Spectral Doppler Interrogation of the Pulmonary Veins in Atrial Septal Defect

The various components of the pulmonary venous (PV) flow are linked to physiological and pathological changes that predominantly occur in the left heart. Thus, spectral Doppler interrogation of the PVs provides hemodynamic insight mainly into left‐sided cardiac function. An exception to the dependence of PV flow on left heart events occurs in the setting of an atrial septal defect (ASD). The latter causes a portion of the PV blood flow, intended to cross the mitral valve, to be channeled into the more compliant right heart. This phenomenon makes the PV flow more dependent on the left‐to‐right interatrial shunt. The identification on the PV Doppler of a pattern that suggests uncoupling with left heart hemodynamics should raise the suspicion of an underlying ASD.     

Use of recombinant calreticulin and cercarial transformation fluid (CTF) in the serodiagnosis of Schistosoma mansoni

Schistosomiasis is traditionally diagnosed by microscopic detection of ova in stool samples, but this method is labour intensive and its sensitivity is limited by low and variable egg secretion in many patients. An alternative is an ELISA using Schistosoma mansoni soluble egg antigen (SEA) to detect anti-schistosome antibody in patient samples. SEA is a good diagnostic marker in non-endemic regions but is of limited value in endemic regions, mainly because of its high cost and limited specificity. Here we assess seven novel antigens for the detection of S. mansoni antibody in an endemic region (the Northern Nile Delta). Using recombinant S. mansoni calreticulin (CRT) and fragments thereof, anti-CRT antibodies were detected in the majority of 97 patients sera. The diagnostic value of some of these antigens was, however, limited by the presence of cross-reacting antibody in the healthy controls, even those recruited in non-endemic areas. Cercarial transformation fluid (CTF), a supernatant that contains soluble material released by the cercariae upon transformation to the schistosomula, is cheaper and easier to produce than SEA. An ELISA using CTF as the detection antigen had a sensitivity of 89.7% and an estimated specificity of 100% when used in non-endemic regions, matching the performance of the established SEA ELISA. CTF was substantially more specific than SEA for diagnosis in the endemic region, and less susceptible than SEA to cross-reacting antibody in the sera of controls with other protozoan and metazoan infections.     

Prevalence and burden of dengue infection in Europe: A systematic review and meta‐analysis

Imported dengue cases are thought to be important source for transmission of autochthonous dengue in Europe. We aimed to investigate the prevalence of dengue in Europe, its severity, and factors associated with it. Out of 5287 reports resulting from the search of nine electronic search engines, we included 174 reports. Meta‐analysis was performed by pooling the event rate and 95% confidence interval (CI). Subgroup meta‐analyses were performed to test the effect of the covariates. Among 20 284 reported cases, 130 autochthonous dengue cases were reported in eight countries with the highest number of cases reported in Israel (n = 41). The highest number of imported dengue cases was in Germany (n = 6638) then France (n = 6610). Most cases were imported from Southeast Asia (n = 2533) especially Thailand. Dengue infection cases increased with time, with 4157 cases reported in 2010. Second dengue infection and dengue serotype 2 were positively associated with dengue severity. The proportion of autochthonous dengue infection increased with time to reach 14.8% (95% CI, 7.6‐26.9) in 2015. The pooled proportion of severe dengue was 6.18% (95% CI, 2.7‐13.3). The United Kingdom and France had the highest rate of severe dengue (25%; 95% CI, 6.3‐62.3, and 21.4%; 95% CI, 24.5‐18.7, respectively). This change may be due to the surveillance efforts instead of true biological phenomenon; thus, the lack of surveillance is an obvious limitation. In conclusion, imported and autochthonous dengue has been increasing in Europe. Severe dengue began to increase recently in Europe. European health authorities should pay more attention for the diagnosis and control of dengue infection among returning travelers, especially the travelers with fever of unknown origin.     

Prevalence and predictors of habitual snoring in a sample of Saudi middle-aged adults

Objectives:

To determine the prevalence of habitual snoring among a sample of middle-aged Saudi adults, and its potential predictors.

Methods:

A cross-sectional study was conducted from March 2013 until June 2013 in randomly selected Saudi Schools in Jeddah, Kingdom of Saudi Arabia. The enrolled subjects were 2682 school employees (aged 30-60 years, 52.1% females) who were randomly selected and interviewed. The questionnaire used for the interview included: the Wisconsin Sleep Questionnaire to assess for snoring, medical history, and socio-demographic data. Anthropometric measurements and blood pressure readings were recorded using standard methods.

