A Systematic Literature Review of 3D Deep Learning Techniques in Computed Tomography Reconstruction

Computed tomography (CT) is used in a wide range of medical imaging diagnoses. However, the reconstruction of CT images from raw projection data is inherently complex and is subject to artifacts and noise, which compromises image quality and accuracy. In order to address these challenges, deep learning developments have the potential to improve the reconstruction of computed tomography images. In this regard, our research aim is to determine the techniques that are used for 3D deep learning in CT reconstruction and to identify the training and validation datasets that are accessible. This research was performed on five databases. After a careful assessment of each record based on the objective and scope of the study, we selected 60 research articles for this review. This systematic literature review revealed that convolutional neural networks (CNNs), 3D convolutional neural networks (3D CNNs), and deep learning reconstruction (DLR) were the most suitable deep learning algorithms for CT reconstruction. Additionally, two major datasets appropriate for training and developing deep learning systems were identified: 2016 NIH-AAPM-Mayo and MSCT. These datasets are important resources for the creation and assessment of CT reconstruction models. According to the results, 3D deep learning may increase the effectiveness of CT image reconstruction, boost image quality, and lower radiation exposure. By using these deep learning approaches, CT image reconstruction may be made more precise and effective, improving patient outcomes, diagnostic accuracy, and healthcare system productivity.

I-Cubid: a nonlinear cubic graph-based approach to visualize and in-depth browse Flickr image results

The existing image search engines allow web users to explore images from the grids. The traditional interaction is linear and lookup-based. Notably, scanning web search results is horizontal-vertical and cannot support in-depth browsing. This research emphasizes the significance of a multidimensional exploration scheme over traditional grid layouts in visually exploring web image search results. This research aims to antecedent the implications of visualization and related in-depth browsing via a multidimensional cubic graph representation over a search engine result page (SERP). Furthermore, this research uncovers usability issues in the traditional grid and 3-dimensional web image search space. We provide multidimensional cubic visualization and nonlinear in-depth browsing of web image search results. The proposed approach employs textual annotations and descriptions to represent results in cubic graphs that further support in-depth browsing via a search user interface (SUI) design. It allows nonlinear navigation in web image search results and enables exploration, browsing, visualization, previewing/viewing, and accessing images in a nonlinear, interactive, and usable way. The usability tests and detailed statistical significance analysis confirm the efficacy of cubic presentation over grid layouts. The investigation reveals improvement in overall user satisfaction, screen design, information & terminology, and system capability in exploring web image search results.

Role of Ommaya Reservoir in Pediatric Hydrocephalus: Experience in Bangladesh Medical College Hospital from 2019-2021

The goal of this study was to analyze the efficacy of the Ommaya reservoir within all the different types of hydrocephalus in pediatric patients. At the same time, it's safe for repeated aspirations or long-term retention of the reservoir in the body. This retrospective, cross-sectional study was performed from January 2019 to December 2021, 33 consecutive cases of reservoir implantation were taken into the study irrespective of the etiology of hydrocephalus in the Neurosurgery Department of Bangladesh Medical College Hospital, Dhaka, Bangladesh. These were mostly placed along with endoscopic third ventriculostomy and some were placed as an intermediary procedure to combat shunt complications in emaciated infants. Cerebrospinal fluid (CSF) aspiration was done in case of failed endoscopic third ventriculostomy and the frequency of aspiration depended upon the production of cerebrospinal fluid. Acetazolamide was routinely administered in each patient to reduce the frequency of aspiration. Most of the patients required ventriculo-peritoneal (VP) shunt while they had sufficient body weight and few required no surgery. The average age at presentation was 76.88 days. All the neonates and infants had less weight in terms of their age. 42.4% of babies needed aspiration 2 times per week. Among all cases, 9.1% developed reservoir complications. Complications were not related to the number and volume of aspiration or duration of the reservoir in the body. Two (2) patients died after one year of reservoir implantation due to unknown etiology. Out of the 31 survivors, 3 patients did not need any further aspiration and 19 patients needed a ventriculo-peritoneal shunt, but the reservoir was kept in situ for a future emergency. The rest of them is waiting for a definitive shunt procedure. Other findings include low socioeconomic group was more prone to low birth weight and they carried the burden of congenital hydrocephalus and meningomyelocele. Most affected babies had their prenatal period in arsenic-affected areas in Bangladesh. Overall folic acid supplementation was started after the formation of the neural tube irrespective of socioeconomic status. Ommaya reservoir placement along with endoscopic third ventriculostomy plays a vital role in delaying shunt in endoscopic third ventriculostomy failure. It is a 'time buying' procedure until the baby has sufficient weight for successful shunt surgery. It has been found very effective intermediary intervention for managing shunt infection and it also helps revive a channel in shunt obstruction.

