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Abstract Background Cystic fibrosis (CF) is an autosomal recessive disorder that, despite advances in medical care, continues to be a life-limiting disease. With increase in life expectancy of the CF population, bone disease has emerged as a common complication. Aim The aim of the study was to determine bone mineral density (BMD) and total body composition (TBC) in a sample of Egyptian children with CF and assess the contributing factors that might be related to BMD deficits. Materials and methods This was a cross-sectional case–control study that included 15 children with CF who were of a mean age of 6.3±3.68 years (2.5–15 years) and were diagnosed by sweat chloride testing. All CF children were subjected to detailed history taking, thorough clinical examination, laboratory investigations, and pulmonary function tests. They also underwent growth, puberty, and nutrition evaluation. BMD and TBC were evaluated using dual-energy X-ray absorptiometry. Results CF children had significantly decreased mean BMD and TBC compared with the control group. An overall 26.66% of these patients had osteopenia and one patient was 3 years old. They also showed delayed growth when compared with Egyptian standards, and most of them (> 80%) presented with recurrent chest infections, malabsorption, undernutrition, and treatment with inhaled steroids for more than 6 months. Conclusion We demonstrated the presence of osteopenia in our CF patients that presented early in life. Improving nutritional status, correcting malabsorption, and limiting chest infections are necessary for prevention. Annual assessment of BMD and body composition should be initiated early in life to target those who need preventive treatment against osteoporosis and reduce the risk for fractures later in life.

Pseudomonas aeruginosa is a hard-to-treat human pathogen for which new antimicrobial agents are urgently needed. P. aeruginosa is known for forming biofilms, a complex aggregate of bacteria embedded in a self-generated protective matrix that enhance its resistance to antibiotics and the immune system. Within the biofilm, persister cells, sub-populations of slow-growing or growth-arrested cells, are associated with recalcitrance of infections and antibiotic treatment failure. Here, we investigate the influence of the anionic photosensitiser chlorophyllin (CHL) 1 exposed to red light alone and in combination with an activator of the mechanosensitive channels butylparaben (BP) on P. aeruginosa growing cells, persister cells, and biofilms. Antimicrobial susceptibility tests were performed using the broth microdilution checkerboard method. Serine hydroxamate (SHX) was used for the induction of persister cells. Under illumination, a combination of CHL (250 µg/ml) and BP (97.12 µg/ml) reduced the number of growing cells and persister cells by 2.2±0.46 log 10 and 1.7±0.15 log 10 , respectively after 30 min of exposure at 79 J/cm 2 . A higher concentration of BP (194.23 µg/ml) or longer exposure time (60 min at 158 J/cm 2 ) effectively eliminated approximately ≥99.99 % of growing and persister cells. Visual evidence from confocal and TEM images illustrates the influence of CHL and red light, which intensifies when combined with BP. Nevertheless, the addition of BP did not enhance the efficacy of CHL against biofilms; CHL (500 µg/ml) reduced biofilm viability by 2.6 log 10 at 791 J/cm 2 . No toxicity has been observed in darkness. This study highlights the potential antimicrobial effect of CHL against P. aeruginosa., (Copyright © 2024. Published by Elsevier B.V.)

