Endogenous endophthalmitis is a rare but devastating disease that may frequently result in visual loss despite appropriate and early antibiotic treatment. Recent reports have suggested an increased incidence of endogenous endophthalmitis in East Asia, particularly in Taiwan, where the major source of infection has been liver abscess secondary to Klebsiella pneumoniae. Here we report three cases who presented in Qatar with severe endogenous endophthalmitis associated with Klebsiella pneumonia septicemia secondary to pyogenic liver abscess in a diabetes mellitus underlying.

Cancer metastasis is a multistep process, which results in cancer cells disseminating to other organs. The crucial metastasis step involves cancer invasion which occurs via actin-protrusion by invasive malignant cells, termed as invadopodia. In solid tumours, invadopodia formation increases as a result of hypoxia which is found to be resistant against chemotherapy and radiotherapy. Phytochemicals have been potentially identified as a prime source of effective conventional drugs for metastasis treatments, which target cancer cell invasion, particularly molecular components of the invadopodia formation. The Hypoxia-Inducible Factor-1α (HIF-1α) is an essential target in terms of treatment for hypoxic tumour, as well as helping to identify the mode of action for the drugs, particularly phytochemical compounds. The aim of this review is to highlight the current development with regards to the ability of phytochemicals in targeting cancer metastasis, as well as phytochemical compounds which are able to inhibit HIF-1α and invadopodia formation. The use of phytochemicals for targeting hypoxic cancer cells may open new prospects for reducing cancer metastasis
Cancer Metastasis

BACKGROUND/AIMS: Approximately one-third of non-erosive reflux disease (NERD) patients are refractory to proton pump inhibitors (PPI) and face a therapeutic challenge. Therefore, it is important to differentiate between pathological and non-pathological reflux utilizing multichannel intraluminal impedance-pH (MII-pH) to analyze symptom-reflux association and diagnose true NERD versus hyper-sensitive esophagus (HE) and functional heartburn (FH). Herein, we evaluated the diagnostic yield of MII-pH in refractory NERD and sub-classified it based on quantity and quality of acid/non-acid reflux and reflux-symptom association. METHODS: Sixty symptomatic NERD patients on twice daily PPI for > 2 months were prospectively evaluated by MII-pH. Distal and proximal refluxes, bolus exposure time (BET), esophageal acid exposure time, symptom index (SI) and symptom association probability (SAP) were measured. RESULTS: Thirty-two (53%) patients had BET > 1.4% (MII-pH positive-true NERD), while 28 (47%) had BET < 1.4% (MII-pH negative NERD) where SI and SAP were negative in 15/60 (25%; categorized as FH) and SI or SAP were positive in 13/60 (22%; identified as HE). Thirty-eight (63%) patients reported significant SI or SAP parameters where > 80% of symptoms were associated with non-acid reflux. The number of distal refluxes in true NERD versus FH or HE were significantly different, but not between FH and HE. CONCLUSIONS: Approximately 60% of refractory PPI NERD patients had positive reflux-symptom association, primarily due to non-acid reflux. Nearly half of NERD patients on PPI had normal MII-pH monitoring, sub-divided further into FH and HE equally.
Esophagus ; Heartburn ; Humans ; Prospective Studies ; Proton Pump Inhibitors

Objective: To detect the presence of specific CTX-M class of extended spectyum β-lactamases (ESBLs) in a collection of cephalosporin-resistant Enterobacteriaceae isolates from Bahrain. Methods: A subset of 80 cephalosporin-resistant Enterobacteriaceae collected from Salmaniya Medical Complex, Bahrain, were characterized further for the presence of specific genogroups of CTX-M β-lactamases by multiplex- and monoplex- PCRs. The primers used for the multiplex and monoplex PCRs were of genogroups- 1, 2, 8, 9 and 25. Sequencing of the representative isolates was performed to find the circulating CTX-M-types. Results: A total of 93.8% (75/80) isolates showed the amplicons corresponding to any of the genogroups (1, 2, 8, 9, 25) and the remaining 6.2% isolates turned out negative in multiplex PCR. Some of the isolates demonstrated multiple bands corresponding to the sizes of different genogroups. Further confirmation with respective monoplex PCR on these 75 isolates demonstrated that 93.3% (70/75) harbored CTX-M genogroup-1 and 6.7% (5/75) harbored genogroup-9. We did not find the presence of genogroups 2, 8, and 25 in these isolates by monoplex PCR. Sequencing results of genogroup-1 isolates demonstrated the presence of CTX-M-15-like ESBL, however, discrepant results were noticed in genogroup-9 isolates, sequencing showed them as CTX-M-55-like ESBL. Conclusions: This is the first report from Bahrain characterizing the CTX-M genogroups of ESBLs and reporting the emergence of bla