Development of a prediction model for recurrence in patients with colorectal peritoneal metastases undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy.

INTRODUCTION: Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) improves survival outcomes for selected patients with colorectal peritoneal metastases (PM), but recurrence rates are high. The aim of this study was to develop a tool to predict recurrence in patients with colorectal PM that undergo CRS-HIPEC. MATERIALS AND METHODS: For this retrospective cohort study, data of patients that underwent CRS-HIPEC for colorectal PM from four Dutch HIPEC centers were used. Exclusion criteria were perioperative systemic therapy and peritoneal cancer index (PCI) ≥20. Nine previously identified factors were considered as predictors: gender, age, primary tumor characteristics (location, nodal stage, differentiation, and mutation status), synchronous liver metastases, preoperative Carcino-Embryonal Antigen (CEA), and peritoneal cancer index (PCI). The prediction model was developed using multivariable Cox regression and validated internally using bootstrapping. The performance of the model was evaluated by discrimination and calibration. RESULTS: In total, 408 patients were included. During the follow-up, recurrence of disease occurred in 318 patients (78%). Significant predictors of recurrence were PCI (HR 1.075, 95% CI 1.044-1.108) and primary tumor location (left sided HR 0.719, 95% CI 0.550-0.939). The prediction model for recurrence showed fair discrimination with a C-index of 0.64 (95% CI 0.62, 0.66) after internal validation. The model was well-calibrated with good agreement between the predicted and observed probabilities. CONCLUSION: We developed a prediction tool that could aid in the prediction of recurrence in patients with colorectal PM who undergo CRS-HIPEC.

The role of adverse childhood experiences in predicting child abuse perpetration among married mothers in Alexandria, Egypt: a cross-sectional study.

BACKGROUND: Adverse childhood experiences (ACEs) are receiving increased amounts of attention as a critical public health issue. ACEs have a massive impact on future violence victimization and perpetration. They are also associated with lifelong mental and physical health consequences as well as premature mortality. The present study aimed to investigate the role of different ACEs among married mothers in predicting the risk of child abuse perpetration in offspring. METHODS: A cross-sectional study was conducted on 350 mothers of children aged 2-12 years attending family health centres in Alexandria. The mothers completed a predesigned interview questionnaire on sociodemographic data and data related to ACEs, spousal violence, and child abuse perpetration. Suitable bivariate and multivariate statistical tests were used to analyse the collected data using version 20.0 of the Statistical Package for Social Sciences (SPSS). RESULTS: Two-thirds of mothers (66.3%) reported ever having been exposed to any ACE, and 18.6% of them had experienced 3 or more ACEs. Psychological abuse (46%) and witnessing domestic violence (17%) were the most common. Psychological aggression (95.4%), minor physical assault (79%), and neglect (52%) were the most common forms of child abuse perpetrated by the mothers. The number of ACEs experienced by mothers showed a moderate positive significant correlation with the 5 forms of child abuse examined. Different ACEs, mother's age, socioeconomic status, and current exposure to spousal violence were found to be independent predictors of different forms of child abuse (psychological aggression, neglect, minor physical assault, and severe physical assault). CONCLUSION: Different practices of family violence are strongly connected throughout different stages of an individual's life and across generations. Further understanding of the interconnections among forms of violence and addressing them should be prioritized. Additionally, concerted national strategies across all levels and sectors are needed to address this complex problem.

Mirtazapine, an atypical antidepressant, mitigates lung fibrosis by suppressing NLPR3 inflammasome and fibrosis-related mediators in endotracheal bleomycin rat model.

Idiopathic pulmonary fibrosis (IPF) is a progressive and irreversible lung disease with a poor prognosis. There is currently no definitive cure for IPF. The present study establishes a platform for the development of a novel therapeutic approach for the treatment of PF using the atypical antidepressant, mirtazapine. In the endotracheal bleomycin rat model, mirtazapine interfered with the activation of NLRP3 inflammasome via downregulating the NLRP3 on the gene and protein expression levels. Accordingly, the downstream mediators IL-1ß and IL-18 were repressed. Such observation is potentially a direct result of the reported improvement in oxidative stress. Additionally, mirtazapine corrected the bleomycin-induced disparities in the levels of the fibrogenic mediators TGF-ß, PDGF-BB, and TIMP-1, in consequence, the lung content of hydroxyproline and the expression of α-SMA were reduced. Besides, mirtazapine curbed the ICAM-1 and the chemotactic cytokines MCP-1 and CXCL4. This protective property of mirtazapine resulted in improving the BALF total and differential cell counts, diminishing LDH activity, and reducing the BALF total protein. Moreover, the inflammation and fibrosis scores were accordingly lower. To conclude, we reveal for the first time the efficacy of mirtazapine as a potential treatment for PF. The combination of social isolation, sleep problems, breathing difficulties, and fear of death can lead to psychological distress and depression in patients with IPF. Hence, mirtazapine is a promising treatment option that may improve the prognosis for IPF patients due to its antifibrotic effects, as well as its ability to alleviate depressive episodes.