Results:

Forty percent of the 2682 enrolled subjects were snorers: 23.5% were habitual snorers, 16.6% were moderate snorers, and 59.9%, were non-snorers. A multivariate analysis revealed that independent predictors of snoring were ageing, male gender, daytime sleepiness, hypertension, family history of both snoring and obstructive sleep apnea, water-pipe smoking, and consanguinity.

Conclusion:

This study shows that snoring is a common condition among the Saudi population. Previously reported risk factors were reemphasized but consanguinity was identified as a new independent predictive risk factor of snoring. Exploring snoring history should be part of the clinical evaluation.Snoring is defined as a harsh buzzing noise produced by vibration of the soft palate and pillars of the oropharyngeal inlet, primarily with inspiration during sleep. Habitual snoring (HS) is defined as the presence of loud snoring at least 3 nights per week, and is strongly associated with obstructive sleep apnea (OSA).1,2 Even in the absence of OSA, HS is associated with health and social consequences including sleep fragmentation, family discord, excessive daytime sleepiness, and more seriously, the development of systemic hypertension in individuals aged <50 years.3 However, many individuals regard HS as a benign and a common behavior; moreover, physicians often disregard snoring as a disorder in their clinical practice. Such denial may lead to delayed recognition and management of OSA.1 Loud snorers have a 40% greater chance of developing hypertension, 34% greater chance of developing heart attack, and 67% greater chance of developing stroke, compared to non-snorers after adjustments for age, gender, body mass index, diabetes, level of education, smoking, and alcohol consumption.4 More recently, heavy snoring has been independently associated with carotid atherosclerosis and treating it was suggested as an important goal in prevention of stroke.5 There have been many international epidemiological studies to establish the prevalence of habitual snoring. Habitual snoring was reported to affect 35.7% of American,2 37.2% of Polish,6 35% of Spanish,7 19.6% of Chinese,8,9 17.3% of Korean,10 and 25.6% of Indian populations.20 The main reported risk factors were aging, male gender, obesity, and smoking. However, very limited data is available on the prevalence and impact of HS in the Middle Eastern countries. A limited study on Saudi health care workers reported HS in only 5.4%.11 Another primary health care clinics based study found a snoring prevalence of 52.3% in Saudi males, and 40.8% in Saudi females.12,13 Therefore, we conducted the current study to assess the actual prevalence and risk factors predictive of HS in a cohort of subjects in Saudi Arabia. Our results will be used to assess the size of the problem and increase awareness of this health disorder among health care professions, so that sleep disordered breathing can be effectively diagnosed and treated.     

Design,synthesis and pharmacophoric model building of new 3‐alkoxymethyl/3‐phenyl indole‐2‐carboxamides with potential antiproliferative activity

Novel 3‐alkoxymethyl/3‐phenyl indole‐2‐carboxamide derivatives were synthesized and evaluated for their anticancer activity. Most of the tested compounds showed moderate to excellent activity against the tested cell lines (MCF7 and HCT116). 3‐Phenyl substitution on indole with p‐piperidinyl phenethyl 24a and p‐dimethylamino phenethyl 24c exhibited anticancer activity against MCF7 with IC₅₀ of 0.13 and 0.14 μm , respectively. Further mechanistic study of the most active compounds through their action on cell cycle showed disturbance in cell cycle progression and cell cycle arrest. For future development of this series of compounds, pharmacophore study was conducted which indicated that the enhancement of the activity could be achieved through the addition of acceptor or donating groups to the already‐present indole nucleus.     

Design,synthesis, and modelling study of new 1,2,3-triazole/chalcone hybrids with antiproliferative action as epidermal growth factor receptor inhibitors

A novel series of 1,2,3-triazole/chalcone hybrids 6a–n was designed and synthesized using a molecular hybridization approach to develop a new cytotoxic agent capable of targeting epidermal growth factor receptor (EGFR) and/or BRAF. The antiproliferative effect of the novel hybrids was investigated against four cancer cells using doxorubicin as a reference. Hybrids 6a , 6d , 6f–h , and 6n have the highest antiproliferative activity (IC₅₀ values 0.95–1.80 μM) compared to doxorubicin (IC₅₀ 1.14 μM). The most potent antiproliferative derivative, compound 6d , was also the most potent EGFR inhibitor with an IC₅₀ of 0.09 ± 0.05 μM, which is comparable to the reference Erlotinib (IC₅₀ = 0.05 ± 0.03 μM). 6d has modest BRAF inhibitory action with an IC₅₀ of 0.90 ± 0.10 μM. The findings were also related to molecular docking studies, which provided models of strong interactions with the EGFR-TK domain for the inhibitors. In cell cycle analysis, hybrid 6d caused a cell cycle arrest at the G1 transition phase.