Predicted efficacy of the Palestinian wheat flour fortification programme: complementary analysis of biochemical and dietary data.

OBJECTIVE: To utilize complementary biochemical and dietary data collected before the initiation of national flour fortification to (i) identify micronutrient insufficiencies or deficiencies and dietary inadequacies in Palestinian women and children in vulnerable communities and (ii) assess the suitability of the current wheat flour fortification formula. DESIGN: Quantitative dietary intake questionnaires were administered and fasting venous blood samples collected in randomly selected households in Gaza City and Hebron. The impact of fortification was simulated by estimating the additional micronutrient content of fortified wheat flour. SETTING: Households in Gaza City and Hebron that were not receiving food aid from social programmes. SUBJECTS: Non-pregnant women (18-49 years) and children aged 36-83 months. RESULTS: The micronutrients with highest prevalence of insufficiency were vitamin D in women (84-97 % with serum 25-hydroxyvitamin D <50 nmol/l) and vitamin B12 in women and children (43-82 % with serum B12 <221 pmol/l). Deficiencies of vitamin A, Fe and Zn were also of public health concern. Current levels of wheat flour fortificants were predicted to improve, but not eliminate, micronutrient intake inadequacies. Modification of fortificant concentrations of vitamin D, thiamin, vitamin B12, Zn and folic acid may be indicated. CONCLUSIONS: Micronutrient insufficiencies or deficiencies and intake inadequacies were prevalent based on either biochemical or dietary intake criteria. Adjustments to the current fortification formula for wheat flour are necessary to better meet the nutrient needs of Palestinian women and children.

Factors Affecting the Awareness of Diabetic Retinopathy: An Observational Cross-Sectional Study.

BACKGROUND: Diabetes mellitus (DM) is a chronic metabolic disease characterized by elevated blood glucose levels. Over time, it can lead to serious complications in the eyes, heart, blood vessels, kidneys, and nerves, being the leading cause of blindness among working-age patients. AIM AND METHODS: This descriptive observational cross-sectional study aims to evaluate the factors affecting the awareness of the general adult diabetic population about their chronic disease and its complications. A survey was distributed anonymously among diabetic patients in different parts of Jordan over four months (January 2023-April 2023), targeting diabetic patients (DMT2 or adults DMT1). The link was sent via WhatsApp to willing candidates. Data collected included age, sex, region, education, home blood sugar (BS) testing, knowledge about cumulative blood sugar test (HbA1c), eye affection by DM, optician role, and doctor and nutritionist follow-up visits. A chi-squared test or Fisher's exact test explored the association between categorical data; a z-test was applied for column proportion differences. An alpha level of 0.05 was deemed statistically significant. IBM SPSS Statistics for Windows, Version 28 (Released 2021; IBM Corp., Armonk, New York) was used for data analysis. RESULTS: The sample comprised 447 diabetic adults aged 18-80 years. The majority were school-educated or school leavers (278; 62.2%); 20 (4.5%) held a master's or PhD degree. The largest group had DM for one to five years. Insulin was the sole treatment for 188 patients (42.1%), while oral hypoglycemic agents (OHA) were used by 170 patients (38%) as the only anti-DM medication. A total of 174 patients (38.9%) had never been seen by an ophthalmologist, and 153 (34.2%) believed an optometrist checkup suffices. Although 381 (85.2%) reported knowing DM affects the eyes, 272 (60.9%) believed they needed to see an ophthalmologist only when experiencing eye symptoms. Less than half (186; 41.6%) had an HbA1c reading of 7% or less. There was a significant correlation between education level and awareness of DM and diabetic retinopathy (DR): HbA1c, regular home BS checkups, early DR symptoms, and optometrist visits. Significant variations in awareness were noted across Jordan's major areas. Diabetics with abnormal HbA1c who visited a nutritionist were almost triple those who did not. The main information source about DM and DR was the treating physician for 298 (66.7%) respondents. CONCLUSION: Awareness of DM and DR in Jordan is not satisfactory for assisting patients in their long journey with minimal complications. A national awareness campaign utilizing social media and a sustainable screening program prioritizing the north, south, and middle regions of Jordan are needed.

Adherence to guidelines in the follow-up of non-muscle-invasive bladder cancer among urology trainers and trainees in Jordan: a cross-sectional study.

