Effect of 17-Hydroxyprogesterone Caproate on Interleukin-6 and Tumor necrosis factor-alpha in expectantly managed early-onset preeclampsia.

The study aimed to evaluate the effect of 17 hydroxy progesterone (17-OHPC) on interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in expectantly managed early-onset preeclampsia (PE). A randomized open-label controlled study included women who were diagnosed as early-onset PE if they assigned to expectant management according to the American College of Obstetricians and Gynecologists (ACOG) 2013 criteria for diagnosis of severity of PE. Patients were randomized into Group A (40 patients) received 17-OHPC 250 mg intra-muscular at admission and every 7 days thereafter and Group B (40 patients) was given the usual conservative measures of early-onset PE as a control group. Blood samples were obtained from all participants for measurements of TNF-α and IL-6 levels at admission and repeated at termination of pregnancy. The primary outcome was the mean difference between TNF-α and IL-6 levels before and after treatment in both groups. TNF-α and IL-6 levels at admission were not different between the two groups. However, there was a significant difference concerning these inflammatory biomarkers within the same group at admission and at termination (p < 0.001), with significant decline of IL-6 and TNF-α level in the 17-OHPC treated group and significant rise of IL-6 and TNF-α in the control group. There was a strong positive correlation between systolic blood pressure (SBP) at admission and TNF-α level (r= 0.867, p=0.017), and moderately positive significant correlation between diastolic blood pressure (DBP) at admission and TNF-α (r=0.610, p < 0.001). There was a mild positive significant correlation between IL-6 levels and SBP (r= 0.231, p=0.039), and DBP (r= 0.203, p= 0.041) at admission. In conclusion, 17-OHPC has no effect in improving maternal or neonatal outcomes in conservatively managed early onset PE, although it alters the inflammatory markers levels (IL-6 and TNF-α) that could improve the pathogenesis of PE.

Chronic exposure to tramadol induces cardiac inflammation and endothelial dysfunction in mice.

Tramadol is an opioid extensively used to treat moderate to severe pain; however, prolonged therapy is associated with several tissues damage. Chronic use of tramadol was linked to increased hospitalizations due to cardiovascular complications. Limited literature has described the effects of tramadol on the cardiovascular system, so we sought to investigate these actions and elucidate the underlying mechanisms. Mice received tramadol hydrochloride (40 mg/kg body weight) orally for 4 successive weeks. Oxidative stress, inflammation, and cardiac toxicity were assessed. In addition, eNOS expression was evaluated. Our results demonstrated marked histopathological alteration in heart and aortic tissues after exposure to tramadol. Tramadol upregulated the expression of oxidative stress and inflammatory markers in mice heart and aorta, whereas downregulated eNOS expression. Tramadol caused cardiac damage shown by the increase in LDH, Troponin I, and CK-MB activities in serum samples. Overall, these results highlight the risks of tramadol on the cardiovascular system.

Can Hematological Ratios Predict Outcome of COVID-19 Patients? A Multicentric Study.

INTRODUCTION: Coronaviruses belong to a large family that leads to respiratory infection of various severity. Hematological ratios are indicators of inflammatory response widely used in viral pneumonia with affordability in developing countries. PURPOSE: Study the role of the neutrophil lymphocyte ratio (NLR), derived NLR ratio (d-NLR), platelet lymphocyte ratio (PLR), and lymphocyte monocyte ratio (LMR) in predicting the outcome of COVID-19 Egyptian patients. METHODS: A retrospective study on 496 COVID-19 Egyptian patients, managed in four tertiary centers, grouped into non-severe, severe, and critical. Patients' laboratory assessment including total leucocyte count (TLC), absolute neutrophil count (ANC), absolute lymphocyte count (ALC), absolute monocyte count (AMC), NLR, d-NLR, LMR and, PLR were reported as well as C reactive protein (CRP), D-dimer and serum ferritin. RESULTS: TLC, ANC, AMC, NLR, d-NLR and, PLR were highest in the critical group (p<0.001 for all except AMC p=0.033), while this group had the least ALC and LMR (p=0.049 and <0.001, respectively). Higher CRP and d-dimer levels were reported in the critical group (p<0.001). At the same time, higher ferritin was found in the severe group more than the critical and non-severe groups (p<0.001, p=0.005, respectively). We calculated the optimal cut-off values of the hematological ratio; NLR (3.5), d-NLR (2.86), PLR (192), and LMR (3). D-NLR had the highest specificity (89.19%), while NLR had the highest sensitivity (71.38%). By univariate logistic regression, age, DM, HTN, cardiovascular diseases, COPD, NLR, d-NLR, LMR and PLR, CRP, steroid, oxygen aids, and mechanical ventilation were associated with the severity of COVID-19. Still, only age, NLR, CRP, and oxygen aid were independent predictors in multivariate logistic regression. CONCLUSION: NLR is a predictor for severity in COVID-19. LMR, d-NLR, and PLR may assist in risk stratification.

