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Natural chitosan-based films (CS) were fabricated by changing ingredient corporations between gold nanoparticles (AuNPs), lithium oxide (Li2O), and graphene oxide (GO). A Series of films with different components were obtained. The structural examination is executed by XRD, FTIR, and EDX to analyze crystal structure, chemical bonding, and chemical contents, respectively. The findings illustrated that, the Li2O@CS exhibited the lowest contact angle with 70 ± 4.6°. Scanning Electron Microscopy (SEM) displayd rod-shaped AuNPs with an average length of 0.3 µm and an average width of 90 nm. The refractive index of CS recorded 2.142, while AuNPs/Li2O/GO@CS slightly declined to 2.085. Concerning AuNPs/Li2O/GO@CS, the detected cell viability percentage of normal lung cells among the usage of 156.25 µg/mL is 98.91%, while 9.77 µg/mL achieved 125.78%. Therefore, combining AuNPs, GO and Li2O within the CS matrix results in films of boosted biocompatibility and can be suggested for medical applications.
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Quitosana , Nanopartículas Metálicas , Quitosana/química , Ouro/química , Óxidos , Lítio , Sobrevivência Celular , Nanopartículas Metálicas/químicaRESUMO
BACKGROUND: Polycystic ovary syndrome (PCOS) is a multifactorial hormonal disorder accompanied by impairment of endometrial function and structure. Pomegranate is recognized for its role in normalizing the female sex hormones in PCOS with little known about its effect on the accompanying endometrial histological alterations. AIM OF THE WORK: To assess the possible ameliorative role of pomegranate juice extract (PJE) on endometrial injury in a rat model of PCOS. MATERIAL AND METHODS: Forty adult albino rats were equally divided into 4 groups; control, PJE-treated (400mg/kg/day for 3 weeks), letrozole-treated (PCOS) (1mg/kg/day for 3 weeks), and PJE & PCOS groups. Serum Follicle-stimulating hormone (FSH), Luteinizing hormone (LH), testosterone, estradiol, and tissue malondialdehyde (MDA) were assayed. Uterine samples were processed for histological staining with hematoxylin & eosin and Masson's trichrome stains, Ki67 and androgen receptor immunohistochemical staining, and scanning electron microscopy. RESULTS: PCOS group revealed a significant increase in serum FSH, LH, testosterone, estradiol, and tissue MDA. Uterine sections depicted various histological alterations in the endometrium with signs of inflammation. A significant increase in the endometrial collagen fiber content, as well as a significant upregulation in Ki67 and androgen receptor immunohistochemical expression were detected. Scanning electron microscopy showed a significant decrease in the mean number of pinopodes. Concomitant administration of PJE efficiently restored the studied biochemical, histological, and immunohistochemical parameters. CONCLUSION: PJE ameliorated PCOS accompanying endometrial histological alterations through its antioxidant, anti-inflammatory, anti-fibrotic, anti-proliferative, and anti-androgenic effects most probably due to its polyphenols content.
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Extratos Vegetais , Síndrome do Ovário Policístico , Punica granatum , Receptores Androgênicos , Androgênios , Animais , Proliferação de Células , Endométrio/metabolismo , Endométrio/patologia , Estradiol , Feminino , Hormônio Foliculoestimulante , Antígeno Ki-67 , Hormônio Luteinizante , Extratos Vegetais/farmacologia , Síndrome do Ovário Policístico/tratamento farmacológico , Síndrome do Ovário Policístico/metabolismo , Punica granatum/química , Ratos , Receptores Androgênicos/metabolismo , TestosteronaRESUMO
In this study, the surface-initiated atom transfer radical polymerization (SI-ATRP) technique and electroless deposition of silver (Ag) were used to prepare a novel multi-functional cotton (Cotton-Ag), possessing both conductive and antibacterial behaviors. It was found that the optimal electroless deposition time was 20 min for a weight gain of 40.4%. The physical and chemical properties of Cotton-Ag were investigated. It was found that Cotton-Ag was conductive and showed much lower electrical resistance, compared to the pristine cotton. The antibacterial properties of Cotton-Ag were also explored, and high antibacterial activity against both Escherichia coli and Staphylococcus aureus was observed.
