Investigating circulatory microRNA expression profiles in Egyptian patients with HCV induced hepatocellular carcinoma

Hepatitis C virus (HCV) infection is a serious health challenge affecting over 185 million individuals globally. Egypt has the highest rate for chronic HCV infection worldwide. Recent studies have shown that from 10%-30% of HCV infected individuals would progress to more deteriorating conditions such as cirrhosis and/or hepatocellular carcinoma (HCC). Current biomarkers for HCC diagnosis are lacking both sensitivity and specificity. As a result there is demand to develop reliable biomarkers that are sensitive, specific and non-invasive for early diagnosis and rapid intervention of HCC to increase the survival rate of patients. Recently, circulatory miRNAs have drawn great attention as promising non-invasive biomarkers for various diseases. They are highly stable in blood and their expression profiles reflect disease progression and/or drug response status. Besides, a number of miRNAs were found to be commonly dysregulated in HCC. In this study, we investigated mi-RNA expression profile from the plasma of Egyptian patients with chronic hepatitis C, cirrhosis and HCV associated HCC compared with healthy control. We aimed to assess the diagnostic potential of the selected miRNAs to differentiate between healthy, HCV and HCV associated disorders (cirrhosis and HCC). In addition to studying the expression pattern in the different studied stages. Using real time PCR, we compared the levels of circulating mir-122, miR-21 and miR-155 in plasma from healthy control (n=40), cirrhosis (n=39) and HCC (n=40) to CHC (n=37). Synthetic miR-39 was spiked in the samples to be used as a normalizing control for the samples. Plasma miR-122 was significantly up-regulated iii in HCC than in the three other categories (P\u3c0.001). The plasma level of miR-122 in HCC patients was significantly higher than healthy control and cirrhotic patients (P = 0.002 and P\u3c0.001, respectively). The plasma level of miR-21 was significantly upregulated in HCC compared to cirrhotic patients (P=0.03). Although Control and HCC in mir-21 increased by 3.52 and 6 log2 scale respectively, they were in marginal insignificance (p=0.093) that might be due to limited number of samples used in this study. There had been no significant dys-regulation in the expression levels of miR155 between the 4 categories. Receiver operating characteristic curves’ analysis revealed that miR-122 differentiated HCC patients from healthy control with a specificity and sensitivity 57.50% and 65.52% respectively (at a cutoff \u3e1.86). To discriminate cirrhotic patients from HCC subjects, a specificity and sensitivity of 61.54% and 1.43% (at a cutoff\u3e 0.43) were determined. Additionally, analyzing ROC curve indicated that miR-21 differentiated HCC patients from cirrhotic patients with best sensitivity and specificity 72.97% and 50% (at a cutoff \u3e-0.43). In conclusion, plasma miR-122 and miR-21 may be further investigated as potential markers for HCV associated HCC

Systematic review of the safety of medication use in inpatient, outpatient and primary care settings in the Gulf Cooperation Council countries

Background Errors in medication use are a patient safety concern globally, with different regions reporting differing error rates, causes of errors and proposed solutions. The objectives of this review were to identify, summarise, review and evaluate published studies on medication errors, drug related problems and adverse drug events in the Gulf Cooperation Council (GCC) countries. Methods A systematic review was carried out using six databases, searching for literature published between January 1990 and August 2016. Research articles focussing on medication errors, drug related problems or adverse drug events within different healthcare settings in the GCC were included. Results Of 2094 records screened, 54 studies met our inclusion criteria. Kuwait was the only GCC country with no studies included. Prescribing errors were reported to be as high as 91% of a sample of primary care prescriptions analysed in one study. Of drug-related admissions evaluated in the emergency department the most common reason was patient non-compliance. In the inpatient care setting, a study of review of patient charts and medication orders identified prescribing errors in 7% of medication orders, another reported prescribing errors present in 56% of medication orders. The majority of drug related problems identified in inpatient paediatric wards were judged to be preventable. Adverse drug events were reported to occur in 8.5–16.9 per 100 admissions with up to 30% judged preventable, with occurrence being highest in the intensive care unit. Dosing errors were common in inpatient, outpatient and primary care settings. Omission of the administered dose as well as omission of prescribed medication at medication reconciliation were common. Studies of pharmacists’ interventions in clinical practice reported a varying level of acceptance, ranging from 53% to 98% of pharmacists’ recommendations. Conclusions Studies of medication errors, drug related problems and adverse drug events are increasing in the GCC. However, variation in methods, definitions and denominators preclude calculation of an overall error rate. Research with more robust methodologies and longer follow up periods is now required.Peer reviewe