Diacetylrhein, an anthraquinone antiarthritic agent, suppresses dextran sodium sulfate-induced inflammation in rats: A possible mechanism for a protective effect against ulcerative colitis.

Ulcerative colitis (UC) is a chronic inflammatory life-threatening and premalignant disorder with no cure that even might end up with surgical removal of a large section or even all of the colon. It is characterized by relapsing-remitting courses of intestinal inflammation and mucosal damage in which oxidative stress and exaggerated inflammatory response play a significant role. Most of the current medications to maintain remission are symptomatic and have many adverse reactions. Therefore, the potential for improved management of patients with UC continues to increase. Yet, the benefits of using the antiarthritic agent diacetylrhein to counteract inflammation in UC are still obscure. Hence, our study was designed to explore its potential role in UC using a model of dextran sodium sulfate-induced acute colitis in rats. Our results revealed that diacetylrhein targeted the NLRP3 and inhibited the inflammasome assembly. Consequently, caspase-1 activity and the inflammatory cytokines IL-1ß and IL-18 were inhibited leading to a curbed pyroptosis process. Additionally, diacetylrhein revealed a significant antiapoptotic potential as revealed by the levels of pro-apoptotic and anti-apoptotic proteins. Concomitant to these effects, diacetylrhein also interrupted NFκB signals leading to improved microscopic features of inflamed colon and decreased colon weight to length ratio, indices of disease activity, and macroscopic damage. Additionally, a reduction in the myeloperoxidase activity, IL-6, and TGF-ß alongside an increase in the gene expression of Ocln and ZO-1 were detected. To conclude diacetylrhein showed a significant antioxidant and anti-inflammatory potential and therefore might represent a promising agent in the management of acute UC.

Pimitespib, an HSP90 inhibitor, augments nifuroxazide-induced disruption in the IL-6/STAT3/HIF-1α autocrine loop in rats with bleomycin-challenged lungs: Evolutionary perspective in managing pulmonary fibrosis.

Idiopathic pulmonary fibrosis is a fatal lung disorder in which the etiology and pathogenesis are still unobvious. Effective treatments are urgently needed considering that lung transplantation is the only treatment that could improve outcomes. This study aimed to investigate the therapeutic significance of the dual administration of pimitespib, an HSP90 inhibitor, and nifuroxazide, a STAT3 inhibitor, against bleomycin-induced pulmonary fibrosis in rats. Our results revealed that pimitespib/nifuroxazide inhibited bleomycin-induced alterations in the structure and the function of the lungs. They demonstrated significant decreases in the BALF total and differential cell counts, LDH activity, and total protein. Concurrently, there was a reduction in the accumulation of collagen as proved by decreased hydroxyproline and the gene expression of COL1A1 accompanied by lower levels of PDGF-BB, TIMP-1, and TGF-ß. The levels of IL-6 were also downregulated. Pimitespib-induced inhibition of HSP90 led to subsequent inhibition of HIF-1α and STAT3 client proteins since the closed HSP90 would not enclose its client proteins. Therefore, pimitespib resulted in the repression of HIF-1α/CREB-p300 HAT as well as the STAT3/CREB-p300 HAT nuclear interactions. On the other hand, nifuroxazide resulted in a notable decline in pSTAT3 and HIF-1α levels. Subsequently, the combined effects of both drugs led to a substantial reduction in ECM deposition. Herein, pimitespib augmented nifuroxazide-induced disruption in the IL-6/STAT3/HIF-1α autocrine loop. Our findings also disclose that this novel loop is a promising therapeutic attack site for possible pulmonary fibrosis repression studies. Therefore, the use of pimitespib/nifuroxazide embodies an evolutionary perspective in managing pulmonary fibrosis.

