Effects of Hydroxychloroquine on Proteinuria in IgA Nephropathy: A Systematic Review and Meta-Analysis

Introduction. The present meta-analysis was to explore the efficacy of hydroxychloroquine (HCQ) in IgA nephropathy patients in terms of proteinuria. Method. We systematically searched PubMed and Embase for studies that compared HCQ and other treatments to reduce proteinuria in patients with IgA nephropathy up to June 2021. Mean ± SD of percentage change and level of proteinuria was calculated. Results. A total of 5 studies with 587 participants were included. IgA nephropathy patients who received HCQ were at a lower level of mean proteinuria at 6 months. However, there was no statistical difference between HCQ and control group considering percentage reduction in proteinuria. The long-term therapeutic effect of HCQ might be inferior to HCQ and renin-angiotensin-aldosterone system inhibition. Conclusion. HCQ might play a role in the reduction of proteinuria in IgA nephropathy patients. The addition of HCQ to other immunosuppressive agents should be clarified further.

Increased anteroventral striatal dopamine transporter and motor recovery after subthalamic deep brain stimulation in Parkinson’s disease

OBJECTIVE Subthalamic nucleus deep brain stimulation (STN-DBS) in Parkinson’s disease is effective; however, its mechanism is unclear. To investigate the degree of neuronal terminal survival after STN-DBS, the authors examined the striatal dopamine transporter levels before and after treatment in association with clinical improvement using PET with [11C]2β-carbomethoxy-3β-(4-fluorophenyl)tropane ([11C]CFT). METHODS Ten patients with Parkinson’s disease who had undergone bilateral STN-DBS were scanned twice with [11C]CFT PET just before and 1 year after surgery. Correlation analysis was conducted between [11C]CFT binding and off-period Unified Parkinson’s Disease Rating Scale (UPDRS) scores assessed preoperatively and postoperatively. RESULTS [11C]CFT uptake reduced significantly in the posterodorsal putamen contralateral to the parkinsonism-dominant side after 1 year; however, an increase was noted in the contralateral anteroventral putamen and ipsilateral ventral caudate postoperatively (p < 0.05). The percentage increase in [11C]CFT binding was inversely correlated with the preoperative binding level in the bilateral anteroventral putamen, ipsilateral ventral caudate, contralateral anterodorsal putamen, contralateral posteroventral putamen, and contralateral nucleus accumbens. The percentage reduction in UPDRS-II score was significantly correlated with the percentage increase in [11C]CFT binding in the ipsilateral anteroventral putamen (p < 0.05). The percentage reduction in UPDRS-III score was significantly correlated with the percentage increase in [11C]CFT binding in the ipsilateral anteroventral putamen, ventral caudate, and nucleus accumbens (p < 0.05). CONCLUSIONS STN-DBS increases dopamine transporter levels in the anteroventral striatum, which is correlated with the motor recovery and possibly suggests the neuromodulatory effect of STN-DBS on dopaminergic terminals in Parkinson’s disease patients. A preoperative level of anterior striatal dopamine transporter may predict reserve capacity of STN-DBS on motor recovery.

Phytoremediation of Crude Oil Polluted Microbial Augmented Soil Using Cyperus esculentus and Phyllanthus amarus