Evaluation of circulating microRNAs-211 and 25 as diagnostic biomarkers of colorectal cancer.

Colorectal cancer is one of the most prevalent and deadly cancers worldwide. MicroRNAs are short single stranded non-coding RNAs that play important roles in carcinogenesis, tumor growth and tumor survival. Circulating microRNAs are increasingly becoming efficient and important biomarkers for several types of cancers. Herein, we aim to evaluate the diagnostic potentials of plasma microRNA-211 and microRNA-25 in colorectal cancer patients. Forty-four patients diagnosed with colorectal cancer and 40 healthy controls were recruited for the present study. Expressions of circulating microRNAs -211 and 25 were assessed by quantitative real-time polymerase chain reaction (RT-qPCR). Expression of transforming growth factor-beta, a key factor in tumorigenesis and a key inducer of epithelial to mesenchymal transition was assessed by enzyme-linked immunosorbent assay (ELISA) in patients' tissue and plasma. Our results demonstrated upregulated expressions of plasma microRNAs-211 and 25 correlated with the high transforming growth factor-beta (TGF-ß1) expression in patients. In addition, plasma levels were positively correlated with lymph node metastasis. Moreover, receiver operating characteristic analysis demonstrated the reliability of microRNAs-211 and 25 for discriminating colorectal cancer patients from healthy individuals. MicroRNA-211 and microRNA-25 might have a tumorigenic role in colorectal cancer and their plasma levels could be potential biomarkers in its diagnosis.

Vaginal suppositories of cumin seeds essential oil for treatment of vaginal candidiasis: Formulation, in vitro, in vivo, and clinical evaluation.

Fungal infections by resistant Candida species continue to be a significant health problem. Novel antifungal agents such as essential oils of cumin seeds (EOCS) are tested against vulvovaginal candidiasis (VVC). The aim of this study was to develop coated polyethylene glycol (PEG) vaginal suppositories containing EOCS for treatment of VVC. PEG suppositories containing EOCS were prepared ppearance, weight variation, drug content, hardness, dissolution time, release, stability and anticandida activity were evaluated. Biocompatibility of selected formulation was tested in female rabbits, followed by clinical evaluation. Coated suppositories showed complete release of the oil after 30 min, in vitro anti-candida activity, enhanced stability and sufficient safety on the vaginal tissues of rabbits. Clinical results showed significant lower rates of vaginal itching, discharge and dyspareunia combined with negative cultures in 70% of patients, revealing efficacy of EOCS-containing vaginal suppositories for treatment of VVC.

Assessment of Complement Regulatory Proteins CD55 and CD59 on Erythrocytes in Beta-Thalassemia Major Patients.

This study intended to measure the expression of complement regulatory proteins CD55 and CD59 on RBCs membrane in patients with ß-thalassemia (ß- thal) major in addition to investigate if splenectomy affects their expression pattern. This was a case-control study, participants were allocated in three groups. The study group 1 consisted of ß-thal patients who underwent splenectomy. The study group 2 consisted of ß-thal patients without splenectomy. Group 3 consisted of apparently healthy volunteers as a control group. A significant decrease in CD55 expression in patients' group 1 (46.35±14.61) and group 2 (56.90±9.28) in comparison with group 3 (86.20±9.62) was observed. The percentage of CD55 expression was significantly lower in group 1 patients than group 2 (P=0.01). However, there was no difference in the percentage of CD59 marker expression between any of the patient's groups and the control group. In conclusion, CD55 under-expression on RBCs of ß- thal patients may be considered one of the factors that cause hemolysis in those patients and this complement mediated hemolysis may be one of the underlying causes of organ damage. Additional deficiency of this receptor occurs with splenectomy.

Prognostic Significance of Circulating CD28 Negative Suppressor T Cells and Memory B Cells in Patients with Breast Cancer.