A hybrid mask RCNN-based tool to localize dental cavities from real-time mixed photographic images

Nearly 3.5 billion humans have oral health issues, including dental caries, which requires dentist-patient exposure in oral examinations. The automated approaches identify and locate carious regions from dental images by localizing and processing either colored photographs or X-ray images taken via specialized dental photography cameras. The dentists' interpretation of carious regions is difficult since the detected regions are masked using solid coloring and limited to a particular dental image type. The software-based automated tools to localize caries from dental images taken via ordinary cameras requires further investigation. This research provided a mixed dataset of dental photographic (colored or X-ray) images, instantiated a deep learning approach to enhance the existing dental image carious regions' localization procedure, and implemented a full-fledged tool to present carious regions via simple dental images automatically. The instantiation mainly exploits the mixed dataset of dental images (colored photographs or X-rays) collected from multiple sources and pre-trained hybrid Mask RCNN to localize dental carious regions. The evaluations performed by the dentists showed that the correctness of annotated datasets is up to 96%, and the accuracy of the proposed system is between 78% and 92%. Moreover, the system achieved the overall satisfaction level of dentists above 80%.

Cryopreservation Studies on Silver Carp (Hypophthalmichthys molitrix) Embryos

BACKGROUND

Cryopreservation is an effective tool for the preservation of live biological materials.

OBJECTIVE

This study examined the suitability of cryopreservation protocols and the effectiveness of ultrasound for silver carp embryos.

MATERIALS AND METHODS

Embryos at three developmental stages were exposed to 10, 15, 20, and 25% of five cryoprotectants (CPAs), namely propylene glycol (PG), dimethylformamide (DFA), DMSO, MeOH, and ethylene glycol (EG) for 20 min. Embryos were exposed to twelve vitrification solutions (VSs) for 10 (five steps of 2 min), 15 (five steps of 3 min), 20 (five steps of 4 min) min. Embryos were also exposed to ultrasound in VSs prior to cooling for cryopreservation.

RESULTS

Hatching rates decreased with increasing CPA concentrations while toxicity varied in the order of PG < DMSO < EG < MeOH < DFA. Tail elongation stage was more tolerant to CPA than 6-somites and morula stages. The survival of embryos exposed to ultrasound in VS was remarkably lower than in water. Embryos exposed to ultrasound in VSs under the best conditions did not response well after attempted vitrification.

CONCLUSION

Ultrasound-mediated CPA impregnation could be effective but other innovative methods may be needed to attain successful cryopreservation.

An architecture for non-linear discovery of aggregated multimedia document web search results

The recent proliferation of multimedia information on the web enhances user information need from simple textual lookup to multi-modal exploration activities. The current search engines act as major gateways to access the immense amount of multimedia data. However, access to the multimedia content is provided by aggregating disjoint multimedia search verticals. The aggregation of the multimedia search results cannot consider relationships in them and are partially blended. Additionally, the search results' presentation is via linear lists, which cannot support the users' non-linear navigation patterns to explore the multimedia search results. Contrarily, users' are demanding more services from search engines. It includes adequate access to navigate, explore, and discover multimedia information. Our discovery approach allow users to explore and discover multimedia information by semantically aggregating disjoint verticals using sentence embeddings and transforming snippets into conceptually similar multimedia document groups. The proposed aggregation approach retains the relationship in the retrieved multimedia search results. A non-linear graph is instantiated to augment the users' non-linear information navigation and exploration patterns, which leads to discovering new and interesting search results at various aggregated granularity levels. Our method's empirical evaluation results achieve 99% accuracy in the aggregation of disjoint search results at different aggregated search granularity levels. Our approach provides a standard baseline for the exploration of multimedia aggregation search results.

Roosting ecology and morphometric analysis of Pteropus medius (Indian flying fox) in Lower Dir, district, Pakistan

The present study was conducted to explore morphometric variations of Pteropus medius (the Indian flying fox) and the roosting trees in Lower Dir, Pakistan. The bats were captured from Morus alba, Morus nigra, Brousonetia papyrifera, Pinus raxburghii, Hevea brasiliensis, Platanus orientalis, Populous nigra, Melia azedarach, Eucalyptus camaldulensis and Grevillea robusta through sling shot and mess net methods. A total of 12 bats were studied for the differential morphological features based on age and sex. Male bats were recorded higher in weight than females. The variations were found in body mass (821.1±34.65gm), circumference of body with wings (25.43±0.39cm), wingspan (112.58±1.90cm), Body length (20.73±0.68cm), Snout length (3.42±0.04cm), Eye length (1.45±0.033cm), Length of ear (3.56±0.05cm), Width of ear (2.46±0.04cm), Length b/w ear (5.51±0.11cm), Circumference of neck (12.23±0.24cm), Circumference of body without wings (18.68±0.31cm), Arm wing length (23.2±1.03cm), Length of thumb (5.43±0.1cm), Length of nail (1.89±0.05cm), Hand wing length (29.1±0.51cm), Maximum width of wing (21.03±0.68cm), Length b/w tip of wing to 5th digit (29.39±0.30cm), Length b/w 5th digit to foot (22.97±1.09cm), Length b/w feet (18.31±0.74cm) and Length of foot claw (4.23±0.05cm). This study was designed for analysis of external morphological variations for P. medius (the Indian flying fox) that may help in identification of these bats and their roosting sites.

Pattern of first- and second-line drug resistance among pulmonary tuberculosis retreatment cases in Pakistan

BACKGROUND

Drug resistance in general, and multidrug-resistant tuberculosis (MDR-TB) in particular, threatens global tuberculosis (TB) control efforts. Population-based estimates of drug resistance are needed to develop strategies for controlling drug-resistant TB in Pakistan.