Aim: To assess the phytoremediation potential of Cyperus esculentus and Phyllanthus amarus in crude oil polluted soil and ascertain the enhancement of augmented microbes (fungi). Study Design: The study employs experimental design, statistical analysis of the data and interpretation. Place and Duration of Study: Rivers State University demonstration farmland in Nkpolu- Oroworukwo, Mile 3 Diobu area of Port Harcourt, was used for this study. The piece of land is situated at Longitude 4°48’18.50” N and Latitude 6ᵒ58’39.12” E measuring 5.4864 m x 5.1816 m with a total area of 28.4283 square meter. Phytoremediation process monitoring lasted for 240 days, analyses were carried out weekly at 30 days’ interval. Methodology: Seven (7) experimental plots (two Control (Unpolluted and polluted soil) and five polluted amended/treated plots) employing Randomized Block Design (each having dimensions: 100 x 50 x 30 cm LxBxH) were formed and mapped out on agricultural soil and left fallow for 6 days before contamination on the seventh day; after which it was allowed for 21 days for proper contamination and exposure to natural environmental factors (to mimic soil crude oil spill site); thereafter bioaugmenting organisms were applied. Baseline studies were carried out on the top soil before and after contamination, major parameters monitored and assessed were Total Petroleum Hydrocarbon (TPH) uptake by plant roots and stem, Polycyclic Aromatic Hydrocarbon (PAHs) and TPH reduction in soil. Other physicochemical analyzed in the soil of different plots were pH, Electrical Conductivity, Moisture Content, Total Nitrogen, Available Phosphorus, Potassium, Total Organic Carbon, Plant Height, Iron, Lead at regular intervals; days 1, 60, 90, 120, 150, 180, 210 & 240. Application of augmenting organisms was to enhance phytoremediation by test plant Cyperus esculentus (Cyp) and Phyllanthus amarus (Phy). The rate of phytoremediation was estimated from percentage (%) uptake of Total petroleum hydrocarbon (TPH) in plant roots and stem from day 1 -240; while percentage (%) reduction of TPH and PAHs in soil was estimated from day 1 to the residual at day 240. Results: The test plants decreased significant amount of crude oil as revealed in TPH uptake in their roots and Stem. Mean amount and percentage Total Petroleum Hydrocarbon (TPH) uptake by Cyperus esculentus roots and stem were; 152.33±50.34mg/kg, 12.57±4.16% and 201.13±8.80mg/kg, 13.27±0.58% respectively; while that of Phyllanthus amarus roots and stem were 141.50±35.62mg/kg, 11.68±2.94% and 174.44±19.98mg/kg, 11.51±1.32% respectively. Similar trend was observed in the control plots were TPH uptake by Cyperus esculentus roots and stem were; 24.2mg/kg, 2.00% and 20.01mg/kg, 1.32% respectively while in control plot of Phyllanthus amarus TPH uptake by roots and stem were 23.19mg/kg, 1.91% and 19.80mg/kg, 1.31% respectively. Comparatively, uptake of TPH was higher in plant stem than roots. From the initial TPH contamination value of 5503.00mg/kg , Total Petroleum Hydrocarbon Reduction and % Hydrocarbon Reduction in soil at 240 days in the different treatment plots in a decreasing order were as follows: PS+AN+MR+SMS+Phy (5470.9mg/kg; 99.43%) >PS+MR+SMS+Phy (5460.60mg/kg; 99.23%) >PS+AN+MR+Phy (5451.30mg/kg; 99.06%) >PS+MR+Cyp (5448.30mg/kg; 99.01%) >PS+AN+MR+Cyp (5440.00mg/kg; 98.86%) >PS+AN+Phy (5422.905mg/kg; 98.54%) >PS+Cyp (no amendment) (5380.90mg/kg; 97.78%). Comparative evaluation revealed higher reduction of PAHs in soil (plot) planted with Phyllanthus amarus. Highest PAHs reduction in soil was seen in PS+AN+MR+SMS+Phy (31.3mg/kg; 65.89%) while least was recorded in PS+ Cyp (no amendment) (23.4mg/kg, 49.26%). Conclusion: it was observed that plots planted with Cyperus esculentus (TPH 5492.75±76.36mg/kg) showed higher reduction of TPH from soil than those planted with Phyllanthus amarus (TPH 5449.72±18.27mg/kg); while PAHs degradation/reduction in plots planted with Phyllantus amarus (PAHs 28.72±2.74mg/kg; 60.46±5.77%) was higher than plots planted with Cyperus esculentus (PAHs 25.77±2.12mg/kg, 54.24±4.47%). More so, plots amended with augmentating microbes showed significant higher percentage reduction in hydrocarbon in the polluted soil than unamended polluted soil. It is therefore recommended that Cyperus esculentus is a suitable plant species for phytoremediation of crude oil contaminated soil with high TPH value while Phyllanthus amarus is the best option for phytoremediation of polluted soil with high PAHs value, in combination with augmenting microbes.

Physicochemical Indices of Phyto Remediated Hydrocarbon Polluted Soil and the Effect of Bio-nutrient Amendment