Fiber Reinforced Elastomeric Isolators for Bridge Applications

Bridge structures are considered a critical component in transportation systems. Bridges are divided into two main components, the superstructure and the substructure. Often the superstructure is integrated with the substructure. However, this type of integrated connection results in a direct transmission of straining actions developed within the superstructure to the substructure and vice versa. This consequently leads to a significant increase in the demand capacity of both elements. Examples of various actions that can develop in the superstructure include thermal expansion/contraction, pre-stress shortening/camber and creep. Deformation induced from ground motions during a seismic event is an example of an action that develops in the substructure. It has been proposed to isolate the superstructure and substructure by implementing bearings/isolators between these two components in order to reduce the transmission of straining actions. If the elements are used only to transfer the vertical loads as well as to accommodate the rotational and/or lateral deformations then it is referred as a bearing. However, if the bearings are also used for seismic isolation of the bridge then they are defined as isolators. Thus, isolators also act as bearings, but bearings may not be capable of acting as isolators. Elastomeric bearings/isolators are among the most common and widely used bearing type. Traditional elastomeric bearings are comprised of elastomer layers reinforced with steel plates/shims and are called Steel Reinforced Elastomeric Isolators (SREI). However, the application of these bearings has been limited to high-importance structures. This is due to the fact that SREI are characterized by their high cost and weight. These features result from labour intensive manufacturing costs and significant weight of the steel shims and end plates. As such, it has been proposed that a reduction in weight and cost could be achieved if the steel reinforcement was replaced with another type of material having comparable mechanical properties to steel, such as fiber fabric sheets. This relatively new type of isolator is called a Fiber Reinforced Elastomeric Isolators (FREI). FREI can be constructed without thick steel end plates and are placed, unfastened, between the superstructure and the substructure. In this case, the isolator is denoted as an unbonded-FREI (U-FREI). In addition to the expected reduction in weight and potential cost, U-FREI can be manufactured and cut to the desired shape and size from large sheets using a standard band saw. Furthermore, U-FREI are able to detach from the contact supports by rollover and lift-off under excessive deformations in the lateral and rotational direction, respectively. This is due to the unbonded boundary conditions and the negligible flexural rigidity of the fiber reinforcement. Research studies have revealed that U-FREI have desirable performance characteristics for building applications. This dissertation investigates the feasibility of extending the use of U-FREI to bridge applications. Experimental testing was carried out to study U-FREI behaviour under a wide range of bridge loading conditions in the vertical, rotational, and lateral directions. Numerical studies were also completed to assess the resulting stress and strain state within U-FREI. Finally, the seismic performance of a bridge, equipped with a U-FREI isolation system was evaluated via non-linear time history analysis using a large suite of earthquake motions.DissertationDoctor of Philosophy (PhD

Inherent Safety and Chlorine in Water Treatment

Chlorine has been used for water treatment purposes for more than one hundred years. The simplicity and effectiveness of using chlorine and its derivatives for water treatment is one of the wonders of modern chemistry: it is cheap, it is safe, and it works. Chlorine has uses on water intake structures, for the removal of aquatic organisms, for pre-filtration, to kill bacteria and for water disinfection. The gas has a greenish-yellowish color and has a molecular weight that is two and a half times larger than that of air. In its gaseous form, chlorine is extremely toxic and dangerous. It also has a very high coefficient of expansion. For this reason, all chlorine containers’ volume must not be filled up past eighty five percent of their capacity. Chlorine gas is fed into the water treatment system under vacuum conditions. Chlorine tanks have an automated system of regulators, feed equipment and vacuum ejectors. Piping connections must be sealed with proper pipe thread compound and compression fittings must be sealed with a new lead washer. Also, chlorine gas scrubbers should be installed in any facility that uses chlorine gas. The Environmental Protection Agency (EPA) requires wastewater plants which store two-thousand five-hundred pounds or more of chlorine gas to conduct a risk management plan. Risk reduction begins with using the smallest cylinders possible of chlorine gas for the application. Water treatment plants can manifold as many ton containers as necessary while controlling for leaks at each individual container and throughout the entire system. In addition, the water plant should be located as far out of the city as possible, downwind of the prevailing winds. Booster systems at strategic locations can be placed. The Pasquill-Gifford model is a very good way to estimate the concentrations of a release at different distances from the source. However, a better Al-Obaidli, Anany, Hamad 3 3 model to use would be the Britter and McQuaid model for dense gases. Risk assessment software such as PHAST provides planners and retrofitters with a tool to determine various levels of risk. The example used about Ras-Laffan was simulated using PHAST for the three cases involved. The companies at Ras-Laffan assume that the wind direction from that region will always be North-West. If that were true, then the results from PHAST show that there would be no risk of the leak reaching any of the surrounding cities. The rupture of a one- ton cylinder could potentially produce a cloud one mile high by a half- mile wide by one mile long of toxic mustard gas that will kill everything in its wake. A train in Ontario derailed and a tank car of chlorine gas ruptured; if there had not been a large propane fire funneling the heavier-than-air mustard gas upwards into the atmosphere, many thousands of people in the city of Mississauga might have died. Although chlorine is by far the cheapest chemical to use for water treatment, the most widely accepted, and has the fewest risks to public health, other chemicals should also be investigate

Efficacy and safety of once daily liraglutide versus twice daily exenatide in type 2 diabetic patients in Qatar: an observational study.