OBJECTIVE

To obtain population-based data on Mycobacterium tuberculosis drug resistance in Pakistan.

METHODS

To obtain drug resistance data, we conducted a population-based study of TB cases in all provinces of Pakistan. We performed culture and drug susceptibility testing on M. tuberculosis isolates from patients with a prior history of anti-tuberculosis treatment (retreatment cases) from all over the country.

RESULTS

Of 544 isolates from previously treated cases, 289 (53.1%) were susceptible to all first-line drugs, 255 (46.9%) were resistant to at least one anti-tuberculosis drug and 132 (24.3%) were MDR-TB. Among MDR-TB isolates, 47.0% were ofloxacin (OFX) resistant. Extensively drug-resistant TB was found in two (0.4%) isolates.

CONCLUSION

Prevalence of drug resistance in retreatment isolates was high. The alarmingly high prevalence of OFX resistance among MDR-TB isolates may threaten the success of efforts to control and treat MDR-TB.

Control of ammonia and urea emissions from urea manufacturing facilities of Petrochemical Industries Company (PIC), Kuwait

Petrochemical Industries Company (PIC) in Kuwait has mitigated the pollution problem of ammonia and urea dust by replacing the melting and prilling units of finished-product urea prills with an environmentally friendly granulation process. PIC has financed a research project conducted by the Coastal and Air Pollution Program's research staff at the Kuwait Institute for Scientific Research to assess the impact of pollution control strategies implemented to maintain a healthy productive environment in and around the manufacturing premises. The project was completed in three phases: the first phase included the pollution monitoring of the melting and prilling units in full operation, the second phase covered the complete shutdown period where production was halted completely and granulation units were installed, and the last phase encompassed the current modified status with granulation units in full operation. There was substantial decrease in ammonia emissions, about 72%, and a 52.7% decrease in urea emissions with the present upgrading of old melting and prilling units to a state-of-the-art technology "granulation process" for a final finished product. The other pollutants, sulfur dioxide (SO2), nitrogen oxides (NOx), and volatile organic compounds (VOCs), have not shown any significant change, as the present modification has not affected the sources of these pollutants.

IMPLICATIONS

Petrochemical Industries Company (PIC) in Kuwait has ammonia urea industries, and there were complaints about ammonia and urea dust pollution. PIC has resolved this problem by replacing "melting and prilling unit" of final product urea prills by more environmentally friendly "granulation unit." Environmental Pollution and Climate Program has been assigned the duty of assessing the outcome of this change and how that influenced ammonia and urea dust emissions from the urea manufacturing plant.

Adsorption Assisted Photocatalytic Removal of Methyl Orange by MgAl2O4-Sb2S3 Composite Material

BACKGROUND

The current article is about the water treatment in which colored water contaminated by methyl orange has been used for adsorption assisted photocatalysis. Coupling of photocatalysis with the traditional water treatment processes has been in practice since last couple of years for the improvement of degradation efficiencies, for example, photocatalysis coupled with ultrafilteration, adsorption, flocculation, biological methods, photolysis, membrane distillation, etc. Among all these coupling approaches, adsorption assisted photocatalysis being a very simple and highly efficient approach is suffering from few drawbacks on the account of high cost, low stability and surface area of the adsorbent support. The present study is a contribution towards improvement in this coupling approach. A low cost, highly stable spinel magnesium aluminate (MgAl2O4) material synthesized at nanoscale is used for composite formation with antimony sulphide (Sb2S3) material having high absorption coefficient in the visible light of solar spectrum. A review of recent patents shows that the field of photoctalysis is dominated by the traditional TiO2 catalyst. The modification of TiO2 by either composite formation or by doping is the main focus.

METHODS

Coprecipitation method is used for the synthesis of spinel in which the desired precursors in the respective molar ratios were mixed and annealing of the resulting precipitates was carried out at 800oC for 8 h. Sb2S3 was synthesized by the hydrothermal method in which the required molar solution of precursors was mixed with urea solution and the whole mixture was maintained at 105oC for 6 hrs in a Teflon lined autoclave. The resulting suspension was then annealed at 37oC for 3 hours. The composite of Sb2S3 and MgAl2O4 has been synthesized by mixing both the materials in 1:1 and heat treated in an oven at a temperature of 200oC.

RESULTS

Peaks in X-ray diffraction pattern correspond to both the Sb2S3 and spinel phase. All the peaks corresponding to the Sb2S3 and spinel phase were found to be shifted to higher d-spacing values. This indicates the expansion of unit cells of the Sb2S3 and MgAl2O4 phases. Thermal studies show that only 3% weight loss is observed at a temperature of 200-1000oC which may be due to the loss of surface water from the sample. Surface area, pore volume and pore size obtained from N2 adsorption were 143m2/g, 0.21cc/g and 23.26Å, respectively. The removal efficiency of 0.1g catalyst for methyl orange solution of 5mg/L concentration after reaction in dark conditions for the time of one hour was calculated to be 24% owing to the adsorption. The visible light degradation efficiency of the 0.1g catalyst for 1, 5, 19, 25 and 50 mg/L concentrations of MO solutions were 97, 93, 75, 72 and 62% respectively. The dosage of the catalyst was found to have a direct relationship with the degradation efficiency. Lower pH was found suitable for the degradation owing to better interaction of catalyst surface and the adsorbed dye. Percent degradation increased with the increase in the time and temperature of reaction. The degradation kinetics followed pseudo first order rate equation; the calculated value of rate constant was 0.0102 min-1.

