mechanical strength. The pattern of drug release and ability to promote the proliferation of Saos-2osteosarcoma cells had also been reported. Osteogenic potential of the scaffolds was evaluated by testing their effect on healing critical-sized dog's mandibular bone defects. Increasing chitosan and nBG in the porous scaffolds induced decrease in drug release, increased the scaffold's strength and supported their cell proliferation, alkaline phosphatase (ALP) activities, as well as increased calcium deposition. Histological and histomorphometric results demonstrated newly formed bone trabeculae inside critical-sized mandibular defects when treated with scaffolds. Trabecular thickness, bone volume/tissue volume and the percentage of mature collagen fibers increased in groups treated with scaffolds loaded with 10% nBG and risedronate or loaded with 30% nBG with/without risedronate compared with those treated with non-loaded scaffolds and empty control groups. These findings confirmed the potential osteogenic activity of chitosan/polyvinyl alcohol-based scaffolds loaded with risedronate and nBG.

Gigantic Ocular Squamous Cell Carcinoma Mixed With Fibrosarcoma in a Mare: Clinical, Laboratory, Ultrasonography and Histopathology Findings.

Ocular neoplasms represent 10% of all equine neoplasms and ocular squamous cell carcinoma (OSCC) is the most common one. This report describes the clinical presentation, laboratory, ultrasonography, postmortem, histopathology and immunohistochemistry findings of a mixed ocular neoplasm in a 10-year-old draft mare. The mare had a one-year history of left ocular mass. Complete destruction of the left eye with loss of vision was observed. A large ulcerated mass oozing blood replaced the left eye. Left parotid lymph node was swollen and had a sinus tract discharging pus. Ultrasonography revealed absence of all intraocular structures, several lobular echogenic tissues and several hyperechoic areas of ossification with acoustic shadowing. Color Doppler scanning revealed numerous neovascularization all over the tumor, particularly along the periphery. The neovascularization demonstrated mainly arterial with few mixed blood flow signals. The amplitude of systolic and diastolic blood flow was markedly increased. Enucleation was decided but the mare died just after examination. The ocular mass was excised and its weight was 390 g. Postmortem examination revealed no distant metastasis in all internal organs. Histopathology confirmed OSCC mixed with fibrosarcoma and associated with cartilaginous and osseous metaplasia. The neoplastic cells gave positive nuclear p53 immunoreactivity. The left parotid lymph node revealed metastasis. Despite the unsuccessful outcome in this particular case, this report documents a mixed eye neoplasm, highlights the ultrasonography and histopathology features of OSCC, and reinforces the need for early diagnosis and surgical treatment in such cases to improve the outcome and to decrease the drastic complications and mortality.

Microbial aspects and potential markers for differentiation between bacterial and viral meningitis among adult patients.

OBJECTIVES: Meningitis is a medical emergency with permanent disabilities and high mortality worldwide. We aimed to determine causative microorganisms and potential markers for differentiation between bacterial and viral meningitis. METHODOLOGY: Adult patients with acute meningitis were subjected to lumber puncture. Cerebrospinal fluid (CSF) microorganisms were identified using Real-time PCR. PCT and CRP levels, peripheral and CSF-leucocyte count, CSF-protein and CSF-glucose levels were assessed. RESULTS: Out of 80 patients, infectious meningitis was confirmed in 75 cases; 38 cases were bacterial meningitis, 34 cases were viral meningitis and three cases were mixed infection. Higher PCT, peripheral and CSF-leukocytosis, higher CSF-protein and lower CSF-glucose levels were more significant in bacterial than viral meningitis patients. Neisseria meningitides was the most frequent bacteria and varicella-zoster virus was the most common virus. Using ROC analyses, serum PCT and CSF-parameters can discriminate bacterial from viral meningitis. Combined ROC analyses of PCT and CSF-protein significantly improved the effectiveness in predicting bacterial meningitis (AUC of 0.998, 100%sensitivity and 97.1%specificity) than each parameter alone (AUC of 0.951 for PCT and 0.996 for CSF-protein). CONCLUSION: CSF-protein and serum PCT are considered as potential markers for differentiating bacterial from viral meningitis and their combination improved their predictive accuracy to bacterial meningitis.

