In Vitro and In Vivo Anti-Inflammatory Activity of a Combination of Extracts from Cinnamomum zeylanicum, Alpinia galanga, and Withania somnifera used in Unani Medicine.

Objectives: Continuous and excessive secretion of pro-inflammatory and anti-inflammatory chemicals and cytokines may further deteriorate inflammation. Anti-inflammatory drugs play an imperative role in inhibiting the evolution of inflammatory diseases. As per the Unani doctrine, a holistic treatment approach is used to treat illnesses. Therefore, drugs having different actions are used to achieve the synergic effect. Three drugs (Cinnamomum zeylanicum, Alpinia galanga, and Withania somnifera), which are frequently used in Unani medicine for joint disorders were selected to evaluate the anti-inflammatory activity of the extract derived from them. Methods: We used RAW 264.7 macrophage cells to see the expression of inflammatory markers IL-1ß, IL-6, and TNF-α. Cytotoxic activity was assessed with MTT assay and Nitric Oxide (NO) was evaluated using Griess reagent. Further, anti-inflammatory activity was evaluated in Wistar Albino rats using carrageenan-induced paw oedema and immunohistochemistry assays for Cyclooxygenase-2 (COX-2). All the data were analyzed using ANOVA and Dunnett t test for multiple comparisons. Results: This extract did not show any cytotoxic effect and the gene expression was significantly reduced for IL-1ß, IL-6, and TNF-α in a dose-dependent manner. Further, NO production was also significantly reduced in the test groups. Immunohistochemistry revealed that the test groups had less inflammation as compared to the control group. Conclusion: It may be inferred that the ethanolic extract of the three herbs has strong anti-inflammatory activity in the tested inflammatory models and the extract is safe as it did not show any cytotoxic effects in both in vitro and in vivo conditions.

Molecular Epidemiology of Omicron CH.1.1 Lineage: Genomic and Phenotypic Data Perspective.

BACKGROUND: The Omicron variant (B.1.1.529 lineage) of SARS-CoV-2 represents a substantial global health challenge due to its high transmissibility and potential resistance to immunity from vaccines or previous infections. Among the rapidly evolving Omicron lineages, the BA.2.75 and the emerging CH.1.1 have garnered attention. While BA.2.75 is marked by mutations that may enhance immune evasion, CH.1.1 is distinguished by the S: L452R mutation, linked to increased pathogenicity and transmission. Initially identified in India by the end of 2021, these variants have exhibited global dissemination, signaling an urgent need to track and analyze their progression. METHODS: In this study, the genomic and geographical distribution data of CH.1.1 were collected from the Global Initiative on Sharing Avian Influenza Data (GISAID), PANGOLIN, CoV-Spectrum, and NextStrain databases. Due to the unavailability of epidemiological and genomic data of the CH.1.1 lineage, PubMed and ScienceDirect were used as sources of the phenotypic data of the lineage variations. Amino acid variations utilized in the data mining included S: R346T, S: K444T, S: L452R, and S: F486S. RESULTS: The current epidemiological data indicate that CH.1.1 is more likely to become one of the dominant spreading lineages in the United Kingdom, New Zealand, Australia, and the United States based on a 32% growth advantage, present CH.1.1 lineage cases number, and the amino acid variation's impact. CONCLUSION: A significant increase in the newly detected lineage CH.1.1 is highly anticipated. The rise in the detected sequences number from 13,231 on January 21, 2023, to 23,181 on February 6, 2023, supports the prediction and growth advantage of the lineage detected cases. Increases in viral transmissibility caused by higher affinity to ACE2 receptors and immune evasion are deduced from amino acid variations analyzed in the study.

Assessment of the antibacterial effect of Barium Titanate nanoparticles against Staphylococcus epidermidis adhesion after addition to maxillofacial silicone.