Multivariate statistics explaining groundwater chemistry, Asyut, Egypt.

Groundwater is an important source for domestic and irrigation purposes in Asyut area. Water quality varied widely due to complex geochemical processes and pollution sources. Understanding the processes controlling groundwater chemistry is necessary to overcome related problems. Multivariate statistics revealed that groundwater is affected by anthropogenic recharge (agricultural/organic pollution), mineralization, and redox processes. Contributions from natural vs. anthropogenic sources explain the variance in hydrochemical data. Shallow wells are relatively higher in bicarbonate content due to oxidation of organic pollutants. Shallow wells anomaly high with iron and organically polluted are most probably owing to pipe corrosion in residential areas. N fertilization impact on natural weathering has been demonstrated. Groundwater is getting more mineralized toward desert fringes due to lithological and hydrogeological characteristics under unconfined conditions. Evaporation factor enhances groundwater salinity under aridity. Fe and Mn contents are relatively higher as the redox potential is getting more reducing. The current study will help in building suitable management plan to protect the aquifer.

Systematic review of Plasmodium knowlesi in Indonesia: a risk of emergence in the context of capital relocation to Borneo?

BACKGROUND: The Indonesian Republic plans to relocate its capital from Jakarta to East Kalimantan, Borneo Island, in the next few years. This relocation may be associated with deforestation, decreased biodiversity, and an increased risk of emerging zoonotic infections, including Plasmodium knowlesi malaria. The Malaysian part of Borneo Island is one of the main hotspots of P. knowlesi malaria. METHODS: Considering this risk, we evaluated the transmission dynamics of P. knowlesi in the Indonesian Archipelago based on a literature search and extensive review of data from the Indonesian Ministry of Health. RESULTS: We report that 545 P. knowlesi cases were documented in Indonesia, mainly in the Aceh and North Sumatra provinces, with 95% of these occurring in the last 4 years. CONCLUSIONS: The main P. knowlesi vectors are present in the area of the future capital, requiring strengthened surveillance to reduce the risk of emerging cases in a rapidly growing population.

Survival Outcomes After Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy in Patients with Synchronous Versus Metachronous Onset of Peritoneal Metastases of Colorectal Carcinoma.

BACKGROUND: Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is a treatment option for peritoneal metastases (PM) from colorectal carcinoma (CRC). Because of considerable morbidity, optimal patient selection is essential. This study was designed to determine the impact of the onset of PM (synchronous vs. metachronous) on survival outcomes after CRS-HIPEC. METHODS: Patients undergoing CRS-HIPEC for colorectal PM in two academic centers in the Netherlands between 2010 and 2020 were eligible for inclusion. Patients were classified as synchronous (s-PM, i.e., diagnosis at time of presentation, staging, or primary surgery) or metachronous onset (m-PM, i.e., diagnosis during follow-up) of colorectal PM. Survival outcomes were compared between groups by Kaplan-Meier survival and Cox regression analyses. RESULTS: Of 390 included patients, 179 (45.9%) had synchronous onset of colorectal PM. These patients more often presented with higher TN-stage and poor differentiation/signet cell histology. Treatment with perioperative chemotherapy was more common in s-PM patients. m-PM patients experienced more serious postoperative complications (Clavien-Dindo ≥ III). There was no significant difference in disease-free survival (DFS) between s-PM (median 9 months, interquartile range [IQR] 5-15) and m-PM patients (median 8 months, IQR 5-17). Overall survival (OS) was significantly shorter for s-PM (median 28 months, IQR 11-48) versus m-PM patients (median 33 months, IQR 18-66, p = 0.049). Synchronous onset of PM was not independently associated with OS in a multivariable analysis. CONCLUSIONS: Synchronous onset of colorectal PM was associated with poor tumor characteristics and more advanced disease, but was not an independent predictor of survival outcomes after CRS-HIPEC.

In Patients Undergoing CRS/HIPEC for Colorectal Adenocarcinoma with Peritoneal Metastases, Presence of Ascites on Computed Tomography Imaging is not a Prognostic Marker for Survival.