B-Scan Biometry and Color Doppler Ultrasound Imaging of the Eye in Clinically Normal Donkeys (Equus asinus): Effect of Laterality, Maturity and Gender.

Despite the extensive research on ocular ultrasonography, there is paucity of information regarding ocular biometry and color Doppler imaging of the donkey's eye. This study establishes B-scan ocular biometry and color Doppler ultrasonographic reference values in normal donkeys and describes effect of laterality, maturity and gender on ocular biometry and vasculature. Forty (80 eyes) clinically normal immature and mature donkeys of both sexes were included. Transpalpebral ocular ultrasonography was made using a 12-MHz linear transducer. Biometric ocular measurements were made including the anterior chamber depth, central lens thickness, vitreous chamber depth, axial globe length, longitudinal globe length, lens pole diameter and posterior wall thickness. Color Doppler velocimetric measurements including peak systolic velocity and end-diastolic velocity were made. Blood flow indices represented by resistive and pulsatility indices were calculated. Results revealed that laterality and gender did not represent variability factors in ocular biometry (P >.05), while the animal's maturity had an influence on axial globe length (P <.001), longitudinal globe length (P = 0.000) and lens pole diameter (P = .000). Laterality had no effect on velocimetric parameters and indices (P >.05) while gender had significant effect on resistive index (P = .024), pulstality index (P = .000) and volume flow per area (P = .008). The state of maturity had significant effects on peak systolic velocity (P = .027) and blood volume flow per distance (P = .012), and area (P = .048). Ocular biometry and color Doppler ultrasonography provided a clinically useful tool to evaluate the donkey's eye that will be helpful in diagnosing donkeys with ocular diseases.

Efficacy of Flat-Top Hand-Piece Using 980 nm Diode Laser Photobiomodulation on Socket Healing after Extraction: Split-Mouth Experimental Model in Dogs.

The objective was to evaluate the effect of photobiomodulation (PBM) using 980 nm diode laser therapy (0.60 W, 0.77 W cm-2 , 36 J, 46 J cm-2 , 60 s) irradiated in continuous wave mode by flat-top hand-piece on socket healing in the maxilla and mandible. A split-mouth experimental design was performed on 6 dogs. The 3rd premolar tooth was extracted from the maxilla and mandibles for both sides. The right-sided sockets were irradiated (PBM group), and the left-sided sockets were kept as control. Irradiation was done after extraction and at 48-h interval for 14 days. Both the buccal and lingual sides were irradiated to reach a total irradiation time of 120 s. Bone density was evaluated at 3, 4 and 5 weeks using cone beam computed tomography. We showed that maxillary sockets in the PBM group had higher bone density compared to control one at 3, 4, 5 weeks (P = 0.029, <0.001, <0.001), respectively. Mandibular sockets revealed no significant difference between PBM and control at 3 weeks (P = 0.347), while at 4 and 5 weeks PBM group showed higher bone density (P = 0.004, <0.001). In both groups, there was a significant increase (P < 0.001) in bone density by time which was higher in the PBM group. We concluded that PBM using a flat-top hand-piece of 980-nm improved the bone density of extraction sockets.

Feline aortic thromboembolism: Presentation, diagnosis, and treatment outcomes of 15 cats.