To assess the clinical practice in the follow-up of non-muscle-invasive bladder cancer (NMIBC) among urology specialists (trainers) and residents (trainees) in Jordan. Methods: An electronic questionnaire containing, in addition to demographic data, four questions regarding the follow-up of NMIBC was sent by e-mail to 115 urologists (53 residents and 62 specialists) selected randomly by stratified random sampling from different clinical institutions, 105 of them were returned complete. Results: In all, 105 out of 115 (91%) questionnaires were returned complete. All of the candidates are male. For low-risk NMIBC follow-up, 46 of the specialists (79%) and 35 of the trainees (74%) decided to do a follow-up cystoscopy at 3 months after diagnosis, followed by a check cystoscopy 9 months later than yearly, while for high-risk patients, all of the specialists and 45 of the trainees (96%) decide to do a check cystoscopy every 3 months in the first 2 years after diagnosis. For upper tract follow-up in high-risk NMIBC, all of the urologists in the survey (specialists and trainees) routinely perform upper tract imaging in the form of a computed tomography scan with contrast in the first year after diagnosis. On the other hand, in the follow-up of the upper urinary tract in low-risk NMIBC, 16 of the trainees (34%) and 19 of the specialists (33%) still perform a yearly scan. Conclusion: Because of the high recurrence rate for NMIBC, this raises the importance of adherence to guidelines in the follow-up for these patients and, at the same time to avoid overdoing unnecessary cystoscopies or upper tract scans.

The role of living/controlled radical polymerization in the formation of improved imprinted polymers.

In this work, living/controlled radical polymerization (LRP) is compared with conventional free radical polymerization in the creation of highly and weakly cross-linked imprinted poly(methacrylic acid-co-ethylene glycol dimethacrylate) networks. It elucidates, for the first time, the effect of LRP on the chain level and begins to explain why the efficiency of the imprinting process is improved using LRP. Imprinted polymers produced via LRP exhibited significantly higher template affinity and capacity compared with polymers prepared using conventional methods. The use of LRP in the creation of highly cross-linked imprinted polymers resulted in a fourfold increase in binding capacity without a decrease in affinity; whereas weakly cross-linked gels demonstrated a nearly threefold increase in binding capacity at equivalent affinity when LRP was used. In addition, by adjusting the double bond conversion, we can choose to increase either the capacity or the affinity in highly cross-linked imprinted polymers, thus allowing the creation of imprinted polymers with tailorable binding parameters. Using free radical polymerization in the creation of polymer chains, as the template-monomer ratio increased, the average molecular weight of the polymer chains decreased despite a slight increase in the double bond conversion. Thus, the polymer chains formed were shorter but greater in number. Using LRP neutralized the effect of the template. The addition of chain transfer agent resulted in slow, uniform, simultaneous chain growth, resulting in the formation of longer more monodisperse chains. Reaction analysis revealed that propagation time was extended threefold in the formation of highly cross-linked polymers when LRP techniques were used. This delayed the transition to the diffusion-controlled stage of the reaction, which in turn led to the observed enhanced binding properties, decreased polydispersity in the chains, and a more homogeneous macromolecular architecture.

Psychological Distress among Hospitalized COVID-19 Patients in Denmark during the First 12 Months of the Pandemic.

This study aimed to investigate psychological distress among patients hospitalized with a COVID-19 diagnosis in Denmark during the first 12 months of the pandemic and to assess changes in psychological distress in the three months following discharge. A single-center prospective observational survey study among patients hospitalized with a COVID-19 diagnosis between May 2020 and May 2021 was conducted. Participants completed a survey at three time points: at admission, and 1 and 3 months after discharge. Psychological distress was assessed by validated scales measuring symptoms related to depression, anxiety, stress, insomnia, post-traumatic stress disorder (PTSD), and health-related quality of life (HRQoL). In total, 95 patients were included. At admission, the proportion of patients with symptoms of depression was 43%, symptoms of anxiety 32%, moderate/high level of stress 39%, insomnia 52%, and probable/positive PTSD 19%. The burden of symptoms related to depression and anxiety decreased significantly over time, while there was no significant change over time in stress, insomnia, or PTSD. Suboptimal levels of physical and mental HRQoL were detected at admission but improved over time. Patients hospitalized due to COVID-19 during the first year of the pandemic experienced considerable levels of psychological distress at admission, with some improvements within 3 months after discharge.

