The potential therapeutic effect of metformin in type 2 diabetic patients with severe COVID-19.

OBJECTIVE: Type 2 diabetes mellitus (T2DM) is regarded as a chief risk factor for(coronavirus disease 2019 (COVID-19) owing to dysregulation of the expression of angiotensin-converting enzyme 2 (ACE2) and chronic low-grade inflammatory disorders. Metformin, an insulin-sensitizing agent for managing T2DM, has pleiotropic anti-inflammatory and oxidant potentials, which may lessen the risk of diabetic complications. So, we aimed to reveal the potential role of metformin monotherapy in treating T2DM patients with COVID-19. PATIENTS AND METHODS: In this prospective cohort study, 60 hospitalized T2DM patients with COVID-19 on metformin plus standard anti-COVID-19 treatments compared to 40 hospitalized T2DM patients with COVID-19 on other diabetic pharmacotherapy like insulin and sulfonylurea, were recruited. Inflammatory and oxidative stress biomarkers and radiological and clinical outcomes were assessed at admission time and at the time of discharge. RESULTS: The results of this study illustrated that metformin treatment in T2DM patients with COVID-19 was more effective in reducing inflammatory and oxidative stress biomarkers with significant amelioration of radiological scores and clinical outcomes compared to T2DM patients with COVID-19 on another diabetic pharmacotherapy. CONCLUSIONS: Our findings highlighted that metformin efficiently managed T2DM patients with COVID-19 by reducing inflammatory and oxidative stress with mitigating effects on the radiological scores and clinical outcomes.

Effect of Vitamin D supplementation in patients with liver cirrhosis having spontaneous bacterial peritonitis: a randomized controlled study.

OBJECTIVE: Spontaneous Bacterial Peritonitis (SBP) is one of the most serious liver cirrhosis with ascites complications. Vitamin D (Vit D) deficiency has been associated with a high risk of infection and mortality in cirrhotic patients. Herein, the assessment of Vit D level as a prognostic marker in SBP patients and the impact of Vit D supplementation on their treatment plan was studied as well. PATIENTS AND METHODS: Ascetic patients with SBP and Vit D deficiency were divided randomly into treatment and control groups. The control group received standard treatment without Vit D and the treatment group received standard treatment plus Vit D. Clinical monitoring of Vit D was done over 6 months. RESULTS: At baseline, all patients in both groups revealed an elevated serum and ascetic TLC, AST, ALT, total and direct bilirubin, in addition to elevation in INR and procalcitonin (PCT) level. Univariate regression analysis confirmed that deficiency of Vit D was an independent predictor of infection and mortality (p < 0.01; Crude Hazard Ratio: 0.951). Over 6 months, the study revealed significant improvement in serum Vit D level in the treatment group (34.6 ± 9.2 and 18.3 ± 10.0 ng/mL; p < 0.001). Moreover, a statistically significant increase in survival rate (64% vs. 42%; p < 0.05) and duration (199.5 days vs. 185.5 days; p < 0.05) were recorded as well. Univariate and multivariate regression analysis confirmed that Vit D supplementation was positively correlated to survival over 6 months (p < 0.001; Adjusted Hazard Ratio: 0.895). CONCLUSIONS: Vit D deficiency is prevalent in SBP cirrhotic patients and is used as an independent predictor of infection and death. Therefore, Vit D supplementation revealed improvement in their response to treatment.

The use of multiplex PCR for the diagnosis of viral severe acute respiratory infection in children: a high rate of co-detection during the winter season.

Respiratory tract infection is a major cause of hospitalization in children. Although most such infections are viral in origin, it is difficult to differentiate bacterial and viral infections, as the clinical symptoms are similar. Multiplex polymerase chain reaction (PCR) methods allow testing for multiple pathogens simultaneously and are, therefore, gaining interest. This prospective case-control study was conducted from October 2013 to February 2014. Nasopharyngeal (NP) and oropharyngeal (throat) swabs were obtained from children admitted with severe acute respiratory infection (SARI) at a tertiary hospital. A control group of 40 asymptomatic children was included. Testing for 16 viruses was done by real-time multiplex PCR. Multiplex PCR detected a viral pathogen in 159/177 (89.9 %) patients admitted with SARI. There was a high rate of co-infection (46.9 %). Dual detections were observed in 64 (36.2 %), triple detections in 17 (9.6 %), and quadruple detections in 2 (1.1 %) of 177 samples. Seventy-eight patients required intensive care unit (ICU) admission, of whom 28 (35.8 %) had co-infection with multiple viruses. AdV, HBoV, HRV, HEV, and HCoV-OC43 were also detected among asymptomatic children. This study confirms the high rate of detection of viral nucleic acids by multiplex PCR among hospitalized children admitted with SARI, as well as the high rate of co-detection of multiple viruses. AdV, HBoV, HRV, HEV, and HCoV-OC43 were also detected in asymptomatic children, resulting in challenges in clinical interpretation. Studies are required to provide quantitative conclusions that will facilitate clinical interpretation and application of the results in the clinical setting.

Diagnosis of human brucellosis in Egypt by polymerase chain reaction.

This study aimed to establish an accurate and sensitive polymerase chain reaction (PCR) technique for the diagnosis of active human brucellosis in Egypt. We failed to extract Brucella DNA with a commercial kit, but an extraction kit designed in-house using 2 sets of primers [B4/B5 (223 bp) and JPF/JPR (193 bp)] was successful and more economical. The technique showed high sensitivity, specificity and accuracy. The PCR positivity increased significantly with increasing seropositivity titres by the standard tube agglutination test and showed 100% positivity in patients with positive blood cultures. We recommend using PCR as an alternative to culture for diagnosis of brucellosis.

