Ahmed Mahmoud Galal

Background: Fibrosis is a pathological consequence of chronic organ injury characterized by excessive extracellular matrix deposition leading to tissue scarring and organ dysfunction. Angiotensin-converting enzyme 2 (ACE2) is a counter-regulatory component of the renin–angiotensin system that degrades angiotensin II to angiotensin-(1–7), shifting signaling towards anti-fibrotic pathways. Loss of ACE2 activity exacerbates fibrosis in multiple organs, whereas augmenting ACE2 activity can mitigate fibrogenesis. Main body: Recent research has focused on discovering ACE2 activators as a novel anti-fibrotic strategy. Structure-based drug design and high-throughput screening have identified several small-molecule ACE2 activators (e.g., xanthenone XNT and diminazene aceturate [DIZE]) and natural product-derived compounds (e.g., bile acid derivatives and phytochemicals) that enhance ACE2 activity. Preclinical studies in cardiac, renal, pulmonary, and hepatic fibrosis models demonstrate that ACE2 activation increases angiotensin-(1–7) signaling, reduces angiotensin II levels, and attenuates fibrotic remodeling and inflammation in vivo. ACE2 activators broadly fall into synthetic allosteric molecules, repurposed drugs, and indirect up-regulators of ACE2 expression. These agents have shown improved cardiac function and reduced collagen deposition in heart failure models, nephroprotection in chronic kidney injury, protection against bleomycin-induced lung fibrosis, and decreased liver fibrosis in cholestatic injury models. ACE2 activation appears well-tolerated in animals, though specificity and optimal delivery remain challenges. Conclusion: Targeting ACE2 with activators represents a promising therapeutic avenue to counter fibrosis by restoring the balance of profibrotic and antifibrotic RAS signaling. Ongoing advancements in ACE2 activator design and testing support their potential to become innovative treatments for fibrotic diseases, pending further preclinical validation and clinical trials.

Background: The breast is a cornerstone image of femininity, and the heart of womanhood, as nourisher and comforter. The term "oncoplastic surgery" (OPS) refers to more than only the fusion of plastic and oncologic concepts. Surgeons can do wider excisions with free margins by modifying the residual breast tissue using different mammoplastic techniques, which lowers the incidence of re-excision. Objective: To assess and evaluate wide local excision technique as an oncoplastic procedure for management of breast carcinoma in the upper/upper lateral quadrant with matrix rotation technique regarding cosmetic, surgical outcomes, and patient satisfaction Patients and Methods: This prospective randomized controlled study included 30 patients with cancer breast scheduled for oncology breast surgery. They were divided to two equal groups: Group I: wide local excision technique. Group II: matrix rotation technique. Results: When testing the postoperative outcomes for all included patients, we found that 63.3% of patients had good cosmetic outcome postoperatively. 16.7% of patients had very good cosmetic outcome. Concerning patients’ point of view, 80% of patients (24 patients) were totally satisfied about their postoperative outcome. 63.3% of them (19 patients) thought they had equal breast sizes while 36.7% of them (11 patients) thought they had a better breast shape as shown in table 3. Conclusion: Wide local excision is a safe oncoplastic technique, causing significantly less post-operative hematoma, mild seroma, minimal blood loss, less areolar deviation and better breast symmetry than matrix rotation technique.

The introduction of effective vaccines in December 2020 marked a significant step forward in the global response to COVID-19. Given concerns with access, acceptability, and hesitancy across Africa, there is a need to describe the current status of vaccine uptake in the continent. An exploratory study was undertaken to investigate these aspects, current challenges, and lessons learnt across Africa to provide future direction. Senior personnel across 14 African countries completed a self-administered questionnaire, with a descriptive analysis of the data. Vaccine roll-out commenced in March 2021 in most countries. COVID-19 vaccination coverage varied from low in Cameroon and Tanzania and up to 39.85% full coverage in Botswana at the end of 2021; that is, all doses advocated by initial protocols versus the total population, with rates increasing to 58.4% in Botswana by the end of June 2022. The greatest increase in people being fully vaccinated was observed in Uganda (20.4% increase), Botswana (18.5% increase), and Zambia (17.9% increase). Most vaccines were obtained through WHO-COVAX agreements. Initially, vaccination was prioritised for healthcare workers (HCWs), the elderly, adults with co-morbidities, and other at-risk groups, with countries now commencing vaccination among children and administering booster doses. Challenges included irregular supply and considerable hesitancy arising from misinformation fuelled by social media activities. Overall, there was fair to reasonable access to vaccination across countries, enhanced by government initiatives. Vaccine hesitancy must be addressed with context-specific interventions, including proactive programmes among HCWs, medical journalists, and the public.

Aim and Background: Malignant pleural mesothelioma (MPM) is a lethal cancer mainly caused by chronic exposure of asbestos. In this pilot study, we aimed to assess the expression of serum RNA‐based biomarker panel exploring their clinical utility as diagnostic and prognostic biomarkers for MPM.Methods: We have selected an MPM‐specific RNA‐based biomarker panel through bioinformatics analysis based on the integration of DNA damage regulated autophagy modulator 1 (DRAM1) and arylsulfatase A ( ARSA) gene expression with their epigenetic regulators microRNA ( miR‐2053) and long noncoding RNA ( lncRNA‐RP1‐86D1.3). Then, quantitative real‐time polymerase chain reaction (qPCR) validation in sera of 60 MPM patients, 20 chronic asbestos exposure patients, and 20 healthy volunteers was done. Lastly, the prognostic power of the selected panel was assessed.Results: The expression of serum DRAM1 messenger RNA (mRNA), ARSA mRNA, hsa‐miR‐2053 and lncRNA‐RP1‐86D1.3 were positive in 78.3%, 90%, 85%, and 83.3% of MPM patients, respectively. The RNA‐based biomarker panel was able to discriminate between MPM patients and controls with high accuracy and their combined sensitivity reached 100% for the diagnosis of MPM. Kaplan‐Meier analysis showed that hsa‐miR‐2053 is an independent prognostic factor of MPM.Conclusion: Our preliminary data revealed that the chosen RNAs play an important role in driving MPM development and progression.