Background: Feline aortic thromboembolism (FATE) is a fatal disease where a blood clot gets lodged into the aortic trifurcation. Methods: Fifteen cats with a sudden onset of hind limb paresis/paralysis, vocalization, and pain were admitted to the surgery clinic. A full case history was obtained and clinical, orthopedic, neurologic, radiographic, electrocardiographic, and echocardiographic examinations were performed for each cat. The treatment protocol included daily administration of multiple anticoagulant drugs with different mode of actions and meloxicam for 7 successive days. Prophylactic anticoagulant therapy (clopidogrel and acetylsalicylic acid) was continued for 6 months. All data were statistically analyzed and the correlation between time of admission and treatment outcome was tested using Pearson's correlation coefficient. Results: The case history and clinical, orthopedic, and neurologic examinations revealed a sudden onset of hind limb paralysis (n = 12) or paresis (n = 3) associated with vocalization and pain, absence of trauma, cold and pale paws of hind limbs (n = 13, 86.7%) or cyanosed hind paws (n = 2, 13.3%), absence of femoral pulsation, shallow and rapid open-mouth respiration (61 ± 8 breaths/minutes), hypothermia (37.9°C ± 0.6°C) and tachycardia (155 ± 12 beats/minutes), with a muffled heart sound in four cats (26.7%). Radiography revealed no abnormalities in the hind limbs, pelvis, and spines, cardiomegaly in five cats (33.3%), mild pleural effusion and vascular pattern of the lung in six cats (40%), and Valentine's heart shape in four cats (26.7%). Electrocardiography (ECG) revealed an R-wave< 0.9 mV, prolongation of QRS interval in five cats (33.3%), and conduction disturbance in four cats (26.7%). Echocardiography was consistent with hypertrophic cardiomyopathy (HCM) in five cats (33.3%). A statistically significant (p= 0.023) strong negative correlation (r= -0.6) was reported between time of admission and subsequent early treatment and recovery from clinical signs. The treatment was successful in nine cats (60%), while four cats (26.7) were euthanized and two cats (13.3%) were subjected to hind limb amputation, at the owners' requests. Conclusion: Clinical signs, radiography, ECG, and echocardiography are valuable for diagnosis of FATE. The outcome of the multiple anticoagulants therapy depends mainly upon early diagnosis and treatment within the first 6 hours from the onset of clinical signs.

Radiological evaluations of low cost wollastonite nano-ceramics graft doped with iron oxide in the treatment of induced defects in canine mandible.

Wollastonite with/without maghemite [(Fe2O3), 0, 3 and 10 wt%] was prepared by facile wet precipitation method. Effect of Fe2O3 presence in the obtained nano-ceramics on physical structure, morphology, size and the mechanical features was evaluated using X-ray diffraction, transmission electron microscope, and universal testing machine. Moreover, the in vitro biomineralization was examined using simulated body fluid (SBF) by means of scanning electron microscope/energy dispersive X-ray, Fourier transform infrared, and inductively coupled plasma. An in vivo study was conducted on 24 adult male mongrel dogs to test the biosafety of fabricated samples in the reconstruction of experimentally induced mandibular bone defects. Bone density was measured through cone beam computed tomography analysis conducted at 1 and 3 months following surgery. Wollastonite was the main phase in all the prepared samples however little maghemite was developed in Fe-containing samples. No remarkable changes were recognized for physical structure of obtained microcrystalline structures, however, a decrease in particle size was noted in the existence of Fe2O3 (10-15 nm) when compared to the pure wollastonite (30-50 nm). Mechanical features were dependent on the included Fe2O3 concentration within the wollastonite ceramic matrix. The degree of biomineralization of the samples immersed in SBF was elevated with the increase in Fe2O3 percentage. Clinically, the reconstruction of bone defects was uneventful without any adverse toxic effect. Bone density was significantly increased at 1 and 3 months (p < .001) in grafted defects compared to control ones. Increasing the doping concentrations of iron oxide was associated with significant increase (p < .001) of bone density in all induced defects. Due to the impressive healing effect of current fabricated nano-ceramics, they are recommended to be utilized as low cost bone graft alternatives.

Autoimmune Hepatitis: Shifts in Gut Microbiota and Metabolic Pathways among Egyptian Patients.

Autoimmune hepatitis (AIH) is a chronic inflammatory disorder with complex immunopathogenesis. Dysbiosis has been linked to many autoimmune diseases, but its detailed role in autoimmune hepatitis (AIH) still needs rigorous evaluation, especially in Egypt. We aimed to identify the shift in the gut microbiota profile and resultant metabolic pathways in AIH Egyptian patients compared to healthy individuals. Stool samples were collected from 15 AIH-naive patients and from 10 healthy individuals. The V3-V4 hyper-variable regions in16S rRNA gene was amplified and sequenced using Illumina MiSeq platform. Significantly lower bacterial diversity in AIH patients was found compared to the controls. A phylum-level analysis showed the overrepresentation of Firmicutes, Bacteroides, and Proteobacteria. At the genus level, AIH-associated enrichment of Faecalibacterium, Blautia, Streptococcus, Haemophilus, Bacteroides, Veillonella, Eubacterium, Lachnospiraceae and Butyricicoccus was reported in contrast to Prevotella, Parabacteroides and Dilaster, which were significantly retracted in such patients. Overall, the predicted metabolic pathways associated with dysbiosis in AIH patients could orchestrate the potential pathogenic roles of gut microbiota in autoimmune disease, though not in a disease-specific manner, calling for future large-scale studies.