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Antibacterianos/química , Antibacterianos/farmacologia , Fibra de Algodão/análise , Condutividade Elétrica , Prata/química , Prata/farmacologiaRESUMO
Upper respiratory tract infections (URTIs) account for substantial attendances at emergency departments (EDs). There is a need to elucidate determinants of antibiotic prescribing in time-strapped EDs - popular choices for primary care despite highly accessible primary care clinics. Semi-structured in-depth interviews were conducted with purposively sampled physicians (n = 9) in an adult ED in Singapore. All interviews were analysed using thematic analysis and further interpreted using the Social Ecological Model to explain prescribing determinants. Themes included: (1) reliance on clinical knowledge and judgement, (2) patient-related factors, (3) patient-physician relationship factors, (4) perceived practice norms, (5) policies and treatment guidelines and (6) patient education and awareness. The physicians relied strongly on their clinical knowledge and judgement in managing URTI cases and seldom interfered with their peers' clinical decisions. Despite departmental norms of not prescribing antibiotics for URTIs, physicians would prescribe antibiotics when faced with uncertainty in patients' diagnoses, treating immunocompromised or older patients with comorbidities, and for patients demanding antibiotics, especially under time constraints. Participants had a preference for antibiotic prescribing guidelines based on local epidemiology, but viewed hospital policies on prescribing as a hindrance to clinical judgement. Participants highlighted the need for more public education and awareness on the appropriate use of antibiotics and management of URTIs. Organisational practice norms strongly influenced antibiotic prescribing decisions by physicians, who can be swayed by time pressures and patient demands. Clinical decision support tools, hospital guidelines and patient education targeting at individual, interpersonal and community levels could reduce unnecessary antibiotic use.
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Antibacterianos/administração & dosagem , Infecções Bacterianas/tratamento farmacológico , Serviço Hospitalar de Emergência , Padrões de Prática Médica , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/epidemiologia , Adulto , Envelhecimento , Comorbidade , Uso de Medicamentos , Feminino , Humanos , Hospedeiro Imunocomprometido , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde , Singapura , Inquéritos e Questionários , Adulto JovemRESUMO
Granulomatosis with polyangiitis (GPA) commonly presents with glomerulonephritis and inflammation of upper and lower respiratory tracts. It can also involve other organs including those of the urinary tract. The involvement of the urethra is very rarely reported. We present a case of GPA in a patient who had recurrent urinary tract infections and an acute bladder outlet obstruction due to a urethral thickening by GPA. In this report, we discuss urethral involvement with GPA. The incidence of such involvement, as with other urinary tract organs, might be underestimated. It can affect both sexes, with male predominance, and can occur at any age. It responds to standard GPA medical treatment but may require surgical intervention. Rheumatologists should be aware of this limited form of GPA as early recognition and treatment can decrease the risk of complications.
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Granulomatose com Poliangiite/diagnóstico , Uretra/patologia , Feminino , Granulomatose com Poliangiite/patologia , Humanos , Pessoa de Meia-IdadeRESUMO
The basic fundamentals of ferrous oxalate dihydrate (FeC2O4.2H2O) crystallization including supersaturation, nucleation and crystal growth in simulated dihydrate phosphoric acid product with and without cetyl pyridinium chloride (CPC) additive were studied. Oxalic acid and ferrous sulfate heptahydrate crystals were mixed with dilute phosphoric acid (28% P2O5) at 60 °C and the turbidity of the reaction mixture was measured at different time intervals. Induction time of ferrous oxalate dihydrate crystals was calculated at different supersaturation ratios ranging from 2.5 to 6.7. With increasing the supersaturation ratio, the induction time decreased. The nucleation rates are 46.4 × 1028 nuclei cm-3 s-1 and 50.2 × 1028 nuclei cm-3 s-1 at supersaturation ratio 6.7 with and without CPC addition, respectively. The surface energy increases with CPC addition compared to the baseline. In addition, the formed crystals are modified from cubic shape to rod-like shape with increasing CPC dose.
