Differences in COVID-19 Preventive Behavior and Food Insecurity by HIV Status in Nigeria

AIDS and Behavior - The aim of the study was to assess if there were significant differences in the adoption of COVID-19 risk preventive behaviors and experience of food insecurity by people living...     

Reply to “Using Transthoracic Echocardiography to Predict Fluid Responsiveness after Passive Leg Raising Test: Caution Needed”

How to cite this article: El Nawawy AA, Farghaly PM, Hassouna HM. Reply to “Using Transthoracic Echocardiography to Predict Fluid Responsiveness after Passive Leg Raising Test: Caution Needed”. Indian J Crit Care Med 2020;24(11):1149.

Dear Sir,Thank you for your valuable comments.As you mentioned, performing passive leg raising (PLR) in infants and small children may be challenging. PLR was performed passively by the automatic raising of the bed''s leg while simultaneously lowering the bed''s head to the horizontal position (PLR). Ventilator settings (in ventilated patients), as well as infusion rates of inotropic/vasopressor agents and sedation/analgesia, were held constant during fluid bolus administration. The test was performed for patients whom fluid therapy was decided to be given based on the existence of at least one sign of poor tissue perfusion: (a) tachycardia defined as a mean heart rate >2 SD above normal for age, (b) decrease in blood pressure <5th percentile or systolic blood pressure <2 SD below normal for age, (c) urine output <0.5 mL/kg/hour, and (d) prolonged capillary refill: >5 seconds. Besides test was performed mainly on day 1 in which almost all patients were sedated on mechanical ventilation.Second, about your concerns regarding the use of transthoracic echocardiography (TTE) to track the changes in velocity-time integral (VTI)/stroke volume (SV), echocardiography was performed by a 5-year experienced operator who received adequate training course in functional echocardiography for an intensivist. All results were reviewed instantaneously by a pediatric cardiologist who was blinded to the clinical condition of the studied patients and the purpose of the study. All readings were repeated in three consecutive cycles and results were averaged. A pilot study including 15 patients showed an excellent degree of intraobserver reliability in three baseline measurements of SV. The average measure intraclass correlation (ICC) was 0.93 [95% confidence interval (CI) = 0.91–0.95, p < 0.001].Patients having irregular dysrhythmia were excluded. And this was mentioned in the article. About the phase of respiration during obtaining measurements was difficult due to the relatively high respiratory rate in children under 5 years of age. However, all readings were repeated in three consecutive cardiac cycles, and results were averaged. About hand position, different views were used and they were mentioned in the method section.About the least significant change (LSC) and precision of repeated values by same and different operators, you referred to Jozwiak et al. They included patients older than 18 years scheduled for neurosurgery, and SV was then determined by pulse contour analysis. They depend on stroke volume variation (SVV) which is reflected by arterial blood pressure changes in relation to the pattern of respiration. However, in El Nawawy et al., SV was evaluated before and after PLR, and change in SV (delta SV) was calculated. So, the comparison of delta SV to SVV does not make sense. Also, Jozwiak et al. obtained SV using ProAQT not echocardiography.     

A Panel of Autoantibodies Against Neural Proteins as Peripheral Biomarker for Pesticide-Induced Neurotoxicity