Dose-Dependent Clinical, Radiographic, and Histopathologic Changes of 17ß-Estradiol Levels Within the Temporomandibular Joint: An Experimental Study in Ovariectomized Dogs.

PURPOSE: The aim of this study was to test the hypothesis that the dose of estrogen replacement therapy may have an influence on the clinical, radiographic, and histopathologic changes within the temporomandibular joint (TMJ). MATERIALS AND METHODS: A prospective experimental study was conducted in 12 mature ovariectomized dogs. Dogs were randomly allocated into 1 of 4 groups (OVX-E0, dogs that did not receive any estrogen replacement therapy; OVX-E0.5, dogs that received 0.15 mg/kg of estradiol; OVX-E1, dogs that received 0.3 mg/kg of estradiol; and OVX-E2, dogs that received 0.6 mg/kg of estradiol); dogs were evaluated clinically for 12 weeks; and contact radiographic and histopathologic examinations of the TMJ were performed just after euthanasia. RESULTS: Radiographic examination of the TMJ in the OVX-E0 group showed narrowing of the joint space with marginal osteophyte formation along the mandibular condyle. The OVX-E0.5 group showed mild widening of the joint space with no remarkable changes within the mandibular fossa or condyle. The OVX-E1 group was free of radiographic changes within the TMJ. High doses of estrogen in the OVX-E2 group showed marked flattening of the mandibular condyle and fossa with sclerosis of the subchondral bone. Histopathologic sections in the OVX-E0 group showed thin compact bone with scanty, less organized lacunae. The OVX-E0.5 group showed compact bone of medium thickness with large osteons and disorganized lacunae. The OVX-E1 group showed thick compact bone with reduced intertubercular spaces and organized lacunae. The OVX-E2 group showed thin bone with reduced trabecular and increased intertrabecular thickness. The collagen content did not change significantly among the 4 groups, whereas its quality changed significantly (P < .05). CONCLUSIONS: Estrogen dosage is potentially a key regulator of bone metabolism within the TMJ. Estrogen replacement therapy exhibited an inverted U-shaped beneficial effect. Estrogen depletion as well as high doses of estrogen resulted in clinical, radiographic, and histopathologic changes within the TMJ. Estrogen replacement therapy should be prescribed at the optimum dose when indicated as hormonal replacement therapy.

Influence of phase of respiration on thoracic conformation at multiple vertebral levels in German shepherd dog.

This study aimed to objectively assess the influence of phase of respiration on thoracic conformation at different vertebral levels. An observational prospective study was done on 30 German shepherd dogs. Thoracic radiographs were obtained at peak inspiration and expiration; thoracic depth and width were measured at each vertebral level. The change in thoracic dimensions, and the frontosagittal and vertebral indices were calculated at each level. The level of the 10th thoracic segment was the deepest and widest level of the thorax. At the first three thoracic segments, the percentage change of thoracic depth ranged from 3.2 ± 3.0 to 5.1 ± 3.9 % and 4.2 ± 2.8 to 6.6 ± 4.9 % for thoracic width. At the 4th-9th thoracic segments, this change increased to 13.3 ± 5.0 to 19.3 ± 3.8 % in thoracic depth and 13.9 ± 6.2 to 18.8 ± 8.2 % in thoracic width. The percentage change in thoracic width was significantly greater than thoracic depth at the level of the 6th and 7th thoracic segments (P = 0.027, 0.019). Phase of respiration had an influence on thoracic conformation objectively evaluated at multiple vertebral levels.

