Dr Mohammed Mahmoud Youssif

BACKGROUND AND AIMS: Studies assessing caudal block's effects on children's cardiac output are scarce. We aimed to estimate the effects of the caudal block using different volumes of plain bupivacaine 0.25% on the cardiac index assessed by electrical cardiometry.

METHODS: Children aged 1-8 years undergoing minor lower abdominal surgeries were randomly assigned to one of three equal groups: The 0.8 group received general anaesthesia (GA) along with caudal block with 0.8 mL/kg of bupivacaine 0.25%, the 1.2 group received GA along with caudal block with 1.2 mL/kg of bupivacaine 0.25%, and the control group received GA only. The primary outcome was the percentage of change in the cardiac index from the baseline 10 minutes after the caudal block. Continuous variables were analysed using the ANOVA test, while categorical data was analysed using a chi-squared test with the significance level set at < 0.05.

RESULTS: The mean percentage of change of cardiac index from baseline 10 minutes after caudal block was significantly lower in the 0.8 and 1.2 groups (-11.4 (standard deviation (SD): 12.5%) and -17.1 (SD: 15.5%), respectively) compared to the control group (-0.7 (SD: 11.5%), ( = 0.007 and = 0.0001). Mean differences were -11 (0.8 vs control, 95% confidence interval (CI): -18.7, -3.3%, and -15.2 (1.2 vs control, 95% CI: -23, -7.5%).

CONCLUSION: The cardiac index progressively decreased with the increase in the volume of the caudal block with plain bupivacaine at 0.25% compared to the baseline. However, this decrease was not clinically significant, suggesting that the cardiac index remained within an acceptable range after the caudal block. Nevertheless, caution is warranted due to the increased incidence of hypotension with increasing volumes of plain local anaesthetics in the caudal block.

Lead is a common heavy metal used in a variety of products. We investigated the effect of lead-oxide nanoparticles (PbO-NPs) on the histological structure of the rat olfactory bulb (OB) and the potential therapeutic effect of stem cell-derived exosomes (EXOs). Forty male rats were included: 8 for EXO isolation and 32 were distributed into 4 groups: control, PbO-NPs group [intranasal (IN) 50 µL PbO-NPs/rat for 3 weeks], recovery group (PbO-NPs for 3 weeks and left for another 4 weeks), and PbO-NP-EXO (PbO-NPs for 3 weeks then IN EXO for another 3 weeks). After 7 weeks, olfactory behavioral tests were done before scarification. OBs were stained with hematoxylin and eosin, toluidine blue, and immunohistochemistry for synaptophysin (SYP), and ionized calcium-binding adaptor molecule-1 (Iba-1) and glial fibrillary acidic protein (GFAP). The results were confirmed by histomorphometry and statistical analysis. PbO-NPs and recovery groups showed a significant olfactory dysfunction, significant decrease in the thickness of OB layers and diameter of glomeruli, Nissl's granules of mitral cells and SYP immunostaining, and a significant increase in Iba-1 and GFAP expression compared with control rats. In PbO-NP-EXO, notable regaining of OB structure and function was obvious with reversal of most of the behavioral and morphometric findings compared with the untreated groups. IN EXO administration improved the structure and function of PbO-NP-induced OB neurotoxicity.

The most prevalent disease in the world and the main reason for women mortality from cancer is breast cancer. The recommended treatment for hormone receptor-positive metastatic breast cancer (MBC) is cyclin-dependent kinase 4/6 inhibitor (CDK4/6i), Abemaciclib. Radiotherapy (RT) is one of the main options to control breast cancer. This work intended to examine the impact of CDK 4/6i and palliative radiation on human breast cancer cell lines. Breast cancer cell lines (MCF7, MDA-MD-468, and MDA-MD-231) were treated with varying doses of Abemaciclib and left to incubate for 48 h. Different radiation doses were applied to the lines that had the best IC50. The intrinsic treatment objectives for MBC are presented in this study, along with the PI3K/AKT/mTOR pathway; CDK4, CDK6, and the NF-κβ/TGF-β pathway; BAX/BcL2, P53; caspase-3, caspase-6, caspase-7, caspase-8, and caspase-9; cytokeratin 18 (CK18); cycloxygenase-2 (COX2); IL-6; IL1β; matrix metalloproteinases (MMP2 and MMP9); and oxidative stress markers. The biochemical assays revealed that abemaciclib hindered the progression of breast cancer cells MDA-MB-231 and MCF-7 and enhanced RT (10 Gy) by provoking cell cycle arrest throughout the restraint of CDK4 and CDK6 expression and increasing apoptosis, in addition to decreasing the PI3K/AKT/mTOR and NF-κβ/TGF-β pathway expression; inhibiting CK18 and COX2 activity; boosting the protein concentration of BAX and P53; and decreasing Bcl-2, IL-6, IL-1β, MMP2, and MMP9, modulating oxidative stress markers. These results implied potential effects of radiation and CDK4/6i abemaciclib on breast cancer cell lines.

BACKGROUND AND STUDY AIMS: Hepatitis C virus (HCV) infection is a significant problem in Egypt, as it is associated with various hematological disorders, both benign and malignant. In Egypt, direct-acting antivirals (DAAs) serve as the principal therapy for HCV to achieve a sustained virological response (SVR). This study investigated the effects of sofosbuvir (SOF) and daclatasvir (DCV) on HCV patients with benign blood index abnormalities and examined the correlation between these abnormalities and SVR.

PATIENTS AND METHODS: Data were obtained from 59,069 enrolled patients who were treatment-naïve and met the eligibility criteria for therapy as per the standards of Egypt's National Committee for Control of Viral Hepatitis (NCCVH). The patients adhered to the SOF and DCV therapy protocol.

RESULTS: The predominant hematological abnormality was thrombocytopenia, followed by leukopenia and anemia. Non-SVR was significantly correlated with the existence of one or more baseline cytopenias. The primary predictors of treatment failure were male gender, elevated Fib-4 score, and baseline thrombocytopenia. Despite the low incidence of cytopenia among patients after therapy, non-SVR was seen in instances of anemia.

CONCLUSION: Hematological problems often occur in HCV patients both before and after SOF and DCV treatment. Treatment failure was associated with the presence of one or more baseline cytopenias, as well as the development of anemia during treatment. Nonetheless, SOF and DCV are still safe to be used in the presence of cytopenia.

PURPOSE: The purpose of this study was to assess the impact of testosterone therapy on mood and cognitive symptoms in perimenopausal and postmenopausal women.

METHODS: A retrospective cohort study undertaken in a UK specialist menopause clinic. 510 women using hormone replacement therapy (HRT) with persistent low libido, cognitive and negative mood symptoms were treated with testosterone cream or gel for 4 months. A modified version of the Greene Climacteric Scale was used to measure self-reported symptom frequency and severity at baseline and 4 months after initiating treatment.

RESULTS: All nine cognitive and mood symptoms significantly improved across the study period. Mood improved more than cognition (47% of women reported an improvement in mood vs. 39% reported an improvement in cognition; 34% vs. 22% decrease in mean symptom scores, respectively). Regarding libido, 52% of women reported an improvement; mean symptom score decreased by 33%.

CONCLUSION: Transdermal testosterone therapy for 4 months was associated with significant improvements in mood and cognition. Further research including randomised clinical trials are needed to establish the long-term efficacy and safety of testosterone for the treatment of menopausal cognitive and psychological symptoms.