BACKGROUND: Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is a potentially curative treatment for patients with colorectal peritoneal metastases (CRPM). Patient selection is key to optimizing outcomes after CRS/HIPEC. The aim of this study was to determine the prognostic value of ascites diagnosed on preoperative imaging. METHODS: A prospective database of patients eligible for CRS/HIPEC between 2010 and 2020 was retrospectively analyzed. The presence of ascites, postoperative complications, overall survival (OS), disease-free survival (DFS), and completeness of cytoreduction were assessed. Univariable and multivariable logistic regression was performed to identify independent predictors for outcome. RESULTS: Of the 235 included patients, 177 (75%) underwent CRS/HIPEC while 58 (25%) were not eligible for CRS/HIPEC. In 42 of the 177 patients (24%) who underwent CRS/HIPEC, ascites was present on preoperative computed tomography (CT) imaging. Peritoneal Cancer Index (PCI) score was significantly higher in patients with preoperative ascites compared with patients without (11 [range 2-30] vs. 9 [range 0-28], respectively; p = 0.011) and complete cytoreduction was more often achieved in patients without ascites (96.3% vs. 85.7%; p = 0.007). There was no significant difference in median DFS and OS after CRS/HIPEC between patients with and without ascites {10 months (95% confidence interval [CI] 7.1-12.9) vs. 9 months (95% CI 7.2-10.8), and 25 months (95% 9.4-40.6) vs. 27 months (95% CI 22.4-31.6), respectively}. CONCLUSIONS: Ascites on preoperative imaging was not associated with worse survival in CRS/HIPEC patients with CRPM. Therefore, excluding patients from CRS/HIPEC based merely on the presence of ascites is not advisable.

Assessment of quantitative and semi-quantitative biological test methods of artesunate in vitro.

Artesunate is the current most potent antimalarial drug widely used for the treatment of malaria. Considering the emergence of artemisinin resistance, several situations may require a simple method for artesunate quantification. We thus developed a quantitative and a semi-quantitative biological method for the determination of artesunate in liquid samples. The tests are based on the measurement of samples' antimalarial activity on Plasmodium falciparum 3D7 using a modified SYBR Green I drug susceptibility test. For the quantitative test, we established a standard curve that resulted from a dose-response curve and evaluated its performances using controls samples. Whereas the linear regression analysis between artesunate concentration and antimalarial activity showed promising results (linearity range 1.5-24.6 ng/mL, r2 = 0.9373), we found that artesunate content of the controls was significantly overestimated (p = 0.0313). For the semi-quantitative test, we compared the antimalarial activities of samples collected during permeation studies of artesunate to that of a reference (artesunate IC50) by statistical analysis. We demonstrated that antimalarial activities of samples from permeation tests using a powder formulation of artesunate were greater than those of samples from tests using a solution formulation. Bioassays can be simple techniques to assess artesunate in liquid samples, particularly in resource-limited settings. Comparison with reference methods is still recommended when accurate drug quantification is required.

Title: Évaluation de méthodes de tests biologiques quantitatives et semi-quantitatives de l'artésunate in vitro. Abstract: L'artésunate est le médicament antipaludique le plus puissant actuellement, largement utilisé pour le traitement du paludisme. Compte tenu de l'émergence de la résistance à l'artémisinine, plusieurs situations peuvent nécessiter une méthode simple de quantification de l'artésunate. Nous avons ainsi développé un test biologique quantitatif et un test semi-quantitatif pour le dosage de l'artésunate dans des échantillons liquides. Les méthodes sont basées sur la mesure de l'activité antipaludique des échantillons sur Plasmodium falciparum 3D7 à l'aide d'un test de sensibilité aux médicaments SYBR Green I modifié. Pour le test quantitatif, nous avons établi une courbe standard issue d'une courbe dose-réponse et évalué ses performances à l'aide d'échantillons témoins. Alors que l'analyse de régression linéaire entre la concentration d'artésunate et l'activité antipaludique a montré des résultats prometteurs (gamme de linéarité de 1,5 à 24,6 ng/mL, r2 = 0,9373), nous avons constaté que la teneur en artésunate des témoins était significativement surestimée (p = 0,0313). Pour le test semi-quantitatif, nous avons comparé les activités antipaludiques d'échantillons collectés lors des études de perméation de l'artésunate à celle d'une référence (artésunate IC50) par analyse statistique. Nous avons démontré que les activités antipaludiques des échantillons provenant de tests de perméation utilisant une formulation en poudre d'artésunate étaient supérieures à celles des échantillons provenant de tests utilisant une formulation en solution. Les dosages biologiques peuvent être des techniques simples pour évaluer l'artésunate dans des échantillons liquides, en particulier dans les milieux à ressources limitées. La comparaison avec des méthodes de référence est toujours recommandée lorsqu'une quantification précise du médicament est requise.