Myelomatous Pleural Effusion: A Rare Case Report and Literature Review.

Multiple myeloma (MM) is typically characterized by the neoplastic proliferation of plasma cells producing a monoclonal immunoglobulin. Pleural effusion in MM is uncommon and usually caused by heart failure, pulmonary embolus, and nephrotic syndrome [Arch Intern Med. 1978;138(5):727-30; Chest. 1994;105(2):622-4]. Here, we report a case of myelomatous pleural effusion as part of the initial presentation of MM in a patient with the IgG-lambda subtype, which is extremely uncommon.

Prevelance of depression and anxiety with their effect on quality of life in chronic kidney disease patients.

Chronic kidney disease is one of the most common chronic diseases globally. Many studies have shown it is strongly associated with increased social and psychological problems such as depression and anxiety which are considered as common psychiatric disorders that occur in patients with chronic kidney disease. We investigated the prevalence of depression, anxiety and perception of quality of life in a sample of chronic kidney disease patients at the Jordan University Hospital. We aimed to see any association of the mental health in these patients; mainly depression and anxiety with their quality of life and correlation to socio-demographics or laboratory and metabolic profile of this population. 103 chronic kidney disease patients were interviewed using a questionnaire in the Nephrology outpatient clinics of the Jordan University Hospital, the questionnaire included four sections, the first sections handled socio-demographic data. Also, it contains a brief Clinical and laboratory parameter of our patients. The second part consisted of the 9-item Patient Health Questionnaire (PHQ-9) that used to measure the severity of depression. The third part included the 7-item Generalized Anxiety Disorder (GAD-7) to evaluate the severity of anxiety, the fourth part assessed participants quality of life (QOL) using The World Health Organization Quality of Life, Short Form (WHOQOL-BREF) questionnaire. More than half of the participants have depression and anxiety with a percentage of 58.3% and 50.5%, respectively. There was a negative moderate to strong correlation between depression score and quality of life domains scores (p < 0.001).Only marital status had a significant relationship with depression (p < 0.001).Weak positive correlation between Glomerular Filtration Rate and anxiety score (p = 0.04),with significant positive correlation between lipid profile and anxiety score. There was a negative correlation between anxiety score and quality of life domains scores. Females had higher anxiety score than males (p = 0.27). Patients who do not work had a lower physical functioning score compared to others (p value = 0.024).Patients with higher serum Hemoglobin had higher physical and psychological scores. Anxiety, Depression are common among our chronic kidney disease patients, more interventions are needed to improve the mental health of our patients and their quality of life perception. This kind of study allows us to gain a deeper understanding regarding the effects of chronic kidney disease on psychosocial well-being of those patients, and helps health care providers to put depression, anxiety and Quality of life into consideration when treating patients.

Gold(I)-catalyzed diastereo- and enantioselective 1,3-dipolar cycloaddition and Mannich reactions of azlactones.

Azlactones participate in stereoselective reactions with electron-deficient alkenes and N-sulfonyl aldimines to give products of 1,3-dipolar cycloaddition and Mannich addition reactions, respectively. Both of these reactions proceed with good to excellent diastereo- and enantioselectivity using a single class of gold catalysts, namely C(2)-symmetric bis(phosphinegold(I) carboxylate) complexes. The development of the azlactone Mannich reaction to provide fully protected anti-α,ß-diamino acid derivatives is described. 1,3-Dipolar cycloaddition reactions of several acyclic 1,2-disubstituted alkenes and the chemistry of the resultant cycloadducts are examined to probe the stereochemical course of this reaction. Reaction kinetics and tandem mass spectrometry studies of both the cycloaddition and Mannich reactions are reported. These studies support a mechanism in which the gold complexes catalyze addition reactions through nucleophile activation rather than the more typical activation of the electrophilic reaction component.

Mast Cell Numbers in Primary Eosinophilic Colitis are Significantly Higher than in Secondary Tissue Eosinophilia and Normal Control: a Possible Link to Pathogenesis.

