Brain Changes in Long-Term Zen Meditators Using Proton Magnetic Resonance Spectroscopy and Diffusion Tensor Imaging: A Controlled Study

Introduction: This work aimed to determine whether 1H magnetic resonance imaging (MRI), magnetic resonance spectroscopy (MRS), diffusion-weighted imaging (DWI) and diffusion tensor imaging (DTI) are correlated with years of meditation and psychological variables in long-term Zen meditators compared to healthy non-meditator controls. Materials and Methods: Design. Controlled, cross-sectional study. Sample. Meditators were recruited from a Zen Buddhist monastery. The control group was recruited from hospital staff. Meditators were administered questionnaires on anxiety, depression, cognitive impairment and mindfulness. 1H-MRS (1.5 T) of the brain was carried out by exploring four areas: both thalami, both hippocampi, the posterior superior parietal lobule (PSPL) and posterior cingulate gyrus. Predefined areas of the brain were measured for diffusivity (ADC) and fractional anisotropy (FA) by MR-DTI. Results: Myo-inositol (mI) was increased in the posterior cingulate gyrus and Glutamate (Glu), N-acetyl-aspartate (NAA) and N-acetyl-aspartate/Creatine (NAA/Cr) was reduced in the left thalamus in meditators. We found a significant positive correlation between mI in the posterior cingulate and years of meditation (r = 0.518; p = .019). We also found significant negative correlations between Glu (r =20.452; p = .045), NAA (r =20.617; p = .003) and NAA/Cr (r =20.448; P = .047) in the left thalamus and years of meditation. Meditators showed a lower Apparent Diffusion Coefficient (ADC) in the left posterior parietal white matter than did controls, and the ADC was negatively correlated with years of meditation (r =20.4850, p = .0066). Conclusions: The results are consistent with the view that mI, Glu and NAA are the most important altered metabolites. This study provides evidence of subtle abnormalities in neuronal function in regions of the white matter in meditators

Platelet Indices as a marker of severity in Acute Coronary Syndrome patients at Qena University Hospital

Background: Coronary artery disease (CAD) is the leading global cause of death, with acute coronary syndrome (ACS) being a severe form leading to myocardial injury. Platelets and lipids play a key role in thrombosis and atherogenesis. Complete blood count (CBC) ratios may predict ACS outcomes. Objectives: To assess the relationship between platelet and inflammatory indices and the severity of ACS. Patients and methods: This cross-sectional study involved ACS patients aged 18+. Patients were divided into groups 1 (stable CAD) and 2 (acute myocardial infarction). Clinical and laboratory assessments included ECG, echocardiography, CBC, cardiac enzymes, and inflammatory markers. Results: Cases had significantly higher systolic blood pressure; ECG was abnormal in 95%. ST depression was present in 59% of patients, 53% had an ejection fraction (EF) of less than 50%; and the mean EF was 48.09±8.93%. Patients with EF<50% had higher platelet count (336.962±73.198 vs 246.83±54.308, P<0.0001) and increased inflammatory indices (P < 0.05), but lower mean platelet volume (MPV) (8.91±2.72 vs 11.92±3.57, P<0.0001) and lymphocyte count (2.551±1.211 vs 2.989±1.298, P=0.0297). Neutrophil platelets score (NPS) and prognostic index (PI) scores of 1 and 2 were more prevalent among ACS cases with EF of < 50% (P<0.05). Platelet distribution width (PDW) and systemic immune-inflammation index (SII) were independent positive predictors of left ventricular ejection fraction (LVEF) (P<0.0001), whereas C-reactive protein (CRP) level was a significant independent negative predictor (P<0.0001). Conclusion: Hematologic inflammatory indices and EF were correlated in ACS patients; higher ratios are associated with systemic inflammation and reduced EF

Red Cell Osmotic Fragility Status and its Contributing Factors in Type 2 Diabetes Mellitus Patients at South Valley University Hospital