BACKGROUND: It has been suggested that routine assessment and quantification of different lymphocyte subsets can provide clinically meaningful prognostic information in breast cancer (BC). OBJECTIVE: To determine the relationship between peripheral blood lymphocyte subsets and pathological parameters and response to therapy in patients with BC. METHODS: Thirty patients with operable breast cancer treated surgically with either modified radical mastectomy or breast conservative surgery, and 20 healthy controls were included. For detection of lymphocyte subsets in peripheral blood; Fluorochrome-labeled monoclonal antibodies were used andcells were analyzed by flow cytometry. Patients were treated with chemotherapy, radiotherapy and hormonal treatment, and followed up to determine relapse and recurrence-free survival (RFS). RESULTS: Significant differences were found in the frequencies of B, T, NK, NKT, and CD28‒T cells between patients with BC and controls. Moreover, a significant difference was found in the percentage of CD8+CD28‒ T cells between patients with different pathologic subtypes of BC and negative correlations were observed between the frequency of CD8+CD28‒T cells and memory B cells, and RFS. Also, a significant difference in the frequency of naïve B cells was found in patients with different tumor grades and a negative correlation was found between the frequencies of B cells and NKT cells. CONCLUSION: NK, NKT, lymphocytes, and CD28‒ T cells significantly differed between healthy controls and BC patients. Also, memory B cells were associated with good response to treatment while CD28‒ T cells were associated with shorter RFS.

Hydatidiform mole in the era of COVID-19 pandemic. Is there an association?

Coronavirus disease 2019 (COVID-19) is considered a worldwide pandemic. COVID-19 patients had profound immune dysregulation so they could be susceptible for adverse pregnancy outcomes as hydatidiform mole. In this article, we tried to explain the link between hydatidiform mole and COVID-19.

Prognostic value of serum soluble FMS-like tyrosine kinase (sFlt-1) levels in pre-eclampsia and eclampsia; a prospective cohort study.

OBJECTIVE: To evaluate the levels of circulating sFlt-1 in pre-eclampsia (PE) and eclampsia patients and to assess its prognostic value in detection of PE complications. METHODS: The present study was a prospective cohort study conducted in tertiary hospital between January and December 2016. Included patients were divided into two groups; (Group I) severe PE group and (Group II) eclampsia group. Age-, parity-, and gestational age-matched women had approached to participate in the study as a control group (Group III). Serum sFlt-1 levels were measured at inclusion and 2 days later with all basic investigations. Patients were followed up until delivery to record any complications. Correlation analysis was performed between the serum sFlt-1 levels and clinical, laboratory investigations. Receiver operating characteristic analysis was constructed for the evaluation of the area under curve (AUC) as well as the sensitivity and specificity regarding the cutoff point of sFlt-1 level that predict occurrence of complications. RESULTS: The study included 84 women. Women with complicated severe PE showed higher sFlt-1 levels than in non-complicated cases (120.2 ± 19.6 versus 72.2 ± 19.6, p < 0.001). Similarly, the mean serum level of sFlt-1 in complicated eclampsia was higher than in non-complicated cases (298.3 ± 75.2 versus 128.1 ± 36.5, p < 0.001) (OR = 1.119, 95% CI: 10.057-1.184, p < 0.001). SFlt-1 levels were strongly correlated with systolic blood pressure (r = 0.641) and diastolic blood pressure (r = 0.540) (p < 0.001 and p < 0.001, respectively). At cutoff point 102.60 ng/ml of sFlt-1 levels, the sensitivity was 90% and specificity was 80% with AUC = 0.923, 95% CI: 0.871-0.975. CONCLUSIONS: Serum sFlt-1 can be used as a prognostic marker to predict the occurrence of complications of preeclampsia.

Effect of IL6 and IL23 on double negative T cells and anti ds-DNA in systemic lupus erythematosus patients.

Several evidences suggest that DN T cells, IL23 and IL6 play a role in the pathogenesis of SLE. This study aimed to evaluate the frequency of DN T cells in SLE patients and the relation to their activity also to assess the possible role of IL6 and IL23 on DN T cells. Thirty patients with SLE and sixteen healthy blood donor females were enrolled. There was a significant increase in DN T cells in patients than controls (P=0.001). These cells had a significant positive correlation with SLEDAI (r=0.486, P=0.006). DN T cells from SLE patient samples were expanded when stimulated in vitro with RhIL6 or RhIL23 in patients than controls. Furthermore, anti ds-DNA level was found to be increased in supernatant of PBMCs when stimulated by these cytokines in different concentrations. Our findings suggest that IL6 and IL23 may play role in SLE pathogenesis through their effect on DN T cells and anti ds-DNA.