Salinization of groundwater during 20 years of agricultural irrigation, Luxor, Egypt.

Groundwater salinization is a global problem accounting for 11-30% of the world's irrigated areas. Luxor region in Upper Egypt is one of such areas affected by salinity. Multivariate statistics indicate that groundwater is affected by intermixed processes; mineralization (salinization), fertilization, domestic wastes, and meteoric recharge. Temporal change in salinity and hydrochemical facies during 1997-2017 revealed aquifer salinization, due to the dissolution of salts from overlain saline soil and marine deposits underneath as well as up-coning of deep saline water. Increasing salinity over time was statistically documented, exhibited temporally high significant differences (P < 0.05), where salinization consumed a quarter of the aquifer during 20 years. Evolution of water facies from less mineralized Ca-Cl, Mg-Cl to highly mineralized Na-Cl species explains the salinization process over time. Elevated content of Na and Cl is associated with the dissolution of marine sediments and saltwater intrusion. The shift from silicate weathering into evaporation dominance confirmed the saltwater intrusion. As a result, groundwater has a high degree of salinity, is not suitable for domestic and other uses. On other hand, fertilization and domestic sewage are probably responsible for the high NO3- and Cd content. Over 80% of Cd exists in mobile species facilitates Cd-plant uptake indicating an alarming environmental situation. Cd mobility is closely related to elevated salinity and chlorinity, allowing competition with major ions and forming of soluble complexes. The present approach will improve the uncertainties of environmental interpretation, as an initial step for aquifers management in reclaimed lands.

Association between overcrowded households, multigenerational households, and COVID-19: a cohort study

IntroductionThe role of overcrowded and multigenerational households as a risk factor for COVID-19 remains unmeasured. The objective of this study is to examine and quantify the association between overcrowded and multigenerational households, and COVID-19 in New York City (NYC). MethodsWe conducted a Bayesian ecological time series analysis at the ZIP Code Tabulation Area (ZCTA) level in NYC to assess whether ZCTAs with higher proportions of overcrowded (defined as proportion of estimated number of housing units with more than one occupant per room) and multigenerational households (defined as the estimated percentage of residences occupied by a grandparent and a grandchild less than 18 years of age) were independently associated with higher suspected COVID-19 case rates (from NYC Department of Health Syndromic Surveillance data for March 1 to 30, 2020). Our main measure was adjusted incidence rate ratio (IRR) of suspected COVID-19 cases per 10,000 population. Our final model controlled for ZCTA-level sociodemographic factors (median income, poverty status, White race, essential workers), prevalence of clinical conditions related to COVID-19 severity (obesity, hypertension, coronary heart disease, diabetes, asthma, smoking status, and chronic obstructive pulmonary disease), and spatial clustering. Results39,923 suspected COVID-19 cases presented to emergency departments across 173 ZCTAs in NYC. Adjusted COVID-19 case rates increased by 67% (IRR 1.67, 95% CI = 1.12, 2.52) in ZCTAs in quartile four (versus one) for percent overcrowdedness and increased by 77% (IRR 1.77, 95% CI = 1.11, 2.79) in quartile four (versus one) for percent living in multigenerational housing. Interaction between both exposures was not significant ({beta}interaction = 0.99, 95% CI: 0.99-1.00). ConclusionsOver-crowdedness and multigenerational housing are independent risk factors for suspected COVID-19. In the early phase of surge in COVID cases, social distancing measures that increase house-bound populations may inadvertently but temporarily increase SARS-CoV-2 transmission risk and COVID-19 disease in these populations.

Social and Clinical Determinants of COVID-19 Outcomes: Modeling Real-World Data from a Pandemic Epicenter