CONCLUSION

The mechanism involves the excitation of electrons in the valence band of Sb2S3 to the conduction band by the absorption of visible and UV light. The electrons and holes participate in the surface reactions resulting in the formation of superoxide and hydroxyl radicals which degrade the targeted polluted. Lower concentration of MO solutions, acidic pH, higher catalyst dosage and greater reaction times were found suitable for the degradation efficiency.

Synthesis, spectroscopic characterization, biological screenings, DNA binding study and POM analyses of transition metal carboxylates

This article contains the synthesis of a novel carboxylic acid derivative, its transition metal complexes and evaluation of biological applications. Six carboxylate complexes of transition metals, Zn(II) and Hg(II), have been successfully synthesized and characterized by FT-IR and NMR (1H, 13C). The ligand, HL, (4-[(2,6-Diethylphenyl)amino]-4-oxobutanoic acid) was also characterized by single crystal X-ray analysis. The complexation occurs via oxygen atoms of the carboxylate moiety. FT-IR date show the bidentate nature of the carboxylate moiety of the ligand as the Δν value in all complexes is less than that of the free ligand. The ligand and its complexes were screened for antifungal and antileishmanial activities. The results showed that the ligand and its complexes are active with few exceptions. UV-visible spectroscopy and viscometry results reveal that the ligand and its complexes interact with the DNA via intercalative mode of interaction. A new and efficient strategy to identify the pharmacophores and anti-pharmacophores sites in carboxylate derivatives for the antibacterial/antifungal activity using Petra, Osiris and Molinspiration (POM) analyses was also carried out.

Prostatic biopsies in selected men aged 75 years and older guide key clinical management decisions

PURPOSE

Increasing life expectancy and PSA testing has increased the number of men over the age of seventy-five presenting for investigation of potential prostate malignancies. Prostatic biopsies provide diagnostic information; however, they are invasive and may not alter management decisions. Therefore, this study aimed to investigate whether prostate biopsies in this age group were justified.

MATERIALS AND METHODS

All men aged 75 years and older who underwent prostatic biopsies between January 2010 and November 2011 at Bedford Hospital were identified and the indication for the biopsies, histopathological results and subsequent management plan investigated.

RESULTS

One hundred and thirty-eight (138) prostatic biopsies were undertaken and malignancies identified in 60/138 (43 %) cases. Prebiopsy PSA and examination findings had a poor positive predictive value of 54 %. Fifty-five out of sixty (92 %) cancers were classified as high or medium risk disease with 30/60 (50 %) patients commencing radiotherapy treatment with curative intent.

CONCLUSION

In selected patients aged 75 years or over, prostatic biopsies provide important diagnostic information which directly impacts on clinical decisions, supporting their use in this age group.

Systematic review of publications on economic evaluations of caries prevention programs

The aim of this study was to perform a systematic review of economic evaluations (EEs) of dental caries prevention programs to objectively retrieve, synthesize and describe available information on the field. Several strategies were combined to search for literature published between January 1975 and April 2012. MEDLINE, EconoLit and ISI formed the basis of the literature search. The study selection was done using predefined inclusion and exclusion criteria. Bibliographic listings of all retrieved articles were hand-searched. The search identified 206 references. An evaluative framework was developed based on the Centre for Reviews and Dissemination's 'Guidance for undertaking reviews in health care' (York University, 2009). Background information included publication vehicle, year of publication, geographic focus, type of preventive program and type of economic analysis. 63 studies were included in the review. The most common preventive strategies evaluated were dental sealants (n = 13), water fluoridation (n = 12) and mixed interventions (n = 12). By type of EE undertaken, 30 were cost-effectiveness analyses, 22 were cost-benefit analyses, and 5 presented both cost-effectiveness and cost-benefit analyses. Few studies were cost-utility analyses (n = 5) or cost minimization analyses (n = 2). By year of publication, most were published after 2003. The review revealed that, although the number of publications reporting EEs has increased significantly in recent years, the quality of the reporting needs to be improved. The main methodological problems identified in the review were the limited information provided on adjustments for discounting in addition to inadequate sensitivity analyses. Attention also needs to be given to the analysis and interpretation of the results of the EEs.

Corticosteroid Induced, HHV-8 Positive Kaposi's Sarcoma in a Non-HIV Elderly Patient

Kaposi’s sarcoma (KS) was first described in 1872 by Moritz Kaposi. In 1994, Chang et al. first identified DNA sequences corresponding to human herpesvirus-8 (HHV-8) in AIDS-associated Kaposi sarcoma biopsies. It is now believed that presence of HHV-8 is necessary but not sufficient to cause KS. Other factors like immunosuppressive therapy also play a role. We describe an HIV-negative elderly patient who developed KS of skin and mucous membrane after prolonged use of corticosteroids for knee pain. The patient was positive for HHV-8.