Background: Diabetes mellitus (DM) is a growing public health issue in Egypt. Chronic hyperglycemia, impaired erythropoietin production, and increased RBC fragility, lead to increased destruction. Objective: To assess the red cell osmotic fragility status and its determinants in type 2 DM (T2DM) patients. Patients and methods: A cross-sectional study involving 200 participants, 100 with T2DM, and 100 controls, subjected to clinical, physical examination, and laboratory investigations, including an osmotic fragility test. Results: Anemia was prevalent in 56% of T2DM; 93% had HbA1c > 7, a higher rate of infection, and the presence of complications and associated comorbidities. Anemic patients have higher WBC, platelets, reticulocyte counts, CRP, and ferritin; hemolysis starts at higher NaCl%, especially in females. Hemolysis is linked to various health indicators, including age, disease duration, blood pressure, red cell indices, inflammatory markers, kidney function, and lipid levels. The HbA1c positively correlated with disease duration (r=0.3321, p=0.001), systolic BP (r=0.3342, p=0.001), serum creatinine (r=0.456, p < 0.00001), cholesterol (r=0.5552, p < 0.00001), and VLDL (r=0.3342, p=0.001), and negatively correlation with diastolic BP (r=-0.3318, p=0.001), MCV (r=-0.317, p=0.001), triglycerides (r=-0.3212, p=0.001), and eGFR (r=-0.2391, p=0.0166). Conclusion: Anemia was prevalent in T2DM patients, accompanied by the presence of comorbidities and complications. Poor glycemic control leads to a decline in RBC count, indices, and increased fragility, which may exacerbate disease progression and worsen complications. Regular monitoring and strict glycemic control aid in complication prevention

The Role of Prolactin as a Disease Activity Indicator in Some Rheumatic Diseases

Background: Autoimmune rheumatic diseases, including rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and scleroderma, predominantly affect women and are characterized by systemic inflammation, leading to organ failure. Prolactin (PRL), a hormone produced by the pituitary gland and lymphocytes, significantly affects immune regulation and is implicated in the pathophysiology of these diseases. Objectives: This study aimed to evaluate the relationship between PRL levels and disease activity in RA, SLE, and scleroderma. Patients and methods: A cross-sectional case-control study involved 150 premenopausal women (50 with RA, 30 with SLE, and 20 with scleroderma) and 50 age-matched healthy controls. Clinical disease activity assessments (DAS28 for RA, SLEDAI for SLE, and MRSS for scleroderma) and laboratory estimation of serum PRL level were conducted. Results: The mean PRL levels in RA (26.17 ng/ml), SLE (25.23 ng/ml), and scleroderma (32.07 ng/ml) were significantly higher than controls (15.48 ng/ml) (P < 0.001). 42% of RA patients, 30% of SLE patients, and 50% of scleroderma patients had elevated PRL levels. Hyperprolacinemia is correlated with disease activity (DAS28 (r = 0.493, p = 0.0001), SLEDAI (r = 0.546, p = 0.002), and MRSS (r = 0.893, p = 0.0001), respectively). Conclusion: Serum PRL levels were significantly elevated in RA, SLE, and scleroderma, which is consistent with disease activity scores. Regular monitoring may be necessary because of the potential of PRL to function as a marker of disease activity. The therapeutic potential of dopamine agonists in autoimmune diseases warrants further investigation, as they have the potential to reduce flare-ups and organ involvement

Prospective multi-center trial utilizing electronic brachytherapy for the treatment of endometrial cancer

<p>Abstract</p> <p>Background</p> <p>A modified form of high dose rate (HDR) brachytherapy has been developed called Axxent Electronic Brachytherapy (EBT). EBT uses a kilovolt X-ray source and does not require treatment in a shielded vault or a HDR afterloader unit. A multi-center clinical study was carried out to evaluate the success of treatment delivery, safety and toxicity of EBT in patients with endometrial cancer.</p> <p>Methods</p> <p>A total of 15 patients with stage I or II endometrial cancer were enrolled at 5 sites. Patients were treated with vaginal EBT alone or in combination with external beam radiation.</p> <p>Results</p> <p>The prescribed doses of EBT were successfully delivered in all 15 patients. From the first fraction through 3 months follow-up, there were 4 CTC Grade 1 adverse events and 2 CTC Grade II adverse events reported that were EBT related. The mild events reported were dysuria, vaginal dryness, mucosal atrophy, and rectal bleeding. The moderate treatment related adverse events included dysuria, and vaginal pain. No Grade III or IV adverse events were reported. The EBT system performed well and was associated with limited acute toxicities.</p> <p>Conclusions</p> <p>EBT shows acute results similar to HDR brachytherapy. Additional research is needed to further assess the clinical efficacy and safety of EBT in the treatment of endometrial cancer.</p