IMPORTANCEAs the United States continues to accumulate COVID-19 cases and deaths, and disparities persist, defining the impact of risk factors for poor outcomes across patient groups is imperative. OBJECTIVEOur objective is to use real-world healthcare data to quantify the impact of demographic, clinical, and social determinants associated with adverse COVID-19 outcomes, to identify high-risk scenarios and dynamics of risk among racial and ethnic groups. DESIGNA retrospective cohort of COVID-19 patients diagnosed between March 1 and August 20, 2020. Fully adjusted logistical regression models for hospitalization, severe disease and mortality outcomes across 1-the entire cohort and 2-within self-reported race/ethnicity groups. SETTINGThree sites of the NewYork-Presbyterian health care system serving all boroughs of New York City. Data was obtained through automated data abstraction from electronic medical records. PARTICIPANTSDuring the study timeframe, 110,498 individuals were tested for SARS-CoV-2 in the NewYork-Presbyterian health care system; 11,930 patients were confirmed for COVID-19 by RT-PCR or covid-19 clinical diagnosis. MAIN OUTCOMES AND MEASURESThe predictors of interest were patient race/ethnicity, and covariates included demographics, comorbidities, and census tract neighborhood socio-economic status. The outcomes of interest were COVID-19 hospitalization, severe disease, and death. RESULTSOf confirmed COVID-19 patients, 4,895 were hospitalized, 1,070 developed severe disease and 1,654 suffered COVID-19 related death. Clinical factors had stronger impacts than social determinants and several showed race-group specificities, which varied among outcomes. The most significant factors in our all-patients models included: age over 80 (OR=5.78, p= 2.29x10-24) and hypertension (OR=1.89, p=1.26x10-10) having the highest impact on hospitalization, while Type 2 Diabetes was associated with all three outcomes (hospitalization: OR=1.48, p=1.39x10-04; severe disease: OR=1.46, p=4.47x10-09; mortality: OR=1.27, p=0.001). In race-specific models, COPD increased risk of hospitalization only in Non-Hispanics (NH)-Whites (OR=2.70, p=0.009). Obesity (BMI 30+) showed race-specific risk with severe disease NH-Whites (OR=1.48, p=0.038) and NH-Blacks (OR=1.77, p=0.025). For mortality, Cancer was the only risk factor in Hispanics (OR=1.97, p=0.043), and heart failure was only a risk in NH-Asians (OR=2.62, p=0.001). CONCLUSIONS AND RELEVANCEComorbidities were more influential on COVID-19 outcomes than social determinants, suggesting clinical factors are more predictive of adverse trajectory than social factors. KEY POINTSO_ST_ABSQUESTIONC_ST_ABSWhat is the impact of patient self-reported race, ethnicity, socioeconomic status, and clinical profile on COVID-19 hospitalizations, severity, and mortality? FINDINGSIn patients diagnosed with COVID-19, being over 50 years of age, having type 2 diabetes and hypertension were the most important risk factors for hospitalization and severe outcomes regardless of patient race or socioeconomic status. MEANINGIn this large sample pf patients diagnosed with COVID-19 in New York City, we found that clinical comorbidity, more so than social determinants of health, was associated with important patient outcomes.

Optimization of taste-masked dapoxetine oral thin films using factorial design: in vitro and in vivo evaluation.

Dapoxetine HCl is used for the treatment of premature ejaculation. Dapoxetine is primarily metabolized in the liver and kidney and its metabolites are inactive; resulting in reduced bioavailability. Also, one of the commonly encountered issues in the oral dapoxetine formulae is its bitter taste. Thus, the objective of this study was to develop and to optimize novel dapoxetine taste-masked oral thin films (OTFs), to offer a faster dissolution rate, rapid release pattern, lower liver metabolism, and better patient compliance. To achieve our goal, the applicability of either pullulan or maltodextrin as strip forming polymers were investigated in the preparation of (OTFs), while glycerol was used as a plasticizer. Also, the physicochemical characteristics of dapoxetine in a resinate complex with AmberLiteTM -IRP69 as taste masking were evaluated. Furthermore, a 23 factorial design was used to study and to optimize the effect of the independent variables (strip forming polymer (X1), glycerol (X2) and AmberLiteTM (X3) amounts) on the disintegration time (Y1), degree of elongation (Y2), and degree of in vitro drug release in phosphate buffer pH 6.8 at 5 minutes (Q5min, Y3) as responses. P2 batch (OTF) (pullulan 96 mg, glycerol 12 mg, AmberLiteTM 32 mg, and dapoxetine 30 mg) was identified as an optimized formulation showing an in vitro disintegration time 9.33 s, 35.56% elongation, and 91.43% Q5min; excellent in vivo disintegration time; good overall taste acceptability and stable resinate complex.

Facile Fabrication of ZnMgAl/LDH/Algae Composites as a Potential Adsorbent for Cr(VI) Ions from Water: Fabrication and Equilibrium Studies.

