The Potentiality of Prostate-Specific Antigen as a Prognostic Biomarker in Breast Cancer.

Background Serum prostate-specific antigen (PSA) is a well-established marker that can be measured as an indicator for screening, diagnosing, and managing prostate cancer due to its advanced tissue specificity. Numerous studies have revealed that free PSA is the predominant molecular form of PSA in breast cancer cases. In contrast, total PSA is prevalent in benign breast tumor cases and healthy females. This case-control study aims to measure PSA levels among individuals with breast cancer in order to establish PSA as a prognostic biomarker. Methods The study involved 150 female subjects between the ages of 18 and 70 and was conducted between 2013 and 2014. The subjects were then categorized into three groups: those with malignant breast cancer, those with benign breast tumors, and the control group with no history of malignant or benign breast tumors. Participants were asked to complete a lifestyle questionnaire and interview using hospital medical records to establish past and pertinent patient medical history. These cases were acquired from the 7th of October Hospital's surgery department and Benghazi Central Hospital's oncology clinic in Libya. Sandwich-type ELISA's were used for PSA quantitation, while the Wilcoxon Rank-Sum test was used to identify statistically significant differences between total PSA and free PSA measurements within each patient group. Results This study did not reveal significant statistical differences in total PSA levels between breast cancer cases and control groups (p=0.200), or between breast cancer and fibroadenoma patients (p=0.472). However, there was a significant difference in F-PSA levels between breast cancer and fibroadenoma cases (p=0.0001). Neither total-PSA (p=0.200) nor F-PSA (p=0.262) levels showed significant differences between breast cancer cases and controls. This study paved the way for further investigations into PSA's role in breast cancer. Despite its limitations, it offers an opportunity to delve deeper into understanding PSA's potential role and use in breast cancer. Conclusion A comprehensive statistical analysis revealed a positive correlation between F-PSA levels and breast cancer diagnosis. The findings suggest that PSA may serve as a prognostic biomarker for breast cancer. This may contribute to improved customized treatment approaches, offering precise and accurate risk assessments, understanding breast cancer biology, and improving health outcomes for patients with breast cancer.

Utility of Direct Immunofluorescence in Cutaneous Autoimmune Bullous Disorders.

Background Autoimmune bullous disorders (AIBD) are a heterogeneous group of disorders with substantial clinical overlap associated with blistering of skin or mucosa. Aims The present study aimed to study the histopathological spectrum and evaluate the utility of direct immunofluorescence (DIF) on snap-frozen and paraffin-embedded sections in resolving the differential diagnosis of AIBD and connective tissue disorders of the skin. We also compared the efficacy of DIF on paraffin versus the snap-frozen sections in diagnosing AIBD. Methods The present study was conducted for three years (2017-2019) and included 27 biopsies. We also included a retrospective analysis that included 25 biopsies collected over three years (2014-2017). Histopathological examination and DIF were conducted on all samples. Results Pemphigus vulgaris was the most common autoimmune cutaneous disorder constituting 37% (n = 10) in prospective and 36% (n = 9) in the retrospective study. DIF showed a specificity of 81.25% in our prospective study. While on the paraffin-embedded sections, it showed a specificity of 66.6% in our retrospective study. In the prospective study, DIF on paraffin-embedded sections had a positivity rate of 43.75% as compared to 81.25% in DIF done on snap-frozen sections. Conclusion DIF is a sensitive tool for the diagnosis as well as distinguishing immune-mediated bullous disorders from other lesions primarily when performed on snap-frozen sections. The diagnostic yield is enhanced by DIF in cases that pose a diagnostic dilemma both clinically and histologically. The final diagnosis depends on all clinical, histopathological and immunofluorescence findings.

Effectiveness of Empagliflozin With Vitamin D Supplementation in Peripheral Neuropathy in Type 2 Diabetic Patients.