Background: Maxillofacial silicones are the most popular and acceptable material for making maxillofacial prostheses, but they are not perfect in every sense. To enhance their effectiveness, more improvements to their properties are required, such as their antimicrobial efficiency. This study assess the antibacterial effect of barium titanate nanoparticles in various percentages against staphylococcus epidermidis biofilm adhesion after addition to maxillofacial silicone. Methods: Barium titanate nanoparticles were added into VST-50 platinum silicone elastomer in four weight percentages (0.25wt%, 0.5wt%, 0.75wt% and 1wt%). 50 specimens were prepared and categorized into five groups; one control group and four experimental groups. All conducted data was statistically analyzed using (one-way ANOVA) analysis of variance, and Games-Howell multiple comparison test (significant level at p < 0.05). Shapiro-Wilk and Levene's tests were used, respectively, to evaluate the normal distribution and homogeneity of the data. Result: One-way ANOVA test revealed a highly significant difference between all groups, and Games-Howell test revealed a highly significant difference between the control group and the four experimental groups. The 0.25wt% and 0.5wt% groups revealed a highly significant difference between them and with the (0.75%wt and 0.1%wt) groups. While the 0.75wt% group revealed a significant difference with 1wt% group. Conclusions: The addition of barium titanate to VST-50 maxillofacial silicone enhanced the antibacterial activity of silicon against Staphylococcus epidermidis, and this activity seems to be concentration dependent. FTIR analysis demonstrated no chemical interaction between the Barium Titanate and the VST-50 maxillofacial silicone elastomer. SEM pictures show that the barium titanate nanopowder was effectively dispersed inside the maxillofacial silicone matrix.

Evaluating Rutting Resistance of Rejuvenated Recycled Hot-Mix Asphalt Mixtures Using Different Types of Recycling Agents.

Growing environmental pollution worldwide is mostly caused by the accumulation of different types of liquid and solid wastes. Therefore, policies in developed countries seek to support the concept of waste recycling due to its significant impact on the environmental footprint. Hot-mix asphalt mixtures (HMA) with reclaimed asphalt pavement (RAP) have shown great performance under rutting. However, incorporating a high percentage of RAP (>25%) is a challenging issue due to the increased stiffness of the resulting mixture. The stiffness problem is resolved by employing different types of commercial and noncommercial rejuvenators. In this study, three types of noncommercial rejuvenators (waste cooking oil (WCO), waste engine oil (WEO), and date seed oil (DSO)) were used, in addition to one type of commercial rejuvenator. Three percentages of RAP (20%, 40%, and 60%) were utilized. Mixing proportions for the noncommercial additives were set as 0−10% for mixtures with 20% RAP, 12.5−17.5% for mixtures with 40% RAP, and 17.5−20% for mixtures with 60% RAP. In addition, mixing proportions for the commercial additive were set as 0.5−1.0% for mixtures with 20% RAP, 1.0−1.5% for mixtures with 40% RAP, and 1.5−2.0% for mixtures with 60% RAP. The rutting performance of the generated mixtures was indicated first by using the rutting index (G*/sin δ) for the combined binders and then evaluated using the Hamburg wheel-track test. The results showed that the rejuvenated mixtures with the commercial additive at 20 and 60% RAP performed well compared to the control mixture, whereas the rejuvenated ones at 40% RAP performed well with noncommercial additives in comparison to the control mixture. Furthermore, the optimum percentages for each type of the used additives were obtained, depending on their respective performance, as 10%, 12.5%, and 17.5% of WCO, 10%, 12.5−17.5%, and 17.5% of WEO, <10%, 12.5%, and 17.5% of DSO, and 0.5−1.0%, 1.0%, and 1.5−2.0% of the commercial rejuvenator, corresponding to the three adopted percentages of RAP.

Prediction of Ecofriendly Concrete Compressive Strength Using Gradient Boosting Regression Tree Combined with GridSearchCV Hyperparameter-Optimization Techniques.