BACKGROUND: Primary Eosinophilic Colitis (PEC) is one of the rare eosinophilic gastrointestinal diseases with a poorly understood pathogenesis. Eosinophilic esophagitis (EE) is the most common and best-understood disease in this category. Activated mast cells (MCs) have a role to play in the tissue damage in EE. It is not known if PEC shares this mechanism. OBJECTIVE: This cross-sectional study aimed to investigate the number of MCs in PEC and to compare them with cases of secondary colonic tissue eosinophilia (TE) and normal colon. METHODS: The study included 19 PEC cases, 47 cases of secondary tissue eosinophilia and 50 normal colon tissues. Histopathological slides of all cases were reviewed to confirm the diagnosis and count the number of eosinophils. Glass slides for all cases were stained for C-kit (CD117) to highlight and count the MCs. RESULTS: The mean number of the MCs in normal controls was 9.7 MCs per HPF (SD= 4.6). The mean number of MCs in the PEC cases was 26.5 (SD=7.1) which was significantly higher than the normal counts (p-value <0.000). The mean number of MCs in the secondary TE group was 18.0 (SD=7.1), which was significantly higher than normal controls; p-value <0.000. Comparing MC counts in PEC and secondary TE also revealed a significant difference with a p-value of < 0.000. CONCLUSION: MCs in PEC are significantly higher than those in secondary TE and normal controls. This suggests the role of the MCs in the pathogenesis of Primary Eosinophilic Colitis.

Gold-catalyzed three-component coupling: oxidative oxyarylation of alkenes.

The three-component coupling of terminal alkenes with arylboronic acids and oxygen nucleophiles is described. The reaction employs a binuclear gold(I) bromide as a catalyst and Selectfluor reagent as the stoichiometric oxidant. Alcohols, carboxylic acids, and water can be employed as oxygen nucleophiles, thus providing an efficient entry into beta-aryl ethers, esters, and alcohols from alkenes.

The three members of the selectin receptor family recognize a common carbohydrate epitope, the sialyl Lewis(x) oligosaccharide.

The selectins (lectin-EGF-complement binding-cell adhesion molecules [LEC-CAMs]) are a family of mammalian receptors implicated in the initial interactions between leukocytes and vascular endothelia, leading to lymphocyte homing, platelet binding, and neutrophil extravasation. The three known selectins, L-selectin (leukocyte adhesion molecule-1 [LECAM-1]), E-selectin (endothelial-leukocyte adhesion molecule-1 [ELAM-1]), and P-selectin (GMP-140) share structural features that include a calcium-dependent lectin domain. The sialyl Lewis(x) carbohydrate epitope has been reported as a ligand for both E- and P-selectins. Although L-selectin has been demonstrated to bind to carbohydrates, structural features of potential mammalian carbohydrate ligand(s) have not been well defined. Using an ELISA developed with a sialyl Lewis(x)-containing glycolipid and an E-selectin-IgG chimera, we have demonstrated the direct binding of the L-selectin-IgG chimera to sialyl Lewis(x). This recognition was calcium dependent, and could be blocked by Mel-14 antibody but not by other antibodies. Recognition was confirmed by the ability of cells expressing the native L-selectin to adhere to immobilized sialyl Lewis(x). These data suggest that the sialyl Lewis(x) oligosaccharide may form the basis of a recognition domain common to all three selectins.

Transcaruncular medial canthal ligament plication for repair of lower eyelid malposition.

OBJECTIVE: To evaluate the long-term efficacy of transcaruncular medial canthal ligament (MCL) plication in the treatment of eyelid malposition. METHODS: Transcaruncular MCL plication was performed on 176 eyelids of 125 patients with symptomatic ocular exposure due to lower eyelid malposition in which MCL laxity was an important component. Preoperative and postoperative ocular exposure symptoms, lower eyelid position, lagophthalmos, and keratopathy were compared. RESULTS: At an average +/- SD follow-up time of 25 +/- 27 months (range, 1-103 months), 88% of preoperative symptoms resolved or improved. Lower eyelid position (P<.001), lagophthalmos (P<.001), and keratopathy (P<.001) were significantly improved. In 11% of eyelids undergoing MCL plication as the only repair, results were comparable with those in which other repairs were performed concurrently. Complications were suture breakage in 2 cases and pyogenic granuloma in 1 case. CONCLUSIONS: Transcaruncular MCL plication is a safe and effective technique for MCL laxity that contributes to lower eyelid malposition. This minimally invasive technique achieves good functional and cosmetic outcomes by re-establishing the vectoral forces for eyelid support that are normally provided by the tripartite ligament.