Patients with concurrent heart failure (HF) and atrial fibrillation (AF) have poor outcomes. Randomized clinical trials comparing rhythm control approaches to rate control of AF have yielded conflicting results and there is a paucity of updated and comprehensive evidence summaries to inform best practice in HF patients. We therefore conducted a systematic review and meta-analysis to compare outcomes with rhythm versus rate control of AF in various subgroups of HF patients. In HF patients overall, we found high certainty evidence that rhythm control decreased all-cause and cardiovascular mortality (hazard ratio [HR, 95 % confidence interval] 0.64 [0.43-0.94]) and HR 0.50 [0.34-0.74] respectively). Rhythm control was associated with decreased HF hospitalization (risk ratio [RR] 0.79 [0.63-0.99], moderate certainty), but did not significantly decrease thromboembolic events (RR 0.67 [0.32-1.39], low certainty). The mean difference in left ventricular ejection fraction [LVEF] from baseline to last follow-up was greater in rhythm control group by 6.01 % [2.73-9.28 %] compared with rate control. Subgroup analyses by age, HF etiology (ischemic or non-ischemic), LVEF, presence of diabetes and hypertension did not reveal any significant differences in treatment effect. The survival and hospitalization reduction benefit of rhythm control of AF in HF patients likely reflects the success of catheter ablation especially in HF with reduced ejection fraction. These data are important to guide shared decision-making when managing AF in HF patients., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Indian Heart Rhythm Society. Published by Elsevier B.V. All rights reserved.)

We share the experience of research laboratories in the Eastern Mediterranean Region (EMR) that contributed to preparedness and response to highly pathogenic avian influenza (HPAI), Middle-East respiratory syndrome coronavirus (MERS-CoV), and coronavirus disease (COVID-19). Research groups in the region were pivotal in identifying, characterizing the pathogens and describing their evolution, distribution, transmission routes, and the immunological profile of exposed populations. They demonstrated the capacity to develop and test antivirals and potential vaccines. The EMR experience is a model of how national systems can work with researchers to improve regional preparedness and response to future epidemics and pandemics., (© 2024 The Authors. Influenza and Other Respiratory Viruses published by John Wiley & Sons Ltd.)

Background: Vasovagal syncope (VVS) is a prevalent condition characterized by a sudden drop in blood pressure and heart rate, leading to a brief loss of consciousness and postural control. Recurrent episodes of VVS significantly impact the quality of life and are a common reason for emergency department visits. Non-pharmacological interventions, such as tilt training, physical counter pressure maneuvers, and yoga, have been proposed as potential treatments for VVS. However, their efficacy in preventing VVS remains uncertain., Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. PubMed, Web of Science, and Embase were searched up to March 2023 for randomized controlled trials comparing non-pharmacological interventions with control in preventing VVS recurrence. The primary outcome was the recurrence rate of VVS episodes., Results: A total of 1130 participants from 18 studies were included in the meta-analysis. The overall mean effect size for non-pharmacological interventions versus control was 0.245 (95 % CI: 0.128-0.471, p-value <0.001). Subgroup analysis showed that yoga had the largest effect size (odds ratio 0.068, 95 % CI: 0.018-0.250), while tilt training had the lowest effect size (odds ratio 0.402, 95 % CI: 0.171-0.946) compared to control. Physical counter pressure maneuvers demonstrated an odds ratio of 0.294 (95 % CI: 0.165-0.524) compared to control., Conclusion: Non-pharmacological interventions show promise in preventing recurrent VVS episodes. Yoga, physical counter pressure maneuvers, and tilt training can be considered as viable treatment options. Further research, including randomized studies comparing pharmacological and non-pharmacological approaches, is needed to evaluate the safety and efficacy of these interventions for VVS treatment., Competing Interests: Declaration of competing interest The authors declared no conflict of interest., (Published by Elsevier B.V.)