A crucial factor in the efficient design of concrete sustainable buildings is the compressive strength (Cs) of eco-friendly concrete. In this work, a hybrid model of Gradient Boosting Regression Tree (GBRT) with grid search cross-validation (GridSearchCV) optimization technique was used to predict the compressive strength, which allowed us to increase the precision of the prediction models. In addition, to build the proposed models, 164 experiments on eco-friendly concrete compressive strength were gathered for previous researches. The dataset included the water/binder ratio (W/B), curing time (age), the recycled aggregate percentage from the total aggregate in the mixture (RA%), ground granulated blast-furnace slag (GGBFS) material percentage from the total binder used in the mixture (GGBFS%), and superplasticizer (kg). The root mean square error (RMSE) and coefficient of determination (R2) between the observed and forecast strengths were used to evaluate the accuracy of the predictive models. The obtained results indicated that-when compared to the default GBRT model-the GridSearchCV approach can capture more hyperparameters for the GBRT prediction model. Furthermore, the robustness and generalization of the GSC-GBRT model produced notable results, with RMSE and R2 values (for the testing phase) of 2.3214 and 0.9612, respectively. The outcomes proved that the suggested GSC-GBRT model is advantageous. Additionally, the significance and contribution of the input factors that affect the compressive strength were explained using the Shapley additive explanation (SHAP) approach.

Therapeutic utility of percutaneous cecostomy in adults: an updated systematic review.

OBJECTIVE: Percutaneous cecostomy is a minimally invasive procedure that provides access to the colon for therapeutic interventions. This review aimed to update and summarize the existing information on the use and application of percutaneous endoscopic cecostomy in the field of therapeutic gastroenterology. DATA SOURCES: A systematic review of the literature was performed without any restrictions on the year of publication from the date of inception in 1986 to January 2021. METHODS: The review was performed using the medical subject heading keywords in the following search engines: MEDLINE, EMBASE, Cochrane, and Google Scholar. RESULTS: A total of 29 articles were subjected to final data extraction. The review included a total of 174 patients who underwent percutaneous cecostomy. Most of the included studies were conducted in the United States (n = 14). The most common comorbidity was cancer (n = 10) and the major indication for performing percutaneous cecostomy was colonic pseudo-obstruction or Ogilvie's syndrome (n = 15). The main technique for performing percutaneous cecostomy was endoscopy (17 studies), followed by fluoroscopy- (five studies), computed-tomography- (three studies), laparoscopy- (two studies), and ultrasound- (one study) guided procedures. The procedure was technically successful in 153 (88%) cases. The total cumulative rates of major and minor complications were 47.5%. These complications included tube malfunction, local wound site infections, and bleeding and rare complications of peritonitis and death. CONCLUSION: Percutaneous cecostomy is a safe and effective option for managing acute colonic pseudo-obstruction. It leads to durable symptom relief with low to minimal risk.

Abnormal Phase Transition and Band Renormalization of Guanidinium-Based Organic-Inorganic Hybrid Perovskite.

Low-dimensional organic-inorganic hybrid perovskites have attracted much interest owing to their superior solar conversion performance, environmental stability, and excitonic properties compared to their three-dimensional (3D) counterparts. Among reduced-dimensional perovskites, guanidinium-based perovskites crystallize in layered one-dimensional (1D) and two-dimensional (2D). Here, our studies demonstrate how the dimensionality of the hybrid perovskite influences the chemical and physical properties under different pressures (i.e., bond distance, angle, vdW distance). Comprehensive studies show that 1D GuaPbI3 does not undergo a phase transition even up to high pressures (∼13 GPa) and its band gap monotonically reduces with pressure. In contrast, 2D Gua2PbI4 exhibits an early phase transition at 5.5 GPa and its band gap follow nonmonotonic pressure response associated with phase transition as well as other bond angle changes. Computational simulations reveal that the phase transition is related to the structural deformation and rotation of PbI6 octahedra in 2D Gua2PbI4 owing to a larger degree of freedom of deformation. The soft lattice allows them to uptake large pressures, which renders structural phase transitions possible. Overall the results offer the first insights into how layered perovskites with different dimensionality respond to structural changes driven by pressure.

Lean non-alcoholic fatty liver disease and associated metabolic disturbance: A Saudi Arabian cross-sectional study.