Histological improvement of liver fibrosis in well-treated patients with autoimmune hepatitis: A cohort study.

Autoimmune hepatitis (AIH) is a chronic autoimmune liver disease that if left untreated may lead to the development of cirrhosis. Previous studies on AIH patients have suggested that fibrosis and even cirrhosis can be reversed by medical treatment. The aim of this study was to evaluate the efficacy of medical treatment for protection of developing fibrosis and cirrhosis.A total of 258 liver biopsies from 101 patients (72 women, 29 men) were analyzed by a single pathologist and classified according to the Ishak grading (inflammation) and staging (fibrosis) system. Liver histology was stratified according to the temporal changes of fibrosis stage (increased, decreased, or stable), and groups were compared.Complete or partial response to medical treatment was 94.9%. Reduction of fibrosis stage from the first to the last biopsy was seen in 63 patients (62.4%). We found an association between a reduction in the fibrosis stage and continuous glucocorticoid medication, as well as lowered scores of inflammation at last biopsy. Twenty-one patients had cirrhosis (Ishak stage 6) at least in one of the previous biopsies, but only 5 patients at the last biopsy.Histological improvement is common in AIH patients that respond to medical treatment, and a reduction or stabilization of fibrosis stage occurs in about 2/3 of such patients.

Thyroid cancer post radioactive iodine treatment for hyperthyroidism - case series and review of the literature.

INTRODUCTION: To assess the rate of thyroid cancer and mortality rate in a cohort of patients who received RAI¹³¹ treatment for hyperthyroidism and to report the index cases' characteristics and management MATERIAL AND METHODS: A cohort of 264 patients who received RAI¹³¹ treatment for different causes of thyrotoxicosis were followed up over a period of 18 years (1996-2014) by physical exam, radiological evaluation and serial thyroid function tests. RESULTS: During the follow up period, three cases of thyroid cancer were identified. The prevalence of thyroid cancer was 1.136% of cases who received RAI¹³¹. The relative risk was 378.79 (95% CI: 76.8 < RR < 1868.23). The P value was < 0.0000004 and the SMR is 1.99/1000. CONCLUSIONS: The prevalence of thyroid cancer was 1.136% in the cohort of patients treated with RAI¹³¹. Despite the fact that no direct cause-effect relationship between RAI and thyroid cancer could be established, these cases highlights the importance of life-long surveillance of patients who receive RAI¹³¹.

Owner impressions of three premium diets fed to healthy adult dogs.

OBJECTIVE: To determine owner impressions of 3 premium canine diets when factors such as price and retail source were removed; to compare body condition scores (BCSs) assigned by owners versus a veterinarian; and to determine consistency of owner impressions of diets when owners were not informed that they were feeding the same diet during 2 consecutive periods. DESIGN: Randomized controlled trial. ANIMALS: 44 healthy adult dogs. PROCEDURE: During the initial 12 months of the study, dogs were each fed 3 premium diets for 4 months in random order. After feeding each diet for 1 and 4 months, owners completed questionnaires regarding palatability of the diet; the dog's attitude, energy level, fecal consistency, frequency of defecation, hair coat quality, and BCS; and whether they would feed the diet if available commercially. During the last 4 months of the study, owners fed the same diet they had been feeding during the previous 4 months. RESULTS: Scores for most variables did not differ among diets. However, mean BCS assigned by owners was significantly lower than mean BCS assigned by an investigator, with a moderate correlation between scores. When asked at the end of the third and fourth study periods whether they would consider feeding the diet long-term, 12 of the 44 (27%) owners gave inconsistent responses. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicate that when unaware of retail price and source, owners have similar impressions of 3 premium diets fed to healthy adult dogs, suggesting that factors other than the diets themselves may affect owner impressions. Owners also underestimate their dog's BCS.

Partial characterization of the N-linked oligosaccharide structures on P-selectin glycoprotein ligand-1 (PSGL-1).

