No abstract

Background: Psoriasis is a common inflammatory disorder of the skin. Psoriasis is a disease of multifactorial origin where certain environmental factors acting on individuals with specific genetic predisposition leads to an immune dysregulation. Claudins are transmembrane proteins, which participate in the formation of tight junctions by binding to the actin cytoskeleton. Claudin-3 present in the blood is considered as a useful biomarker of intestinal permeability. Objective: To evaluate serum level of claudin-3 in patients with psoriasis in comparison to control group and correlate its levels with disease severity . Patients and methods: Fifty-three patients (32 males and 21 females) with psoriasis and forty normal healthy control (23 males and 17 females) who matched the cases group as regard age and sex were included in this work. They were randomly selected from the Dermatology Department outpatient clinic in Mansoura University Hospital. Results: Psoriasis group showed significantly higher level of claudin-3 when compared to control group (mean=58.3 versus 41.2; p<0.001). Smoking was significantly associated with higher Claudin-3 level (p=0.031). In addition, claudin-3 level increased gradually with increased severity grades (p<0.001). No significant associations were found regarding claudin-3 level according to gender, nutritional status, family history, in psoriasis group (p>0.05 for each). Higher BMI, smoking and higher claudin-3 level were associated with prediction of higher PASI score in univariate analysis. While multivariate analysis revealed that only smoking and higher claudin-3 level were considered independent predictor of more severe psoriasis cases. Conclusion: Claudin-3 level was significantly higher in patients with psoriasis than healthy controls. PASI correlated with claudin-3 levels.

Background: Myocardial damage due to ischemia and reperfusion is still unavoidable during coronary surgery. Anesthetic agents have myocardial preconditioning effect. Ketamine has sympathomimetic effect, while dexmedetomidine has a sympatholytic effect in addition to anesthetic, analgesic, and anti-inflammatory properties of both the drugs. This study was carried out to compare ketamine–dexmedetomidine (KD) combination with fentanyl–propofol (FP) combination on the release of cardiac troponin T (cTnT) and outcome after coronary artery bypass graft. Patients and Methods: Ninety adult patients who underwent coronary artery bypass grafting (CABG) were assigned to receive either KD base anesthesia (KD group) or FP anesthesia (FP group). Trends of high-sensitive cTnT, CK-MB, and serum cortisol were followed in the first postoperative 24 h. Other outcomes were vital signs, weaning from cardiopulmonary bypass, tracheal extubation time, and echocardiographic findings. Results: There was a significant lower release of cTnT in KD group than FP group during its peak values at 6 h after aortic unclamping (92.01 ± 7.332 in KD versus 96.73 ± 12.532 ng.L −1 P = 0.032). significant lower levels of serum cortisol levels were noted KD group than in FP group at 6 and 12 h after aortic unclamping P < 0.001. As regard tracheal extubation time, patients assigned to KD group extubated earlier than whom in FP group 202.22 ± 28.674 versus 304.67 ± 40.598 min respectively P < 0.001. Conclusion: The use of KD during on-pump CABG confers better myocardial protective and anti-inflammatory effect than fentanyl propofol.

<abstract> <p>The <italic>pks</italic> genotoxic <italic>K. pneumoniae</italic> has recently triggered a widespread alarm. DNA damage and higher virulence have been linked to colibactin, a genotoxin expressed by the <italic>pks</italic> genomic island. Little is known about its molecular epidemiology in clinical isolates from Egypt. Therefore, this study was conducted to determine the prevalence and the microbiological and clinical features of <italic>pks</italic> harboring hospital-acquired <italic>K. pneumoniae</italic> isolates from Egypt. Eighty-seven hospital-acquired <italic>K. pneumoniae</italic> isolates from various specimen types were screened for <italic>pks</italic> colibactin island markers <italic>clbB</italic>, <italic>clbQ</italic>, <italic>clbA</italic>, and <italic>clbN</italic> by PCR. The <italic>pks</italic>-positive hvKp isolates were classified to one of the capsular types K1 and K2 using multiplex-PCR targeting <italic>K</italic>-serotype <italic>wzi</italic> and <italic>rmpA</italic> genes. The prevalence of <italic>pks⁺</italic> strains was 27.6% (24/87). K1 capsular type, phenotypic, and genotypic hypervirulent isolates were significantly higher among <italic>pks⁺</italic> strains than <italic>pks⁻</italic> strains (<italic>P</italic> &lt; 0.001), while <italic>pks⁺ K. pneumoniae</italic> strains were found to be significantly less resistant to 8 of the antibiotic compounds tested than <italic>pks⁻</italic> strains. Carriage of K1 capsular type and mucoviscosity-associated <italic>rmp A</italic> gene and diabetes mellitus were identified to remain independent risk factors having a substantial association to <italic>pks</italic>-positivity by multivariate regression analysis. In conclusion, Hospital-acquired <italic>K. pneumoniae</italic> isolates in Egypt had an increased prevalence of the <italic>pks</italic> colibactin genotoxin. The significant occurrence of hypervirulent determinants in <italic>pks⁺ K. pneumoniae</italic> highlighted the genotoxin's possible pathogenicity combined with its distribution in several specimen types, which necessitates clinical attention and epidemic tracking.</p> </abstract>

