"Haleem's Hen"; A mnemonic for the anatomy of hindfoot structures at the level of sustentaculum tali on coronal T1-weighted magnetic resonance images.

Magnetic resonance anatomy of the hindfoot as seen at the level of the sustentaculum tali is intricate due to surrounding muscles, tendons, aponeurosis and ligaments. The objective of this work is to provide a mnemonic with illustrative figures to simplify this complex anatomical region on coronal T1-weighted MR images (T1-MRIs). One hundred and twenty-four patients referred for foot and ankle complaints were scanned utilizing standard MRI imaging protocols for depiction of the hindfoot. Only coronal T1-MRIs of the calcaneus at the level of sustentaculum tali of unremarkably reported patients were selected for this work. Upon viewing the calcaneus with the adjacent anatomical structures on coronal T1-MRIs, the overall appearance resembles a "Hen in the Nest with Four Eggs''. The calcaneus represents the body of the hen, while the sustentaculum tali forms the head and neck. The posterior tibial tendon represents the crest of the hen, and the flexor digitorum longus and flexor hallucis longus tendons represent its beak and wattle, respectively. The peroneus brevis and peroneus longus tendons represent the tail, and the long plantar ligament represents the flexed legs of Haleem's hen. The plantar aponeurosis represents the hen's nest. Whereas the abductor hallucis, flexor digitorum brevis, abductor digiti minimi and quadratus plantae muscles are the four eggs. The mnemonic, "Haleem's Hen in the Nest with Four Eggs", serves as a simplified phrase for radiologists and orthopedic surgeons to easily recall the anatomy of the hindfoot when viewing it at the level of the sustentaculum tali on coronal T1-MRIs.

Efficient inactivation of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in human apheresis platelet concentrates with amotosalen and ultraviolet A light.

OBJECTIVES: The detection of SARS-CoV-2 RNA in blood and platelet concentrates from asymptomatic donors, and the detection of viral particles on the surface and inside platelets during in vitro experiments, raised concerns over the potential risk for transfusion-transmitted-infection (TTI). The objective of this study was to assess the efficacy of the amotosalen/UVA pathogen reduction technology for SARS-CoV-2 in human platelet concentrates to mitigate such potential risk. MATERIAL AND METHODS: Five apheresis platelet units in 100% plasma were spiked with a clinical SARS-CoV-2 isolate followed by treatment with amotosalen/UVA (INTERCEPT Blood System), pre- and posttreatment samples were collected as well as untreated positive and negative controls. The infectious viral titer was assessed by plaque assay and the genomic titer by quantitative RT-PCR. To exclude the presence of infectious particles post-pathogen reduction treatment below the limit of detection, three consecutive rounds of passaging on permissive cell lines were conducted. RESULTS: SARS-CoV-2 in platelet concentrates was inactivated with amotosalen/UVA below the limit of detection with a mean log reduction of>3.31±0.23. During three consecutive rounds of passaging, no viral replication was detected. Pathogen reduction treatment also inhibited nucleic acid detection with a log reduction of>4.46±0.51 PFU equivalents. CONCLUSION: SARS-CoV-2 was efficiently inactivated in platelet concentrates by amotosalen/UVA treatment. These results are in line with previous inactivation data for SARS-CoV-2 in plasma as well as MERS-CoV and SARS-CoV-1 in platelets and plasma, demonstrating efficient inactivation of human coronaviruses.

Amotosalen and ultraviolet A light efficiently inactivate MERS-coronavirus in human platelet concentrates.

OBJECTIVE: This study aimed to assess the efficacy of the INTERCEPT™ Blood System [amotosalen/ultraviolet A (UVA) light] to reduce the risk of Middle East respiratory syndrome-Coronavirus (MERS-CoV) transmission by human platelet concentrates. BACKGROUND: Since 2012, more than 2425 MERS-CoV human cases have been reported in 27 countries. The infection causes acute respiratory disease, which was responsible for 838 deaths in these countries, mainly in Saudi Arabia. Viral genomic RNA was detected in whole blood, serum and plasma of infected patients, raising concerns of the safety of blood supplies, especially in endemic areas. METHODS: Four apheresis platelet units in 100% plasma were inoculated with a clinical MERS-CoV isolate. Spiked units were then treated with amotosalen/UVA to inactivate MERS-CoV. Infectious and genomic viral titres were quantified by plaque assay and quantitative real-time reverse transcription polymerase chain reaction (RT-qPCR). Inactivated samples were successively passaged thrice on Vero E6 cells to exclude the presence of residual replication-competent viral particles in inactivated platelets. RESULTS: Complete inactivation of MERS-CoV in spiked platelet units was achieved by treatment with Amotosalen/UVA light with a mean log reduction of 4·48 ± 0·3. Passaging of the inactivated samples in Vero E6 showed no viral replication even after nine days of incubation and three passages. Viral genomic RNA titration in inactivated samples showed titres comparable to those in pre-treatment samples. CONCLUSION: Amotosalen and UVA light treatment of MERS-CoV-spiked platelet concentrates efficiently and completely inactivated MERS-CoV infectivity (>4 logs), suggesting that such treatment could minimise the risk of transfusion-related MERS-CoV transmission.

Testing for HTLV 1 and HTLV 2 among blood donors in Western Saudi Arabia: prevalence and cost considerations.