Formulation, and physical, in vitro and ex vivo evaluation of transdermal ibuprofen hydrogels containing turpentine oil as penetration enhancer

The aim of the present study was to investigate the transdermal permeation enhancing capability of turpentine oil for ibuprofen from hydrogels. Ibuprofen 1% w/v hydrogels were developed with carboxypolymethylene with and without turpentine oil. Turpentine oil was incorporated in increasing concentrations, i.e. 0.5, 1, 1.5, 2, 2.5 and 3% of the total gel formulation, and its permeation enhancing effect was examined. Gels were examined physically for pH, viscosity, spreadability, extrudability, smoothness and appearance. To study the in vitro and ex vivo permeation potential of formulated gels, permeation studies were performed with a Franz diffusion cell using cellulose membrane and excised rabbit abdominal skin. Ibuprofen hydrogel with 3% turpentine oil showed a maximum flux of 10.87 mg/cm2/h across artificial skin and 17.26 mg/cm2/h across rabbit abdominal skin.

Repair of cleft lip and simultaneous repair of cleft hard palate with vomer flap in unilateral complete cleft lip and palate: a comparative study

Repair of anterior palate after repairing the cleft lip in complete cleft lip and palate patient is sometimes very difficult. It needs wide, extensive and difficult dissection, and has later chances of wound infection, wound dehiscence, complete wound disruption, recurrent oronasal fistula formation and also maxillary hypoplasia. In this study, we compare the outcome of simultaneous repair of cleft lip and cleft hard palate with vomer flap against cleft lip repair alone in patients with unilateral complete cleft lip and palate (UCLP).

METHODS

A prospective study was carried out in 43 patients with UCLP. In Group A, 23 patients underwent cleft lip and cleft hard palate repair with vomer flaps simultaneously, and only cleft lip repair was done in another 20 patients in Group B at the first sitting. After 3 months in both groups, repair of the cleft soft palate and cleft entire palate was done. The gaps of the cleft alveolus and posterior border of the cleft hard palate were measured during the first and second operation, and duration of operations, postoperative complications and requirement of blood transfusion during the operation were also recorded.

RESULTS

The procedure of simultaneous repair of cleft lip and closure of cleft hard palate with a vomer flap is easy to perform. Cleft alveolar and gap of the posterior border of the cleft hard palate were reduced remarkably. No fistula formation occurred and no blood transfusion was needed, but the procedure took some extra operating time. These were compared with simple cleft lip repair.

CONCLUSION

Repairs of cleft lip and simultaneous closure of cleft hard palate with vomer flaps are safe in patients with UCLP, and it makes easy the closure of the soft palate later on and decreases the chance of oronasal fistula.

Sonographic biophysical profile in detection of foetal hypoxia in 100 cases of suspected high risk pregnancy

BACKGROUND

The foetus has become increasingly accessible and visible as a patient over the last two decades. Ultrasound imaging has broadened the scope of foetal assessment. Dynamic real time B-Mode ultrasound is used to monitor cluster of biophysical variables, both dynamic and static collectively termed as biophysical profile. The purpose of this study was to determine the effect of sonographic biophysical profile score on perinatal outcome in terms of mortality and morbidity.

METHODS

This descriptive study was carried on 100 randomly selected high risk pregnant patients in Radiology Department PGMI, Government Lady Reading Hospital, Peshawar from December 2007 to June 2008. Manning biophysical profile including non-stress was employed for foetal screening, using Toshiba ultrasound machine model Nemio SSA-550A and 7.5 MHZ probe.

RESULTS

Out of 100 cases 79 (79%) had a normal biophysical profile in the last scan of 10/10 and had a normal perinatal outcome with 5 minutes Apgar score > 7/10. In 13 (13%) cases Apgar score at 5 minute was < 7/10 and babies were shifted to nursery. There were 2 (2%) false positive cases that showed abnormal biophysical profile scores of 6/10 but babies were born with an Apgar score of 8/10 at 5 minutes. There were 2 (2%) neonatal deaths in this study group. The sensitivity of biophysical profile was 79.1%, specificity 92.9%. Predictive value for a positive test was 98.55%; predictive value for a negative test was 41.93%.

CONCLUSION

Biophysical profile is highly accurate and reliable test of diagnosing foetal hypoxia.

The impact of the disease early warning system in responding to natural disasters and conflict crises in Pakistan

The disease early warning system (DEWS) was introduced in the immediate aftermath of the 2005 earthquake in Pakistan, with the objective to undertake prompt investigation and mitigation of disease outbreaks. The DEWS network was replicated successfully during subsequent flood and earthquake disasters as well as during the 2008-09 internally displaced persons' crisis. DEWS-generated alerts, prompt investigations and timely responses had an effective contribution to the control of epidemics. Through DEWS, 1360 reported alerts during 2005-09 averted the risk of disease outbreaks through pre-emptive necessary measures, while the 187 confirmed outbreaks were effectively controlled. In the aftermath of the disasters, DEWS technology also facilitated the development of a disease-surveillance system that became an integral part of the district health system. This study aims to report the DEWS success and substantiate its lead role as a priority emergency health response intervention.

