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Calcium molybdate (CaMoO4) is of significant interest due to its unique properties and numerous industrial applications, such as catalysis, electrochemistry, and optoelectronics. In this study, we developed an economical and environmentally friendly method to synthesize calcium molybdate from Moroccan phosphogypsum (PG) industrial waste and sodium molybdate, all at room temperature. Comprehensive analysis through X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FT-IR), Raman vibrational spectroscopy, and scanning electron microscopy (SEM) revealed the high purity of the synthesized calcium molybdate, with particle sizes of only 12 nm. Additionally, optical characteristics were studied using ultraviolet-visible spectroscopy (UV-vis), which showed an optical band gap of Egap = 3.96 eV for CaMoO4. These results confirm the successful synthesis of calcium molybdate nanoparticles from Moroccan phosphogypsum, demonstrating an effective pathway to valorize this industrial waste into a valuable material. This approach contributes to environmental sustainability by reducing dependence on rare chemicals while offering innovative solutions for the industry’s sustainable development.

This study investigates a controlled synthesis and particle size optimization of nanocalcite particles using phosphogypsum, a waste byproduct from the phosphate fertilizer industry, and cesium carbonate (Cs2CO3), a common carbonate source. The effects of synthesis parameters, including temperature and pH, on the size, morphology, and crystallinity of the synthesized nanocalcite particles were systematically examined. The optimized synthesis conditions for obtaining nanocalcite particles with desired properties are discussed. The synthesized nanocalcite particles were characterized using various techniques, such as XRD, FTIR, and SEM, to analyze their crystal structure, morphology, and elemental composition. Particle sizes were determined using the Debye–Scherrer method, and accordingly, nanometric sizes were achieved. The potential applications of the synthesized nanocalcite particles in cementitious materials, agriculture, and drug delivery are highlighted. This research provides valuable insights into the sustainable synthesis and size optimization of nanocalcite particles from phosphogypsum and Cs2CO3 at a controlled temperature and pH.

NT-proBNP is the gold standard biomarker for early diagnostics of heart failure, disease prevention, and stratified and individualized patient care. In this work, we aim to develop a novel ultra-sensitive immunosensor for direct NT-proBNP detection in human artificial saliva (AS), which represents an intriguing biological matrix potentially rich in biomarkers. The immunosensor will enhance the sensitivity of detection, reduce measurement time, and enable the simultaneous detection of various biomarkers. The developed biosensor, based on gold working microelectrodes (WEs), was biofunctionalized using 4-carboxymethyl aryl diazonium (CMA) to immobilize anti-NT-proBNP antibodies. The deposition of CMA onto the gold surface of the microelectrodes was accomplished using cyclic voltammetry (CV). The binding between NT-proBNP antibodies and NT-proBNP antigens was tracked using electrochemical impedance spectroscopy (EIS) in conjunction with the standard addition method. A linear detection response within the range of 1–20 pg/mL for NT-proBNP detection in PBS and artificial saliva was demonstrated, with good selectivity in the presence of other potential interfering biomarkers (interleukin 6 (IL-6), interleukin 10 (IL-10), and interleukin 1 β (IL-1β)). The developed immunosensor shows great promise for rapid and accurate analysis in biomedical applications.

In this geophysical study, we carried out four Electrical Resistivity Tomography (ERT) profiles and one Vertical Electrical Sounding (VES) in the Palaeozoic Zone in the Rabat-Tiflet region, Morocco. Measurements were accomplished in and around the limestone quarry exploited by the company named ‘Société Des Granulats de Tiflet’ (SDGT) located in our study area. The aim of this study is to delineate the structural organization, especially the spatial distribution of limestone deposits which represents the main formations of this Palaeozoic zone in the Rabat-Tiflet region. Analysis of 2D inverse model resistivity sections show some anomalous contacts and the existence of subsurface lenticular bodies with resistivity going from 100 to 1500 Ωm, potentially corresponding to limestone rock. Also, vertical electrical sounding achieving near the SDGT showed a layer with a resistivity of 317 Ωm at 6 m depth interpreted as limestone conglomerates or limestone deposits. More, during our geological survey, we observed along the Oued Bou Regreg valley and in some abandoned quarries located in the same area, lenticular blocks with different sizes globally having an NNW–SSE direction. These results contributed, even in small scall, to clarify the structural organization of the Palaeozoic Zone in the Rabat-Tiflet region. To map out with high precision this geological complex region, more electrical and seismic profiles as well geochemical studies are recommended.

The Taghbalet region is a part of the Paleozoic cover of the Moroccan Anti-Atlas, known by a rich mineral potential of vein type. This paper presents the results of a field investigation and processing of Landsat 8oli and Aster satellite images. The pre-processing allows for improving the image quality by applying a radiometric calibration, atmosphere correction and a pan-sharpening correction. Landsat-8 oli data is used to map structural lineaments including fracture and/or vein. C compositions ( RGB: 2, 5 and 7) and band ratios (5/7, 3/1, 4/3 and 5/7, 5/4, 3/1) were applied, both of which showed the lithological contrast between formations. Then directional filters (N-S, NE-SW, E-W and NW-SE) were applied on the spectral bands and principal component analysis to map the different lineaments. Validation and correction of lineaments obtained by automatic extraction are based on visual interpretation and field verification. The mining prospecting is performed using ASTER multispectral images. Therefore the results obtained show that we have two main directions; one E-W and the other NE-SW. The majority of these lineaments are concentrated in the south of the area. The results of mapping the hydrothermal alteration zones show us that these zones have a clear relationship with the fault.

Ahmed AH Abdellatif,1,2,* Fatma Ahmed,3,* Ahmed M Mohammed,2 Mansour Alsharidah,4 Amal Al-Subaiyel,1 Waad A Samman,5 Aisha A Alhaddad,5 Samiah Hamad Al-Mijalli,6 Mohammed A Amin,1,2 Hassan Barakat,7,8 Shaaban K Osman2,* 1Department of Pharmaceutics, College of Pharmacy, Qassim University, Qassim, 51452, Saudi Arabia; 2Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Al-Azhar University, Assiut, 71524, Egypt; 3Department of Zoology, Faculty of Science, Sohag University, Sohag, 82524, Egypt; 4Department of Physiology, College of Medicine, Qassim University, Buraydah, 51452, Saudi Arabia; 5Department of Pharmacology and Toxicology, College of Pharmacy, Taibah University, Medina, 42353, Saudi Arabia; 6Department of Biology, College of Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, 11671, Saudi Arabia; 7Department of Food Science and Human Nutrition, College of Agriculture and Veterinary Medicine, Qassim University, Buraydah, 51452, Saudi Arabia; 8Food Technology Department, Faculty of Agriculture, Benha University, Moshtohor, 13736, Egypt*These authors contributed equally to this workCorrespondence: Shaaban K Osman, Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Al-Azhar University, Assiut, 71524, Egypt, Tel +2 01129059936, Fax +2-088-312191, Email Shaabanosman@azhar.edu.eg Ahmed AH Abdellatif, Department of Pharmaceutics, College of Pharmacy, Qassim University, Qassim, 51452, Saudi Arabia, Email a.abdellatif@qu.edu.saAbstract: The real problem in pharmaceutical preparation is drugs’ poor aqueous solubility, low permeability through biological membranes, and short biological t1/2. Conventional drug delivery systems are not able to overcome these problems. However, cyclodextrins (CDs) and their derivatives can solve these challenges. This article aims to summarize and review the history, properties, and different applications of cyclodextrins, especially the ability of inclusion complex formation. It also refers to the effects of cyclodextrin on drug solubility, bioavailability, and stability. Moreover, it focuses on preparing and applying gold nanoparticles (AuNPs) as novel drug delivery systems. It also studies the uses and effects of cyclodextrins in this field as novel drug carriers and targeting devices. The system formulated from AuNPs linked with CD molecules combines the advantages of both CD and AuNPs. Cyclodextrins benefit in increasing aqueous drug solubility, loading capacity, stability, and size control of gold NPs. Also, AuNPs are applied as diagnostic and therapeutic agents because of their unique chemical properties. Plus, AuNPs possess several advantages such as ease of detection, targeted and selective drug delivery, greater surface area, high loading efficiency, and higher stability than microparticles. In the present article, we tried to present the potential pharmaceutical applications of CD-derived AuNPs in biomedical applications including antibacterial, anticancer, gene-drug delivery, and various targeted drug delivery applications. Also, the article highlighted the role of CDs in the preparation and improvement of catalytic enzymes, the formation of self-assembling molecular print boards, the fabrication of supramolecular functionalized electrodes, and biosensors formation.Keywords: AuNPs, nanotechnology, drug delivery, drug targeting, inclusion complexes, cancer management

In the Foum Tizza area of Taghbalt, which is located in the Paleozoic cover of the eastern Anti-Atlas of Morocco, a mineralogical study has been done by electrical tomography, with the objective of drawing up a plan of action for future mineral exploitation. To achieve this objective, we first performed a geological assessment of the study area, followed by a geophysical investigation using electric resistivity and induced polarization surveys. The arrangement used is dipole-dipole and the processing of the geophysical data before and after inversion was carried out using Res2Dinv software. After defining the structural contacts and locating the metallogenic anomalies in relation to the field stratigraphy, the faults are mineralized and loaded in barite (BaSO4) and lead sulfide (PbS) with veins orientation WNW-ESE to E-W.