Aim: To assess the Physicochemical indices of Phytoremediated Crude Oil polluted amended soil using grass plant Cyperus esculentus (Cyp) and Phyllanthus amarus (Phy). Study Design: The study employs experimental design, statistical analysis of the data and interpretation. Place and Duration of Study: Rivers State University demonstration farmland in Nkpolu- Oroworukwo, Mile 3 Diobu area of Port Harcourt, was used for this study. The piece of land is situated at Longitude 4°48’18.50” N and Latitude 6ᵒ58’39.12” E measuring 5.4864 m x 5.1816 m with a total area of 28.4283 square meter. Phytoremediation process monitoring lasted for 240 days; analyses were carried out monthly at 30 days’ interval. Methodology: The study was carried out on Crude Oil Polluted soil (PS) amended with bio-nutrient supplements (Spent Mushroom Substrate (SMS) and selected fungi (Aspergillus niger(AN) andMucor racemosus (MR)) used to stimulate and augment the indigenous microbial population present in a crude oil polluted soil thereby enhancing hydrocarbon reduction in pari per sue with phytoremediation (uptake of Crude oil by test plants) over a period of 240 days. Ten (10) experimental plots (two Control (Unpolluted and polluted soil without amendment) and eight polluted amended/treated plots) employing Randomized Block Design (each having dimensions: 100 x 50 x 30 cm LxBxH); formed and mapped out on agricultural soil and left fallow for 6 days before contamination on the seventh day; after which it was allowed for 21 days for proper contamination and exposure to natural environmental factors (to mimic soil crude oil spill site); thereafter nutrients/organics (biostimulating agents) and bioaugmenting organisms were applied. Baseline studies were carried out on soil profile before and after contamination, major parameters monitored and assayed were Total Petroleum Hydrocarbon (TPH) uptake by plant roots and stem, Polycyclic Aromatic Hydrocarbons (PAHs) and TPH reduction in soil. Other physicochemical properties analyzed in the soil from different plots were pH, Electrical Conductivity, Moisture Content, Total Nitrogen, Available Phosphorus, Potassium, Total Organic Carbon, Plant Height, Iron, Lead and Zinc at regular intervals; days 1, 60, 90, 120, 150, 180, 210 & 240. The rate of phytoremediation was estimated from percentage (%) uptake of Total petroleum hydrocarbon (TPH) in plant roots and stem from day 1 -240; while percentage (%) reduction of TPH and PAHs in soil was estimated from day 1 to the residual at day 240. Results: The test plants decreased significant amount of crude oil as revealed in TPH uptake in their roots and Stem. Mean amount and percentage Total Petroleum Hydrocarbon (TPH) uptake by Cyperus esculentus roots and stem were; 152.33±50.34mg/kg, 12.57±4.16% and 201.13±8.80mg/kg, 13.27±0.58% respectively; while that of Phyllanthus amarusroots and stem were 141.50±35.62mg/kg, 11.68±2.94% and 174.44±19.98mg/kg, 11.51±1.32% respectively; revealing higher Uptake of TPH in plant stem than roots. From the initial TPH contamination value of 5503.00mg/kg, it was observed that plots planted with Cyperus esculentus (TPH 5492.75±76.36mg/kg) showed higher reduction of TPH from soil than those planted with Phyllanthus amarus(TPH 5449.72±18.27mg/kg); while PAHs degradation/reduction showed a reverse trend with plots planted with Phyllanthus amarus (PAHs 28.72±2.74mg/kg; 60.46±5.77%) higher than plots planted with Cyperus esculentus s (PAHs 25.77±2.12mg/kg, 54.24±4.47%). Conclusion: Plots planted with Cyperus esculentus showed higher reduction of TPH from soil than those planted with Phyllanthus amarus while PAHs degradation/reduction in plots planted with Phyllanthus amarus was higher than plots planted with Cyperus esculentus. TPH uptake was higher in plant stems than roots; more so, plots amended with nutrient supplements showed significant higher percentage reduction in hydrocarbon in the polluted soil than unamended polluted soil. It is therefore recommended that Cyperus esculentus is a suitable plant species for phytoremediation of crude oil contaminated soil with high TPH value while Phyllanthus amarusis the best option in phytoremediation of polluted soil with high PAHs value, both in combination with bio-nutrient supplement.

Evaporation of Heavy Crude Oil in Soil

Heavy crude oil spillage on soil threatens productivity and affects the natural biota of the ecosystem. Evaporation is an important parameter increases crude oil density, viscosity and fraction of lower molecular weight substances which reduce its infiltration into the soil and groundwater. The evaporation of heavy crude oil showed API of 21.5, viscosity of 15mm2/s, density 0.8952 g/cm3, pour point of 11.37. The crude oil was exposed to solar radiation for 35 days. The percentage reduction in mass of the crude oil and temperature on five day interval showed 8.22(38OC) on day 0, on day 5 was 8.13(34oC), on day 10 was 5.92(39oC), on day 15 was 5.38(39oC), on day 20 was 3.16(37oC), on day 25 was 2.94(31oC), on day 20 was 2.56 (41oC) and on day 35 was 1.79(38oC). The lighter molecules evaporated first leaving the heavier molecules behind causing a reduction in the rate of evaporation with time. This analysis will be provide insight to modelling oil spill in terrestrial ecosystem.