Clinical Value of Presepsin in Comparison to hsCRP as a Monitoring and Early Prognostic Marker for Sepsis in Critically Ill Patients.

Sepsis carries a poor prognosis for critically ill patients, even withintensive management. We aimed to determined early predictors of sepsis-related in-hospital mortality and to monitor levels of presepsin and high sensitivity C reactive protein (hsCRP) during admission relative to the applied treatment and the development of complications.An observational study was conducted on 68 intensive care unit (ICU) patients with sepsis. Blood samples from each patient were collected at admission (day 0) for measuring presepsin, hsCRP, biochemical examination, complete blood picture and microbiological culture and at the third day (day 3) for measuring presepsin and hsCRP. Predictors of sepsis-related in-hospital mortality were assessed using regression analysis. Predictive abilities of presepsin and hsCRP were compared using the area under a receiver operating characteristic curve. The Kaplan⁻Meier method was used to estimate the overall survival rate.Results showed that the sepsis-related in-hospital mortality was 64.6%. The day 0 presepsin and SOFA scores were associated with this mortality. Presepsin levels were significantly higher at days 0 and 3 in non-survivors vs. survivors (p = 0.03 and p < 0.001 respectively) and it decreased over the three days in survivors. Presepsin had a higher prognostic accuracy than hsCRP at all the evaluated times. Overall, in comparison with hsCRP, presepsin was an early predictor of sepsis-related in-hospital mortality in ICU patients. Changes in presepsin concentrations over time may be useful for sepsis monitoring, which in turn could be useful for stratifying high-risk patients on ICU admission that benefit from intensive treatment.

Role of miRNA-210, miRNA-21 and miRNA-126 as diagnostic biomarkers in colorectal carcinoma: impact of HIF-1α-VEGF signaling pathway.

Colorectal cancer (CRC) is a major cause of death worldwide. Novel non-invasive, high diagnostic value screening test is urgently needed to improve survival rate, treatment and prognosis. Stable, small, circulating microRNA (miRNA) offers unique opportunities for the early diagnosis of several diseases. It acts as tumor oncogenes or suppressors and involve in cell death, survival, and metastasis. Communication between miRNA and carcinogenesis is critical but it still not clear and needs further investigation. The aim of our study is to evaluate the role of miR-210, miR-21, miR-126, as non-invasive diagnostic biomarkers for screening, early detection of CRC, studying their correlation with prognostic variables, and clarifying the roles of miRNAs on HIF-1α-VEGF signaling pathway. The expression of miR-210, miR-21 and miR-126 was performed using qRT-PCR in adenocarcinoma (no = 35), adenomas (no = 51), and neoplasm free controls (no = 101). Serum levels of VEGF and HIF-1α was determined by ELISA Kit. The results show that the expression of miR-210, miR-21, VEGF, HIF-1α was significantly up-regulated while that miRNA-126 was down-regulated in both adenocarcinoma and adenomas compared with controls (p < 0.001 for each). No significant difference was noted comparing patients with adenocarcinoma and adenomas. The three miRNAs correlated with VEGF, HIF-α. The miR-210 and miR-21 associated with TNM classification and clinical staging of adenocarcinoma (p < 0.001) and they show high diagnostic value with sensitivity and specificity 88.6%, 90.1% and 91.4%, 95.0% respectively. Our study revealed that circulating miR-210, miR-21 were up-regulated while miR-126 was down-regulated in CRC and adenomas patients, they all correlated with TNM staging and they had high diagnostic value. HIF-1α VEGF signaling pathways regulated by miRNAs played a role in colon cancer initiation. To the best of our knowledge, this is the first study of this miRNAs panel in CRC in our community. These data suggested that these biomarkers could be a potential novel, non-invasive marker for early diagnosis, screening and predicting prognosis of CRC. Understanding the molecular functions by which miRNAs affect cancer and understanding its roles in modulating the signaling output of VEGF might be fruitful in reducing the incidence and slowing the progression of this dark malignancy.

Correlation between clinical severity and type and degree of pectus excavatum in twelve brachycephalic dogs.