The known mineralization in the Rehamna Massif is essentially vein type and linked to the presence of granitic bodies and pneumatolytic - hydrothermal fluid circulations. This part of western Moroccan Meseta, belongs to the Hercynian belt, was the seat of enormous mining productions mainly base metals during the 20th century. Subsequently, exploitations are ended with artisanal extractions, in relation to exploration decline. The present work aims to search for new favourable mining targets, using gravimetric and remote sensing data. Gravimetric data allowed us to delineate leucogranitic apexes of shallow depth. Data filtering and processing consist of separation between Regional and Residual fields from Bouguer anomaly, then, calculation of horizontal, vertical and tilt derivatives to get different gravity anomalies. A Satellite image is used to obtain structural lineaments of the study region through directional filters (N0°, N45°, N90°, N135°). These treatments, supported by field investigations, enabled us to discriminate potential areas, suitable for tactical mining exploration.

Ahmed AH Abdellatif,1,2 Mahmoud A Younis,3 Mansour Alsharidah,4 Osamah Al Rugaie,5 Hesham M Tawfeek3 1Department of Pharmaceutics, College of Pharmacy, Qassim University, Buraydah, 51452, Saudi Arabia; 2Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Al-Azhar University, Assiut, 71524, Egypt; 3Department of Industrial Pharmacy, Faculty of Pharmacy, Assiut University, Assiut, 71526, Egypt; 4Department of Physiology, College of Medicine, Qassim University, Buraydah, 51452, Saudi Arabia; 5Department of Basic Medical Sciences, College of Medicine and Medical Sciences, Qassim University, Unaizah, Al Qassim, 51911, Saudi ArabiaCorrespondence: Ahmed AH Abdellatif, Department of Pharmaceutics, College of Pharmacy, Qassim University, Buraydah, 51452, Saudi Arabia, Email a.abdellatif@qu.edu.sa Hesham M Tawfeek, Department of Industrial Pharmacy, Faculty of Pharmacy, Assiut University, Assiut, 71526, Egypt, Email heshamtawfeek@aun.edu.egAbstract: Despite the massive advancements in the nanomedicines and their associated research, their translation into clinically-applicable products is still below promises. The latter fact necessitates an in-depth evaluation of the current nanomedicines from a clinical perspective to cope with the challenges hampering their clinical potential. Quantum dots (QDs) are semiconductors-based nanomaterials with numerous biomedical applications such as drug delivery, live imaging, and medical diagnosis, in addition to other applications beyond medicine such as in solar cells. Nevertheless, the power of QDs is still underestimated in clinics. In the current article, we review the status of QDs in literature, their preparation, characterization, and biomedical applications. In addition, the market status and the ongoing clinical trials recruiting QDs are highlighted, with a special focus on the challenges limiting the clinical translation of QDs. Moreover, QDs are technically compared to other commercially-available substitutes. Eventually, we inspire the technical aspects that should be considered to improve the clinical fate of QDs.Graphical Abstract: Keywords: quantum dots, clinical translation, clinical trials, in vivo imaging, photodynamic therapy, biosensors

At the Moroccan Western Meseta, the study of airborne magnetic data from the Rehamna massif, using the potential aeromagnetic methods, has allowed us to improve and describe the geometry of the geological structures of the Rehamna variscan granitoids and their subsurface components. These methods have proven to be an adequate geophysical technique to study the deep and subsurface structures of this area covered by a thick Mesozoic-Cenozoic sedimentary cover. The calculation of the reduced map to pole and upward continuation of the reduced residual magnetic field to the pole at 2 km to 30 km shows the close relationship between the positive anomalies and the deep magma bodies that outcrop locally in the tectonic contacts; thus, a strong correlation between the aeromagnetic lineaments and the regional crustal-scale faults-oriented N-S to NE-SW. The calculation of the Euler deconvolution of these lineaments, using the different structural indices, shows a depth of aeromagnetic lineaments about ten kilometers due to the presence of a very thick sedimentary layer. The final structural map reveals four groups of faults oriented, respectively NNW-SSE, N-S, NNE-SSW, NE-SW, and E-W.

Ahmed AH Abdellatif,1,2 Mansour Alsharidah,3 Osamah Al Rugaie,4 Hesham M Tawfeek,5 Nahla Sameh Tolba6 1Department of Pharmaceutics, College of Pharmacy, Qassim University, Buraydah, 51452, Saudi Arabia; 2Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Al-Azhar University, Assiut, 71524, Egypt; 3Department of Physiology, College of Medicine, Qassim University, Buraydah, 51452, Saudi Arabia; 4Department of Basic Medical Sciences, College of Medicine and Medical Sciences, Qassim University, Unaizah, AlQassim, 51911, Saudi Arabia; 5Department of Industrial Pharmacy, Faculty of Pharmacy, Assiut University, Assiut, 71526, Egypt; 6Department of Pharmaceutics, Faculty of Pharmacy, Sadat City University, Sadat City, EgyptCorrespondence: Ahmed AH AbdellatifDepartment of Pharmaceutics, College of Pharmacy, Qassim University, Buraydah, 51452, Saudi ArabiaEmail a.abdellatif@qu.edu.saIntroduction: Cancer is one of the leading causes of death worldwide. In many cases, cancer is related to the elevated expression of a significant cytokine known as tumor necrosis factor-α (TNF-α). Breast cancer in particular is linked to increased proliferation of tumor cells, high incidence of malignancies, more metastases, and generally poor prognosis for the patient. The research sought to assess the effect of silver nanoparticles reduced with ethyl cellulose polymer (AgNPs-EC) on TNF-α expression in MCF-7 human breast cancer cells.Methods: The AgNPs-EC were produced using the green synthesis reduction method, and their formation was proofed via UV–VIS spectroscopy. Furthermore, AgNPs-EC were characterized for their size, charge, morphology, Ag ion release, and stability. The MCF-7 cells were treated with AgNPs-EC. Then, the expression of TNF-α genes was determined through PCR in real time, and protein expression was studied using ELISA.Results: The AgNPs-EC were spherical with an average size of 150± 5.1 nm and a zeta-potential of − 41.4± 0.98 mV. AgNPs-EC had an inhibitory effect on cytokine mRNA and protein expression levels, which suggests that they could be used safely in the fight against cancer. AgNPs-EC cytotoxicity was also found to be non-toxic to MCF-7.Conclusion: Our data determined AgNPs-EC as a novel inhibitor of TNF-α production. These results are promising for developing novel therapeutic approaches for the future treatment of cancer with safe materials.Keywords: silver nanoparticles, tumor necrosis factor-α, ethyl cellulose, MCF-7 cells

