Under cadmium stress, silicon has a defensive effect on the morphology, physiology, and anatomy of pea (Pisum sativum L.) plants.

Soil pollution with cadmium (Cd) is a serious threat to plant growth and development. On the other hand, silicon (Si) can support plants to cope with Cd stress. However, the Cd stress mitigating impact of Si reduction in pea (Pisum sativum L.) is not known. The objective of this study is to see if and how Si can reduce Cd toxicity. To the end, a greenhouse pot experiment was performed twice during the 2018/2019 and 2019/2020 seasons to investigate the effect of Si on the growth, anatomy, and biochemistry of Cd stressed peas plants. Cd exposure increased the contents of Cd ions in the root and shoot of pea plants. Consequentially, Cd accumulation in pea tissue significantly reduced plant growth i.e., plant height, leaf area, and shoot and root dry weights. The effect of Cd was concentration-dependent, where at low concentration (50 mg/kg soil), the plant height was 94.33 and 97.33cm and at high concentration (100 mg/kg soil), it was 89.0 and 91.0 cm in the two seasons, respectively. This growth reduction can be explained by the decrease in plants' photosynthesis, whereas plants exposed to Cd toxicity had lower chlorophyll levels. At the anatomy level, high Cd concentrations resulted in anatomical abnormalities such as an unusual vascular system, abnormal lignification in the pith parenchyma, and enlarged cortical cells. Moreover, all Cd concentrations resulted in a highly significant decrease in stomatal area and stomatal density (the number of stomata per mm2). In addition to growth inhibition, Cd-induced oxidative damage to pea plants as indicated by increased hydrogen peroxide (H2O2) and Malondialdehyde (MDA) levels. To reduce stress toxicity, plants treated with Cd at 50 and 100 (mg/kg) showed a significant increase in antioxidant capacity. Peroxidase (POD) enzyme activity was significantly increased by 41.26%, 28.64%, 77.05%, and 60.77% in both seasons, respectively. Si at 300 ppm under Cd (100 mg/kg) stress conductions considerably reduced (MDA) contents by 29.02% and 29.12%, in the two seasons, respectively. The findings pointed out that Si's ability to protect pea against the oxidative stress caused by Cd toxicity.

Nano-selenium, silicon and H2O2 boost growth and productivity of cucumber under combined salinity and heat stress.

The production of cucumber under combined salinity and heat stress is a crucial challenge facing many countries particularly in arid environments. This challenge could be controlled through exogenous foliar application of some bio-stimulants or anti-stressors. This study was carried out to investigate the management and improving cucumber production under combined salinity and heat stress. Nano-selenium (nano-Se, 25 mg L-1), silicon (Si, 200 mg L-1) and hydrogen peroxide (H2O2, 20 mmol L-1) were foliar applied on cucumber plants as anti-stress compounds. The results revealed that studied anti-stressors improved growth and productivity of cucumber grown in saline soil regardless the kind of anti-stressor under heat stress. The foliar application of nano-Se (25 mg L-1) clearly improved cucumber growth parameters (plant height and leaf area) compared to other anti-stressor and control. Foliar Si application showed the greatest impact on enzymatic antioxidant capacities among the other anti-stressor treatments. This applied rate of Si also showed the greatest increase in marketable fruit yield and yield quality (fruit firmness and total soluble solids) compared to untreated plants. These increases could be due to increasing nutrient uptake particularly N, P, K, and Mg, as well as Se (by 40.2% and 43%) in leaves and Si (by 11.2% and 22.1% in fruits) in both seasons, respectively. The potential role of Si in mitigating soil salinity under heat stress could be referred to high Si content found in leaf which regulates water losses via transpiration as well as high nutrient uptake of other nutrients (N, P, K, Mg and Se). The distinguished high K+ content found in cucumber leaves might help stressed plants to tolerate studied stresses by regulating the osmotic balance and controlling stomatal opening, which support cultivated plants to adapt to soil salinity under heat stress. Further studies are needed to be carried out concerning the different response of cultivated plants to combined stresses.

Nomenclature and definition of metabolic-associated fatty liver disease: a consensus from the Middle East and north Africa.

