Mapping the effect of drugs on ACE2 as a novel target site for COVID-19 therapy.

Angiotensin converting enzyme 2 (ACE2) has potentially conflicting roles in health and disease. COVID-19 coronavirus binds to human cells via ACE2 receptor, which is expressed on almost all body organs. Boosting the ACE2 receptor levels on heart and lung cells may provide more cellular enter to virus thereby worsening the infection. Therefore, among the drug targets, ACE2 is suggested as a vital target of COVID-19 therapy. This hypothesis is based on the protective role of the drugs acting on ACE2. Therefore, this review discusses the impact and challenges of using ACE2 as a target in the current therapy of COVID-19.

One week stenting after pediatric laparoscopic pyeloplasty; is it enough?

INTRODUCTION: The use of ureteric stents for urinary diversion after pediatric dismembered pyeloplasty and its duration remain debatable. Classically, an indwelling Double J ureteric stent has to be left for 4-6 weeks. However, such a duration is not free of stent-related complications, in addition to the need to remove it under general anesthesia in the pediatric age group. OBJECTIVES: This study aims to evaluate the outcome of short-term stenting after laparoscopic pyeloplasty in pediatric sector. METHODS: A prospective randomized study of 37 children (less than 16 years-old) with pelvi-ureteric junction obstruction (PUJO) were managed by laparoscopic pyeloplasty by the same surgeon in the period between April 2015 and September 2017. In group A (18 patients), the DJ was removed after 4 weeks under general anesthesia, while in group B (19 patients), the DJ was fixed to the urethral catheter by a stitch, and it was removed with the urethral catheter after one week in the outpatient office. All patients were followed regularly for symptomatic improvement. Urine culture and sensitivity was done 1 month postoperatively. Abdominal ultrasound was done at 3, 6, 12 months and annually thereafter, while renal isotope scanning was done after 6 months. RESULTS: There were no significant differences between both groups regarding operative duration, postoperative leakage, hospital stay, early postoperative complications. Both groups improved after pyeloplasty with no significant differences regarding symptoms, follow-up ultrasound, and renal scanning. The incidence of irritative symptoms and need for anticholinergics after catheter removal as well as urinary tract infection after 1 month were significantly higher in group A (P-value: 0.004 and 0.029, respectively) (Table). DISCUSSION: To the authors knowledge, this is the first prospective controlled randomized study comparing short-term stenting with the classic 4 weeks stenting after laparoscopic pyeloplasty in the pediatric age group. In addition, the used technique of stenting not only allows stent removal on outpatient basis without anesthesia but also benefits from the pre-operative retrograde study so as not to miss any associated pathology in the ureter. CONCLUSION: Short-term ureteric stenting after laparoscopic pyeloplasty in pediatric age group is safe and not inferior to the standard 4-week stenting. It also avoids the stent-related complications.

Protective effects of erdosteine against nephrotoxicity caused by gamma radiation in male albino rats.

The aim of this study was focused on investigating the possible protective effect of erdosteine against gamma radiation-induced renal lesions in male albino rats. Twenty-eight albino rats were divided into four equal groups as follows: control group, irradiated group (animals subjected to whole-body gamma irradiation at a dose of 5 Gy), treated group (each rat received 100 mg/kg body weight once daily, orally by gastric tube, erdosteine for 1 week), and treated irradiated group (each rat received 100 mg/kg body weight once daily, orally by gastric tube, erdosteine for 1 week, then exposed to whole-body gamma irradiation at a dose of 5 Gy). The results revealed that the administration of erdosteine to rats before irradiation significantly ameliorated the changes occurred in kidney function (creatinine and urea) compared with irradiated group. Also the changes in serum tumor necrosis factor α, interleukin 1ß, and interleukin 6 activities were markedly improved compared with the corresponding values of irradiated group. Kidney catalase and glutathione peroxidase (GPx) activities and reduced glutathione concentration showed approximately normal level when compared with the irradiated group. The histopathological results showed distinctive pattern of renal lesions in irradiated group, while in treated irradiated group the renal tissues showed relatively well-preserved architecture. Erdosteine acts in the kidney as a potent scavenger of free radicals to prevent or ameliorate the toxic effects of gamma irradiation as shown in the biochemical and histopathological changes and might provide substantial protection against radiation-induced inflammatory damage.

Vascular endothelial growth factor is up-regulated after status epilepticus and protects against seizure-induced neuronal loss in hippocampus.

Vascular endothelial growth factor (VEGF) is a protein factor which has been found to play a significant role in both normal and pathological states. Its role as an angiogenic factor is well-established. More recently, VEGF has been shown to protect neurons from cell death both in vivo and in vitro. While VEGF's potential as a protective factor has been demonstrated in hypoxia-ischemia, in vitro excitotoxicity, and motor neuron degeneration, its role in seizure-induced cell loss has received little attention. A potential role in seizures is suggested by Newton et al.'s [Newton SS, Collier EF, Hunsberger J, Adams D, Terwilliger R, Selvanayagam E, Duman RS (2003) Gene profile of electroconvulsive seizures: Induction of neurotrophic and angiogenic factors. J Neurosci 23:10841-10851] finding that VEGF mRNA increases in areas of the brain that are susceptible to cell loss after electroconvulsive-shock induced seizures. Because a linear relationship does not always exist between expression of mRNA and protein, we investigated whether VEGF protein expression increased after pilocarpine-induced status epilepticus. In addition, we administered exogenous VEGF in one experiment and blocked endogenous VEGF in another to determine whether VEGF exerts a neuroprotective effect against status epilepticus-induced cell loss in one vulnerable brain region, the rat hippocampus. Our data revealed that VEGF is dramatically up-regulated in neurons and glia in hippocampus, thalamus, amygdala, and neocortex 24 h after status epilepticus. VEGF induced significant preservation of hippocampal neurons, suggesting that VEGF may play a neuroprotective role following status epilepticus.