Ahmed AH Abdellatif,1,2 Zafar Rasheed,3 Ahmad H Alhowail,4 Abdulmajeed Alqasoumi,5 Mansour Alsharidah,6 Riaz A Khan,7 Abdullah SM Aljohani,8 Maha A Aldubayan,4 Waleed Faisal9,10 1Department of Pharmaceutics, College of Pharmacy, Qassim University, Buraydah 51452, Kingdom of Saudi Arabia; 2Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Al-Azhar University, Assiut 71524, Egypt; 3Department of Medical Biochemistry, College of Medicine, Qassim University, Buraydah 51452, Kingdom of Saudi Arabia; 4Department of Pharmacology and Toxicology, College of Pharmacy, Qassim University, Buraydah 51452, Kingdom of Saudi Arabia; 5Department of Pharmacy Practice, College of Pharmacy, Qassim University, Buraydah 51452, Kingdom of Saudi Arabia; 6Department of Physiology, College of Medicine, Qassim University, Buraydah 51452, Kingdom of Saudi Arabia; 7Department of Medicinal Chemistry and Pharmacognosy, College of Pharmacy, Qassim University, Buraydah 51452, Kingdom of Saudi Arabia; 8Department of Veterinary Medicine, College of Agriculture and Veterinary Medicine, Qassim University, Buraydah, Kingdom of Saudi Arabia; 9School of Pharmacy, University College Cork, Cork, Ireland; 10Faculty of Pharmacy, Minya University, Minya, EgyptCorrespondence: Ahmed AH AbdellatifCollege of Pharmacy, Qassim University, Buraydah 51452, Kingdom of Saudi ArabiaEmail a.abdellatif@qu.edu.saBackground: The nuclear factor kappa-B (NF-κB) is a major transcription factor responsible for the production of numerous inflammatory mediators, including the tumor necrosis factor (TNFα), which has a lethal association with cancer’s onset. The silver nanoparticles (AgNPs) are widely used in cancer treatment and several other biomedical applications.Objective: The study aimed to determine the effects of silver citrate nanoparticles (AgNPs-CIT) on NF-κB activation together with TNFα mRNA/protein expressions in the phorbol myristate acetate (PMA)-stimulated MCF-7 human breast cancer cell-lines.Methods: The AgNPs-CIT were synthesized by the reduction method, and the prepared AgNPs-CIT were characterized for their shape, absorption in UV-VIS electromagnetic radiations, size distribution, ζ-potential, and antioxidant activity. The MCF-7 cell-lines were pretreated with AgNPs-CIT and stimulated with PMA. The TNFα mRNA expressions were determined by real-time PCR, whereas the protein production was determined by the ELISA. The NF-κB activity was distinctly observed by highly-specific DNA-based ELISA, and by NF-κB-specific inhibitor, Bay 11– 7082.Results: The prepared AgNPs-CIT were spherical and have an absorption wavelength range of 381– 452 nm wherein the particles size ranged between 19.2± 0.1 to 220.77± 0.12 nm with the charge range − 9.99± 0.8 to − 34.63± 0.1 mV. The prepared AgNPs-CIT showed comparative antioxidant activity at > 40% inhibitions level of the DPPH radicals. The AgNPs-CIT were found to be non-toxic to MCF-7 cell-lines and inhibited PMA-induced activation of the NF-κBp65, and also the mRNA/protein expression of TNFα.Conclusion: This is the first report that showed AgNPs-CIT inhibited TNFα expression via deactivation of the NF-κB signaling event in stimulated breast cancer cells. The results have important implications for the development of novel therapeutic strategies for the prevention/treatment of cancers and/or inflammatory disorders.Keywords: phorbol myristate acetate, PMA, TNFα, NF-κB, silver citrate nanoparticles, MCF-7 cell lines, cancer, inflammatory cytokines

Background: Paracetamol (PAC) overdose causes acute liver injury through oxidative stress, inflammation, and apoptosis. While N-acetyl cysteine (NAC) is the standard treatment, fucoxanthin (FUC), a carotenoid from brown seaweed, has shown hepatoprotective effects in animal studies, but its role in PAC toxicity is unclear., Objective: Compared to NAC, this study assessed the hepatoprotective potential of oral FUC solution towards PAC-induced injury to the rat's liver., Method: FUC was formulated as a pharmaceutical solution and characterized via UV-VIS spectroscopy. Six groups of male Wistar rats each contain five animal which are in total thirty rats: negative control (NC), positive control (PC, 2 g/kg PAC), NAC (1200 mg/kg), and three oral FUC doses (100, 200, and 500 mg/kg) for seven days, with PAC administered on day-8. Liver tissues were analyzed for oxidative stress, gene expression, and histology., Results: FUC solution was clear with absorbance at 433 nm. PAC caused 30% mortality (p < 0.01 vs. others). NAC reduced ALT (56%), AST (78%), ALP (28%), and increased TP by 25% (p < 0.001 vs. PC). FUC at 500 mg/kg (F500) was superior, reducing ALT (82%), AST (93%), ALP (40%), and increasing TP (35%) (p < 0.001 vs. NAC). PAC increased oxidative stress, CYP2E1/CYP3A2 expression, apoptosis markers, and suppressed Nrf2/AMPK/AKT1. F500 improved antioxidants, reduced oxidative stress, and apoptosis, enhanced the Nrf2/AMPK pathway, and downregulated CYP2E1/CYP3A2 (p < 0.01)., Conclusion: FUC, particularly at 500 mg/kg, offers significant hepatoprotection against PAC-induced liver injury by modulating drug metabolizing enzymes and enhancing antioxidant defences, warranting further research.

Uric acid is a toxin retained with advancing kidney disease. Clinical manifestations of hyperuricemia include gout and systemic inflammation that are associated with increased risk of cardiovascular mortality. As many as one-third of all patients with chronic kidney disease have a history of gout, yet <25% of these patients are effectively treated to target serum urate levels of ≤6 mg/dl. A major reason for ineffective management of gout and hyperuricemia is the complexity in managing these patients, with some medications contraindicated and others requiring special dosing, potential drug interactions, and other factors. Consequently, many nephrologists do not primarily manage gout despite it being a common complication of chronic kidney disease, leaving management to the primary physician or rheumatologist. We believe that kidney specialists should consider gout as a major complication of chronic kidney disease and actively manage it in their patients. Here, we present insights from nephrologists and rheumatologists for a team approach to gout management that includes the nephrologist., (Copyright © 2024 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.)

Tenoxicam (TX) is a non-steroidal anti-inflammatory agent that can be used to control pain in various ophthalmic lesions like cataracts, refractive surgery, and corneal abrasion. TX has a very slightly aqueous solubility of 0.072 mg/mL resulting in difficulty to be formulated in ophthalmic solutions. This study aims to improve TX solubility by converting it into its potassium salt to achieve a target of 10 mg/mL (1%w/v) concentration of TX in the desired aqueous medium for the formulation of aqueous ophthalmic solutions. The synthesized TX salt was characterized by different evaluation parameters such as solubility studies, 1 H NMR, IR, and elemental analyses. Different TX potassium solutions were formulated at concentrations of 0.5% and 1% w/v using different viscosity-imparting agents. The prepared solutions were characterized for their physicochemical properties including visual inspection, pH, rheological, in vitro release, and kinetic behavior. Also, the formulations were biologically evaluated in vivo using male albino rabbits. The obtained results showed the successful synthesis of TX salt, as indicated by IR and NMR, and elemental analysis. The solubility study showed that the solubility of TX was improved hugely to 18 mg/mL (250-fold). In addition, the results showed that the prepared formulations showed acceptable physicochemical properties. The highest release rate was obtained with formula F1, which contains no viscosity-imparting agents. While as, the lowest release rate was obtained in the case of formula F9, composed of Pluronic F127 (12% w/v). The in vivo results showed that TX optimized ophthalmic solutions F8 and F9 inhibited the redness and edema in an extended or sustained manner., (© 2023. The Author(s), under exclusive licence to American Association of Pharmaceutical Scientists.)

Background and Objectives: The highest incidence of death in systemic sclerosis due to pulmonary disease raises the need for early detection and treatment. The study aim is the assessment of interstitial pulmonary disease by Multi Detector High Resolution CT (MDCT) and finds its relationship with the other disease parameters and the Pulmonary Function tests (PFT)., Patients and Methods: A prospective cross-sectional study was performed in Assiut University Hospitals from May 2018 to January 2020 and included 62 consecutive SSc female patients. Demographic, clinical, Laboratory, PFT and MDCT assessment were conducted for all participants., Results: The coarseness of fibrosis was 8.32 (range 0.0-17), the average proportion of ground-glass opacification was 28.3% (range, 0.0%-75%). Honey-comb pattern was seen in (52.5%). Mean Extent of disease was 46.25±3.7 (range 5-81). Restrictive deficit found in 42 patients. Significant relation was found between the extent of disease and the percentage predicted FVC (r=0.373, p 0.018) and FEV1/FVC (r=0.593, p 0.000) and coarseness of fibrosis and proportion of ground glass opacification correlated inversely with VC (r=-0.385, p=0.014, r=-0.376, p=0.017 respectively), Rayanud's phenomena, modified Rodnan Skin Score and Medsger's general are positively correlated with MDCT disease extent., Conclusion: Scoring of systemic sclerosis (SSc) related interstitial lung disease (SSc-ILD) could be applicable as one of the important tools for disease assessment., (Copyright © 2021 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.)