Trace element levels in alopecia areata

BACKGROUND

Alopecia areata (AA) is a recurrent, nonscarring type of hair loss considered to be an autoimmune process. Though its etiopathology is not fully understood, there are claims that imbalance of trace elements may trigger the onset of AA.

AIM

The aim of the present study was to assess the levels of zinc, copper, and magnesium in the serum of AA patients.

METHODS

Fifty AA patients (34 men and 16 women), and fifty age and sex matched healthy control subjects were studied. Samples were analyzed using atomic absorption spectrometric methods.

RESULTS

Serum zinc levels were significantly decreased (P < 0.05) in AA patients whose disease was extensive, prolonged, and resistant to treatment, whereas serum copper and magnesium levels showed insignificant rise compared to controls.

CONCLUSION

We conclude that copper and magnesium levels are not altered in AA, but the decreased zinc levels found in our study may merit further investigation of the relationship.

Synthesis of α-Mannosylated Phenolics as α-Glucosidase Inhibitors*

BF3OEt2-catalysed glycosidation of phenolic compounds 3 and 6 with the mannofuranosyl glycosyl donor 2 separately gave the corresponding alpha-mannofuranosyl derivatives 4 and 7 in good yield, and the latter on selective deacetonation (hydrolysis) with 2% aqueous HCl afforded 5 and 8 respectively. Compounds 4 and 7 inhibited rat intestinal alpha-glucosidase more effectively than a standard drug acarbose.

Inflammatory markers, insulin resistance and carotid intima-media thickness in North-Indian type 2 diabetic subjects

OBJECTIVE

To study the interrelationship of the inflammation, insulin resistance and atherosclerosis in recently diagnosed type 2 diabetes.

METHODOLOGY

Eighty-one newly diagnosed type 2 diabetic patients were compared with 81 healthy age, sex and BMI matched controls. Plasma glucose and insulin (fasting and after 2 hours of 75 gm of oral glucose), lipids and serum levels of C-reactive protein (CRP), fibrinogen and Tumour Necrosis Factor (TNF)-alpha were measured. Carotid (Intima-Medial Thickness) IMT was measured using high "resolution B-Mode ultrasonography. Insulin resistance was calculated using HOMA-IR model. Electrocardiogram (ECG) and exercise ECG were recorded for the evidence of coronary heart disease (CHD).

RESULTS

Carotid IMT was significantly thicker in diabetic patients than in control group across the whole age range (p < 0.01). In merged group of diabetes, composite IMT was significantly correlated with LDL-cholesterol, fasting insulin, serum cholesterol, BMI and HOMA-IR (p < 0.01). After controlling for age and sex, all glycaemic parameters were correlated with IMT in both diabetic and control group. HOMA-IR, waist hip ratio, serum triglycerides, serum cholesterol, fasting serum insulin and CRP were significant predictor of IMT. Concentrations of inflammatory markers were significantly higher in diabetic patients than in control group. Serum levels of CRP (p < 0.05) were found to be higher in diabetic patients with CHD than without CHD. CRP was significantly correlated with IMT (r = 0.603, p < 0.01) in diabetic subjects with and without CHD after controlling for age and sex.

CONCLUSION

Inflammatory markers are associated with type 2 diabetes but only CRP is associated with development of accelerated atherosclerosis and subsequent CHD.

The constipated child: how likely is Hirschsprung's disease?

The incidence of Hirschsprung's disease (HD) was determined in children who presented with constipation to a specialist paediatric surgical unit. During a 5-year period, 355 rectal biopsies were performed on 182 neonates, infants and children presenting with chronic constipation or intestinal obstruction: 25 (14%) were diagnosed HD. One hundred and four patients had suction and 78 had full-thickness rectal biopsies. Haematoxylin-eosin (HE) staining and acetylcholinesterase (AChE) histochemistry was used. In 13 cases (8%) of suction and 2 cases (2.5%) of full thickness rectal biopsies, specimens were inadequate to diagnose HD. The mean age of all patients was 2.9 years and that of patients diagnosed with HD was 3.64 months. Nineteen patients with HD were diagnosed in the first month, 5 in 1-12 months and 1 at 4 years of age (Fig. 1). The authors found that along with onset of constipation convincing indications for rectal biopsy to exclude HD were as follows: those infants and children who do not pass meconium within 48 hours, have low intestinal obstruction of unknown cause, severe constipation, chronic abdominal distension and failure to thrive. A diagnostic accuracy of 94% was achieved with AChE histochemistry for suction rectal biopsy. After this review, referring paediatricians were advised that screening of other common organic causes of constipation with the least invasive investigations, including laboratory, dietary and paediatric gastroenterology advice, should be undertaken to avoid unnecessary rectal biopsy to exclude HD and related disorders.

In hydronephrosis less than 10 % kidney function is not an indication for nephrectomy in children

PURPOSE

To reduce the incidence of nephrectomy or hydronephrosis in children.