Non-alcoholic liver disease (NAFLD) is a metabolic liver disease associated with visceral adiposity and insulin resistance. Recently, NAFLD has been described in lean individuals who additionally have impaired metabolic parameters similar to their non-lean counterparts. We aimed to explore this further in Saudi Arabia. From 2016 to 2019, we prospectively studied a group of newly diagnosed NAFLD patients at a tertiary hospital in Saudi Arabia. Patients were classified into three groups: lean (body mass index [BMI] <25), overweight (BMI ≥25 and <30), and obese (BMI ≥30). We made comparisons between these groups on basic clinical, demographic, and laboratory parameters. In total, 1753 patients were recruited and 1262 patients met the inclusion criteria. Altogether, 159 (12.6%), 365 (29%), and 737 (58.4%) patients were in the lean, overweight, and obese categories, respectively. Lean NAFLD patients were, on average, younger than those in the overweight group (mean 49.95 ± 15.3) and had a significantly higher high-density lipoprotein value (HDL) (mean 52.56 ± 16.27). Sex, hyperlipidemia, type 2 diabetes, and hypertension were significantly associated with BMI. Lean NAFLD patients displayed the features of metabolic syndrome including elevated glycosylated hemoglobin and abnormal lipid profile but had higher serum HDL. This is in contrast to the widely held belief that lean individuals have no dysmetabolic changes compared to overweight individuals. Recognition of this problem is essential so that lean NAFLD patients can be screened for metabolic changes and managed appropriately to prevent complications.

Determination of "indeterminate score" measurements in lean nonalcoholic fatty liver disease patients from western Saudi Arabia.

BACKGROUND: Noninvasive measures to estimate liver fibrosis in lieu of biopsy in nonalcoholic liver disease (NAFLD) can broadly differentiate high vs low degrees of condition extent. However, an "indeterminate score" necessitates further clinical investigation and biopsy becomes essential, highlighting the need for identification of other noninvasive factors with accuracy for this midlevel extent and its prognosis. Lean NAFLD cases are of particular interest regarding this issue, as they present as otherwise healthy, and will benefit greatly from the less invasive assessment. AIM: To estimate the agreement of two noninvasive assessment tools in lean NAFLD patients, and assess factors related to indeterminate scores. METHODS: Ultrasound-diagnosed NAFLD patients, without sign of other chronic liver disease (n = 1262), were enrolled from a tertiary private medical centre between 2016-2019. After grouping by body mass index (obese, overweight, and lean), each participant underwent FibroScan. NAFLD fibrosis score (NFS) was used for subclassification (lower, higher, and indeterminate). No patient underwent liver biopsy. The kappa statistic was used to assess inter-rater agreement between the three groups on liver fibrosis degree assessed via FibroScan and NFS. Indeterminate score among the three groups was assessed to identify factors that predict its determination. RESULTS: The NAFLD study cohort was composed of lean (159/1262, 12.6%), overweight (365/1262, 29%) and obese (737/1262, 58.4%) individuals. The lean patients were significantly younger (49.95 ± 15.3 years, P < 0.05), with higher serum high density lipoprotein (52.56 ± 16.27 mg/dL, P < 0.001) and lower prevalences of type 2 diabetes mellitus, hypertension and hyperlipidaemia. All groups showed a predominance of lower fibrosis degree. The lean NAFLD patients showed a significantly lower NFS (P < 0.001). Degree of agreement between FibroScan and NFS was fair between the lean and obese NAFLD categories, and moderate in the overweight category. NFS was predictive of indeterminate score. Age was a factor among all the body mass index (BMI) categories; other associated factors, but with less strength, were serum alanine aminotransferase in the overweight category and BMI in the obese category. CONCLUSION: Lean NAFLD patients showed lower degree and prevalence of liver fibrosis by NFS; however, follow-up biopsy is still needed.

Undiagnosed Celiac Disease In Patients Presenting With Irritable Bowel Syndrome Symptoms.