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Ácido Oxálico/química , Ácidos Fosfóricos/química , Cetilpiridínio/química , CristalizaçãoRESUMO
Regulatory T cell (Treg) therapy using recipient-derived Tregs expanded ex vivo is currently being investigated clinically by us and others as a means of reducing allograft rejection following organ transplantation. Data from animal models has demonstrated that adoptive transfer of allospecific Tregs offers greater protection from graft rejection compared to polyclonal Tregs. Chimeric antigen receptors (CAR) are clinically translatable synthetic fusion proteins that can redirect the specificity of T cells toward designated antigens. We used CAR technology to redirect human polyclonal Tregs toward donor-MHC class I molecules, which are ubiquitously expressed in allografts. Two novel HLA-A2-specific CARs were engineered: one comprising a CD28-CD3ζ signaling domain (CAR) and one lacking an intracellular signaling domain (ΔCAR). CAR Tregs were specifically activated and significantly more suppressive than polyclonal or ΔCAR Tregs in the presence of HLA-A2, without eliciting cytotoxic activity. Furthermore, CAR and ΔCAR Tregs preferentially transmigrated across HLA-A2-expressing endothelial cell monolayers. In a human skin xenograft transplant model, adoptive transfer of CAR Tregs alleviated the alloimmune-mediated skin injury caused by transferring allogeneic peripheral blood mononuclear cells more effectively than polyclonal Tregs. Our results demonstrated that the use of CAR technology is a clinically applicable refinement of Treg therapy for organ transplantation.
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Rejeição de Enxerto/prevenção & controle , Antígeno HLA-A2/imunologia , Receptores de Antígenos/imunologia , Transplante de Pele/efeitos adversos , Linfócitos T Reguladores/imunologia , Aloenxertos , Animais , Rejeição de Enxerto/etiologia , Sobrevivência de Enxerto/imunologia , Xenoenxertos , Humanos , Leucócitos Mononucleares , Camundongos , Camundongos Endogâmicos BALB C , Tolerância ao Transplante/imunologiaRESUMO
In this work, Co/Cr nanoparticles-decorated carbon nanofibers were studied as a platinum-free catalyst for electrooxidation of ethanol in the alkaline medium. The investigated nano composites were prepared by simple, high yield and effective technique; electrospinning of cobalt acetate, chromium acetate and polyvinyl alcohol as a polymer precursor at 20 kV followed by calcination under inert atmosphere at 900 °C for 2 h. The suitable physicochemical characterizations such as XRD, SEM, TEM, TEM mapping, Line TEM-EDX and FE-SEM indicated the formation of pure CoCr nanoparticles allocated in/on carbon nanofibers. Electro catalytic activity measurements showed that the investigated CoCr carbon nanofibers can be effectively utilized in ethanol electrooxidation in 1 mol/l KOH solution. The observed current density was 105 mA/cm2 which is considered high value for non-precious electrocatalyst. Also, study the influence of Cr content in CrCo alloy toward ethanol oxidation was investigated to obtain the most effective composition. The suitable Cr concentration found to be 10% of Co content.
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The main purposes of this undertaking were to determine how often patients with Down syndrome (DS) are screened for celiac disease (CD) across five DS specialty clinics, which symptoms of CD are most often reported to DS specialty providers at these clinics, and, how many individuals were diagnosed with CD by these clinics. This was accomplished by following 663 individuals with DS for 1 year, across five clinics in different states specializing in the comprehensive care of people with DS. Of the 663 participants, 114 individuals were screened for CD at their visit to a DS specialty clinic. Protracted constipation (43.2%) and refractory behavioral problems (23.7%) were symptoms most often reported to DS specialty providers. During the 1 year study period, 13 patients screened positive for CD by serology. Of those, eight underwent duodenal biopsy, and three were diagnosed with CD. We conclude that CD is an important consideration in the comprehensive care of individuals with DS. However, while symptoms are common, diagnoses are infrequent in DS specialty clinics. © 2016 Wiley Periodicals, Inc.