In order to improve the adsorption capacity of natural layered double hydroxyl (LDH) materials, the natural organic sources such as algae containing hydroxyl groups, amino groups, peptide connections, and alginate structures were used to improve LDH for the preparation of ZnMgAl LDH-algae composites (LDH-Ax). The structure of prepared composites was established and characterized via various techniques such as scanning electron microscopy, X-ray diffraction, and Fourier transform infrared spectroscopy. The LDH-A2 sample displayed the highest efficiency for Cr(VI) removal, which reached to 99% at the optimum conditions. The prepared composite LDH-A2 showed high stability and reusability (91.7%) after five cycles. The kinetic studies revealed that the Cr uptake by LDH-A1 is described as pseudo-first order, while the case of LDH-A2 is described as pseudo-second order. This study reported that the easily synthesized LDH-Ax has an interesting environmental approval process to eliminate Cr ions from aqueous media quickly and effectively.

Environmental factors controlling potentially toxic element behaviour in urban soils, El Tebbin, Egypt.

This study focuses on the assessment of surface soils from industrially polluted region (El Tebbin) of southern Cairo, Egypt. The impact of agricultural, residential and industrial land use on soils developed from Nile river sediments has significantly compromised their function. Previous evidence has shown that the food chain is contaminated and enhances risk of contaminant exposure of the residential communities. This study investigates factors controlling potentially toxic element (PTE) distribution (Co, Ni, Pb, Cd, Zn, Cr and Cu) in El Tebbin soils and provide estimates of their mobility and bioavailability. The PTE concentrations are characterised by high variability as result of the variety of natural and anthropogenic influences. Highest spatial variability is found for Zn, Cd, Pb and Cu (C.V = 260.0%, 280.4%, 140.8% and 159.6% respectively) and enrichment factors indicate strong anthropogenic inputs. For Co and Ni, relatively low spatial variability (C.V = 65.8% and 45.0% respectively) with depletion in Ni suggests a relatively minor contribution from anthropogenic sources. For Cr, a more uniform distribution pattern showing depletion to minimal enrichment across the study area (C.V = 19.2%) reflects almost exclusive lithogenic control. Using principle component analysis (PCA) to explore concentration data reveals that the major inputs affecting PTE distribution are modified by primary soil properties (texture and pH). Their relative bioavailability (identified through sequential chemical extraction) relates strongly to local input sources. Those elements dominated by lithogenic input (Ni and Co) were found predominantly in soil residual fractions (95.6% and 90.5% respectively), while elements with stronger anthropogenic contributions (Cd, Zn, Pb and Cu) showed much higher portion in the more mobile and bioavailable fractions obtained from sequential chemical extraction, with average proportions of the totals being 62.6%, 57%, 40.7% and 39.2% respectively. Those PTEs with strong anthropogenic influence are potentially much more mobile for bioaccumulation in food chain with increased health risk for exposed residents and are confirmed by elevated concentrations of Cd, Zn, Pb and Cu recorded in local plant species. The main pollution sources were further highlighted by cluster analysis and showed vehicle traffic and specific industrial activities but which varied significantly from site to site. The identification of sources through the approach developed here allows prioritisation of monitoring and regulatory decisions by the local government to reduce further environmental exposure of the local population.

The prognostic value of left ventricular function on sepsis outcomes in critical care unit patients

Background: Sepsis is the most prevalent life menacing condition presupposed patients' admission to intensive care units. The underlying cardiovascular consequences of sepsis comprehended marvelous increase of the cardiac output, reduction of the peripheral vascular resistance along with impaired capillary permeability.Aim of the study: The present investigation was implemented to retrieve the prognostic value of LVF assessment using speckle tracking echocardiography (STE) among Egyptian adults, who admitted to the intensive care unit as a resultant impact of sepsis or septic shock.Methods: Patients admitted at the Critical Care Unit, who initially diagnosed with sepsis or septic shock within 8 hours. After fulfilling their criteria and being aged more than 18 years, they were eligible for inclusion in the study. All participants were submitted to rigorous history taking, clinical evaluation, laboratory assessment, and STE. The study embraced an overall 50 patients.Results: Left ventricular longitudinal strain (LVGLS) was the only parameter which attained statistically significant highly positive correlation with SOFA score among septic shock patients (r = 0.794, p = 0.021). The results of this model revealed that LVGLS (p<0.001) attained high ability in the prediction of Sepsis-related Organ Failure Assessment (SOFA) score and Acute Physiologic and Chronic Health Evaluation (APACHE) score.Conclusions: The capability of STE investigation for the detection of left ventricular dysfunction among septic or septic shocked critically ill patients is a promising and feasible approach, which have a crucial impact on the prognosis of such patients