Utilization of yellow velvetleaf and water spinach to reduce copper ion in surface water of the estuary of babon river Semarang

The Babon River in East Semarang has been polluted by heavy metals sourced from industrial waste. So that water pollution at the Babon River estuary does not spread, it is necessary to carry out water treatment. This research uses a glass aquarium reactor and utilizes yellow velvetleaf (limmoncharis Flava) and water spinach (Ipomoea aquatic fork) plants as a medium to reduce the concentration of copper ions (Cu2+) by using variations in detention time. The results and analysis showed that yellow velvetleaf and water spinach could reduce the concentration of copper ions (Cu2+) in estuary surface water within 1 hour, 2 hours, 3 hours, and 5 hours. After going through several stages of a simple drinking water pre-treatment process, the results showed that yellow velvetleaf plants could reduce the concentration of copper ions (Cu2+) in Babon river water samples, from an initial concentration of 0.055 mg/L to 0.020 mg/L, with the highest efficiency percentage reduction up to 61.5%. As for water spinach, the concentration of copper ions that can be reduced only reaches the lowest level of 0.047 mg/L, with the highest percentage reduction efficiency of only 9.6% after the same pre-treatment process.

The role of thrombocytapheresis in the management of extreme thrombocytosis: a 6 years’ experience from a tertiary care center

Background. According to the American Society for Apheresis (ASFA) guidelines, thrombocytapheresis is a Category II indication in symptomatic patients and is a Category III indication when used as secondary or prophylactic treatment. The role of thrombocytapheresis is to prevent untoward complications that might occur even before the cytoreductive agents can exert their action. Methods. A retrospective analysis of patients who underwent thrombocytapheresis between 2012 to 2018 was conducted. Demographic details, complete blood counts, diagnosis and indication for thrombocytapheresis were noted. Results. A total of 12 patients with thrombocytosis were included in the study. The cause of thrombocytosis was primary in 3 (25%) patients and secondary in 9 (75%) patients. The average percentage reduction in platelet count was 47.1% (range 12.3%-65.64%). There was a significant decrease in platelet count, platelet crit, and mean platelet volume after the procedure when compared to pre-procedure. Conclusion. Thrombocytapheresis selectively reduces platelet counts with no effect on other cellular and plasma components. The role of thrombocytapheresis in extreme thrombocytosis is to be considered for an immediate decrease in platelet count and to minimize the risks associated with thrombocytosis.

Effects of Nitrogenous Fertilization and some Insecticides on the Natural Enemies of Transgenic Bt Cotton Pests

Field assessment of integrated management of BT cotton pests was carried out in two consecutive seasons; 2016/2017 and 2017/2018 in the experimental research farm of the Kassala University, Sudan. Four insecticides (imidacloprid, abamectin, profenofos, and lufenuron) from different chemical groups and with a different mode of action and three levels (43.81 kgha-1, 87.62 kgha-1, and 131.43 kgha-1) of soil-applied nitrogen were tested in the IPM package. Insecticides were applied at the recommended doses. A total of 7 weekly counts of prevailing natural enemies [Chrysoperla carnea (Stephens) and Aenasius bambawalei Hayat] were carried out for 4 weeks before spraying and 3 weeks post spraying starting the 3rd week from spraying. Results indicated that nitrogen level exerted no significant effects on the populations of prevailing natural enemies; C. carnea and A. bambawalei. Based on average post spray counts and percentage reduction over the control, all insecticide treatments significantly reduced the population of the natural enemies. Imidacloprid and profenofos exerted the highest reduction of C. carnea population followed by abamectin and lufenuron (56.03, 48.25, 07.78 and 06.61% respectively) in the first season, while profenofos, imidacloprid, lufenuron, and abamectin induced the highest reductions (55.94, 45.05, 17.57 and 17.33% respectively) in the second season. On the other hand, reductions in A. bambawalei population (abundant in season 1 only) followed the order; imidacloprid, lufenuron, abmectin, and profenofos (03.95, 02.63, 202.63, and 01.32%, respectively). Interactions between nitrogen fertilization and insecticide were not significant as measured by the population of prevailing natural enemies.