MATERIALS AND METHODS

From September 1998 to October 2000, we treated 58 patients with hydronephrosis; their ages ranged from 35 days to 11 years (mean age 4 years 7 months). All patients were subjected to a DTPA renogram with split function. In 12 patients (study group), kidney function was less than 10 % (range 0 - 10 %). Initially, nephrostomy was carried out in all 12 patients followed by Anderson-Hyne's pyeloplasty after 4 - 6 weeks. Postoperatively renal USG, urine r/m/e & c/s (routine and microscopic examination and culture and sensitivity test), blood urea, serum creatinine were assessed and DMSA scan and DTPA renogram with split functions were carried out in all patients.

RESULTS

In the study group, all 12 patients showed improvement of renal function (more than 10 %) after nephrostomy and in all of them pyeloplasty was subsequently carried out within 4 - 6 weeks. There were no significant pre-, peri- or postoperative complications.

CONCLUSIONS

Contrary to common practice we do not recommend nephrectomy for hydronephrotic kidneys which show < 10 % of renal function on renogram. The renal functional status improves significantly after a preliminary nephrostomy, thus avoiding the need for a straightforward nephrectomy in children along with all the possible long-term effects of a single kidney.

Acidogenic fermentation: utilization of wasted sludge as a carbon source in the denitrification process

Laboratory scale batch experiments were conducted at 20 degrees C to investigate the acidogenic fermentation for the conversion of wasted sludge into short chain fatty acids (SCFA) to be utilized as a carbon source in the denitrification process. Hydraulic retention time (HRT), volatile solid (VS) loading rate and pH were studied as these are the important parameters governing the production of volatile fatty acids (VFA). Four different phases were investigated by varying these parameters. HRT was varied from 2.7 to 8.2 days whereas VS loading rate was varied from 1.2 to 3.6 g d(-1). VFA production decreased with the increase in HRT above 2.7 days. 538.37+/-19.39 mg VFA(produced) x d(-1) (0.176+/-0.010 mg VFA(produced) mg(-1) VS(feed) was found as the maximum value of VFA at 2.7 days. The present results based on wasted sludge showed that almost 0.0483+/-0.0016 mg VFA (as COD mg(-1) initial COD) and about 5% of soluble COD production were achieved, which are slightly less than the results reported for primary sludges. The rates of VFA production increased with the increase in VS, however, opposite results were obtained when pH was increased in the reactor. SCFA/FA ratios during fermentation were found in the range of 67-73%. The specific denitrification rates (SDNR) of methanol (2.20+/-0.44 mg NO3-N g(-1) MLVSS x h(-1)) and the fermenter supernatant (2.00+/-0.45 mg NO3-N g(-1) MLVSS x h(-1)) were found to be comparable. Fermenter supernatant, therefore, has the potential to be utilized as a carbon source. However, the results need to be investigated further on a larger scale to ascertain their validity.

Socioeconomic and cultural influence in the causation of burns in the urban children of Bangladesh

This prospective case-control study was conducted on 105 consecutive cases admitted to the burn units of Dhaka Shishu Hospital and Dhaka Medical College Hospital. The same number of controls were selected randomly from the community and matched with respect to age group, sex, and location of residence within the defined metropolitan area during the period January to September 1997. Both the controls and cases were divided into three age groups. Group A (19 controls and 19 cases) included neonates and infants, group B included children from 1 to 4 years, and group C included children from 4 to 12 years. The mean age of the controls in group A was 8.42+/-3.86 months and in group B and C was 5.72+/-4.05 years. The mean age of cases in group A was 4.79+/-4.05 months and in group B and C was 5.08+/-2.87 years. A scoring system was used to analyze 14 socioeconomic and cultural factors, which indicated highly significant differences between controls and cases (P < 0.001), and also between male (P < 0.001) and female (P < 0.001) controls and cases. There were significant differences between controls and cases in group A (P < 0.001), group B (P < 0.01), and group C (P < 0.001). Differences were not significant between males and females within groups A, B, and C for cases or controls (P > 0.05). Regression analysis of the total scores for cases and controls indicated a negative correlation between burns and the socioeconomic variables included in the study. There were highly significant associations between burns and lack of alertness to burns among parents (P < 0.001), clothing of manmade fabrics (P < 0.001), and cooking equipment in the kitchen within reach of children (P < 0.001). There was a significant association between burns and illiteracy of the mother (P < 0.01), housing located in slums and congested areas (P < 0.01), illiteracy of the father (P < 0.02), presence of preexisting impairment in children (P < 0.05), presence of a history of burns among siblings (P < 0.05), and low economic status of the parents (P < 0.05). No significant associations were indicated between controls and cases with respect to number of children in the family (P > 0.1), family pattern (P > 0.1), conjugal bonding between parents (P > 0.5), and sibling's death and disability from burns (P > 0.5). It is evident that an increase in alertness to burns, easy availability of clothing of natural fabrics, keeping cooking equipment beyond the reach of the children, increased literacy among parents and children, and improvement in family income might decrease the incidence of burns in children.

Clinicopathological patterns and distribution of Schistosomiasis in Asir Region

OBJECTIVE

The objective of this study is to report, for the first time, the histopathologic pattern of Schistosomiasis from the Asir Region and to compare it to patterns reported from other regions of the Kingdom of Saudi Arabia. Several studies have reported the patterns of Schistosomiasis in other regions of the Kingdom of Saudi Arabia and other countries where Schistosomiasis is endemic. Schistosomiasis is endemic in certain areas of Asir region, however no data is available concerning the clinicopathological pattern of Schistosomiasis in the Asir Region.