BACKGROUND: Screening all blood donors for human T-cell lymphotropic viruses 1 and 2 (HTLV 1 and HTLV 2) is mandatory in Saudi Arabia. The aim of this study is to evaluate the results and costs associated with the current testing policy for HTLV 1 and HTLV 2 in blood donors at King Abdulaziz University Hospital (KAUH), Jeddah. STUDY DESIGNS AND METHODS: Donor-testing results from Blood Transfusion Services at KAUH were reviewed over a 10-year period, from January 2006 through December 2015. All donors were screened using chemiluminescent microparticle immunoassay. Reactive samples were then tested by Western blot for confirmation. Costs associated with testing were calculated. RESULTS: Data of 107 419 donations in the study period were reviewed. Saudi nationals constituted 51 168 donors (47·6%). Of 107 419 blood donors tested for HTLV 1 and HTLV 2 antibody, and 95 (0·088%) donors were reactive to screening tests. None of the samples found to be reactive to screening tests was positive by Western blot. The average cost of testing was US$ 171 870 per year. CONCLUSION: No donors were confirmed to have HTLV 1 and HTLV 2 in this cohort exceeding 100 000 donors. We propose changes to the policy mandating universal testing by replacing it with universal leukodepletion coupled with targeted screening to donors coming from endemic area or donors at risk. Such changes are expected to lead to a reduction of testing cost without affecting safety.

Clinical biomarkers in sickle cell disease.

Sickle cell disease (SCD) is a hereditary blood disorder caused by a single gene. Various blood and urine biomarkers have been identified in SCD which are associated with laboratory and medical history. Biomarkers have been proven helpful in identifying different interconnected disease-causing mechanisms of SCD, including hypercoagulability, hemolysis, inflammation, oxidative stress, vasculopathy, reperfusion injury and reduced vasodilatory responses in endothelium, to name just a few. However, there exists a need to establish a panel of validated blood and urine biomarkers in SCD. This paper reviews the current contribution of biochemical markers associated with clinical manifestation and identification of sub-phenotypes in SCD.

Serologial screening of human T cell lymphotropic virus I and II (HTLV I/II) in blood banks by immunoblotting and enzyme-immuno assays: to demand or to defeat?

Human T cell lymphotropic virus I and II (HTLV I/II) has been recommended to be screened for blood donors since 1988, and it become a mandatory test to get college of american Pathologists (CAP) accreditation. The present study aimed at investigating the prevalence rate of HTLV I/II among Arab blood donors, to revise whether is its screening mandatory? Thirty-thousand (30,000) Arab donors along two years attending two central hospital blood banks in Jeddah. Antibodies to HTLV I/II have been screened using enzyme immunoassay (E.I.A) and immunoblotting assay (Western blot). Results revealed zero prevalence rate. Based upon this finding, no potential risk of HTLV I/II transmission among blood donors population exist. As screening for HTLV I/II is still mandatory, it could be done on pools of sera rather than on individual serum samples, after standardization of a pooling protocol, to fulfill coast-effectiveness and reduce the coasts by 90-95%.

Purification of monoterpenyl glycosides by gel-permeation and hydrophobic-interaction chromatography on polyacrylamide (Bio-Gel P-2).

Hydrophobic interaction of the aglycone of monoterpenyl glycosides with the polyacrylamide matrix of Bio-Gel P-2 greatly retards the elution of these substances when chromatographed in dilute aqueous sodium chloride. This hydrophobic interaction is eliminated by inclusion of 15% acetonitrile in the eluant, thereby permitting conventional gel-permeation chromatography. Combination of these techniques by sequential chromatography on the same Bio-Gel column, in the hydrophobic interaction mode followed by the gel-permeation mode, provides a simple, yet mild and highly selective procedure for the purification of monoterpenyl glycosides from crude plant extracts. Examination of the chromatographic properties of beta-D-glucopyranosides and beta-D-galactopyranosides of a number of acyclic, monocyclic, and bicyclic monoterpenols indicates that the extent of hydrophobic interaction is of diagnostic value in determining the nature of the aglycone.

Metabolism of monoterpenes: lactonization of (+)-camphor and conversion of the corresponding hydroxy acid to the glucoside-glucose ester in sage (Salvia officinalis).

The bicyclic monoterpene ketone (+)-camphor is a major constituent (up to 26%) of the volatile oil of immature sage (Salvia officinalis L.) leaves; however, as the plant matures the content of this ketone declines in the fully expanded leaves (to about 65% of maximum) as does the overall yield of oil (to roughly 60% of maximum). Examination of the metabolism of (+)-[G-3H]camphor in discs prepared from mature leaves of flowering sage plants revealed that this ketone was converted to a water-soluble metabolite which on chromatographic analysis proved to be considerably more polar than a simple monoterpenyl glycoside. Mass spectral analysis of several derivatives of the terpenoid moiety of the metabolite obtained from large-scale incubations allowed identification of the aglycone, while degradative studies and detailed radiochromatographic analyses indicated that the metabolite contained two glucose residues; one glycosidically linked and the other in ester linkage. All of the evidence was consistent with the initial lactonization of camphor to 1,2-campholide followed by conversion to the beta-D-glucoside-6-O-glucose ester of the corresponding hydroxy acid (1-carboxymethyl-3-hydroxy-2,2,3-trimethyl cyclopentane). Direct evidence for the intermediacy of 1,2-campholide was also obtained through isotopic dilution experiments and by direct testing of the labeled lactone. The lactonization of camphor in sage resembles a similar step in the catabolism of camphor by microorganisms, but appears to be the first report of this reaction type in higher plants.