This study aimed to investigate the effect of supplementation of chitosan nanoparticles (CSNPs) on the capacitation of bovine spermatozoa during the in vitro fertilization process. Hyperactivated motility (HAM) and acrosome reaction (AR) of sperm cells as well as in vitro fertilization and cleavage rates are the main parameters used to estimate the effect of CSNPs on bovine spermatozoa's fertilizing ability. In this study, three different concentrations of CSNPs (10, 20 and 100 μg/mL) were prepared and characterized. Motile spermatozoa were separated from frozen-thawed semen by a swim-up technique and capacitated in Sperm-TALP medium supplemented with heparin only without CSNPs treatment (positive control), heparin + 10 μg/mL CSNPs, heparin + 20 μg/mL CSNPs, heparin + 100 μg/mL CSNPs and the last one served as a negative control tube which supplemented with 10 μg/mL CSNPs without adding heparin. Sperm cells were incubated for 90 min at 39°C in a 5% CO 2 incubator and evaluated every 30 min at intervals. Cumulus oophorus complex (COCs) were matured in a 5% CO 2 incubator at 39°C and inseminated in vitro with frozen-thawed bull sperm of the above concentrations. The inseminated oocytes were incubated at 39°C in a 5% CO 2 incubator for 24 h and then examined for evidence of fertilization. The results of this investigation showed that HAM and AR were best affected by CSNPs at a concentration of 20 μg/mL during an incubation time of 60 min. As time went on, the overall proportion of spermatozoa with progressive motility (PM) decreased across all groups, and a substantially lower value was found at the dose mentioned above. Additionally, the impact of sperm treated with CSNPs on fertilization rate was assessed. The outcomes demonstrated that in comparison to the other concentrations (10 and 100 μg/mL), the positive control and the negative control, the proportion of fertilized oocytes was significantly higher in the CSNPs concentration (20 μg/mL). In conclusion, it could be inferred from this investigation that CSNPs support sperm functions during IVF and can be used for biomedical interventions in bovine spermatozoa. Additionally, a high IVF rate was achieved by using sperm treated with CSNPs as CSNPs enhance sperm capacitation and acrosome reaction., (© 2023 Wiley-VCH GmbH. Published by John Wiley & Sons Ltd.)

Antimicrobial photodynamic inactivation is considered a promising antimicrobial approach that may not develop resistance in the near future. Here, we investigate the influence of the photosensitizer chlorophyllin (CHL) and the cationic permeabilizer polyethylenimine (PEI), exposed to a red light-emitting diode, on the human pathogen Pseudomonas aeruginosa free-living planktonic cells, the sessile biofilm and persister cells. The broth microdilution checkerboard method was used to test antimicrobial susceptibility. As a substrate for biofilms, the Calgary biofilm device was used, and the quantification of the biofilm biomass was carried out using a crystal violet assay. Serine hydroxamate was used for the induction of persisters. Our findings reveal that PEI ameliorates the antimicrobial activity of CHL against P. aeruginosa planktonic and biofilm states, and the concentration required to eradicate the bacteria in the biofilm is more than fourfold that is required to eradicate planktonic cells. Interestingly, the persister cells are more susceptible to CHL/PEI (31.25/100 µg mL -1 ) than the growing cells by 1.7 ± 0.12 and 0.4 ± 0.1 log 10 reduction, respectively, after 15 min of illumination. These data demonstrate that CHL excited with red light together with PEI is promising for the eradication of P. aeruginosa , and the susceptibility of P. aeruginosa to CHL/PEI is influenced by the concentrations and the exposure time.