Diagnosis of human brucellosis in Egypt by polymerase chain reaction

This study aimed to establish an accurate and sensitive polymerase chain reaction [PCR] technique for the diagnosis of active human brucellosis in Egypt. We failed to extract Brucella DNA with a commercial kit, but an extraction kit designed in-house using 2 sets of primers [B4/B5 [223 bp] and JPF/JPR [193 bp]] was successful and more economical. The technique showed high sensitivity, specificity and accuracy. The PCR positivity increased significantly with increasing seropositivity titres by the standard tube agglutination test and showed 100% positivity in patients with positive blood cultures. We recommend using PCR as an alternative to culture for diagnosis of brucellosis

Genetic characterisation of the Egyptian vaccinal strain Abu-Hammad of bovine herpesvirus-1.

The Egyptian Abu-Hammad vaccinal strain of bovine herpesvirus-1 (BHV-1) was genetically characterised by comparing HindIII endonuclease genomic fingerprints of the Egyptian BHV-1 with reference strain Cooper 1 of BHV-1 subtype 1 (BHV-1.1). Analyses of nucleotide (nt) and deduced amino acid (aa) sequences and phylogeny of the major viral immunogen, glycoprotein D (gD), were used to compare the Egyptian BHV-1 with related alphaherpesviruses. HindIII restriction digests revealed close identity between the Egyptian BHV-1 and reference BHV-1.1. Both nt and aa sequence alignments revealed variable degrees of sequence similarity with other alphaherpesviruses. Possible mutational frameshifts were observed at nt 509 and 615 of the Egyptian BHV-1 gD. The Egyptian vaccinal BHV-1 was grouped with BHV-1.1 in a distinct branch of the phylogenetic tree. Conservation of five cysteine residues and glycosylation domains emphasised the importance of the amino terminus for immunological and biological function of alphaherpesvirus gD. The most divergent domain of 17 residues at positions 168-184 and an additional cysteine residue at position 178 distinguish the Egyptian BHV-1 from other herpesviruses. This work demonstrated that HindIII genomic fingerprinting and sequencing of the gD gene are useful for genetic characterisation of BHV-1. They may also be applied to epidemiological studies and development of BHV-1 vaccines.

Use of polymerase chain reaction to simultaneously detect and type bovine viral diarrhoea viruses isolated from clinical specimens.

The techniques of indirect immunofluorescence (IF), immuno-peroxidase (IP) staining and the one-step reverse transcriptase polymerase chain reaction (RT-PCR) were compared for detection of 102 isolates of bovine viral diarrhoea virus (BVDV) in infected cell cultures. The BVDV was obtained from bovine clinical specimens, including sera, buffy coats and tissues, submitted from farms located in the States of Iowa and Wisconsin, United States of America. The IF technique detected 88/102 (86.3%) of the viral isolates, whereas IP staining detected an additional 4 isolates (92/102; 90%). The one-step RT-PCR using primers derived from the 5' untranslated region of the BVDV genome detected 102/102 (100%) of the BVDV isolates. A second-round PCR utilising another pair of PCR primers from the 5' untranslated region, allowed rapid genotyping of BVDV. The procedure used showed that the PCR assay based on the 5' untranslated region of the virus genome is the most sensitive indicator for BVDV detection in cell culture, and is also of considerable epidemiological importance since it allowed rapid genotyping of BVDV isolated from clinical specimens. In addition to detection and genotyping of BVDV isolated from clinical specimens, the RT-PCR procedure can be used for routine screening of locally produced and imported biologicals for BVDV contamination. However, the procedure requires further refinement to enable direct application on the clinical specimen.

Comparative study of distribution and biochemical characterization of brain calcitonin gene-related peptide receptors in five different species.

Calcitonin gene-related peptide receptors are abundant in the brain, and the pattern of distribution of receptors is similar in the rat, pig, cow, sheep and in man. In comparison to the cerebellum (100%), only a small number of receptors were found in the ventral spinal cord (20%), cerebral white matter (20%), pituitary (27%) and hypothalamus (33%). In contrast, cerebral cortex (70%), thalamus (50%) and dorsal spinal cord (50%) contained a higher number of calcitonin gene-related peptide receptors. Overall, the highest number of receptors was observed in the pig brain followed by the rat, human, sheep and cow. IC50 values of alpha- and beta-calcitonin gene-related peptide for cerebellar membranes were 200 pM, while its antagonist calcitonin gene-related peptide(8-37) and (9-37) had an IC50 approximately 1 nM. The recently discovered 37-amino acid peptide amylin (46% homology with calcitonin gene-related peptide) displaces the membrane bound [125I]calcitonin gene-related peptide with 50-fold molar excess (IC50 = 10 nM). The only other peptide able to compete for calcitonin gene-related peptide receptor binding is salmon calcitonin, at a > 1000-fold molar excess (IC50 = 250 nM). Dissociation of [125I]calcitonin gene-related peptide from cerebellar membranes was biphasic, suggesting that calcitonin gene-related peptide receptors in the brain were heterogeneous.(ABSTRACT TRUNCATED AT 250 WORDS)

Primary cholesteatoma of the mastoid presenting as cervical abscess.

Primary cholesteatoma has been described in a number of sites within the temporal bone. We report an unusual case of primary cholesteatoma, confined to the mastoid, presenting with Bezold's abscess of the anterior cervical triangle, in an otherwise asymptomatic elderly man with normal hearing.