BACKGROUND: Irritable bowel syndrome (IBS) is a common clinical condition that is often diagnosed based on a set of clinical criteria. Celiac disease (CD) has a similar symptom. The study aims to estimate the prevalence of undiagnosed celiac disease (CD) in patients with criteria-positive IBS and compare with healthy control. METHODS: A Case control study conducted from August 2013 to July 2016. For the control group with negative ROME 3 criteria for IBS provided serum total immunoglobulin (IgA) level and serum tissue transglutaminase antibody (tTG IgA). The case group with positive criteria interviewed, examined, competed ROME 3 questionnaire and provided blood sample for haematology, biochemistry, and serum tTG IgA and IgG. Positive for CD invited for upper endoscopy and duodenal biopsy for evaluation of pathological involvement using the modified Marsh classification. RESULTS: Three controls (1.47%) and 21 cases (6.9%) had positive serology for CD. A statistically significant association found between serum tTG positivity and IBS and IBS-diarrhoea subtypes. No correlation was found between tTG positivity and age and sex of the case group. CONCLUSIONS: Celiac disease is common in IBS patients especially those with criteria-positive diagnosis. Serology screening for CD is helpful in IBS and IBS-D patients.

Virucidal Effect of Guggulsterone Isolated from Commiphora gileadensis.

Commiphora gileadensis, locally known as becham, is a plant used in traditional Arabian medicine for treating headache, constipation, stomach, joint pain, and inflammatory disorders. Several studies have reported its antibacterial properties; however, no study has demonstrated its antiviral activity. This study aimed to evaluate the antiviral activity of C. gileadensis as well as to isolate its active compound and investigate its mode of action. This activity was evaluated using 4 viruses, herpes simplex virus type 2 (HSV-2), respiratory syncytial virus type B (RSV-B), coxsackie virus B type 3, and adenovirus type 5 by performing the plaque reduction assay and the 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assays for enveloped and nonenveloped viruses, respectively. The methanol extract of C. gileadensis leaves only showed antiviral activity against enveloped viruses with a selectivity index of 11.19 and 10.25 for HSV-2 and RSV-B, respectively. The study of the mechanism underlying antiviral activity demonstrated a virucidal effect by direct contact with these target viruses. The active compound, isolated using bio-guided assays involving TLC, was identified as guggulsterone by HPLC-diode array detection coupled with electrospray ionization mass spectrometry. Guggulsterone is an antagonist of the bile acid receptor and a modulator of cholesterol metabolism; however, its antimicrobial properties have been reported for the first time in this study.

Effectiveness of individualized, goal directed institutional based rehabilitation programme in children with developmental delay disorders, in a region with limited rehabilitation accessibility.

PURPOSE: To evaluate effectiveness of individualized, goal directed rehabilitation protocol in improving functional outcomes in children with developmental delay disorders in a region with limited rehabilitation accessibility and to explore if goal setting influences changes observed in functional levels. METHODS: Children (6 months to 17 years) with developmental delay, who visited as out-patients to the Department of Physical Medicine and Rehabilitation and whose care givers were willing to participate in the study, were enrolled for a period of one year. Individualized rehabilitation protocol targeting the child's specific problems with a simultaneous home programme was performed. A single group pre-post study design was used to assess the protocol's effectiveness. OUTCOME MEASURES: Goal attainment scale (GAS), Gross Motor Function Classification System (GMFCS) Level, Gross Motor Functional Measure (GMFM) and Manual Ability Classification System (MACS) were administered pre and post-intervention monthly for 3 months. Statistical analysis was done using SPSS statistics version-22. RESULTS: Total of 32 children participated in the study. Significant differences between pre and post scores of GAS score (Wilcoxon's signed rank test [W value] = 4.937, p-value < 0.005), GMFCS (W value: -3.435, p-value < 0.005), GMFM (W value: 4.937, p-value < 0.005) and MAC score (W value: -4.714, p-value < 0.005) were noted at 3 months. No correlation was observed between the GAS pre-post score and GMFM, GMFCS and MAC pre-post scores. CONCLUSION: An effective rehabilitation programme in children with developmental delay should be individualized and should be goal directed to achieve maximum functional improvement. Improvement in the goals set were independent of the improvement in functional outcome levels. Care-givers play a pivotal role in both individualization and goal setting for rehabilitation, especially in a region with limited rehabilitation accessibility.

Review: Biotechnology of mycotoxins detoxification using microorganisms and enzymes.