Background: Extradural transcranial release of the meningo-orbital band occupying the lateral part of the superior orbital fissure is used to approach the orbital apex and middle cranial fossa. The authors tested the feasibility of the release of the meningo-orbital band via an endonasal transmaxillary approach., Materials and Methods: Five injected cadaveric heads were assessed for dimensions of superior orbital fissure by computerized tomography. An endonasal transsphenoid transpterygoid approach was done to the superior orbital fissure and annulus of Zinn medially, down to the maxillary nerve. The periorbita was dissected superolaterally to expose the greater wing of the sphenoid and the meningo-orbital band. The superior orbital fissure was decompressed inferiorly by drilling the greater wing of the sphenoid and the maxillary strut after transposition of the maxillary nerve. The meningoorbital band was cut at the junction of the lateral part of the superior orbital fissure and the periorbita exposing the frontotemporal dural junction. The edge of the lesser wing of the sphenoid was drilled toward the annulus of Zinn and the optic canal. The temporal lobe dura was separated from the periorbita and lateral cavernous dural wall at the meningo-orbital band and the ophthalmic nerve., Results: The superior orbital fissure had an oblique angle (mean: 39 ± 2.75 degrees) to the midsagittal plane, the length of its lateral part corresponding to the meningo-orbital band was (mean: 6.08 ± 2.58 mm) and the distance from its lateral end to midline was (mean 2.97 ± 0.11 cm). The meningo-orbital band was released in 10 cadaveric head sides with a distinct plane between the periorbita and the dura propria. Transmaxillary endoscopy provided less orbital retraction and better visualization of the lateral wall of the cavernous sinus., Conclusion: Endonasal transmaxillary release of the meningoorbital band is feasible, allowing exposure of the orbital apex and the middle cranial fossa., Competing Interests: None

Based on the findings from the Phase III clinical trials of inactivated SARS COV-2 Vaccine, (BBIBP-CORV) emergency use authorization (EUA) was granted for the vaccine to frontline workers in the UAE. A prospective cohort study was conducted among frontline workers to estimate the incidence rate and risk of symptomatic COVID-19 infection 14 days after the second dose of inoculation with BBIBP-CORV inactivated vaccine. Those who received two doses of the BBIBP-CORV vaccine in the period from 14th of September 2020 (first dose) to 21st of December 2020 (second dose) were followed up for COVID-19 infections. 11,322 individuals who received the two-dose BBIBP-CORV vaccine were included and were followed up post the second dose plus fourteen days. The incidence rate of symptomatic infection was 0.08 per 1000-person days (95% CI 0.07, 0.10). The estimated absolute risk of developing symptomatic infection was 0.97% (95% CI 0.77%, 1.17%). The confirmed seroconversion rate was 92.8%. There were no serious adverse events reported and no individuals suffered from severe disease. Our findings show that vaccinated individuals are likely to remain protected against symptomatic infection or becoming PCR positive for SARS COV 2 following the second dose of the vaccination., (© 2022. The Author(s).)

Introduction and Importance: The ectopic parathyroid adenoma is an important cause of refractory and recurrent hyperparathyroidism. The mediastinal location of ectopic parathyroid tissue is reported in up to 20% of cases of ectopic parathyroid adenomas. In around 2% of cases where cervical approach is unfeasible, the mediastinal route imposes a surgical challenge., Case Presentation: We describe a case of a twenty-five-year-old male patient with manifestations of hyperparathyroidism. Computed tomography of the chest showed an anterior mediastinal mass. Nuclear scintigraphy detected a functioning parathyroid tissue in the mediastinum. The mass was excised en block with the surrounding adipose tissue using a three-port video-assisted thoracoscopic surgery. The patient showed a full symptomatic and laboratory recovery., Clinical Discussion: Mediastinal parathyroid glands comprise a unique surgical entity with diagnostic and management difficulties., Conclusion: Mediastinal parathyroid gland is a rare yet important cause of refractory hypercalcemia. The current localization tools improve the thoracoscopic management of MPAs. VATS can provide access and exposure to ectopic parathyroid adenoma with low morbidity., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Aim: This case-controlled study aimed at evaluating whether enthesitis is possibly associated with acne vulgaris., Methods: This study was carried out on 90 patients with acne vulgaris and 30 normal individuals who were subjected to full history talking, acne scoring system, general, dermatological, musculoskeletal examination, and musculoskeletal ultrasonography with Doppler flow., Results: A significant relation (P < 0.05) was discovered between left femoral condyle tenderness, which increased left femoral condyle hypoechogenicity on ultrasound. Moreover, a highly significant relation (P < 0.001) was established between tenderness on clinical examination and hypoechogenicity on ultrasound at three sites (right humerus epicondyle, right femoral condyle, and left humerus epicondyle). An association between tenderness and ultrasound increased thickness was significantly reported in the left femoral condyle (P < 0.05). Hypoechogenicity on ultrasound examination was more statistically evident with increased acne severity at the left Achilles tendon (LA), while enthesis calcifications (enthesophytes) were significantly associated with increased acne severity in the left humerus epicondyle (LA) and the right Achilles tendon (RA) (P < 0.05)., Conclusion: There is a solid possibility acne is a systemic disease triggering other co-morbidities beyond skin which needs to be fully elucidated by further research evidence., (© 2021 Wiley Periodicals LLC.)

Purpose : To investigate the clinical patterns of uveitis patients presenting to the uveitis clinic at Cairo University hospitals. Methods : A retrospective study was conducted on 313 cases of uveitis from May 2015 to May 2017. Patients had detailed ocular and medical examinations. Results : The most common anatomic form of uveitis was panuveitis (53.4%), followed by anterior uveitis (33.2%), posterior uveitis (12.8%) and intermediate uveitis (0.6%). A specific cause of uveitis was identified in 236 patients (75.4%). The most commonly identified causes were Behçet disease (29.1%), parasitic anterior chamber(AC) granulomatous uveitis (14.4%) and VKH (12.8%). Macular holes were found in 13 eyes, Behcet disease was the major contributor (12 eyes that represent 7.3% of eyes with Behcet disease). Conclusion : Panuveitis is the most common anatomic form of uveitis in Egypt and the etiologic diagnosis of uveitis should focus in particular on Behçet disease, parasitic AC granulomatous uveitis, and VKH.

Background and Objectives: The highest incidence of death in systemic sclerosis due to pulmonary disease raises the need for early detection and treatment. The study aim is the assessment of interstitial pulmonary disease by Multi Detector High Resolution CT (MDCT) and finds its relationship with the other disease parameters and the Pulmonary Function tests (PFT)., Patients and Methods: A prospective cross-sectional study was performed in Assiut University Hospitals from May 2018 to January 2020 and included 62 consecutive SSc female patients. Demographic, clinical, Laboratory, PFT and MDCT assessment were conducted for all participants., Results: The coarseness of fibrosis was 8.32 (range 0.0-17), the average proportion of ground-glass opacification was 28.3% (range, 0.0%-75%). Honey-comb pattern was seen in (52.5%). Mean Extent of disease was 46.25±3.7 (range 5-81). Restrictive deficit found in 42 patients. Significant relation was found between the extent of disease and the percentage predicted FVC (r=0.373, p 0.018) and FEV1/FVC (r=0.593, p 0.000) and coarseness of fibrosis and proportion of ground glass opacification correlated inversely with VC (r=-0.385, p=0.014, r=-0.376, p=0.017 respectively), Rayanud's phenomena, modified Rodnan Skin Score and Medsger's general are positively correlated with MDCT disease extent., Conclusion: Scoring of systemic sclerosis (SSc) related interstitial lung disease (SSc-ILD) could be applicable as one of the important tools for disease assessment., (Copyright © 2021 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.)

Objective: Ultrasonography (US) is the most accurate and cost-effective imaging method in diagnosis of thyroid nodules. A practical thyroid imaging reporting and data system (TIRADS) for thyroid nodules has been proposed to classify nodules of the thyroid gland to solve the problem of nodule selection for fine needle aspiration cytology (FNAC). Real-time elastography and strain ratio (SR) is a method used to assess the stiffness and predict the malignancy of thyroid nodules. The objective of this study was to assess the role of elastography and SR and the TIRADS scoring system in discriminating malignant from benign thyroid nodules., Methods: From 2015 to 2018 at Cairo University Hospital, a series of 409 patients with thyroid nodules was referred to undergo thyroid ultrasound. Categorization of each nodule according to the TIRADS ranged from 1 to 5. The qualitative elastography score and semiquantitative SR of the nodules were evaluated. Final diagnosis was done by either post-thyroidectomy histopathological examination or US-guided FNAC., Results: Our study included 409 patients with thyroid nodules. Their mean age was 39 ± 10 SD; 36 were males and 373 were females. There were 22 malignant nodules and 387 benign nodules. There were statistical differences between benign and malignant nodules regarding TIRADS classification, SR, anteroposterior/transverse ratio, degree of echogenicity, border, presence of calcification, and absence of halo sign ( P < 0.001). The elastic properties of thyroid nodules proved to be a good discriminator between malignant and benign nodules ( P- < 0.001) at a cut off value of > 2.32 with 95.2% sensitivity and 86.5% specificity. For every unit increase in SR, the risk of malignancy increased by nearly 2 times. Patients with irregular borders had nearly 17 times increased risk of malignancy than those with regular borders., Conclusion: Elastography and SR proved to be of high significant value in discriminating benign from malignant nodules, so we recommend adding it to the TIRADS classification.