Three-staged stereotactic radiosurgery for brain metastases: a single institution experience

Aims Stereotactic radiosurgery (SRS) using the Leksell Gamma Knife system is a commonly used modality for the treatment of brain metastases (BMs). As the size of the target volume (TV) increases, so too does the dose of radiation delivered to surrounding healthy tissue. Large BMs are therefore a contraindication to the use of SRS. Critical organs adjacent to the TV may also be a contraindication to SRS. Staged SRS was proposed as a novel method of delivering three SRS treatments at a reduced radiation dose with a gap of two weeks between each session as a way of shrinking the TV. This allows treatment of TVs otherwise considered untreatable with standard, single-fraction SRS. Little data exists in the literature as to its efficacy. The objective of this study was to evaluate the efficacy of this novel approach and to identify factors which may predict treatment failure. Method A retrospective analysis was undertaken at a single, tertiary Gamma Knife centre. All patients who underwent treatment of their BMs with three-staged Gamma Knife SRS from January 2014 to December 2020 were identified and included. Patient demographics and primary cancer status was ascertained. SRS treatment details for each lesion were collected, including TV, dose and dosimetric data. The percentage reduction in volume of the TVs between the first and second stage, the second and third stage and the first and third stage were calculated. Follow-up data was collected to include follow-up imaging, further intracranial treatments received and survival status. The percentage reduction in volume between each stage was demonstrated on box-and-whisker plots. Statistical significance in reduction in TV between each stage was ascertained by paired samples T-tests. Correlation between initial TV size and percentage reduction post-SRS was determined by a correlation coefficient. Differences were deemed significant with p-values &lt;0.05. Results 12 patients with 14 staged BMs were identified and included. The median age was 61.5 (range 45-79). Seven had a primary malignancy of breast cancer, five non-small cell lung cancer, one melanoma and one colorectal. Median follow-up was 140.5 days (range 10-821). Median TV was 7.44cc (range 1.14-21.53). All TVs received 10Gy at each stage. The median percentage reduction in size of the TV was 7.41% between 1st-2nd stage (range -16.0-42.49%, p-value 0.06), 19.47% between 2nd-3rd stage (range -5.38-53.53%, p-value &lt;0.01) and 24.25% between 1st-3rd stage (range 10.69-68.67%, p-value &lt;0.01). The correlation coefficient between initial TV size and percentage reduction post-SRS was -0.41 (p-value 0.07). 13/14 lesions showed a partial response on first follow-up scan post-SRS, 1/14 lesions showed a mixed response. One patient died 184 days from completion of treatment but without intracranial progression. Two patients had salvage intracranial surgery, 154 and 536 days from completion of treatment respectively. Conclusion Three-staged Gamma Knife is shown to be effective at shrinking the TV and can therefore be used to treat lesions otherwise considered unsuitable for SRS. The presence of extra-cranial metastases did not predict for poor outcomes. Though local control with SRS is thought to diminish with increasing TV size, all staged lesions showed a reduction in size between first and last treatment, and no significant effect was seen between initial TV size and percentage reduction in TV. No patients experienced disease progression on first follow up scan, with 13 of 14 lesions showing disease response. There were only two cases of intracranial progression, with one occurring 536 days post-SRS. Though limited by small numbers and short median follow up period, our data demonstrate encouraging results for three-stage SRS for lesions otherwise unsuitable for single fraction treatment, and should lead to further study.

Topical Capsaicin for the Treatment of Sensory Neuropathic Cough

Objective To evaluate a novel treatment for sensory neuropathic cough (SNC): topical capsaicin. Study Design Retrospective review. Setting Tertiary care laryngology clinic. Methods A retrospective review was performed on 201 consecutive patients treated for SNC with capsaicin 0.02% to 0.04% applied topically to the upper aerodigestive tract, typically after failure of standard medications. Patients were asked to use the spray 4 times daily for 2 weeks prior to assessment of benefit. Items assessed included the percentage reduction of coughing, type of benefit noted, and side effects. Results Of the 201 patients who used the spray, 36.3% noted no benefit, whereas 63.7% (n = 128) had benefit in terms of cough reduction: 30.8% (n = 62) reported ≥75% reduction; 17.4% (n = 35), 50%-74% reduction; 7.0% (n = 14), 25%-49% reduction; and 8.5% (n = 17), 1%-24% reduction. Of all patients, 78.3% reported no side effects or complications. Of the remaining 21.7%, 1 patient noted a nosebleed after a single administration, and 1 patient noted transient wheezing after administration. The others reported unpleasant local effects, including throat/ear discomfort, voice change, sneezing, reflexive vomiting, and headache. Conclusion In our group of 201 patients with SNC, most of which had failed to respond to standard treatments, 63.7% had some response to capsaicin spray, with 30.8% reporting ≥75% reduction. Minimal side effects of treatment were reported. Thus, we suggest that this therapy can be another treatment option for patients with SNC.