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Doença Celíaca/diagnóstico , Síndrome de Down/diagnóstico , Aconselhamento Genético , Adolescente , Adulto , Biópsia , Doença Celíaca/complicações , Doença Celíaca/fisiopatologia , Criança , Pré-Escolar , Síndrome de Down/complicações , Síndrome de Down/fisiopatologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Adulto JovemRESUMO
The epidemiology and public health significance of Cryptosporidium species and genotypes were investigated in Beni-Suef Governorate, Egypt. A total of 610 animal fecal samples (480 from cattle and 130 from buffaloes) beside 290 stool samples from humans were collected in the period between January and December 2014. Based on the microscopic examination, the overall estimated prevalence of Cryptosporidium spp. in cattle, buffaloes, and humans was 10.2, 12.3, and 19 %, respectively. The highest detection rates were in calves less than 2 months of age (17.1 %) and diarrheic animals (13.0 %). Likewise in humans, the highest prevalence of Cryptosporidium was in infants (31.3 %) and diarrheic individuals (21.1 %). The gender distribution in humans denoted that Cryptosporidium was reported more frequently in males (21.7 %) than females (14.5 %). Based on the molecular characterization of Cryptosporidium, Cryptosporidium oocyst wall protein (COWP) and gp60 genes were successfully amplified in 36 out of 50 samples subjected to genotyping. Restriction fragment length polymorphism (RFLP) analysis of the COWP fragments revealed that Cryptosporidium parvum was the only species detected in cattle (12 isolates) and buffaloes (4 isolates), while in humans, the detected species were Cryptosporidium hominis (15 isolates) and C. parvum (5 isolates). Sequence analysis of the gp60 gene identified the subtype IIdA20G1 within C. parvum isolated from both animals and humans. The common occurrence of zoonotic subtypes of C. parvum in cattle and buffaloes highlights the potential role of these animals as significant reservoirs of infection to humans. Also, the presence of C. hominis and C. parvum in humans indicates that both anthroponotic and zoonotic pathways are expected.
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Doenças dos Bovinos/parasitologia , Criptosporidiose/epidemiologia , Cryptosporidium parvum/genética , Cryptosporidium parvum/isolamento & purificação , Proteínas de Protozoários/genética , Sialoglicoproteínas/genética , Adjuvantes Imunológicos , Animais , Búfalos/parasitologia , Bovinos/parasitologia , Doenças dos Bovinos/epidemiologia , Egito/epidemiologia , Fezes/parasitologia , Feminino , Genótipo , Humanos , Lactente , Masculino , Microscopia , Polimorfismo de Fragmento de Restrição , Prevalência , Saúde PúblicaRESUMO
A disaster is a natural or man-made (or technological) hazard resulting in an event of substantial extent causing significant physical damage or destruction, loss of life, or drastic change to the environment. It is a phenomenon that can cause damage to life and property and destroy the economic, social and cultural life of the people; and overwhelms the capacity of the community to cope with the event. The recent tragic aviation accidents in 2014 involving Malaysia Airlines flights MH370 and MH17 shocked the world in an unprecedented manner. This paper focuses on the Malaysian experience in the MH17 mission in Ukraine as well as the first ever international Disaster Victim Identification (DVI) operation for the Malaysian DVI team. The DVI operations in Hilversum, the Netherlands were well described in stages. The Netherlands' Landelijk Team Forensische Opsporing as the lead DVI team in Hilversum operated systematically, ensuring the success of the whole mission. This paper discusses the lessons learned by the Malaysian team on proper DVI structure, inter- and intra-agency cooperation, facilities planning and set up, logistics and health and safety aspects, as well as effective communication and collaboration with other international delegates. Several issues and challenges faced by the Malaysian team were also documented. In addition, the authors shared views, opinions and recommendations for a more comprehensive DVI operation in the future.
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Acidentes Aeronáuticos , Antropologia Forense/métodos , Medicina Legal/métodos , Agências Internacionais , Incidentes com Feridos em Massa , Autopsia , Comunicação , Comportamento Cooperativo , Impressões Digitais de DNA , Antropologia Forense/organização & administração , Medicina Legal/organização & administração , Humanos , Comunicação Interdisciplinar , Agências Internacionais/organização & administração , Cooperação Internacional , Malásia , Países Baixos , Objetivos Organizacionais , UcrâniaRESUMO
Splenectomy has been used in patients with common variable immunodeficiency disorders (CVID), mainly in the context of refractory autoimmune cytopenia and suspected lymphoma, but there are understandable concerns about the potential of compounding an existing immunodeficiency. With increasing use of rituximab as an alternative treatment for refractory autoimmune cytopenia, the role of splenectomy in CVID needs to be re-examined. This retrospective study provides the largest cohesive data set to date describing the outcome of splenectomy in 45 CVID patients in the past 40 years. Splenectomy proved to be an effective long-term treatment in 75% of CVID patients with autoimmune cytopenia, even in some cases when rituximab had failed. Splenectomy does not worsen mortality in CVID and adequate immunoglobulin replacement therapy appears to play a protective role in overwhelming post-splenectomy infections. Future trials comparing the effectiveness and safety of rituximab and splenectomy are needed to provide clearer guidance on the second-line management of autoimmune cytopenia in CVID.