BACKGROUND: Neuropathy is the most prevalent broad-spectrum microvascular complication of diabetes. The present study aims to evaluate the effect of empagliflozin with vitamin D supplementation on diabetic peripheral neuropathy. METHODS: A prospective, randomized, controlled study was conducted for six months including 150 type 2 diabetic patients, divided into three groups (n=50/group): Group 1, patients on oral hypoglycemic agents; Group 2, patients on empagliflozin and Group 3, patients on empagliflozin with vitamin D. Biochemical parameters were estimated for outcome measurements and patients' neuropathic pain was analysed using Douleur Neuropathique 4 Questions, Neuropathic Pain Symptom Inventory and Ipswich Touch the toes test questionnaire. Data were analysed using a one-way analysis of variance. RESULTS: Diabetic neuropathy in males was more prevalent (more than 50%) as compared to females in all three groups, with an average age of 50±6 years, along with a diabetic history of 15±4.5 years and a glycated hemoglobin A1C (HbA1C) level of >10%. The mean value of serum vitamin D level significantly increased by 64.7% (19±5 to 54±8 ng/mL; p<0.05). A remarkable decrease (by 17.4%) from baseline in the HbA1C level was observed after six months of treatment only in Group 3, whereas in other groups (1 and 2), there was a non-significant decrease in HbA1C levels when compared to baseline. Moreover, a significant improvement in neuropathic condition was seen only in Group 3. CONCLUSION: The results indicated that empagliflozin with vitamin D supplementation significantly controlled or reduced HbA1C and improved diabetic neuropathic symptoms in patients. It is suggested that this combination can be considered as the primary therapeutic approach for neuropathic complications in diabetic patients.

Impact of Treatment with Metformin in Comparison with Insulin in Gestational Diabetes in Libyan Population a Randomized Controlled Study.

Background: The aim of this study was the comparison of the glycemic control and maternal outcomes in women affected with gestational diabetes mellitus (GDM) managed with metformin versus insulin. Materials and Methods: The participants included in this study were 140 women diagnosed with GDM. They were randomized into two groups, women included in the first group were treated with metformin and the women of the second group were managed with insulin. Results: The glycemic control was similar in both the treatment arms and the only noteworthy difference was found in the mean fasting blood glucose, which was significantly higher in the women receiving insulin as compared to the women receiving metformin. There were no substantial differences in the maternal outcome with the use of metformin compared to insulin in women with GDM. Conclusion: The incidence of operative delivery was higher in metformin-treated group, whereas the hospital admission rate was considerably elevated in insulin-treated group.

The Mechanisms of Dietary Phytoestrogen as a Potential Treatment and Prevention Agent against Alzheimer's Disease.

Alzheimer's disease (AD) is a major dementia disease worldwide with an increasing incidence rate among the elderly. It is a neurodegenerative disease with symptoms starting slowly and then progressing over time. There has been extensive research on AD prevention and treatment; however, there is no cure as of yet. Several drugs are being researched for the treatment and prevention of AD, with a rising interest in specific dietary compounds as potential interventions with lower side effects. One such dietary compound being tested is phytoestrogen. Phytoestrogens are chemically, structurally, and functionally similar to estrogen, which has numerous functions as a cognition-promoting agent; although, as a supplement it can be damaging. Phytoestrogens have the unique ability to substitute for estrogen in elderly individuals with Alzheimer's disease and depleted estrogen levels. This paper aims to contribute to the collective understanding of phytoestrogen's role in the treatment and prevention of Alzheimer's disease by describing its various mechanisms, including its ability to decrease amyloid beta peptide production, promote calcium outflow and acetylcholine release, and reduce Tau protein phosphorylation. The paper also addresses phytoestrogen's role as an anti-inflammatory and antioxidant agent for the cholinergic neurons associated with Alzheimer's disease.

Vitamin C: A Preventative, Therapeutic Agent Against Helicobacter pylori.

The treatment of Helicobacter pylori (H. pylori) induced infections using antibiotic therapies is clinically well accepted; however, using a noninvasive approach with the implementation of therapeutic agents such as vitamin C is not well investigated. Vitamin C has certain characteristics, which allow for it to be considered as a potential treatment option for patients with H. pylori infections. Vitamin C's hostility and mechanism of action towards H. pylori infection in peptic ulcer disease can be classified into two categories: as a preventative agent and alternatively as a therapeutic agent. Preventatively vitamin C acts as a biological antioxidant as well as an immune boosting agent, while therapeutically it acts as an inhibitor of urease, a potential collagen synthesizing agent, and a stimulant in prostaglandin synthesis. As a result, the dosage of vitamin C should be highly regulated. Furthermore, numerous studies have shown that vitamin C supplementation if taken with antibiotics can increase the efficiency of the treatment leading to an increased possibility of eradication of H. pylori in infected individuals. This paper will investigate the recent studies that show different mechanisms through which vitamin C can be used as a preventative or a therapeutic agent for the treatment of H. pylori related infections.

Investigating the Atherogenic Risk of Lipoprotein(a) in Type 2 Diabetic Patients.