Introduction: The aim of this systematic review and meta-analysis was to determine the reliability of transcranial sonography as an alternative to computed tomography for evaluation of brain midline shift in adult neurocritical patients., Evidence Aquisition: The PubMed, EMBASE, Cochrane Library, Scopus and Web of Science databases were searched. Original studies evaluating brain midline shift in adult neurocritical patients using both transcranial sonography and computed tomography were eligible. Primary outcome measure was concordance between both methods as quantified in terms of concordance correlation coefficient. Secondary outcome measure was limits of agreement, defined as mean difference between sonography and computed tomography plus and minus 1.96 standard deviations., Evidence Synthesis: Twelve studies (574 patients, 689 examinations) were eligible. Ten studies (416 patients, 492 examinations) provided adequate data for evaluation of concordance. Pooling of effect sizes showed strong concordance between both methods (concordance correlation coefficient, 0.91; 95% CI, 0.87 to 0.94). Two missing studies were imputed and effect size was adjusted to 0.88 (95% CI, 0.81 to 0.93). Nine studies (442 patients, 571 examinations) provided adequate data for estimation of limits of agreement. Pooling of effect sizes showed a bias of -0.53 mm (95% limits of agreement, -1.22 to 0.16 mm). Four missing studies were imputed and bias was adjusted to -0.68 mm (95% limits of agreement, -1.31 to -0.04 mm)., Conclusions: Transcranial sonography may serve as reliable alternative to computed tomography for evaluation of brain midline shift in adult neurocritical patients. Both methods have strong concordance with acceptably narrow limits of agreement.

Aim: Proton pump inhibitors (PPIs) are widely used drugs recently linked to chronic kidney disease. However, the invloved mechanisms remained elusive. Since defective autophagy is identified as a new culprit in the pathogenesis of diabetic nephropathy (DN), we aimed to trace the link of autophagy blockade by PPIs to the progression of DN with and without the standard therapy of metformin and enalapril., Main Methods: Male CD1 albino mice (20-25 g) were randomly assigned to normal control or diabetic mice. Diabetes was induced by intraperitoneal streptozotocin (35 mg/kg) injection combined with high fat diet. DN mice were randomized to receive vehicle, lansoprazole (5 mg/kg), metformin (200 mg/kg), lansoprazole + metformin, metformin + enalapril (0.5 mg/kg) or the three drugs together, orally daily for four weeks. At the study end, albuminuria, fasting plasma glucose, HbA1c, renal functions and malondialdehyde were assessed. Renal tissues were examined microscopically, and autophagic changes were evaluated by immunohistochemical detection of LC3-II and p62., Key Findings: Consistent with autophagic blockade, lansoprazole increased both LC3II and p62 in the glomerular and tubular cells. This was associated with impaired creatinine clearance and renal functions, enhanced albuminuria, oxidative stress and augmented DN histopathological changes. Opposite effects on autophagy markers were observed by single or combined treatment of metformin with enalapril; which also ameliorated glycemic control and signs of DN. This improvement was mitigated by combination with lansoprazole., Significance: Autophagy blockade by lansoprazole augmented diabetic nephropathy and opposed the reno-protective effects of metformin and enalapril. The use of PPIs in diabetes should be considered with great caution., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Solid organ transplantation (SOT) service has been disrupted during the current coronavirus disease 2019 (COVID-19) pandemic, which deferred the service in most centers worldwide. As the pandemic persists, there will be an urgency to identify the best and safest practices for resuming activities as areas re-open. Resuming activity is a difficult issue, in particular, the decision of reopening after a period of slowing down or complete cessation of activities., Objectives: To share our experience in resuming living donor liver transplantation (LDLT) in the context of the COVID-19 pandemic in the Liver Transplantation Unit of El-Manial Specialized Hospital, Cairo University, Egypt, and to review the obstacles that we have faced., Material and Methods: This study is a single-center study. We resumed LDLT by the 26th of August 2020 after a period of closure from the 1st of March 2020. We have taken a lot of steps in order to prevent COVID-19 transmission among transplant patients and healthcare workers (HCWs)., Results: In our study, we reported three LDLT recipients, once resuming the transplantation till now. All our recipients and donors tested negative for SARS-CoV-2 by nasopharyngeal RT-PCR a day before the transplantation. Unfortunately, one of them developed COVID-19 infection. We managed rapidly to isolate him in a single room, restricting one team of HCWs to deal with him with strict personal protective measures. Finally, the patient improved and was discharged in a good condition. The second patient ran a smooth course apart from FK neurotoxicity which improved with proper management. The third patient experienced a sharp rise in bilirubin and transaminases on day 14 that was attributed to drug toxicity vs. rejection and managed by discontinuing the offending drugs and pulse steroids. In addition, one of our head nurses tested positive for SARS-CoV-2 that was manageable with self-isolation., Conclusion: Careful patient, donor, personnel screening is mandatory. Adequate supply of personal protective equipments, effective infection control policies, and appropriate administrative modifications are needed for a safe return of LDLT practice., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s) 2021.)

Background: In photoaging, the accumulation of ultraviolet (UV)-induced oxidative damage leads to the characteristic hallmarks of aging. Here arises the importance of autophagy as a cellular degradation process that cleans the cells of defective or aged organelles and macromolecules, thus maintaining cellular homeostasis. In spite of this, the exact impact of autophagy in photoaging is still elusive., Objective: To evaluate the protective effects of resveratrol and/or co-enzyme-Q10 against the UVA-induced alterations and to explore the role of autophagy in their proposed benefits., Methods: Sixty female mice were randomly divided into normal control, untreated UVA-exposed, resveratrol (50mg/kg), co-enzyme-Q10 (100mg/kg), and resveratrol/co-enzyme-Q10-treated UVA-- exposed groups. Clinical signs of photoaging were evaluated using a modified grading score and the pinch test. Skin malondialdehyde and reduced glutathione were assessed as markers of oxidative stress. Tissues were examined for histopathological signs of photodamage, and autophagic changes were determined by immunohistochemical detection of LC3 and P62 in the different cells of the skin., Results: UVA-exposure increased the oxidative stress with subsequent epidermal and dermal injury. This was associated with the stimulation of autophagy in the keratinocytes and inhibition of autophagic flux in the fibroblasts and infiltrating macrophages. Both drugs corrected the impaired pinch test, macro-and microscopic changes, and exhibited distinct staining patterns with anti-LC3 and P62 in the different cell types denoting autophagic modulation., Conclusion: Changes in autophagic flux are strongly implicated in photoaging associated skin damage and the differential modulation of autophagy by resveratrol and, to a lesser extent by Co-enzyme- Q10, is partially involved in their therapeutic benefits., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background: We designed this study to evaluate dexmedetomidine as an adjuvant to local anesthetics in Quadratus lumborum block (QLB) in pediatrics either interfascial versus intravenous on the quality of postoperative analgesia and incidence of side effects., Methods: Fifty pediatric patients ASA I and II, from eight to thirteen years old posted for laparoscopic pyeloplasty were randomized either to: QLB dexmedetomidine intravenous (QD IV) group or QLB dexmedetomidine interfascial (QD IF) group. A 24-h postoperative morphine consumption (primary outcome), time to first analgesic request, postoperative pain and sedation scores were compared. The recovery time after anesthesia and the incidences of intraoperative and postoperative hypotension or bradycardia were recorded., Results: The median [IQR] 24 h postoperative morphine consumption in QD IF group [0.05 (0.05-0.10) mg/kg] was lower compared with QD IV group [0.15 (0.10-0.20) mg/kg] (P<0.001). Longer time to first analgesic request was noted in QD IF group [505 (395-583) min] in comparison to QD IV group [306 (258-388) min] (P<0.001). Pain scores were lower in QD IF group at six and eight hours postoperatively. Sedation scores were lower in QD IF group on admission to PACU and two hours postoperatively. Intraoperative hypotension and bradycardia were lower in QD IF group. Longer recovery time in QD IV group., Conclusions: Interfascial dexmedetomidine adjuvant to QLB provided better postoperative analgesia in terms of less morphine consumption, better pain scores and longer time to first analgesic request when compared with the IV dexmedetomidine.

Background: Large atrial septal defects (ASDs) in children cause increased volume overload of the right side of the heart which in turn lead to impairment of left ventricular (LV) performance., Aim: The aim of this study was to evaluate immediate LV rotational deformation changes in children with large ASDs post-device closure and removal of right ventricle (RV) volume overload., Patients and Methods: Twenty children who underwent transcatheter closure (TCC) of large secundum ASDs were included in the study. LV rotational deformation was assessed pre- and 24 hours post-device closure using speckle tracking imaging (STI)., Results: 55% were females with mean age 6.1 ± 3.5 years. LV peak basal clockwise rotation improved significantly (-6.9 ± 2.6° before vs -10.3 ± 4.1° after TCC, P = .005), and time to peak clockwise rotation (345.1 ± 124.7 milliseconds (ms) before vs 282.2 ± 82.9 ms after closure, P = .02). There was no significant difference in apical rotational parameters including peak counterclockwise rotation (P > .05 for both). LV twist (11.3 ± 3.8° before vs 17.5 ± 7.1° after closure, P = .001) and torsion (2.1 ± 0.7°/cm before vs 3.1 ± 1.2°/cm after closure, P = .01) were significantly improved, mainly as the result of improvement of LV basal rotation. LV revealed a significant increase in LV end-diastolic volumes (P = .02) 24 hour after TCC with no significant change (P > .05) in end-systolic volumes after closure., Conclusion: Increased peak LV twisting and torsion were attributed to the improved peak systolic clockwise basal rotation after TCC of large ASDs in children., (© 2020 Wiley Periodicals LLC.)