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Anticorpos Monoclonais Murinos/uso terapêutico , Imunodeficiência de Variável Comum/terapia , Imunoglobulinas/uso terapêutico , Fatores Imunológicos/uso terapêutico , Adolescente , Adulto , Idoso , Anticorpos Monoclonais Murinos/farmacologia , Criança , Imunodeficiência de Variável Comum/imunologia , Imunodeficiência de Variável Comum/mortalidade , Imunodeficiência de Variável Comum/cirurgia , Gerenciamento Clínico , Feminino , Humanos , Imunoglobulinas/farmacologia , Fatores Imunológicos/farmacologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Rituximab , Esplenectomia , Taxa de Sobrevida , Resultado do TratamentoRESUMO
This retrospective, cross-sectional study was carried out to evaluate the quality of 2208 outpatient prescriptions in a central hospital in the West Bank, Palestine. The physicians' handwriting was poorly readable or illegible in one-third of the prescriptions. The prescriber's name and signature and patient's name were mentioned in almost all orders whereas the patient's age was stated in 54.9%. The vast majority of physicians (95.5%) prescribed drugs using their trade (brand) names. Drug strength, quantity and dose/frequency were stated in 61.1%, 76% and 73.8% of prescriptions respectively. Only 33 prescriptions (1.5%) contained full directions for use for all drugs. Correlation analysis revealed that the presence of certain prescription elements was statistically significantly associated with the clinic of origin and the number of drugs prescribed. The overall poor legibility and incompleteness of the prescriptions is of concern.
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Prescrições de Medicamentos/estatística & dados numéricos , Fidelidade a Diretrizes/estatística & dados numéricos , Médicos , Guias de Prática Clínica como Assunto , Estudos Transversais , Humanos , Oriente Médio , Padrões de Prática Médica/estatística & dados numéricos , Estudos RetrospectivosRESUMO
The catalytic conversion of waste cooking oil (WCO) was carried out over a synthetic nano catalyst of cobalt aluminate (CoAl2O4) to produce biofuel range fractions. A precipitation method was used to create a nanoparticle catalyst, which was then examined using field-emission scanning electron microscopy, X-ray diffraction, energy dispersive X-ray, nitrogen adsorption measurements, high-resolution transmission electron Microscopy (HRTEM), infrared spectroscopy, while a gas chromatography-mass spectrometer (GC-MS) was used to analyze the chemical construction of the liquid biofuel. A range of experimental temperatures was looked at including 350, 375, 400, 425, and 450 °C; hydrogen pressure of 50, 2.5, and 5.0 MPa; and liquid hour space velocity (LHSV) of 1, 2.5, and 5 h-1. As temperature, pressure, and liquid hourly space velocity increased, the amount of bio-jet and biodiesel fractional products decreased, while liquid light fraction hydrocarbons increased. 93% optimum conversion of waste cooking oil over CoAl2O4 nano-particles was achieved at 400 °C, 50 bar, and 1 h-1 (LHSV) as 20% yield of bio-jet range,16% gasoline, and 53% biodiesel. According to the product analysis, catalytic hydrocracking of WCO resulted in fuels with chemical and physical characteristics that were on par with those required for fuels derived from petroleum. The study's findings demonstrated the nano cobalt aluminate catalyst's high performance in a catalytic cracking process, which resulted in a WCO to biofuel conversion ratio that was greater than 90%. In this study, we looked at cobalt aluminate nanoparticles as a less complex and expensive alternative to traditional zeolite catalysts for the catalytic cracking process used to produce biofuel and thus can be manufactured locally, which saves the cost of imports for us as a developing country.
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The biosynthesis of silver nanoparticles (Ag NPs) could play a significant role in the development of commercial antimicrobials. Herein, the biosynthesis of Ag NPs was studied using the edible mushroom Pleurotus floridanus, and following its formation, spectrophotometry was used to detect the best mushroom content, pH, temperature, and silver concentration. After that, the morphology was described via transmission electron microscopy (TEM), and nanoscale-size particles were found ranging from 11 to 13 nm. The best conditions of Ag content and pH were found at 1.0 mM and 11.0, respectively. In addition, the best mushroom extract concentration was found at 30 g/L. According to XRD analysis, the crystal structure of the formed amorphous Ag NPs is cubic with a space group of fm-3m and a space group number of 225. After that, the function groups at the surface of the prepared Ag NPs were studied via FTIR analysis, which indicated the presence of C=O, C-H, and O-H groups. These groups could indicate the presence of mushroom traces in the Ag NPs, which was confirmed via the amorphous characteristics of Ag NPs from the XRD analysis. The prepared Ag NPs have a high impact against different microorganisms, which could be attributed to the ability of Ag NPs to penetrate the cell bacterial wall.