Effect of high parity on occurrence of anemia in pregnancy: a cohort study

<p>Abstract</p> <p>Background</p> <p>Studies that explore the controversial association between parity and anaemia-in-pregnancy (AIP) were often hampered by not distinguishing incident cases caused by pregnancy from prevalent cases complicated by pregnancy. The authors' aim in conducting this study was to overcome this methodological concern.</p> <p>Methods</p> <p>A retrospective cohort study was conducted in Oman on 1939 pregnancies among 479 parous female participants with available pregnancy records in a community trial. We collected information from participants, the community trial, and health records of each pregnancy. Throughout the follow-up period, we enumerated 684 AIP cases of which 289 (42.2%) were incident cases. High parity (HP, ≥ 5 pregnancies) accounted for 48.7% of total pregnancies. Two sets of regression analyses were conducted: the first restricted to incident cases only, and the second inclusive of all cases. The relation with parity as a dichotomy and as multiple categories was examined for each set; multi-level logistic regression (MLLR) was employed to produce adjusted models.</p> <p>Results</p> <p>In the fully adjusted MLLR models that were restricted to incident cases, women with HP pregnancies had a higher risk of AIP compared to those who had had fewer pregnancies (Risk Ratio, RR = 2.92; 95% CI 2.02, 4.59); the AIP risk increased in a dose-response fashion over multiple categories of parity. In the fully adjusted MLLR models that included all cases, the association disappeared (RR = 1.11; 95% CI 0.91, 1.18) and the dose-response pattern flattened.</p> <p>Conclusions</p> <p>This study shows the importance of specifying which cases of AIP are incident and provides supportive evidence for a causal relation between parity and occurrence of incidental AIP.</p

Non-Communicable Disease Risk Factors among Employees and Their Families of a Saudi University: An Epidemiological Study

Objectives:To assess the prevalence of non-communicable disease (NCD) risk factors among Saudi university employees and their families; to estimate the cardiovascular risk (CVR) amongst the study population in the following 10years. Methods:The NCD risk factors prevalence was estimated using a cross-sectional approach for a sample of employees and their families aged ≥ 18 years old, in a Saudi university (Riyadh in Kingdom of Saudi Arabia; KSA). WHO STEPwise standardized tools were used to estimate NCD risk factors and the Framingham Coronary Heart Risk Score calculator was used to calculate the CVR. Results:Five thousand and two hundred subjects were invited, of whom 4,500 participated in the study, providing a response rate of 87%. The mean age of participants was 39.3±13.4 years. The majority of participants reported low fruit/vegetables consumption (88%), and physically inactive (77%). More than two thirds of the cohort was found to be either overweight or obese (72%), where 36% were obese, and 59% had abdominal obesity. Of the total cohort, 22–37% were found to suffer from dyslipidaemia, 22% either diabetes or hypertension, with rather low reported current tobacco use (12%). One quarter of participants was estimated to have >10% risk to develop cardiovascular disease within the following 10-years. Conclusion:The prevalence of NCD risk factors was found to be substantially high among the university employees and their families in this study

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Biochemical assessments of thyroid profile, serum 25-hydroxycholecalciferol and cluster of differentiation 5 expression levels among children with autism

Tarek Desoky,1 Mohammed H Hassan,2 Hanan M Fayed,3 Hala M Sakhr4 1Department of Neuropsychiatry, 2Department of Medical Biochemistry and Molecular Biology, 3Department of Clinical and Chemical Pathology, 4Department of Pediatrics, Qena Faculty of Medicine, Qena University Hospitals, South Valley University, Qena, Egypt Background: The exact pathogenesis of autism is still unknown. Both thyroid hormones and 25(OH)D are important for brain development, in addition to CD5; all have immunomodulatory actions by which their dysregulation may have a potential role in autism pathogenesis.Objectives: The objectives of this study were to assess the thyroid profile, serum 25(OH)D levels and CD5 expression levels among autistic patients and to find out the correlations between the measured biomarkers with each other on one side and with the disease severity on the other side.Patients and methods: This cross-sectional case&ndash;control study has been conducted on 60 children with autism and 40 controls, recruited from Qena Governorate, Upper Egypt. Childhood Autism Rating Scale (CARS) score was used to assess the included patients. Biochemical assays of thyroid function in the form of free triiodothyronine (FT3), free tetraiodothyronine (FT4), thyroid-stimulating hormone (TSH) and 25(OH)D were done using commercially available enzyme-linked immunosorbent assay (ELISA) kits, while CD5 expression levels were measured using flow cytometry (FCM) analysis for all the included patients and controls.Results: The overall measurement results show significant higher mean serum TSH levels, mean CD5 expression levels with significant lower mean serum 25(OH)D levels among autistic children when compared with the control group (p&lt;0.05 for all). Significant negative correlations between CD5 with FT3, FT4 and 25(OH)D were observed. CARS score showed significant negative correlations with both FT3 and 25(OH)D, while it was positively correlated with CD5 in a significant manner (p&lt;0.05 for all).Conclusion: Elevated CD5 expression and decreased 25(OH)D stores could play a potential role in the pathogenesis of autism via their immune-modulator actions. High TSH serum levels among autistic children, although within the physiological range, reflect the presence of thyroid dysfunction among such children, which needs further assessment. Keywords: thyroid hormones, 25(OH)D, CD5, autism, flow cytometry, ELISA&nbsp