Phospholipid-based liposomal vesicles are among the most effective delivery options currently available for various classes of anticancer drugs. The patents granted to inventions disclosing details on liposomal delivery module by the US Patent and Trademark Office, European Patent Office, and world patent holdings through WIPO (World Intellectual Property Organization) patenting have been sorted based upon liposome, and anticancer keywords within the abstract and claims sections of the patents for the period between 2000 and 2019, thereby disclosing novel liposome formulations encapsulating single, or combination of chemotherapeutic agents that have been far more chemically and physiologically stable, therapeutically efficacious, and comparatively less toxic than their nonliposomal free-drug counterparts. The added stability, site-specific transport, and payload delivery, enhanced bioavailability, fast body clearance, and biocompatibility together with the controlled and sustained delivery-related benefits claimed in the patent literature have been exclusively discussed with a focus on the last 5-year period.

Background: COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the newly developed worldwide outbreak of coronavirus disease with a high rate of mortality especially among elderly and multiple co-morbid personnel. Asymptomatic COVID-19-infected patients are a well-known source of transmission of infection. The risk of exposure to respiratory secretions and/or feces is hardly avoidable during the endoscopic procedure; also, the aerosol and droplets take up to an hour disperse, so they remain a risk to staff and other patients after they leave the room; therefore, strict infectious precautions should be taken by all health care workers to limit the virus spread., Main Body: We present an endoscopic trial of duodenal stent insertion in non-operable gastric carcinoma that is proven 2 days later to be a COVID-19-positive case. Fortunately, no one of the health care workers that came in contact with the case becomes infected owing to the proper infection control measures., Conclusion: We recommended that the endoscopy examination and procedures should be strictly limited to urgent cases to minimize the risk of virus infection among health care workers., Competing Interests: Competing interestsThe authors declare no potential competing interests., (© The Author(s) 2020.)

Objective: To compare the interrupted subcuticular skin closure with continuous one in obese women undergoing cesarean delivery. Materials and methods: A randomized controlled study conducted on 169 obese women with term uncomplicated singleton pregnancy who underwent elective cesarean delivery. They were randomized to either skin closure through continuous subcuticular sutures using vicryl 3/0 or interrupted subcuticular suturing using vicryl 3/0. The primary outcome parameter was occurrence of wound infection. Secondary outcomes included other skin complications, postoperative pain, operative duration and hospital stay Results: There was a statistically higher number of cases with wound hematoma (20 vs. 10, p  = .04), infection (30 vs. 15, p  = .008) and those who needed reclosure of wound (8 vs. 0, p  = .004) in the continuous when compared to women in the interrupted subcuticular group, respectively. Healing with secondary intension was significantly higher in women in the continuous subcuticular group (52 vs. 26, respectively, p  < .001). The number of cases with wound seroma and keloid formation was not statistically different between the two groups (25 vs. 19, p  = .272 and 12 vs. 5, p  = .069 in the continuous vs. interrupted groups, respectively). The duration of CS was longer in those who underwent interrupted closure when compared to continuous ones. However, that was statistically insignificant (40.95 + 6.376 vs. 37.05 + 6.455, p  = 0.14). Conclusions: Most surgical wound complications were reduced if skin closure with continuous subcuticular sutures is replaced with interrupted one.

Background: Fetal head attitude has a substantial impact on labor progress and outcome. Fetal head deflexion is basically diagnosed by digital vaginal examination during labor., Objectives: To assess the effect of the fetal occiput-spine angle (OSA) measured through transabdominal ultrasound during the first stage of labor on the progress and outcome of labor., Material and Methods: A prospective cohort study conducted on 400 women with term uncomplicated singleton pregnancy with occipitoanterior position during active labor. The angle between two tangential lines to occipital bone and the vertebral body of the first cervical spine was measured during active labor. Follow up till delivery was done. The primary outcome parameter was the labor duration. Secondary outcomes included the mode of delivery, occurrence of maternal and fetal complications., Results: There was a significant longer duration of both first and second stage of labor among women with OSA <126° when compared to those with OSA ≥126° (6.8 ± 2.1 and1.89 ± 0.85 versus 4.16 ± 1.63 and 0.92 ± 0.43, respectively). Women with OSA <126° had higher incidence of CS (46.3 versus 5.7%), perineal tears (10.4 versus 5.1%), vaginal tears (22.4 versus 6.3%), need for oxytocin augmentation (47.8 versus 21.3%) when compared to those with OSA ≥126. OSA at cutoff value of 126° had a sensitivity, specificity, and accuracy of 8264.6 and 78.4% and 93.79 and 92% in prediction of mode of delivery and overall complications, respectively., Conclusions: There was a significantly longer duration of both first and second stages of labor with higher rates of CS and maternal and fetal complications in women with OSA <126.

Purpose: To evaluate subfoveal choroidal thickness (SFCT) in eyes with diabetic macular edema (DME) using spectral domain OCT (SD-OCT). Materials and methods: Ninety eyes were divided into three equal groups: group A, non-proliferative diabetic retinopathy (NPDR) with no DME; group B, NPDR having DME; and group C, non-diabetic patients. The central subfield retinal thickness (CSRT) and SFCT were measured using spectral domain OCT. Results: There was a moderate negative correlation between age and SFCT in group B ( r =-0.455, P =0.012). We found no significant correlation between best corrected visual acuity (BCVA) and SFCT in all groups (for groups A, B, and C, respectively: r =0.189, P =0.316; r =-0.195, P =0.302; and r =-0.181, P =0.337). There was no significant correlation between duration of diabetes and SFCT ( r =-0.118, P =0.534 and r =-0.136, P =0.475 for groups A and B, respectively). The CSRT was 229.13±16.2, 336.4±74.85, and 223.13±16.9 µm in groups A, B, and C, respectively. The mean SFCT was 260.6±49.2, 259±50.8, and 252±50 µm in groups A, B, and C, respectively. We found no significant correlation between CSRT and SFCT in all groups (for groups A, B, and C, respectively: r =-0.049, P =0.796, r =0.239, P =0.204, r =-0.021, P =0.914). There was no significant difference in SFCT between group B (DME) on one hand and groups A and C on the other hand ( P =0.9 and 0.59, respectively). Conclusion: There is no significant correlation between CSRT and SFCT in DME. Choroidal thickness assessment is not an indicator of the severity of DME and cannot be used as a monitor of its progression., Competing Interests: The authors report no conflicts of interest in this work.

Purpose: The aim of this study was to formulate a hydrogel loaded with polymeric nanoparticles (PoNPs) of simvastatin (SIM) for topical wound healing application., Materials and Methods: The SIM PoNPs were prepared by using the nanoprecipitation method to improve the drug solubility and skin permeation. Furthermore, drug content, solubility, particle size, surface charge, and transmission electron microscopy of the prepared PoNPs were evaluated. Then, the PoNPs were loaded on hydrogel, and physical characteristics, in vitro release, and ex vivo permeation of the hydrogel were evaluated. Finally, the prepared gel was applied on rat wounds, and a histopathological study was performed., Results: The results showed that the drug content in the PoNPs was 86.4%. The PoNPs were spherical in shape with a smooth surface and a uniform size distribution. The particle size was 268.4±2.6, polydispersity index was ≤0.302, and zeta potential was -33±1.67 mV. The hydrogel loaded with SIM PoNPs was homogenous, and the pH was accepted and compatible with the skin. Moreover, the viscosity and spreadability assured its ease of application. The drug content was 97.25±0.02%. Furthermore, about 81% of SIM was released within 24 hours, while in the ex vivo permeation study 69.19% of SIM passed through the skin after 24 hours. Finally, the histopathological studies confirmed the efficacy of the SIM PoNPs-loaded hydrogel in wound healing due to the formation of the normal epithelial layer on day 11 after wound creation., Conclusion: The hydrogel loaded with SIM PoNPs showed a good efficacy in accelerating the healing of the rat wound with complete epithelialization and minimal inflammatory cell infiltration., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Due to the unique optical properties like high brightness and narrow emission bands of Quantum dots, it is used as simple fluorescence materials in bio-imaging, immunoassays, microarrays, and other applications. To easy invistigate cell lines that overexpressed somtostatin receptors, somatostatin (SST) was conjugated with Quantum dots carrying PEG amine (Qdots-PEG-NH 2 ). The conjugation of SST to Qdots-PEG-NH 2 started with the thiolation of SST using Traut's reagent. Moreover, the Qdots-PEG-NH 2 were subsequently activated by 500-fold molar excess of sulfosuccinimidyl 4-(N-maleimidomethyl) cyclohexane-1-carboxylate (sulfo-SMCC) dissolved in phosphate buffer. The Qdots-PEG-NH 2 -sulfo-SMCC was conjugated to the thiolated-SST to form Qdots-SST. The number of sulfhydryl groups can be controlled by the molar ratio of Traut´s reagent to SST. Thiolation was necessary for the conjugation of SST to Qdots-PEG-NH 2 . This was achieved by reacting the SST with Traut's reagent in a 1:1 molar ratio. Ellman's reagent was used to determine the number of sulfhydryle groups. Furthermore, cellular uptake study on triple negative breast cancer cells (HCC-1806) showed that the numbers of Qdots-SST per cell were significantly higher compared to unmodified Qdots-PEG-NH 2 when quantified using inductively coupled plasma optical emission spectroscopy (ICP-OES). Moreover, the binding of Qdots-SST to cells can be suppressed by addition of free SST, indicating that the binding of Qdots-SST to cells is due to receptor-specific binding.