Type 2 diabetes mellitus (T2DM) has high morbidity and results in increased risk of mortality mainly due to cardiovascular diseases. Different factors have been found to be responsible for the increased prevalence of coronary artery disease (CAD) in T2DM. One of these factors includes raised serum levels of lipoprotein(a) (Lp(a)). The present study was designed to evaluate the association of Lp(a) levels with T2DM in Libyan patients and find the degree of association between Lp(a), glycemic control, insulin, and lipid profile. The study included 100 T2DM patients, recruited from the Benghazi Center for Diagnosis and Treatment of Diabetes, and 30 apparently healthy age and sex-matched individuals, to serve as controls. All participants completed a questionnaire to obtain clinical information and medical history. Blood samples were collected and analyzed for Lp(a), fasting blood glucose (FBS), HbA1c, insulin, total cholesterol (TC), triglycerides (TAG), low-density lipoprotein c (LDL-c), and high-density lipoprotein c (HDL-c). The results from the comparison between the control and experimental groups showed that Lp(a) was significantly higher in diabetic patients. It showed the positive correlation with TC and LDL-c. On the contrary, it showed no significant correlations with glycemic control parameters nor insulin, TAG, HDL-c, body mass index (BMI), and blood pressor (BP). Cardiovascular disease (CVD) risk in type 2 diabetic patients could be dependent on risk factors other than LDL-c, which may not be an independent risk factor for the development and progression of atherogenesis in T2DM. Lp(a) may be a new metabolic syndrome risk factor, and it may be useful as a cardiovascular risk biomarker in future clinical practice.

Caffeine: A Potential Protective Agent Against Cognitive Decline in Alzheimer's Disease.

Over the past few decades, caffeine has been well recognized as a stimulant whose effects can be detected particularly in the central nervous system. A stimulating effect of caffeine has been found useful in treating patients with many neurological disorders, including Alzheimer's disease (AD). AD is reported to be a rapidly increasing public health problem with lack of a remedial treatment. However, the assumed protective effects of caffeine against AD are of huge interest. This study substantiates caffeine's role as a potential prevention agent against AD through several epidemiological studies. More than 75% of available study reports support the opinion that caffeine has a favorable effect against cognitive decline and AD. Moreover, other studies have discussed the effect of caffeine drinking and concluded several positive effects on cognitive functioning. The present study, however, focuses more on the potential mechanisms by which caffeine diminishes effects as well as delays the onset of AD.

Gastroesophageal Reflux Disease: A Review of Symptomatic Management.

Considered as a chronic illness, gastroesophageal reflux disease (GERD) has manifested itself as a widespread condition throughout the adult population. As a growing epidemic, GERD has reached a staggering prevalence of 10% to 20% in the Western world, by affecting up to 30 million people in the United States alone. Sixty percent of individuals in an adult population will experience symptoms and the impact of GERD over a period of 12 months, whereas a remarkable 20% to 30% of individuals will have weekly symptoms. This rapid increase in the prevalence of the disease requires equally rapid management techniques. Although the disease itself has no cure, management of symptoms and certain pharmacological and surgical advancements have allowed for individuals affected by GERD to receive specific treatment options sufficient for them to live a healthy life. In this paper, such management options will be examined and discussed in reference to their effectiveness in treating the symptoms presented in GERD patients.

A review on prescribing patterns of antihypertensive drugs.

Hypertension continues to be an important public health concern because of its associated morbidity, mortality and economic impact on the society. It is a significant risk factor for cardiovascular, cerebrovascular and renal complications. It has been estimated that by 2025, 1.56 billion individuals will have hypertension. The increasing prevalence of hypertension and the continually increasing expense of its treatment influence the prescribing patterns among physicians and compliance to the treatment by the patients. A number of national and international guidelines for the management of hypertension have been published. Since many years ago, diuretics were considered as the first-line drugs for treatment of hypertension therapy; however, the recent guidelines by the Joint National Commission (JNC8 guidelines) recommend both calcium channel blockers as well as angiotensin-converting enzyme inhibitors as first-line drugs, in addition to diuretics. Antihypertensive drug combinations are generally used for effective long-term management and to treat comorbid conditions. This review focuses on the antihypertensive medication utilization, their cost factors, adherence to treatment by patients, and physicians' adherence to guidelines in prescribing medications in different settings including Indian scenario. The antihypertensive medication prescribing pattern studies help in monitoring, evaluation and necessary modifications to the prescribing habits to achieve rational and cost-effective treatment. Additionally, periodic updating of recommended guidelines and innovative drug formulations, and prescription monitoring studies help in rational use of antihypertensive drugs, which can be tailored to suit the patients' requirements, including those in the developing countries.