Background:  The incidence and prevalence of heart failure (HF) in the United States has steadily increased in the past few decades. Similarly, the United States has experienced an increase in HF-related hospitalizations which has added to the burden of a resource-stretched healthcare system. With the emergence of the coronavirus disease 2019 (COVID-19) pandemic in 2020, hospitalizations due to the COVID-19 infection sky-rocketed further exacerbating the burden on both patient health and the healthcare system. The focus of this study is to examine how a secondary COVID-19 diagnosis affects the outcome of HF patients, and how a pre-existing diagnosis of heart failure impacts the outcomes of patients hospitalized with COVID-19 infection., Methods: This was a retrospective observational study of adult patients hospitalized with heart failure and COVID-19 infection in the United States in the years 2019 and 2020. Analysis was conducted using the National Inpatient Sample (NIS) database of the Healthcare Utilization Project (HCUP). The total number of patients included in this study from the NIS database 2020 was 94,745. Of those, 93,798 had heart failure without a secondary diagnosis of COVID-19; 947 had heart failure along with a secondary diagnosis of COVID-19. The primary outcome of our study was in-hospital mortality, length of stay, total hospital charges and time from admission to right heart catheterization, which were compared between the two cohorts.  Results: Our main study findings are that mortality in HF patients with secondary diagnosis of COVID-19 infection was not statistically different compared to those who were without a secondary diagnosis of COVID-19. Our study findings also showed that length of stay (LOS) and hospital costs in HF patients who had a secondary diagnosis of COVID-19 were not statistically different compared to those who did not have the secondary diagnosis. Time from admission to right heart catheterization (RHC) in HF patients who had a secondary diagnosis of COVID-19 was shorter in heart failure with reduced ejection fraction (HFrEF) but not in heart failure preserved ejection fraction (HFpEF) compared to those without secondary diagnoses of COVID-19. Finally, when evaluating hospital outcomes for patients admitted with COVID-19 infection, we found that inpatient mortality increased significantly when they had a pre-existing diagnosis of heart failure., Conclusion: The COVID-19 pandemic significantly impacted hospitalization outcomes for patients admitted with heart failure. The time from admission to right heart catheterization was significantly shorter in patients admitted with heart failure reduced ejection fraction who also had a secondary diagnosis of COVID-19 infection. When evaluating hospital outcomes for patients admitted with COVID-19 infection, we found that inpatient mortality increased significantly when they had a pre-existing diagnosis of heart failure. Length of hospital stay and hospital charges also were higher for patients with COVID-19 infection who had pre-existing heart failure. Further studies should focus not just on how medical comorbidities like COVID-19 infection, affect outcomes of heart failure but also on how overall strains on the healthcare system, such as pandemics, may affect the management of conditions such as heart failure., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Alharbi et al.)

Polyethylenimines (PEIs), a group of polycationic molecules, are known to impair the outer membrane of Gram-negative bacteria and exhibit antimicrobial activity. The outer membrane of Gram-negative strains hinders the uptake of photosensitizer chlorophyllin. In this study, we report chlorophyllin and branched PEI combinations’ activity against Escherichia coli strains DH5α and RB791, Salmonella enterica sv. Typhimurium LT2, and Bacillus subtilis 168. The minimal bactericidal concentration (MBC) was determined by plating cells treated with different concentrations of PEI and chlorophyllin on agar and monitoring their growth after 24 h. All tested combinations of PEI and chlorophyllin were lethal for S. enterica after 240 min of incubation in light, whereas PEI alone (<100 µg mL−1) was ineffective. In the darkness, complete inhibition was noted with a combination of ≥2.5 µg mL−1 chlorophyllin and 50 µg mL−1 PEI. If applied alone, PEI alone of ≥800 µg mL−1 of PEI was required to completely inactivate E. coli DH5α cells in light, whereas with ≥5 µg mL−1 chlorophyllin, only ≥100 µg mL−1 PEI was needed. No effect was detected in darkness with PEI alone. However, 1600 µg mL−1 PEI in combination with 2.5 µg mL−1 resulted in complete inactivation after 4 h dark incubation. PEI alone did not inhibit E. coli strain RB791, while cells were inactivated when treated with 10 µg mL−1 chlorophyllin in combination with ≥100 µg mL−1 (in light) or ≥800 µg mL−1 PEI (in darkness). Under illumination, B. subtilis was inactivated at all tested concentrations. In the darkness, 1 µg mL−1 chlorophyllin and 12.5 µg mL−1 PEI were lethal for B. subtilis. Overall, PEI can be used as an antimicrobial agent or potentiating agent for ameliorating the antimicrobial activity of chlorophyllin.