Background: Acoustic puncture assist device (APAD™) is a pressure measurement combined with a related acoustic signal that has been successfully used to facilitate epidural punctures. The principal of loss of resistance (LOR) is similar when performing paravertebral block (PVB). We investigated the usefulness of APAD™ by comparing it with the conventional LOR techniques for identifying paravertebral space (PVS)., Subjects and Methods: A total of 100 women who were scheduled for elective breast surgery under general anesthesia with PVB were randomized into two equal groups. The first group (APAD group) was scheduled for PVB using APAD™. The second group (C group) was scheduled for PVB using conventional LOR technique. We recorded the success rate assessed by clinical and ultrasound findings, the time required to identify the PVS, the depth of the PVS and the number of attempts. The attending anesthesiologist was also questioned about the usefulness of the acoustic signal for detection of the PVS., Results: The incidence of successful PVB was (49) in APAD group compared to (42) in C group P < 0.05. The time required to do PVB was significantly shorter in APAD group than in C group (3.5 ± 1.35 vs. 4.1 ± 1.42) minutes. Two patients in APAD group needed two or more attempts compared to four patients in C group. The attending anesthesiologist found the acoustic signal valuable in all patients in APAD group., Conclusion: Using APAD™ compared to the conventional LOR technique showed a lower failure rate and a shorter time to identify the PVS., Competing Interests: There are no conflicts of interest.

Targeting of G-protein coupled receptors (GPCRs) like somatostatin-14 (SST-14) could have a potential interest in delivery of anti-cancer agents to tumor cells. Attachment of SST to different nano-carriers e.g. polymeric nanoparticles is limited due to the difficulty of interaction between SST itself and those nano-carriers. Furthermore, the instability problems associated with the final formulation. Attaching of SST to gold nanoparticles (AuNPs) using the positive and negative charge of SST and citrate-AuNPs could be considered a new technique to get stable non-aggregated AuNPs coated with SST. Different analyses techniques have been performed to proof the principle of coating between AuNPs and SST. Furthermore, cellular uptake studies on HCC-1806, HELA and U-87 cell lines has been investigated to show the ability of AuNPs coated SST to enter the cells via SST receptors. Dynamic light scattering (DLS) indicated a successful coating of SST on the MUA-AuNPs surface. Furthermore, all the performed analysis including DLS, SDS-PAGE and UV-VIS absorption spectra indicated a successful coating of AuNPs with SST. Cellular uptake studies on HCC-1806, HELA and U-87 cell lines showed that the number of AuNPs-SST per cell is signiflcantly higher compared to citrate-AuNPs when quantified using inductively coupled plasma spectroscopy. Moreover, the binding of AuNPs-SST to cells can be suppressed by addition of antagonist, indicating that the binding of AuNPs-SST to cells is due to receptor-specific binding. In conclusion, AuNPs could be attached to SST via adsorption to get stable AuNPs coated SST. This new formulation has a potential to target SST receptors localized in many normal and tumor cells.

The aim of this work was to study the potential of delivering clindamycin phosphate, as an efficient antibiotic drug, into a more absorbed, elastic ultradeformable form, transfersomes (TRSs). These vesicles showed an enhanced penetration through ex vivo permeation characters. TRSs were prepared using thin-film hydration method. Furthermore, they were evaluated for their entrapment efficiency, size, zeta potential, and morphology. Also, the prepared TRSs were converted into suitable gel formulation using carbopol 934 and were evaluated for their gel characteristics like pH, viscosity, spreadability, homogeneity, skin irritation, in vitro release, stability, and ex vivo permeation studies in rats. TRSs were efficiently formulated in a stable bilayer vesicle structure. Furthermore, clindamycin phosphate showed higher entrapment efficiency within the TRSs reaching about 93.3% ± 0.8 and has a uniform particle size. Moreover, the TRSs surface had a high negative charge which indicated the stability of the produced vesicles and resistance of aggregation. Clindamycin phosphate showed a significantly higher in vitro release (p < 0.05; ANOVA/Tukey) compared with the control carbopol gel. Furthermore, the transfersomal gel showed a significantly higher (p < 0.05; ANOVA/Tukey) cumulative amount of drug permeation and flux than both the transfersomal suspension and the control carbopol gel. In conclusion, the produced results suggest that TRS-loaded clindamycin are promising carriers for enhanced dermal delivery of clindamycin phosphate.

Purpose. To review the epidemiology of serious pediatric ocular trauma presenting to Kasr El Aini Hospital, Cairo University. Methods. Children with serious ocular trauma during a six-month period were examined and their data was analyzed. Results. Eighty eyes of 75 patients were included in this study, with 64% males ( P < 0.001) and average age of 5 years (5 months-15 years). There were 67 (83.75%) open globe injuries, 11 (13.75%) closed globe injuries, and 2 (2.5%) chemical injuries. Of the open globe injuries, 24 (30%) were ruptured globes and 43 (53.75%) were lacerations (31 penetrating injuries (38.75%), 6 IOFBs (7.5%), and 6 perforating injuries (7.5%)). Of the closed globe injuries, 3 had hyphema (3.75%), 5 had traumatic cataracts (6.25%), and 3 had vitreous hemorrhage with retinal detachment (3.75%). Forty-two patients (56%) presented within 24 hours, 28 patients (37.33%) presented between 24 hours and 1 week, and 5 patients (6.6%) presented after one week from the time of trauma. Seven eyes developed posttraumatic endophthalmitis (10% of open globe injuries). On leaving the hospital, 55 (68.75%) eyes had poor vision, 13 (16.25%) had moderate vision, and 12 (15%) had good vision. Conclusion. Children at a higher risk of trauma are males, >5 years, unsupervised, and involved in street activities. Immediate comprehensive primary management and secondary rehabilitation are mandatory in these cases.

Purpose: To assess the accuracy of the potential acuity meter (PAM) in predicting postcataract surgery visual acuity outcome in patients with healed inactive maculopathies., Study Design: Prospective interventional clinical trial., Patients and Methods: Patients scheduled for phacoemulsification had preoperative and 1 month postoperative best-corrected visual acuity (BCVA), PAM test, fluorescein angiography, and macular optical coherence tomography. Patients were grouped to following preoperative BCVA: PRE1: 0.29 and better, PRE2: 0.25-0.13, and PRE3: 0.1 or worse; age: G1 <60, G2 = 60-70, and G3 >70 years. PAM accuracy was divided into: Grade 1: Postoperative BCVA ≤1 or less line error of the PAM score, Grade 2: Between 1 and 2 lines error, and Grade 3: ≥3 lines or more error., Results: This study enrolled 57 patients with a mean age of 71.05 ± 6.78 years where 34 were females. There were 21 (36.84%) patients with diabetic maculopathy and 36 (63.16%) with age-related macular degeneration. The mean preoperative BCVA was 0.198 ± 0.12 (0.1-0.5). The mean PAM score was 0.442 ± 0.24 (0.1-1.3). The mean postoperative BCVA was 0.4352 ± 0.19 (0.17-1.00). The PAM score was in Grade 1, 2, and 3 in 46 (80.7%), 54 (94.7%), and 56 (98.2), respectively. There was a highly significant correlation between the PAM score and the postoperative BCVA (P < 0.001, Chi-square test). There was no correlation between the PAM test accuracy and age, gender, diagnosis, and preoperative BCVA (P = 0.661, 0.667, 0. 0.991, 0.833, Chi-square test; respectively)., Conclusion: The PAM is an accurate method of predicting postoperative visual acuity for eyes with nuclear cataracts Grade I and II and inactive maculopathies.

