Development and evaluation of dexamethasone-loaded bioadhesive polymeric nanocapsules for mitigating cardiac and gastric adverse effects of free dexamethasone

Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a common and challenging complication of platinum and taxane agents and can have a significant impact on patients' quality of life (QoL).
Objective: This study aims to detect the frequency and severity of CIPN in patients receiving Platinum and Taxane compounds and their effect on QoL.
Methods: This prospective study enrolled 47 patients receiving neurotoxic chemotherapy (taxanes and platinum-based agents) at Assiut University Hospital's Clinical Oncology Department between March 2023 and July 2024, with a median 6-month follow-up. CIPN was detected, graded, and assessed clinically by using the NCI-CTCAE v5.0 criteria and electrophysiologically through nerve conduction studies conducted in collaboration with the Neurology Department. Health-related quality of life (HRQoL) was evaluated using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30).
Results: In this study, altered sensory symptoms occurred in 80-86.7% of patients across all regimens. Neuropathy grading revealed grade II in 44% of patients, grade I in 29%, and grade III in 25%. Platinum-based regimens were
significantly associated with grade II neuropathy (p<0.001), while platinum+taxane combinations showed the highest rate of grade III neuropathy (p=0.05). Nerve conduction studies demonstrated significant post-chemotherapy reductions in sensory nerve action potential (SNAP) and motor conduction velocities (MCV) (p<0.001). Higher CIPN grades correlated significantly with worse global health status (commonly with patients received platinum + taxane combinations), reduced physical function, and increased symptom burden on both QLQ-C30 and NCI-CTCAE V5 scales (p<0.014).
Conclusion: CIPN is a frequent and devastating complication in patients receiving taxane and platinum-based chemotherapy, with significant clinical, neurophysiological, and QoL implications. Future research should focus on strategies to prevent and mitigate this debilitating side effect.

Background

Ongoing research aims to correlate ultrasound (US) findings with nerve conduction studies (NCS) results for the diagnosis of Guillain–Barré syndrome (GBS). NCS is currently the gold standard for confirming GBS diagnosis. This study aimed to compare nerve cross-sectional area (CSA) between GBS patients and controls and among different GBS subtypes, determine the correlation between CSA and NCS parameters, and identify a potential CSA cut-off value for early GBS screening. This study included 41 patients with GBS and 35 matched controls. Participants underwent comprehensive history taking, physical examination, NCS, and US measurement of CSA of peripheral nerves in upper and lower limbs. Receiver operating characteristic (ROC) analysis was performed to assess the ability of US CSA measurements to discriminate between GBS cases and controls.

Results

GBS patients had larger US nerve CSA than controls. No significant variations in CSA existed among different GBS electrophysiological subtypes. ROC curve analysis showed that median nerve CSAs at mid-forearm, pronator quadratus, and pronator teres were highly accurate for diagnosing GBS, with an area under the curve (AUC) of 1. Ulnar and posterior tibial nerve CSA were less precise. No substantial correlation existed between CSA and NCS parameters in the same nerve, although some association with clinical rating scales was present.

Conclusions

This study suggests nerve US may complement NCS in early GBS diagnosis, proposing CSA cut-off values for median, ulnar, and posterior tibial nerves. Further larger studies with standardized US protocols are needed to validate the reproducibility and diagnostic utility of these cut-offs.

Background

Up to 96% of patients with Parkinson's disease (PD) experience sleep disturbances, which can emerge before motor symptoms. This study aims to determine the type of sleep disturbances in PD compared to controls using Parkinson's Disease Sleep Scale-2 (PDSS-2) and polysomnography (PSG). Twenty-four PD patients with sleep difficulties and 24 matched controls were included in this prospective case–control study. Sleep disturbances were diagnosed using screening questionnaires and PDSS-2. Patients were clinically assessed using Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS). All participants were evaluated using Beck Depression Inventory (BDI), Montreal Cognitive Assessment (MoCA), and full-night video PSG.

Results

The PD group had significantly higher BDI and lower MoCA scores than the controls. PD patients had significantly lower sleep efficiency (87.32% versus 95.48%) and longer sleep latency (29 versus 2.45 min), shorter REM latency (37.97 versus 78.94 min), higher N2 sleep percentage (65.32% versus 51.43%), and lower REM sleep percentage (15.89% versus 19.22%). PD patients also had a higher arousal index (11.35 ± 9.46/h versus 3.44 ± 2.93/h), more periodic leg movements (7 ± 6.64 versus 2.21 ± 2.39), and a higher apnea–hypopnea index (7.96 ± 4.91 versus 4.12 ± 3.71). Sleep latency showed a negative correlation with MoCA and a positive correlation with disease duration. REM sleep percentage was negatively correlated with BDI. Arousal index /hour was negatively correlated with age onset.

Conclusions

This study confirms significant sleep architecture differences between PD patients and controls, emphasising the importance of comprehensive sleep assessment and management in PD care.

Background: The apolipoprotein E (APOE) gene, encompassing three alleles (ε2, ε3, ε4), is a critical player in lipid metabolism and has been extensively studied for its role in neurodegenerative diseases. This study examines APOE genetic variability and its association with PD in an Egyptian cohort.

Methods: A total of 891 participants, including 422 PD patients and 469 healthy controls, were included in this study. APOE genotyping was performed using Kompetitive Allele Specific PCR (KASP) to detect the rs429358 and rs7412 SNPs, which define the APOE alleles. APOE alleles were categorized based on the genotypes into ε2, ε3, and ε4 groups. Clinical assessments of PD patients included age at onset, disease severity (MDS-UPDRS), and demographic factors. Statistical analyses compared APOE distributions between PD and control groups and examined associations with clinical variables.

Results: The ε3 allele was the most prevalent in the cohort (77.3%), aligning with global and African trends. The ε2 allele was observed in 11.4%, and the ε4 allele in 11.3%, with both frequencies being lower than reported African estimates. The ε3/ε3 genotype was predominant in both PD patients (72.51%) and controls (72.07%). The ε4/ε4 genotype was absent in PD cases and rare among controls (0.64%). No significant association was found between APOE genotypes and PD risk, age at onset, or disease severity.

Conclusion: Our findings do not support a significant role for APOE in PD susceptibility or severity in Egyptians.