Background: There is a paucity of real-world data regarding the temporal trends and outcomes of trans-septal transcatheter mitral valve replacement (TS-TMVR) in the United States (US)., Methods: We queried the Nationwide Readmissions Database (October 2015 to December 2018) for patients undergoing TS-TMVR procedures. We reported the temporal trends in the utilization, in-hospital outcomes and 30-day readmissions after TS-TMVR. The main study outcome was in-hospital mortality., Results: There was an increase in the number of TS-TMVR procedures over time (48 in 2015 vs. 978 in 2018, P trend  < 0.001), with a notable increase in the proportion of women (P trend  = 0.04) and the prevalence of diabetes (P trend  = 0.03). There was an increase in the number of centers performing TS-TMVR (21 in 2015 vs. 164 in 2018, P trend  < 0.001). The overall in-hospital mortality was 7.2% with no change over time (6.3% in 2015 vs. to 5.2% in 2018, P trend  = 0.67). There was no change in the frequency of in-hospital complications after TS-TMVR; however, the median length of stay has decreased over time. The overall 30-day readmission rate was 17.8%, with no change during the study years. The most frequent cause for 30-day readmission after TS-TMVR was acute heart failure followed by bleeding and infection-related complications. Prior coagulopathy and small-sized hospitals were independently associated with higher in-hospital mortality and 30-day readmissions., Conclusion: This nationwide observational analysis of real-world data showed an increase in the number of TS-TMVR procedures over time, which is now performed at a greater number of centers. There was no change in the rate of in-hospital mortality, complications or 30-day readmissions; but a significant reduction in the length of hospital stay over time was noted. As the number of TS-TMVR continue to expand, these data provide a perspective on the early experience with this procedure., (© 2021 Wiley Periodicals LLC.)

Introduction: Older adults are more susceptible to severe COVID-19, with increased all-cause mortality. This has been attributed to their multimorbidity and disability. However, it remains to be established which clinical features of older adults are associated with severe COVID-19 and mortality. This information would aid in an accurate prognosis and appropriate care planning. Here, we aimed to identify the chronic clinical conditions and the comorbidity clusters associated with in-hospital mortality in a cohort of older COVID-19 patients who were admitted to the IRCCS Policlinico San Martino Hospital, Genoa, Italy, between January and April 2020. Methods: This was a retrospective cohort study including 219 consecutive patients aged 70 years or older and is part of the GECOVID-19 study group. During the study period, upon hospital admission, demographic information (age, sex) and underlying chronic medical conditions (multimorbidity) were recorded from the medical records at the time of COVID-19 diagnosis before any antiviral or antibiotic treatment was administered. The primary outcome measure was in-hospital mortality. Results: The vast majority of the patients (90%) were >80 years; the mean patient age was 83 ± 6.2 years, and 57.5% were men. Hypertension and cardiovascular disease, along with dementia, cerebrovascular diseases, and vascular diseases were the most prevalent clinical conditions. Multimorbidity was assessed with the Cumulative Illness Rating Scale. The risk of in-hospital mortality due to COVID-19 was higher for males, for older patients, and for patients with dementia or cerebral-vascular disease. We clustered patients into three groups based on their comorbidity pattern: the Metabolic-renal-cancer cluster, the Neurocognitive cluster and the Unspecified cluster. The Neurocognitive and Metabolic-renal-cancer clusters had a higher mortality compared with the Unspecified cluster, independent of age and sex. Conclusion: We defined patterns of comorbidity that accurately identified older adults who are at higher risk of death from COVID-19. These associations were independent of chronological age, and we suggest that the identification of comorbidity clusters that have a common pathophysiology may aid in the early assessment of COVID-19 patients with frailty to promote timely interventions that, in turn, may result in a significantly improved prognosis., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Mahmoud, Carmisciano, Tagliafico, Muzyka, Rosa, Signori, Bassetti, Nencioni, Monacelli and the GECOVID Study Group.)