PSGL-1, a specific ligand for P-, E- and L-selectin, was isolated from in vivo [3H]-glucosamine labeled HL-60 cells by a combination of wheat germ agglutinin-agarose and P- or E-selectin-agarose chromatography. N-linked oligosaccharides were released from the purified, denatured ligand molecule by peptide: N-glycosidase F treatment and, following separation by Sephacryl S-200 chromatography, partially characterized using lectin, ion-exchange and size-exclusion chromatography in combination with glycosidase digestions. The data obtained suggest that the N-glycans on PSGL-1 are predominantly core-fucosylated, multiantennary complex type structures with extended, poly-N-acetyllactosamine containing outer chains. A portion of the outer chains appears to be substituted with fucose indicating that the N-glycans, in addition to the O-glycans on PSGL-1, may be involved in selectin binding.

Myositis ossificans circumscripta: a complication of tetanus.

Myositis ossificans developed in a 67-year-old man recovering from tetanus. This rare complication develops in the convalescent phase of tetanus through metaplastic changes in undifferentiated connective tissue cells in areas of myocellular injury. Anoxia, hematoma formation, and immobilization may be contributing factors. Permanent loss of joint motion may be the end result of this ossifying process.

Comprehensive midfacial elevation for ocular complications of facial nerve palsy.

BACKGROUND: A chief morbidity of facial nerve palsy is ocular exposure, which is largely due to lower lid retraction and ectropion. OBJECTIVE: To assess the role of midfacial elevation in the comprehensive surgical treatment of paralytic lower lid malposition and ocular exposure. METHODS: Eleven patients with chronic facial nerve palsy causing symptomatic ocular exposure were treated with subperiosteal midface elevation as a component of comprehensive lower lid elevation. Other procedures were performed concomitantly to treat lower lid ligament laxity and reduced lower lid rigidity, as required. Preoperative and postoperative ocular exposure symptoms, visual acuity, lower lid position, lagophthalmos, and keratopathy were compared. RESULTS: At an average of 17 months of follow-up, all patients reported improvement in symptoms. Visual acuity was maintained or improved in all patients. Lower eyelid position (P =.003), lagophthalmos (P =.07), and keratopathy (P<.001) were also improved. CONCLUSIONS: Midfacial elevation is a safe and effective surgical adjunct in the treatment of lower eyelid retraction in chronic facial palsy. Its use reduces the need for tarsorrhaphy, which limits the binocular visual field and negatively impacts cosmesis.

Lacrimal gland hemangiopericytoma.

A 45-year-old man and a 21-year old man presented with palpable lacrimal gland fossa masses and mechanical ptosis and proptosis, respectively. Computed tomography demonstrated well-circumscribed, partially cystic tumors. Echography in one case showed a well-outlined, predominantly low-reflective lesion with cysts and moderate vascularity detected by Doppler flow and standardized A-scan studies. Histopathology of the excised tumors revealed them to be CD34 antigen-positive hemangiopericytomas, in one case associated with lacrimal gland ductal cysts (dacryops) and with cyst-like spaces containing proteinaceous exudate in the other. No recurrence was found at 14 and 30 months, respectively. Although uncommon, hemangiopericytomas should be included in the differential diagnosis of lacrimal gland tumors. Orbital ultrasound revealing vascularity may be a useful adjunct in this diagnosis. Cystic degeneration or dacryops due to tumor infiltration and compression of lacrimal gland ducts may occur.

Graft copolymer polyelectrolyte complexes for delivery of cationic antimicrobial peptides.

Peptides have enormous potential as therapeutic agents for the treatment of infection, in immunomodulation and for other medical applications, but their hydrolytic degradation in biological fluids is a serious limitation to their in vivo performance. Here we demonstrate the potential utility of polyelectrolyte nanoparticle complexes of novel self-assembling anionic graft copolymers for protecting peptides from degradation in human plasma. The anionic graft copolymers are synthesized by covalently attaching pendent polyetheramine chains to poly(alkylacrylic acid) backbones by carbodiimide coupling. The peptide:copolymer nanocomplexes' particle size, zeta-potential, peptide binding, and controlled release of the peptide are shown to be dependent upon the pendent chain graft density, polymer backbone alkyl groups (propyl vs. methyl), and the nanocomplexes' electrostatic charge ratio. The nanocomplexes can provide substantial protection to the bound peptides from degradation in human plasma for at least 24 h and, in standard microbiological assays are shown to retain some or all of the peptide's antimicrobial activity against a clinically relevant strain of Staphylococcus aureus.