The aim of the study was to correlate the clinical severity of pectus excavatum with its type and degree based on objective radiographic evaluation. Twelve brachycephalic dogs were included. Grading of the clinical severity was done based on a 6-point grading score. Thoracic radiographs were used to calculate the frontosagittal and vertebral indices at the tenth thoracic vertebra and the vertebra overlying the excavatum. Correlation between the clinical severity score and frontosagittal and vertebral indices was evaluated using Pearson's correlation coefficient. Typical pectus excavatum was recorded in the caudal sternum in seven dogs, with a mean clinical severity score of 1.7 ± 1.4, whereas in five dogs, atypical mid-sternal deviation was recorded with a mean clinical severity score of 3.8 ± 0.7. A strong correlation (r=0.7) was recorded between the clinical severity score and vertebral index in the atypical form, whereas a weak correlation (r=0.02) was recorded in the typical form (P<0.05). The clinical severity and degree of pectus excavatum was poorly correlated (r=0.3) in the typical form of pectus excavatum, whereas it was strongly correlated (r=0.9) in the atypical form. Pectus excavatum in dogs is associated with compressive cardiopulmonary dysfunction, which depends mainly on the site/type of deviation rather than the degree of deviation.

Radiographic and ultrasonographic characteristics of ventral abdominal hernia in pigeons (Columba livia).

Five female egg-laying pigeons presented with painless, reducible, ventral abdominal swellings located between the keel and the pubis, or close to the cloaca. Based on clinical, radiographic, and ultrasonographic examination, these pigeons were diagnosed with ventral abdominal hernia requiring surgical interference. Reduction was successfully performed under general anesthesia. Radiographic and ultrasonographic examinations were beneficial for confirming the diagnosis and visualizing the hernial content for surgical planning. Lateral radiographs were more helpful than ventrodorsal radiographs for identification of the hernial content and its continuation with the abdominal muscles. Ultrasonographic examination offered a non-invasive diagnostic tool that allowed for the differentiation of hernia from other abdominal swellings. In addition, it played a beneficial role in identification of the hernial content and follow up after surgical interference. In conclusion, radiographic and ultrasonographic examinations were beneficial in the diagnosis, surgical planning, and follow up after surgical interference of ventral abdominal hernia in pigeons.

Health care-associated infections in pre-transplant liver intensive care unit: Perspectives and challenges.

BACKGROUND: Health care-associated infections (HAIs) threaten patient's safety worldwide especially in the intensive care units (ICU). In end-stage liver disease (ESLD), the condition is much more complicated. Data regarding HAIs among ESLD patients is lacking. We aimed to assess the incidence of HAIs, risk factors, causative micro-organisms, antimicrobial susceptibilities and mortality rates among patients with end-stage liver disease (ESLD) admitted to pre-transplant liver intensive care unit (LICU). METHOD: This prospective observational study included 337 ESLD patients admitted to LICU, Al-Rajhi liver center, Assiut University Hospital, Assiut, Egypt between January 2016 and June 2016 and they were followed up for the development of HAI manifestations. The medical history, physical examination and severity of underlying disease were determined. Clinical samples were taken from patients who developed HAIs for microbiological diagnosis and antimicrobial susceptibility testing. RESULTS: A total of 57 (16.9%) ESLD patients developed HAIs with the incidence density of 26.8 per 1000 patient-days. Blood stream infection was the most common (49.1%). Escherichia coli (21.1%) followed by methicillin-resistant Staphylococcus aureus (MRSA) (15.8%) were the commonest bacteria. Multidrug resistant organisms were reported in 52.6% of the isolates. Fungal causes were 15.8% with Candida species dominance. Sphingomonas paucimobilis and Achromobacter dentrificans were reported for the first time as pathogens for HAIs in LICU. Prolonged hospital stay, intravenous line duration, prolonged use of proton pump inhibitors and paracentesis were predictors for HAIs. No significant difference between ESLD patients with and without HAIs regarding mortality (36.8% vs. 48.6%, P=0.2). CONCLUSION: High HAI rate among ESLD patients is a matter of worry. Effective surveillance program, active infection control measures and national antibiotic policies are necessary to reduce the burden of HAIs.