Impact of Subtotal Parathyroidectomy on Clinical Parameters and Quality of Life in Hemodialysis Patients with Secondary Hyperparathyroidism

BACKGROUND: Impairment of quality of life (QOL) is a key clinical characteristic of patients with end-stage renal disease (ESRD), and can be especially severe in the presence of secondary hyperparathyroidism (SHPT). Despite the proven success of parathyroidectomy (PTX) in controlling biochemical parameters in patients with severe SHPT, evidence is lacking regarding the effects of PTX on various clinical outcomes, including QOL.METHODS: Twenty ESRD patients on maintenance hemodialysis with SHPT who underwent subtotal PTX were included in an observational longitudinal study. All studied patients underwent history-taking, clinical examinations, and laboratory investigations, including a complete blood count and measurements of serum calcium, phosphorus, magnesium, parathyroid hormone (PTH), and albumin levels preoperatively and at 3 months postoperatively. QOL was assessed before surgery and at 3 months after surgery using the Kidney Disease Quality of Life 36-Item Short-Form instrument.RESULTS: After PTX, significant decreases in serum PTH and phosphorus levels were observed, as well as a significant increase in serum magnesium levels. Significant weight gain and improvements of QOL were also detected postoperatively.CONCLUSION: Subtotal PTX seems to be an efficient alternative to medical management in uncontrolled cases of SHPT, as it is capable of controlling the biochemical derangements that occur in hyperparathyroidism. Furthermore, PTX had a beneficial effect on clinical outcomes, as shown by weight gain and improvements in all QOL scales.

Baclofen novel gastroretentive extended release gellan gum superporous hydrogel hybrid system: in vitro and in vivo evaluation.

Baclofen is a centrally acting skeletal muscle relaxant with a short elimination half-life, which results in frequent daily dosing and subsequent poor patient compliance. The narrow absorption window of baclofen in the upper gastrointestinal tract limits its formulation as extended release dosage forms. In this study, baclofen extended release superporous hydrogel (SPH) systems, including conventional SPH, SPH composite and SPH hybrid (SPHH), were prepared aiming to increase the residence of baclofen at its absorption window. The applicability of different polymers, namely, gellan gum, guar gum, polyvinyl alcohol and gelatin, was investigated in preparation of SPHH systems. The prepared SPH systems were evaluated regarding weight and volume swelling ratio, porosity, mechanical properties, incorporation efficiency, degree of erosion and drug release. In vivo assessment was performed in dogs to evaluate gastric residence time by X-ray studies. In addition, the oral bioavailability of baclofen relative to commercially available Lioresal® immediate release tablets was also investigated. The novel baclofen gellan SPHH cross linked with calcium chloride was characterized by optimum mechanical properties, acceptable swelling properties as well as extended drug release. It also exhibited a prolonged plasma profile when compared to twice daily administered Lioresal®.

Distribution of 222Rn concentration in an inhabited area adjacent to the Aja granitic heights of Hail Province, Saudi Arabia.

Radon-222 has been measured in groundwater, dwellings, and atmosphere of an inhabited area adjacent to the granitic Aja heights of Hail province, Saudi Arabia. The measurements were carried out in the field using a RAD7 instrument. Twenty-eight water samples, collected from drilled wells scattered in the region, were analyzed. Radon-222 concentration ranged from 2.5-95 kBq m(-3) with an average value of about 30.3 kBq m(-3). The higher values were found in wells drawing water from granitic aquifers. Indoor 222Rn was measured in 20 dwellings of rural areas in Hail city and other towns. Concentrations ranged from 12-125.6 Bq m(-3), with an average value of 54.6 Bq m(-3). Outdoor air 222Rn was measured at 16 sites, with values ranging from 6.2-13.3 Bq m(-3), with an average value of 10.5 Bq m(-3). The estimated average effective dose due to inhalation of 222Rn released from water was 0.08 mSv y(-1). The estimated average annual effective dose due to indoor 222Rn was 1.35 mSv, which lies below the effective dose range (3-10 mSv) given as the recommended action level. Based on the average dose rate values, the excess lifetime cancer risk values were estimated as 69.8 × 10(-4) due to indoor radon and 13.4 × 10(-4) due to outdoor radon.