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Anti-Infecciosos , Nanopartículas Metálicas , Nanopartículas Metálicas/química , Antibacterianos/farmacologia , Antibacterianos/química , Prata/química , Seguimentos , Anti-Infecciosos/farmacologia , Espectroscopia de Infravermelho com Transformada de Fourier , Extratos Vegetais/químicaRESUMO
Multifunctional membrane technology has gained tremendous attention in wastewater treatment, including oil/water separation and photocatalytic activity. In the present study, a multifunctional composite nanofiber membrane is capable of removing dyes and separating oil from wastewater, as well as having antibacterial activity. The composite nanofiber membrane is composed of cellulose acetate (CA) filled with zinc oxide nanoparticles (ZnO NPs) in a polymer matrix and dipped into a solution of titanium dioxide nanoparticles (TiO2 NPs). Membrane characterization was performed using transmission electron microscopy (TEM), field emission scanning electron microscopy (FESEM), and Fourier transform infrared (FTIR), and water contact angle (WCA) studies were utilized to evaluate the introduced membranes. Results showed that membranes have adequate wettability for the separation process and antibacterial activity, which is beneficial for water disinfection from living organisms. A remarkable result of the membranes' analysis was that methylene blue (MB) dye removal occurred through the photocatalysis process with an efficiency of ~20%. Additionally, it exhibits a high separation efficiency of 45% for removing oil from a mixture of oil-water and water flux of 20.7 L.m-2 h-1 after 1 h. The developed membranes have multifunctional properties and are expected to provide numerous merits for treating complex wastewater.
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Background: In COVID-19 patients undetected co-infections may have severe clinical implications associated with prolonged hospitalization, ICU admission, and mortality. Therefore, we aimed to investigate the impact of viral coinfections on the outcomes of hospitalized patients with COVID-19 in a large tertiary Saudi Arabian Hospital. Methods: A total of 178 adult patients with confirmed SARS-CoV-2 who were hospitalized at the Armed Forces Hospital Southern Region (AFHSR), Saudi Arabia, from March 1st to June 30th 2022, were enrolled. Real-time PCR for the detection of viral coinfections was carried out. Cases (SARS-CoV-2 with viral coinfections) and control (SARS-CoV-2 mono-infection) groups were compared. Results: 12/178 (7%) of enrolled COVID-19 patients had viral coinfections. 82/178 (46%) of patients were males. 58% of patients had comorbidities. During the study period, 4/12 (33%) and 21/166 (13%) cases and control patients died, p=0.047, respectively. Duration of hospitalization was the only significant independent factor associated with SARS-CoV-2 coinfections, OR 1.140, 95% CI 1.020-1.274, p=0.021. Conclusions: The findings of this study from a large tertiary Saudi Arabian Center revealed a prevalence of 7% for SARS-CoV-2 viral coinfections. SARS-CoV-2 coinfected patients had a significantly prolonged duration of hospitalization and higher mortality than those with SARS-CoV-2 alone. Future studies are needed.
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Background: The International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC) 4C mortality score has been used before as a valuable tool for predicting mortality in COVID-19 patients. We aimed to address the utility of the 4C score in a well-defined Saudi population with COVID-19 admitted to a large tertiary referral hospital in Saudi Arabia. Methods: A retrospective study was conducted that included all adults COVID19 patients admitted to the Armed Forces Hospital Southern Region (AFHSR), between January 2021 and September 2022. The receiver operating characteristic (ROC) curve depicted the diagnostic performance of the 4C Score for mortality prediction. Results: A total of 1,853 patients were enrolled. The ROC curve of the 4C score had an area under the curve of 0.73 (95% CI: 0.702-0.758), p<0.001. The sensitivity and specificity with scores >8 were 80% and 58%, respectively, the positive and negative predictive values were 28% and 93%, respectively. Three hundred and sixteen (17.1%), 638 (34.4%), 814 (43.9%), and 85 (4.6%) patients had low, intermediate, high, and very high values, respectively. There were significant differences between survivors and non-survivors with regard to all variables used in the calculation of the 4C score. Multivariable logistic regression analysis revealed that all components of the 4C score, except gender and O2 saturation, were independent significant predictors of mortality. Conclusions: Our data support previous international and Saudi studies that the 4C mortality score is a reliable tool with good sensitivity and specificity in the mortality prediction of COVID-19 patients. All components of the 4C score, except gender and O2 saturation, were independent significant predictors of mortality. Within the 4C score, odds ratios increased proportionately with an increase in the score value. Future multi-center prospective studies are warranted.