Mycotoxins are secondary metabolites produced by various toxigenic fungi belonging to the genera Aspergillus, Fusarium and Penicillium. They have mutagenic, teratogenic, carcinogenic, immunosuppressive and endocrine disrupting effects on both humans and animals. The ubiquitous occurrence and heat stability of these mycotoxins during food and feed processing pose serious health problems in human and animals. Therefore successful biotechnological detoxification tools are in great demand. Recently, the use of bacteria, yeast, moulds and enzymes to mitigate/bind or biodegrade various mycotoxins is a novel strategy used for mycotoxins removal. In this review, recent development in biological control of mycotoxins removal and detoxification will be discussed.

Synergistic effect of eugenol, carvacrol, thymol, p-cymene and γ-terpinene on inhibition of drug resistance and biofilm formation of oral bacteria.

Dental caries remains the most prevalent oral infectious disease worldwide. In this study, the antibacterial and the antibiofilm activities of five essential oils (EO's): eugenol (EUG), carvacrol (CAR), thymol (TYH), p-cymene (CYM) and γ-terpinene (TER) were tested (alone or in combinaison with tetracycline) against oral bacteria. In addition, their potential roles to enhance the accumulation of ethidium bromide (EtBr) in bacterial cells were tested. Our results indicated that EO's induced a selective antimicrobial activity. A synergistic effect of EO's and tetracycline (TET) was noticed with a reduction rate ranged from 2 to 8-fold. In addition, the efflux of EtBr was inhibited with a decrease in loss of EtBr from the bacteria. On the other hand a significant anti-biofilm activities of EO's (alone or combined with antibiotics) was noticed. In conclusion the tested EO's may be considered as a potential natural source with a resistance-modifying activity and may be applied to eradicate bacterial biofilm.

Drug resistance of bacterial dental biofilm and the potential use of natural compounds as alternative for prevention and treatment.

Oral diseases, such as dental caries and periodontal disease are directly linked with the ability of bacteria to form biofilm. The development of dental caries involves acidogenic and aciduric Gram-positive bacteria colonizing the supragingival biofilm (Streptococcus, Lactobacillus and Actinomycetes). Periodontal diseases have been linked to anaerobic Gram-negative bacteria forming a subgingival plaque (Porphyromonas gingivalis, Actinobacillus, Prevotella and Fusobacterium). Cells embedded in biofilm are up to 1000-fold more resistant to antibiotics compared to their planctonic ones. Several mechanisms have been proposed to explain biofilms drug resistance. Given the increased bacterial resistance to antibiotics currently used in dentistry, a great importance is given to natural compounds for the prevention of oral bacterial growth, adhesion and colonization. Over the past decade, interest in drugs derived from medicinal plants has markedly increased. It has been well documented that medicinal plants and natural compounds confer considerable antibacterial activity against various microorganisms including cariogenic and periodontal pathogens. This paper provides a review of the literature focusing on the studies on (i) biofilm in the oral cavity, (ii) drug resistance of bacterial biofilm and (iii) the potential use of plant extracts, essential oils and natural compounds as biofilm preventive agents in dentistry, involving their origin and their mechanism of biofilm inhibition.

Public awareness of colon cancer screening among the general population: A study from the Western Region of Saudi Arabia.

BACKGROUND: Screening for colon cancer aims at early detection and prompt treatment of the disease. Prior knowledge of the disease will contribute to increased participation. However, barriers to performing screening are not known. METHODS: A survey using a questionnaire was presented to patients attending the Outpatient Department of a tertiary hospital in the Western Region of Saudi Arabia, to evaluate the background knowledge of colon cancer screening, the diagnostic methods used for that purpose, and the barriers that may resist the implementation of screening. RESULTS: Six hundred and nineteen questionnaires were distributed. Completed questionnaires that were included in the final analysis numbered 321 (51.9%). Age and gender had no statistically significant association with increased awareness of screening options (p = 0.526 and p = 0.2). However, education played a significant role (p = 0.045). Among the group that agreed to undergo screening, there were 55.3% who were willing to undergo colonoscopy or sigmoidoscopy. Contrary to that, among the group that did not agree to undergo screening, 77.4% of them would undergo radiological screening using barium enema and/or a computed tomography (CT) scan of the abdomen. CONCLUSION: There is a deficiency of knowledge of colorectal cancer (CRC) screening influenced by an individual's level of education, yet unrelated to age or gender. The endoscopic modality was usually chosen by individuals who were aware of CRC screening. However, the fear of undergoing this investigation, for the same reason, would likely make them decide to choose less invasive testing, using barium enema or a CT of the abdomen.