Background: In hepatocellular carcinoma (HCC), CK19 is a marker of hepatic progenitor cells and acts as a key player in tumor invasion, indicating poor prognosis. Early diagnosis of HCC heavily affects the clinical outcome of patients. The widely accepted serological marker for HCC diagnosis is alpha-fetoprotein (AFP). However, its diagnostic accuracy is controversial and unsatisfactory because of its low sensitivity. The objective of the current study is to evaluate the influence of CK19 level on Pattern of HCC in patients with liver cirrhosis. Patients and methods: This was a prospective case -control study that was conducted on patients attending at early detection of HCC Outpatient Clinic or admitted to Hepatology and Gastroenterology Unit, Specialized Medical Hospital Mansoura University, over past year. The current study included 75 participants divided into 3 groups: Group 1 (HCC), Group 2 (cirrhosis only) and Group 3 (healthy people without any medical disease). Results: There was statistically significant increase as regard median CK19 level, between degrees of aggressiveness index (A, B and C) (P >0.05). Regarding the validity of CK19 in differentiating the studied groups, there was no statistically significant difference as regard median CK19 level in cirrhosis and control groups with Sensitivity 56% and Specificity 40%. There was no statistically significant difference as regard median CK19 level in HCC and control groups with Sensitivity 64% and Specificity 40%. There was no statistically significant difference as regard median CK19 level in HCC and cirrhosis groups with Sensitivity 64% and Specificity 44%. There is weak significant relationship between the levels of CK19 and AFP in HCC cases (P-value 0.07). Conclusion: CK19 associated carry a poor prognosis as it associated with more aggressive pattern of HCC. CK19 is good negative marker of early HCC, So CK19 negative HCC patients has no priority for treatment.

Objective: Turner syndrome (TS) patients are at high risk of cardiometabolic disorders. Cardiometabolic risk factors are more commonly related to visceral rather than total body adiposity. Adipocytokines have been explored as a potential link between obesity and obesity-related cardiometabolic dysfunction. This study explored the validity of epicardial fat-thickness (EFT) and perihepatic fat-thickness (PHFT) measurement as cardiometabolic-risk predictors in TS-girls in relation to standard obesity-indices and metabolic syndrome (MetS) components. Methods: Forty-six TS girls and twenty-five controls (10-16 years) were subdivided into two age-groups (10 to less than 13 and 13-16). Participants were assessed for body mass index (BMI) Z-scores, waist circumference (WC), total-fat mass (FM) and trunk-FM by bioimpedance-technique, EFT and PHFT by cardiovascular magnetic resonance, lipid-profile, homeostasis model assessment of insulin resistance (HOMA-IR), and serum chemerin. MetS was defined according to International Diabetes Federation criteria. Results: Overweight/obesity and MetS were detected in 45.7% and 37% of TS-girls respectively. BMI Z-score, WC, total-FM, trunk-FM, EFT and PHFT values were significantly higher in TS-age groups compared to age-matched control groups, being more pronounced in the older group when TS-girls had been exposed to estrogen. Dyslipidemia, higher HOMA-IR, chemerin, EFT and PHFT values were observed in lean-Turner compared to BMI-Z-matched controls. EFT and PHFT were significantly correlated with chemerin and several components of MetS. EFT at a cut-off-value of 6.20 mm (area under the curve=0.814) can predict MetS in TS-girls. Conclusion: TS-girls displayed an adverse cardiometabolic profile during late childhood and adolescence. EFT and PHFT are emerging cardiometabolic risk predictors in TS-patients. Excess EFT rather than total body adiposity may contribute to altered metabolic profile among lean-Turner patients.

Objective: Although multiple studies have addressed the clinical outcomes of coronavirus disease, little data exist regarding the definition of immune and inflammatory profiles associated with this infection. Its clinical manifestations often worsen in association with hypercytokinemia (elevated interleukin 8 and interleukin 17). We conducted this research to elucidate the effect of interleukin 17 levels and interleukin 17F gene polymorphism on the severity and outcomes of coronavirus disease. Material and Methods: Ninety patients with confirmed coronavirus disease and 30 healthy controls were enrolled. Coronavirus disease cases were classified into nonsevere, severe, and critical according to the World Health Organization definition. Approximately 10 mL peripheral blood sample was collected from all patients and controls by venipuncture in-plane and ethylenediaminetetraacetic acid tube. Enzyme-linked immunosorbent assay kits were used for calculating serum interleukin 17 levels, whereas real-time polymerase chain reaction was used for genotyping using the 5'-nuclease allelic discrimination assay for single nucleotide polymorphisms genotyping. Results: As regards interleukin 17 levels, there was a significant elevation of interleukin 17 in coronavirus disease cases compared to control healthy persons ( P < .001). Moreover, serum interleukin 17 levels tended to be significantly higher with increased disease severity ( P = .004). Patients with critical diseases expressed a significant rise of interleukin 17 compared to severe ( P = .03) and nonsevere cases ( P = .02). We noted no significant difference between the critical, severe, and nonsevere cases regarding different interleukin 17F genotypes. Conclusion: Coronavirus disease is associated with elevated levels of interleukin 17, which tended to be considerably higher with disease severity. However, different interleukin 17F genotypes do not affect either the predisposition or the severity of coronavirus disease.

Background Postoperative cognitive dysfunction is commonly encountered after major surgical operations. This study was conducted to evaluate the effect of dexmedetomidine on neurocognitive dysfunction and postoperative recovery after total laryngectomy in the elderly population. Results Preoperative characteristics were comparable between the two groups. However, both sevoflurane consumption and recovery time were significantly decreased in the Dex group. Also, the time to first analgesic request and sedation level showed a significant improvement in the same group. The Dex group showed its superiority regarding most of the used cognitive tests. Although there was no significant difference between the two study groups regarding basal S100B, postoperative levels significantly decreased in the Dex group. Conclusions Dexmedetomidine administration is associated with a significant improvement of cognitive function after surgery in the elderly population. It is associated with a better analgesic and sedative profile along with decreased neurological inflammatory markers. However, the patient must be closely monitored for side effects like bradycardia and hypotension.