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We describe a family with the rare mutation R11X that leads to a truncated CD40 ligand (CD40L) missing the intracellular domain. The index case had detectable CD40L expression and presented at the age of 41 years with cerebral toxoplasmosis. A brother and two nephews were also identified as having the same mutation but exhibited milder and variable phenotypes. The older affected nephew had a moderately depressed immunoglobulin G level and a history of pneumonia at 4 months of age. The younger nephew suffered from sinusitis with normal immunoglobulin levels. Both nephews had absent antibody responses to a protein antigen with conserved responses to polysaccharide antigens. The two sisters of the index case are carriers who had elevated levels of IgM but remain well. This mutation may affect CD40 ligand function by reducing cell surface levels, diminishing CD40 interaction or disrupting CD40L intracellular signalling in T cells. The variable phenotype in members of this family offers an opportunity to further understand the CD40-CD40L signalling pathway in human immune responses.
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Ligante de CD40/genética , Hipergamaglobulinemia/genética , Hipergamaglobulinemia/imunologia , Imunoglobulina M , Mutação , Fenótipo , Adolescente , Adulto , Anticorpos Antibacterianos/sangue , Anticorpos Antibacterianos/imunologia , Linfócitos B/imunologia , Linfócitos B/metabolismo , Linfócitos T CD4-Positivos/metabolismo , Ligante de CD40/química , Ligante de CD40/metabolismo , Feminino , Humanos , Hipergamaglobulinemia/diagnóstico , Switching de Imunoglobulina/imunologia , Imunofenotipagem , Ativação Linfocitária/imunologia , Masculino , Pessoa de Meia-Idade , Linhagem , Domínios e Motivos de Interação entre Proteínas/genética , Síndrome , Linfócitos T/imunologia , Linfócitos T/metabolismo , Adulto JovemRESUMO
INTRODUCTION: Many studies support the role of vitamin D in the pathogenesis of both types of diabetes. Pancreatic tissues express the vitamin D receptor (VDR) and vitamin D-binding protein; some allelic variations in genes involved in vitamin D metabolism and VDR are associated with glucose intolerance, defective insulin secretion, and sensitivity. Epidemiological links have been established between type 2 diabetes mellitus (DM) and hepatitis C virus (HCV) infection. AIM: To explore the possible therapeutic potential of pharmacologic doses of 1-α-hydroxy vitamin D therapy in improving pancreatic ß-cell function in HCV seropositive hemodialysis (HD) patients. PATIENTS AND METHODS: Twenty HCV seropositive HD patients and 20 HCV seronegative patients as control group were randomly selected from HD units. 1-α-Hydroxy vitamin D therapy was administrated in the dose ranged from 0.25 to 0.5 µg/day for 3 months. Corrected total serum calcium, phosphorus, intact parathyroid hormone (iPTH), 25-hydroxy vitamin D [25(OH) vitamin D], 1,25-dihydroxy vitamin D, and glucoparameters [fasting blood glucose, glycohemoglobin test (HbA1c%), homeostatic model assessment (HOMA)-insulin resistance, and HOMA-ß-cell function% (B%)] were measured under basal conditions and after 3 months of therapy. RESULTS: There was highly significant improvement in the concentrations of fetal bovine serum (FBS), serum insulin, HbA1c%, 25(OH) vitamin D, and HOMA-ß-cell function in HCV seropositive and HCV seronegative groups after oral 1-alphacalcidiol therapy (p < 0.001). Positive correlation exists between the percentage increase in serum insulin and that in HOMA-ß-cell function versus 25(OH) vitamin D (p < 0.021 and p < 0.027, respectively) in HCV negative group. CONCLUSION: 1-α-Hydroxy vitamin D oral therapy may improve glycemic control in HCV seropositive and HCV seronegative HD patients.