Genome sequences of three species d adenoviruses isolated from AIDS patients.

HAdVD23 and two novel adenoviruses, HAdVD60a and HAdVD62, isolated from feces of AIDS patients in Manchester, United Kingdom, have been sequenced. The HAdVD60a genome lacks the penton arginine-glycine-aspartic acid (RGD) motif and differs from HAdVD60 by a recombinant E3 region. HAdVD62 has penton, hexon, and fiber regions not previously found in other adenoviruses.

Pharmacological management of esophageal food bolus impaction.

Background. Soft esophageal bolus impaction is an emergency that requires skilled endoscopic removal if persistent obstructive symptoms do not resolve spontaneously after careful observation. Expedited care of these patients is crucial to avoid respiratory and mechanical complications. Other possible options for management include medical agents used to manage it prior to performing endoscopy if access to endoscopy was not available or declined by the patient. Aim. To review the available pharmacological and other nonmedicinal options and their mechanism of relief for soft esophageal impaction. Method. Pubmed, Medline and Ovid were used for search of MESH terms pertinent including "foreign body, esophageal, esophageal bolus and medical" for pharmacological and non medicinial agents used for management of esophageal soft bolus impaction as well as manual review of the cross-references. Results. Several agents were identified including Buscopan, Glucagon, nitrates, calcium channel blockers, and papaveretum. Non medicinal agents are water, effervescent agents, and papain. No evidence was found to suggest preference or effectiveness of use of a certain pharmacological agent compared to others. Buscopan, Glucagon, benzodiazepines, and nitrates were studied extensively and may be used in selected patients with caution. Use of papain is obsolete in management of soft bolus impaction.

Survival of patients with portal vein thrombosis: analysis based on disease onset.

BACKGROUND/AIMS: To identify prevalent causes and determine survival rates of patients with portal vein thrombosis (PVT) in the Western Saudi Arabia. METHODOLOGY: Retrospective chart review of patients diagnosed with chronic liver disease and portal vein thrombosis in two major cities in Western Saudi Arabia during the period 2000-2009. RESULTS: Among 1349 patients screened, 109 patients met the inclusion criteria, 67 patients had acute PVT and 42 patients had chronic PVT. The relative risk of developing PVT is higher in males in whom acute PVT is 1.32 vs. 0.68 in females (95% CI: 090-1.94). Mean survival age of acute and chronic PVT (Kaplan-Meier) is 5.61 years (95% CI: 4.52-6.70). Univariate and multivariate regression analysis identified several variables in which international normalized ratio (INR) level on presentation was found to be a significant variable in survival. CONCLUSIONS: Mean survival for acute or chronic PVT is about five years. The first determination of INR level is a useful predictor of survival.

Sequencing and phylogenetic analysis of the hexon, fiber, and penton regions of adenoviruses isolated from AIDS patients.

Sequencing and phylogenetic analysis of the hexon, fiber, and penton regions of adenoviruses isolated between 1986 and 1997 from AIDS patients has been performed. Sequencing the L2 part of the hexon gene of 51 adenoviruses isolated between 1986 and 1997 from AIDS patients revealed only one type each from species A and C and two types from species B with all the remaining isolates from species D. Further sequencing and phylogenetic analysis of the fiber knob region of these species D adenoviruses revealed that 28/46 were intermediate strains with conflicting hexon and fiber sequences. When the penton regions of these intermediate strains were sequenced, it became clear that some had originated from a third adenovirus type presumably by intergene recombination events. Evidence from sequencing the L1 hexon and fiber shaft regions showed no evidence of intragene recombination but penton sequences showed that recombination between the hypervariable region (HVR) and RGD regions was common. Six isolates appear to be from three new adenovirus types. Five AIDS patients showed sequential infection with different adenovirus variants and six such variants were isolated from a single patient in 2 years.