Traditional solutions of food packing are limited for antimicrobial packaging materials that interact with the product to inhibit the growth of microorganisms. In this work, adhesive composite was developed as an active packaging material using allyl isothiocyanate (AIC) in vapor phase. Such adhesive composite was made of gelatin electrospun fibers loaded by AIC and supportive adhesive sheet. Gelatin electrospun fibers loaded by AIC (2-10% v/v) into 24% wt/v gelatin solutions was produced using electrospinning apparatus at 15 kV, 15 cm air gap and 0.2 mL/h flow rate. This mat was supported by pressure-sensitive adhesive (PSA) made of hydroxyethyl cellulose backbone grafted by acrylic acid and methylbutyl acrylate [HEC-g-poly(AA-MBA)]. PSA was characterized in means of spectral, physicochemical and rheological analysis. Final product with AIC (2% v/v) showed significant antimicrobial activities against two food born bacteria including Staphylococcus aureus ATCC 25923 and Escherichia coli O157:H7. Antimicrobial activities on cheese showed that gelatin nanofibers loaded by AIC (10% v/v), applied in the headspace, extended the shelf life of cheese from 4 weeks to 8 weeks., Competing Interests: Declaration of competing interest The authors have declared no conflicts of interest., (Copyright © 2020 Elsevier B.V. All rights reserved.)

A comparison between the most investigated alginate-based encapsulating agents was performed in the current study. Here, the survivability of Lactobacillus plantarum microencapsulated with alginate (Alg) combined with skim milk (Sm), dextrin (Dex), denatured whey protein (DWP) or coated with chitosan (Ch) was evaluated after exposure to different heat treatments and in presence of some food additives, during storage and under simulated gastrointestinal condition. In addition, the encapsulated cells were evaluated for production of different bioactive compounds such as exopolysacchar. ides and antimicrobial substances compared with the unencapsulated cells. The results showed that only Alg-Sm maintained the viability of the cells >10 6 cfu/g at the pasteurization temperature (65 °C for 30 min). Interestingly, storage under refrigeration conditions increased the viability of L. plantarum entrapped within all the tested encapsulating agents for 4 weeks. However, under freezing condition, only Alg-DWP and Alg-Sm enhanced the survival of the entrapped cells for 3 months. All the microencapsulated cells were capable of growing at the different NaCl concentrations (1%-5%) except for cells encapsulated with Alg-Dex, showed viability loss at 3% and 5% NaCl concentrations. Tolerance of the microencapsulated cells toward organic acids was varied depending on the type of organic acid. Alg-Ch and Alg-Sm provide better survival for the cells under simulated gastric juice; however, all offer a good survival for the cells under simulated intestinal condition. Our findings indicated that Alg-Sm proved to be the most promising encapsulating combination that maintains the survivability of L. plantarum to the recommended dose level under almost all the stress conditions adopted in the current study. Interestingly, the results also revealed that microencapsulation does not affect the metabolic activity of the entrapped cells and there was no significant difference in production of bioactive compounds between the encapsulated and the unencapsulated cells., (© 2020 Published by Elsevier Ltd.)

If unrecognized, tamponade after coronary artery bypass grafting can be fatal. We describe a 63-year-old man who developed unexplained hypotension and tachycardia and was found to have severe compression of the right atrial cavity by a large hematoma in the pericardial sac.

The aim of the present study was to prepare and characterize bionanocomposite materials, and to evaluate its use in the coating of Ras cheese. The bionanocomposite materials were made from mixture of chitosan/polyvinyl alcohol with loading of titanium dioxide nanoparticles (TiO 2 -NPs) from (0.5-2%). The prepared nanoparticles as well as the bionanocomposites were evaluated using, XRD, SEM, TEM, FT-IR and final contact angle. Furthermore, the mechanical properties and water vapor transmission rate (WVTR) of the fabricated bionanocomposites were evaluated. The impacts of coating Ras cheese with the prepared bionanocomposite on weight losses and microbiological, chemical, and physical characteristics of the Ras cheese were assessed during ripening in comparison to the uncoated cheese. Coating of cheese decreased the weight and moisture losses but didn't affect the normal ripening changes in the microbiological, chemical and textural properties of Ras cheese. Coating cheese with film containing 2% TiO 2 -NPs eliminated mold growth on the cheese surface., (Copyright © 2018 Elsevier Ltd. All rights reserved.)