In the present study, we screened the sera of subjects chronically exposed to mixtures of pesticides (composed mainly of organophosphorus compounds (OPs) and others) and developed neurological symptoms for the presence of autoantibodies against cytoskeletal neural proteins. OPs have a well-characterized clinical profile resulting from acute cholinergic crisis. However, some of these compounds cause neuronal degeneration and demyelination known as organophosphorus compound-induced delayed neurotoxicity (OPIDN) and/or organophosphorus compound-induced chronic neurotoxicity (OPICN). Studies from our group have demonstrated the presence of autoantibodies to essential neuronal and glial proteins against cytoskeletal neural proteins in patients with chemical-induced brain injury. In this study, we screened the serum of 50 pesticide-exposed subjects and 25 non-exposed controls, using Western blot analysis against the following proteins: neurofilament triplet proteins (NFPs), tubulin, microtubule-associated tau proteins (Tau), microtubule-associated protein-2 (MAP-2), myelin basic protein (MBP), myelin-associated glycoprotein (MAG), glial fibrillary acidic protein (GFAP), calcium-calmodulin kinase II (CaMKII), glial S100-B protein, and alpha-synuclein (SNCA). Serum reactivity was measured as arbitrary chemiluminescence units. As a group, exposed subjects had significantly higher levels of autoantibody reactivity in all cases examined. The folds of increase in of autoantibodies against neural proteins of the subjects compared to healthy humans in descending order were as follows: MBP, 7.67, MAG 5.89, CaMKII 5.50, GFAP 5.1, TAU 4.96, MAP2 4.83, SNCA 4.55, NFP 4.55, S-100B 2.43, and tubulin 1.78. This study has demonstrated the presence of serum autoantibodies to central nervous system-specific proteins in a group of farmers chronically exposed to pesticides who developed neurological signs and symptoms of neural injury. These autoantibodies can be used as future diagnostic/therapeutic target for OP-induced neurotoxicity.     

Diosmin Nanocrystal–Loaded Wafers for Treatment of Diabetic Ulcer: In Vitro and In Vivo Evaluation

This work aimed at loading of diosmin nanocrystals into alginate-based wafers for treatment of highly exuding diabetic ulcer in rats using topical route of administration. For this purpose, different formulation variables and preparation techniques to enhance the flexibility and adhesion properties of the prepared sodium alginate (SA) wafers were carried out. The prepared wafers were characterized regarding hydration capacity, bioadhesion, scanning electron microscope, and Fourier-transform infrared spectroscopy. Efficacy of treating diabetic ulcer was studied using diabetic-induced rat model using streptozotocin. Results obtained showed that using SA:gelatin with 1.5%/1.5% w/w gave acceptable wafers with a sustained release of diosmin over 8 h. A complete re-epithelialization, well-organized dermal layers, well-formed granulation tissue, and mature collagen bundles were observed in treated rats. It was concluded that combination of gelatin with SA provided an excellent wafer as a promising medicated wound dressing holding diosmin nanocrystals while maintaining its stability.     

Lipidic cubic-phase leflunomide nanoparticles (cubosomes) as a potential tool for breast cancer management

Despite the fact of availability of several treatments for breast cancer, most of them fail to attain the desired therapeutic response due to their poor bioavailability, high doses, non-selectivity and as a result systemic toxicity. Here in an attempt made to study the transdermal effect of leflunomide (LEF) against breast cancer. In order to improve the poor physicochemical properties of LEF, it was loaded into cubosomes. Cubosomes were prepared by the emulsification method. Colloidal characteristics of cubosomes including particle size, ζ-potential, entrapment efficiency, in-vitro release profile and ex-vivo permeation were studied. In addition, morphology, stability, cytotoxicity and cell uptake in MDA-MB-231 cell line were carried out for the selected cubosomal formulation. The selected LEF loaded cubosomal formulation showed a small particle size (168 ± 1.08) with narrow size distribution (PI 0.186 ± 0.125) and negative ζ potential (–25.5 ± 0.98). Its Entrapment efficiency (EE%) was 93.2% and showed sustained release profile that extended for 24 h. The selected formulation showed stability when stored at 25 °C for three months in terms of size and EE%. TEM images illustrated the cubic structure of the cubosome. Cell culture results revealed the superiority of LEF cubosomes compared to LEF suspension in their cytotoxic effects with an IC50 close to that of doxorubicin. Furthermore, LEF cell uptake was significantly higher for LEF cubosomes. This may be attributed to the effect of nano-encapsulation on enhancing drug pharmacological effects and uptake indicating the potential usefulness of LEF cubosomes for breast cancer management.