With the increasing prevalence of obesity and type 2 diabetes, fatty liver disease associated with metabolic dysfunction is a global health problem, especially because it is one of the earliest consequences of obesity and it precedes diabetes development. Fatty liver disease associated with metabolic dysfunction is of particular concern in the Middle East and north Africa, where its prevalence is greater than that in the rest of the world. Despite the magnitude of the problem, no regional guidelines have been developed to address this disease. This Review describes suggestions of redefining fatty liver disease associated with metabolic dysfunction, including its terminology and criteria for diagnosis. Experts have raised serious concerns on the current nomenclature, which labels the disease as non-alcoholic fatty liver disease (NAFLD), and its diagnostic criteria. The panel reached a consensus that the disease should be renamed as metabolic-associated fatty liver disease (MAFLD) and that the disease should be diagnosed by positive criteria. The aim is now to work with authorities across the region to implement these proposed changes and reflect them in health-care policy and to improve health care for patients in this region.

Hemodynamic Changes of Hepatic & Renal Vessels in Systemic Bacterial Infection with Fever in HCV Related Cirrhosis.

OBJECTIVES: To study the hemodynamic changes of hepatic & renal vessels in systemic bacterial infection with fever in HCV related cirrhosis with possible complications. METHODS: Three groups of patients with systemic bacterial infection with fever were included in the study; group І included 15 patients with decompensated cirrhosis, group ІІ included 15 patients with compensated cirrhosis and group ІІІ included 10 patients without liver affection. Laboratory parameters and Doppler US of hepatic and renal vessels were evaluated during and after subsidence of fever in all patients. RESULTS: Forty patients were enrolled in this prospective study. There were 22 male and 18 female patients. We found that the direction of blood flow in the portal and splenic veins was hepatopetal and the veins were non pulsatile in all cases with no change during and after subsidence of infection. There was no significant difference in portal or splenic vein diameters during and after subsidence of infection in the three studied groups. However, the mean values of portal and splenic veins peak velocities were significantly lower during infection in cirrhotic groups. The mean value of hepatic artery resistive index during fever was significantly higher than after fever in cirrhotic groups. Renal resistive and pulsatility indices were significantly higher during fever in cirrhotic groups. CONCLUSION: Systemic bacterial infection with fever can affect hepatic haemodynamics leading to aggravation of portal hypertension and increasing the risk of complications as variceal bleeding and hepatic encephalopathy and can also affect renal haemodynamics with increased risk of renal impairment.

Efficacy and safety of sofosbuvir plus ribavirin for treatment of cirrhotic patients with genotype 4 hepatitis C virus in real-life clinical practice.

Egypt has the highest hepatitis C virus (HCV) prevalence in the world. Sofosbuvir is a new highly effective drug for treatment of HCV infection. Compared to previous treatments, sofosbuvir-based regimens provide a higher cure rate, fewer side effects, and a two- to fourfold reduced duration of therapy. The aim of this study was to evaluate the antiviral efficacy, safety, and tolerability of sofosbuvir plus ribavirin in Egyptian patients with liver cirrhosis due to chronic HCV infection. We studied 2400 cirrhotic Egyptian patients with chronic HCV infection who were treated with dual therapy with sofosbuvir and ribavirin for 24 weeks. Efficacy was determined by assessment of serum HCV RNA. Any adverse events during treatment were recorded. Two thousand four hundred cirrhotic Egyptian patients with chronic HCV infection treated with sofosbuvir and ribavirin for 24 weeks were enrolled in the study. The mean age of the studied group (± SD) was 53.9 ± 6.5 years, 1549 (64.54%) were males, all were cirrhotic patients, 3.41% were treatment-experienced, the baseline mean HCV RNA concentration was 4.33 × 106 IU/mL, and 94.37% of the patients had completed the full course of therapy. The overall SVR12 rate was 71.2%. The most common adverse events were fatigue, myalgia, headache, insomnia, and anemia. One hundred thirty-five (5.63%) patients stopped treatment permanently due to the appearance of complications that prevented continuation of treatment. The sofosbuvir and ribavirin combination is safe and effective in treatment of HCV patients with liver cirrhosis. However, further studies are needed to establish the optimal treatment regimen for those cases.

Anti-Nuclear Cytoplasmic Antibody-Associated Vasculitis: A Probable Adverse Effect of Sofosbuvir Treatment in Chronic Hepatitis C Patients.