Tracing hepatitis C and Delta viruses to estimate their contribution in HCC rates in Mongolia.

An estimated incidence of hepatocellular carcinoma (HCC) in Mongolia is currently one of the highest in the world. According to previous reports, the sero-prevalence of hepatitis B (HBV) and hepatitis C (HCV) viruses in general population of the country is very high (HBV, 10% and HCV, 15%, respectively). Moreover, the majority (75-100%) of the HBV-infected individuals have co-infection with hepatitis Delta virus (HDV). Despite reported observations that HBV + HDV/HCV co-infection have significantly stronger association with HCC when compared with HCV-monoinfection, the later is still frequently observed among Mongolian HCC patients (39%). In this study, an approach based on principles of population genetics and mathematical epidemiology was used to trace an epidemic history of HCV and HDV. In agreement with the sero-epidemiological and social-historical background of the country, the results have demonstrated that the viruses had different epidemic dynamics in Mongolia; HCV was characterized by earlier epidemic expansion, whereas HDV spread with approximately 50 years lag. This may explain the comparable contribution of the HCV-monoinfection and HBV + HDV co-infection in current HCC rate despite different levels of risk of carcinogenesis. Used approach is useful in evaluation of current and prospective disease burden.

Histopathological effects of silicone rubber 'Ovabloc' on the human fallopian tube.

OBJECTIVE: To study the histopathological effects of silicone rubber on the human fallopian tube. METHODS: A prospective longitudinal study at Benha University Hospital and Boulak Eldakrour General Hospital, Egypt. Nine patients who were on the waiting list for hysterectomy and requested postponing of their operation for personal reasons. RESULTS: Our results suggest that silicone rubber induces histopathological changes in the form of ciliary loss and intracellular changes. CONCLUSIONS: These effects tend to increase with the increase of the duration of tubal plugging and are best seen by electron microscopy.

A review of 126 cases of ruptured gravid uterus.

Ruptured uterus is a grave obstetric complication, associated with high maternal mortality and morbidity, perinatal mortality and loss of future fertility as hysterectomy is inevitable in many cases. This study reviews the incidence, causes and other factors, to define problem areas and propose preventive measures. During 1979-1988, 126 cases of ruptured uterus occurred in 46,207 deliveries; these 126 cases were retrospectively analyzed in relation to causes, age, parity, maternal mortality and morbidity, perinatal mortality and management. Some of the results were compared with other authors. The incidence was 1/367 (2.7/1000 deliveries), traumatic rupture accounted for 42.86% while spontaneous rupture accounted for 57.14%. Maternal mortality was 21.43% and the perinatal mortality was 73.19%. Supravaginal hysterectomy, repair with sterilization and repair without sterilization were the selected lines of management. Proper quick diagnosis and prompt management will reduce maternal mortality and morbidity. Finally, recommendations to reduce the occurrence of this problem are proposed.

Endoscopic management of the intrauterine septum.

During 20 months of study 29 patients in whom congenital uterine anomalies were previously diagnosed by hysterosalpingography, had a combined hysteroscopy/laparoscopy procedure. In 17 cases, an intrauterine septum was cut under vision using CO2 hysteroscopy and/or optical scissors. No electrocautery or vasoconstrictor agents were needed to minimize the possibility of bleeding as the septum is of fibrous nature. No estrogen therapy was given and no IUDs were inserted post operatively. A second look hysteroscopy done 2 months later showed no intrauterine adhesions. Laparoscopic monitoring during the hysteroscopic procedure allowed avoidance of uterine perforation, assessment of the condition of the tubes and the ovaries as well as differentiation between bicornuate and septate uterus.

Modified technique of puerperal laparoscopic sterilization.

PIP: Results of 78 postpartum laparoscopic sterilizations are reported with procedural comments. Because immediate puerperal laparoscopy is hindered by poor visualization and the danger of bleeding and infection, waiting until the fifth post-partum day is prefered. For insufflation, 50% more gas may be required due to abdominal elasticity. No uterine cannulation was used. The incision for the laparoscope trocar should be only skin deep, and the trocar should be introduced stepwise to avoid herniation. If the fundus is high, the Verres needle and laparoscope trocar should be introduced trangentially to the side of the fundus. Complications included: 2 severe hypotensions, 2 bleedings from broad ligament, 1 hematoma of the broad ligament, 1 omental protrusion through the wound, 2 uterine bleedings and 1 superficial thrombophlebitis.^ieng