Objective: Compare efficacy and safety of liraglutide (1.8 mg subcutaneous once daily) and exenatide (10 mcg subcutaneous twice daily) in uncontrolled type 2 diabetes at 26 and 52 weeks. Method: A retrospective observation study of uncontrolled type 2 diabetes patients who took liraglutide or exenatide in addition to their anti-diabetic medications. This study was conducted at Hamad Medical Corporation, the predominant public healthcare organization in Qatar. The primary outcome was the change in haemoglobin A1C (HbA1C) after 26 and 52 weeks. Key finding: Two hundred and two patients were included in this study (liraglutide 98, exenatide 114). There was no significant HbA1C change observed between two groups at either 26 or 52 weeks (P = 0.23 and 0.40 respectively). However, more patients in the liraglutide group achieved HbA1C ≤7% at week 26. Liraglutide reduced the mean Fasting blood glucose (FBG) more than exenatide at week 26 and 52. Although both medications were associated with some benefits in other studied variables at a certain point (e.g. weight losses, blood pressure), neither of them were able to show a significant change from baseline. No patients in either group reported drug-related side effects (e.g. nausea and vomiting) or episodes of hypoglycaemia during the treatment period. Conclusions; Exenatide and liraglutide resulted in similar glycaemic effects (HbA1C and fasting plasma glucose changes) in patients with type 2 diabetes who were sub-optimally controlled with other anti-diabetic therapy. However, this study supports the effectiveness of both medications for weight reduction at both endpoints. A prospective large-scale study is recommended to overcome the study limitations

Internet-based search of randomised trials relevant to mental health originating in the Arab world

BACKGROUND: The internet is becoming a widely used source of accessing medical research through various on-line databases. This instant access to information is of benefit to busy clinicians and service users around the world. The population of the Arab World is comparable to that of the United States, yet it is widely believed to have a greatly contrasting output of randomised controlled trials related to mental health. This study was designed to investigate the existence of such research in the Arab World and also to investigate the availability of this research on-line. METHODS: Survey of findings from three internet-based potential sources of randomised trials originating from the Arab world and relevant to mental health care. RESULTS: A manual search of an Arabic online current contents service identified 3 studies, MEDLINE, EMBASE, and PsycINFO searches identified only 1 study, and a manual search of a specifically indexed, study-based mental health database, PsiTri, revealed 27 trials. CONCLUSION: There genuinely seem to be few trials from the Arab world and accessing these on-line was problematic. Replication of some studies that guide psychiatric/psychological practice in the Arab world would seem prudent

Bridging vs Non-Bridging with Warfarin Peri-Procedural Management: Cost and Cost-Effectiveness Analyses

The warfarin peri-procedural management in Qatar is predominantly based on bridging (63%), compared to non-bridging. This study sought to perform a first-time cost analysis of current warfarin peri-procedural management practices, including a cost-effectiveness analysis (CEA) of predominant bridging vs predominant non-bridging practices. From the hospital perspective, a one-year decision-analytic model followed the cost and success consequences of the peri-procedural warfarin in a hypothetical cohort of 10,000 atrial fibrillation patients. Success was defined as survival with no adverse events. Outcome measures were the cost and success consequences of the 63% bridging (vs not-bridging) practice in the study setting, ie, Hamad Medical Corporation, Qatar, and the incremental cost-effectiveness ratio (ICER, cost/success) of the warfarin therapy when predominantly bridging based vs when predominantly non-bridging based. The model was based on Monte Carlo simulation, and sensitivity analyses were performed to confirm the robustness of the study conclusions. As per 63% bridging practices, the mean overall cost of peri-procedural warfarin management per patient was USD 3,260 (QAR 11,900), associated with an overall success rate of 0.752. Based on the CEA, predominant bridging was dominant (lower cost, higher effect) over the predominant non-bridging practice in 62.2% of simulated cases, with a cost-saving of up to USD 2,001 (QAR 7,303) at an average of USD 272 (QAR 993) and was cost-effective in 36.9% of cases. Being between cost-saving and cost-effective, compared to predominant non-bridging practices, the predominant use of bridging with warfarin seems to be a favorable strategy in atrial fibrillation patients

Cellulose: from biocompatible to bioactive material

International audienceSince the papyri, cellulose has played a significant role in human culture, especially as paper. Nowadays, this ancient product has found new scientific applications in the expanding sector of paper-based technology. Among paper-based devices, paper-based biosensors raise a special interest. The high selectivity of biomolecules for target analytes makes these sensors efficient. Moreover, simple paper-based detection devices do not require hardware or specific technical skill. They are inexpensive, rapid, user-friendly and therefore highly promising for providing resource-limited settings with point-of-care diagnostics. The immobilization of biomolecules onto cellulose is a key step in the development of these sensing devices. Following an overview of cellulose structural features and physicochemical properties, this article reviews current techniques for the immobilization of biomolecules on paper membranes. These procedures are categorized into physical, biological and chemical approaches. There is no universal method for biomolecule immobilization. Thus, for a given paper-based biochip, each strategy can be considered