Introduction: Granulocyte-macrophage colony-stimulating factor (GM-CSF) is an essential factor in the growth and maturation of blood cells as well as modulation of the immune system. Few studies have investigated its involvement in the development of vitiligo, and no studies have been performed on Egyptian patients., Aim: To assess GM-CSF serum level among non-segmental Egyptian vitiligo patients and to determine its possible role in the etiopathogenesis of the disease., Methods: Forty patients with non-segmental vitiligo and 40 age- and sex-matched subjects were assessed for levels of GM-CSF in serum using the ELISA technique., Results: The patients in this study showed lowerlevels ofGM-CSF in serum compared to controls (mean ± SD was 33.4 ± 5.7 pg/ml versus 63.4 ± 7.4 pg/ml, respectively, p = 0.0001). No appreciable relation was detected between levels of GM-CSF in serum and age, sex, family history, and stressful events or disease activity, type, and extent, p ˃ 0.05., Conclusions: GM-CSF serum level may be one of the determinants of the autoimmune hypothesis in the etiopathogenesis of non-segmental vitiligo.

Chronic kidney disease (CKD) is a comorbid condition that affects, based on recent estimates, between 47% and 54% of patients with gouty arthritis. However, data from randomized controlled trials in patients with gouty arthritis and CKD are limited, and current gouty arthritis treatment guidelines do not address the challenges associated with managing this patient population. Nonsteroidal anti-inflammatory drugs and colchicine are recommended first-line treatments for acute gouty arthritis attacks. However, in patients with CKD, nonsteroidal anti-inflammatory drugs are not recommended because their use can exacerbate or cause acute kidney injury. Also, colchicine toxicity is increased in patients with CKD, and dosage reduction is required based on level of kidney function. Allopurinol, febuxostat, and pegloticase are all effective treatments for controlling elevated uric acid levels after the treatment of an acute attack. However, in patients with CKD, required allopurinol dosage reductions may limit efficacy; pegloticase requires further investigation in this population, and febuxostat has not been studied in patients with creatinine clearance<30 mL/min. This article reviews the risks and benefits associated with currently available pharmacologic agents for the management of acute and chronic gouty arthritis including urate-lowering therapy in patients with CKD. Challenges specific to primary care providers are addressed, including guidance to help them decide when to collaborate with, or refer patients to, rheumatology and nephrology specialists based on the severity of gout and CKD.

Background: Awake fiberoptic intubation is the gold standard for management of predicted difficult intubation. The purpose of this study was to test whether Glide Scope video laryngoscopy (GVL) will provide significant advantages over fiberoptic bronchoscopy (FOB) for awake intubation in morbidly obese patients with predicted difficult intubation. We therefore tested the hypothesis that intubation using GVL is faster than intubation with FOB., Methods: 64 morbidly obese patients with predicted difficult intubation undergoing laparoscopic bariatric surgery were enrolled in this study. Patients were randomly assigned to receive awake oral intubation by either GVL or FOB. After airway topical anesthesia and sedation using target controlled remifentanil infusion to a Ramsay sedation scale of 3, wee compared the two devices for time to intubate, successful intubation on first attempt, glottic view using Cormack and Lehane score system, response of the patient to scope, patients satisfaction and incidence of postoperative sore throat and hoarseness., Results: Intubation time was 84 +/- 37.9 seconds and 73.6 +/- 31.1 seconds for FOB and GVL respectively. 75% of patients were successfully intubated on the first attempt with FOB compared to 80.6% with GVL. Grade I/II glottic view was reported with GVL in 96.7% of patients compared to 100% with FOB. The highest target concentration of remifentanil to maintain patients sedated during intubation was 2.4 +/- 0.6 ng/ml and 2.2 +/- 0.8 ng/ml in FOB and GVL respectively. No significant differences regarding maximum patient response to intubation, adverse effects or patient satisfaction were recorded between groups., Conclusion: GVL can be used as a useful alternative to FOB in morbidly obese patients with predicted difficult intubation.

Background: Emergence agitation (EA) in children is increased after sevoflurane anesthesia. Propofol and dexmedetomidine have been used for prophylactic treatment with controversial results. The aim of the present study was to compare the effect of a single dose of propofol or dexmedetomidine prior to termination of sevoflurane-based anesthesia on the incidence and severity of EA in children., Methods: One hundred and twenty children, American Society of Anesthesiologists I-II, 2-6 years old undergoing adenotonsillectomy under sevoflurane based anesthesia were enrolled in the study. Children were randomly allocated to one of the three equal groups: (Group C) received 10 ml saline 0.9%, (Group P) received propofol 1 mg/kg or (group D) received dexmedetomidine 0.3 ug/kg(-1). The study drugs were administered 5 min before the end of surgery. In post anesthesia care unit (PACU), the incidence of EA was assessed with Aonos four point scale and the severity of EA was assessed with pediatric anesthesia emergence delirium scale upon admission (T0), after 5 min (T5), 15 min (T15) and 30 min (T30). Extubation time, emergence time, duration of PACU stay and pain were assessed., Results: The incidence and severity of EA were lower in group P and group D compared to group C at T0, T5 and T15. The incidence and severity of EA in group P were significantly higher than group D at the same times. The incidence and severity of EA decreased significantly over time in all groups. The modified Children's Hospital of Eastern Ontario Pain Scale was significantly lower in group D compared to group C and group P., Conclusions: Dexmedetomidine 0.3 ug/kg(1) was more effective than propofol 1 mg/kg in decreasing the incidence and severity of EA, when administered 5 min before the end of surgery in children undergoing adenotonsillectomy under sevoflurane anesthesia.

Context: Ultrasound (US) guidance is strongly recommended when performing peripheral nerve blocks in infants and children., Aims: To assess whether US-guided ilioinguinal/iliohypogastric (II/IH) nerve blocks with local anesthetic (LA) would provide comparable postoperative analgesia to blind technique caudal block with LA following pediatric unilateral groin surgery. Secondary endpoints included analgesic consumption, parental satisfaction, and postoperative complications., Settings and Design: Prospective, crossover randomized controlled trial performed on children undergoing unilateral groin surgery., Methods: Fifty children aged 1-6 years scheduled for unilateral groin surgery were included in the study. After induction of general anesthesia and prior to surgical incision, patients were prospectively randomized into one of two groups: Group B received US-guided II/IH nerve blocks with 0.1 ml.kg(-1) of 0.25% bupivacaine and Group C received a caudal blockade with 0.7 ml.kg(-1) of 0.25% bupivacaine. Patients were assessed in the recovery room, the day-stay unit and for 24 h at home for pain score, analgesic consumption, and parental satisfaction., Statistical Analysis: Arithmetic mean and standard deviation values were calculated and statistical analyses were performed for each group. Independent sample t-test was used to compare continuous variables exhibiting normal distribution, and Chi-squared test or Fisher exact test for non-continuous variables. P<0.05 was considered significant., Results: The average pain scores during hospital stay were 1.82±1.71and 1.52±1.41 for group C and group B respectively (P>0.05). The average time to first rescue analgesia was longer in group B 253±102.6 min as compared to 219.6±48.4 min in group C. In recovery room, four patients in group C required pain rescue medication compared to five patients in group B (P>0.05). Similarly eight patients in the group C and six patients in group B required pain rescue medication at day-stay unit or at home (P>0.05). Group C received 0.74 pain rescue medication doses (range 0-8), while group B received 0.65 pain rescue medication doses (range 0-6) at hospital and at home (P>0.05)., Conclusions: US-guided II/IH nerve blocks is an ideal postoperative analgesic for unilateral groin surgery in children, particularly hernia repairs and is as effective as caudal block, with a lower volume of local anesthetics.

Renin-angiotensin-aldosterone system (RAAS) inhibitors in combination with other antihypertensive drugs (eg, calcium channel blockers [CCBs] and/or diuretics) are a preferred treatment option for managing uncontrolled hypertension in high-risk patients with chronic kidney disease (CKD), diabetes, or heart failure because RAAS inhibitors provide cardiorenal benefits in addition to lowering blood pressure (BP). However, when prescribing antihypertensive therapies to high-risk patients, physicians must be aware of the risks of treatment-related adverse events of hyperkalemia and peripheral edema associated with RAAS inhibitors and CCBs, respectively. This review discusses the use of single-pill combination antihypertensive therapy to optimize BP control in high-risk patients with CKD, diabetes, and/or heart failure and provides strategies for preventing and managing hyperkalemia and peripheral edema in this group. Single-pill combination therapy can utilize different classes of antihypertensive drugs to reduce BP while mitigating the risks of treatment-related adverse events, reducing pill burden, lowering medical cost, and improving patient compliance., (© 2012 Wiley Periodicals, Inc.)