Background: Egypt has the largest hepatitis C virus (HCV) epidemic worldwide. Sofosbuvir is an antiviral drug acting by inhibition of the HCV NS5B polymerase. It has shown high efficacy in combination with several other drugs and has a low reported rate of side effects. Objective: The aim of this prospective cohort study was to assess the safety of sofosbuvir-based treatment regimens used to treat chronic hepatitis C infections and to detect any side effects of sofosbuvir not previously reported. Methods: We studied treatment side effects in 3,000 patients with chronic HCV infection treated with sofosbuvir and ribavirin for 24 weeks or treated by pegylated interferon, sofosbuvir, and ribavirin triple therapy for 12 weeks. The endpoint of the study was the end of treatment. Results: Hyperbilirubinemia occurred frequently during treatment in both groups. Treatment was discontinued in 72 cases due to hepatic decompensation and drug complications; 8 of the cases had deep vein thrombosis (DVT) and 7 had cerebral ischemia. Surprisingly, 177/3,000 (5.9%) patients presented with abnormal bleeding, 85 of whom had a vasculitic skin rash. Conclusion: We report the occurrence of previously nonrecorded side effects with sofosbuvir, namely DVT and bleeding disorders associated with anti-nuclear cytoplasmic antibody (ANCA)-associated vasculitis (AAV).We believe this to be the first report of sofosbuvir-induced AAV skin lesions and bleeding disorders.

Pigtail Catheter: A Less Invasive Option for Pleural Drainage in Egyptian Patients with Recurrent Hepatic Hydrothorax.

Background and Aims. Treatment of hepatic hydrothorax is a clinical challenge. Chest tube insertion for hepatic hydrothorax is associated with high complication rates. We assessed the use of pigtail catheter as a safe and practical method for treatment of recurrent hepatic hydrothorax as it had not been assessed before in a large series of patients. Methods. This study was conducted on 60 patients admitted to Tanta University Hospital, Egypt, suffering from recurrent hepatic hydrothorax. The site of pigtail catheter insertion was determined by ultrasound guidance under complete aseptic measures and proper local anesthesia. Insertion was done by pushing the trocar and catheter until reaching the pleural cavity and then the trocar was withdrawn gradually while inserting the catheter which was then connected to a collecting bag via a triple way valve. Results. The use of pigtail catheter was successful in pleural drainage in 48 (80%) patients with hepatic hydrothorax. Complications were few and included pain at the site of insertion in 12 (20%) patients, blockage of the catheter in only 2 (3.3%) patients, and rapid reaccumulation of fluid in 12 (20%) patients. Pleurodesis was performed on 38 patients with no recurrence of fluid within three months of observation. Conclusions. Pigtail catheter insertion is a practical method for treatment of recurrent hepatic hydrothorax with a low rate of complications. This trial is registered with ClinicalTrials.gov Identifier: NCT02119169.

Metabolome classification of Brassica napus L. organs via UPLC-QTOF-PDA-MS and their anti-oxidant potential.

INTRODUCTION: Brassica napus L. is a crop widely grown for its oil production and other nutritional components in the seed. In addition to the seed, other organs contain a wide range of phenolic metabolites although they have not been investigated to the same extent as in seeds. OBJECTIVE: To define and compare the phytochemical composition of B. napus L. organs, namely the root, stem, leaf, inflorescence and seeds. METHOD: Non-targeted metabolomic analysis via UPLC-QTOF-MS was utilised in order to localise compounds belonging to various chemical classes (i.e. oxygenated fatty acids, flavonols, phenolic acids and sinapoyl choline derivatives). RESULTS: The vast majority of identified metabolites were flavonol glycosides that accumulated in most of the plant organs. Whereas other classes were detected predominantly in specific organs, i.e. sinapoyl cholines were present uniquely in seeds. Furthermore, variation in the accumulation pattern of metabolites from the same class was observed, particularly in the case of quercetin, kaempferol and isorhamnetin flavonols. Anti-oxidant activity, based on 2,2-diphenyl-1-picrylhdrazyl analysis was observed for all extracts, and correlated to some extent with total flavonoid content. CONCLUSION: This study provides the most complete map for polyphenol composition in B. napus L. organs. By describing the metabolites profile in B. napus L., this study provides the basis for future investigations of seeds for potential health and/or medicinal use.