METHODS

This is a retrospective analysis of 217 cases of Schistosomiasis from surgical and biopsy files of Asir Central Hospital during a period from January 1990 to October 1999.

RESULTS

Our study revealed that Schistosomiasis was more common among the expatriate population of Asir Region than Saudi nationals residing in this area. The urinary tract was most commonly involved, and then in descending frequency came the vermiform appendix, liver and large bowel.

CONCLUSION

These findings are somewhat different from those observed in the Riyadh Region where the vermiform appendix was the most commonly affected organ. Based on the histopathologic pattern, our study describes the pattern of Schistosomiasis in the Asir Region and may serve as a base-line for future research work.

Syntheses and immunomodulatory activity of 3-O-[2'-hydroxy-3'-N,N-disubstituted aminopropan-1'-yl]-alpha-D-glucofuranoses

A number of 3-O-[2'-hydroxy-3'-N,N-aminopropan-1'-yl]-alpha-D-glucofuranoses were synthesised by regioselective oxirane ring opening in compound 2 with different secondary amines followed by selective deacetalisation. All the compounds were tested for their immunomodulatory potential in vitro; seven of them expressed significant immunostimulant activity.

Synthesis of 5-chloro-1-(2,3-dideoxy-3-fluoro-beta-D-glycero-hex-2- enopyranose-4-ulosyl)uracil as potential anticancer/antiviral agent

Peracetylated alpha-D-glucose was coupled with silylated 5-chlorouracil. The product (2) was deacetylated and 4',6'-hydroxyls were then protected with 4',6'-O-isopropylidene group. Fluorine was introduced at the 3'-position, followed by acetylation, deprotection, tritylation, oxidation and deritylation of subsequent compounds gave the target compound (10).

Copper, zinc and magnesium levels in fibrocalculous pancreatic diabetes

Alterations in trace elements and mineral homeostasis have been documented both in insulin-dependent diabetes mellitus and non-insulin dependent diabetes mellitus. No data are available about trace elements in fibrocalculous pancreatic diabetes, a unique form of secondary diabetes mellitus. This study evaluated the plasma concentrations of copper, zinc and magnesium in this form of diabetes. Twenty-five patients (9 men and 16 women) with fibrocalculous pancreatic diabetes and 25 healthy non-diabetic subjects (16 men and 9 women) were studied. Patients with overt nephropathy were excluded. Plasma copper, zinc, and magnesium levels were analyzed using a GBC 902 double beam absorption spectrophotometer. The effect of glycemic control, microalbuminuria, sex and modality of treatment received on the plasma levels of copper, zinc and magnesium was assessed. Results of the study revealed that plasma copper, zinc, and magnesium levels were comparable between patients with fibrocalculous pancreatic diabetes and control subjects. Plasma copper levels were significantly higher in patients with controlled diabetes (16.15 +/- 0.67 micromol L(-1)) as compared to those with uncontrolled diabetes (13.75 +/- 0.61 micromol L(-1)) and healthy controls (13.91 +/- 0.55 micromol L(-1)). This merits further investigation. Microalbuminuria, modality of treatment received and sex did not influence the levels of these elements in fibrocalculous pancreatic diabetes.

Prevalence and correlates of smoking on the roof of the world

OBJECTIVE

To determine the prevalence and correlates of cigarette smoking among adults in high mountain rural areas of northern Pakistan.

DESIGN

Cross sectional survey.

PARTICIPANTS

A sample of 4203 adults (aged 18 years and over) were selected by stratified random sampling from 16 villages.

MAIN OUTCOME MEASURE

Self reported smoking prevalence; age of smoking initiation; daily cigarette consumption and association between current smoking and sociodemographic variables, use of snuff, wine, body mass index, blood pressure, family history of stroke, and hypertension.

RESULTS

614/1406 men (43.7%) and 154/2797 (5.5%) women reported smoking cigarettes. The age standardised prevalence of smoking was 40.5% for men and 6.3% for women. Men were more likely (odds ratio (OR) 6.5, 95% confidence interval (CI) 4.75 to 8.79) to be smokers. Smokers were more likely to use snuff (OR 1.39, 95% CI 1.12 to 1.73), drink wine (OR 3.47, 95% CI 2.81 to 4.29), and were more likely to work as farmers (OR 1.55, 95% CI 1.05 to 2.29) or shopkeepers (OR 2.63, 95% CI 1.67 to 4.14). Individuals with college level education and with desirable body mass index were less likely to smoke (OR 0.55, 95% CI 0.35 to 0.87; OR 0.74, 95% CI 0.57 to 0.96).

CONCLUSION

Cigarette smoking is a major public health problem in this high mountain community of Pakistan, particularly among the male population, the majority of whom begin to smoke quite early in life. A comprehensive tobacco control effort incorporated into the existing community based health infrastructure is needed.

The pathogenicity of Bacillus thuringiensis ssp. kurstaki to gamma-irradiated Cadra cautella (Walker) (Lepidoptera: Phycitidae)

The present investigation deals with the effects of Bacillus thuringiensis ssp. kurstaki on various biological parameters of gamma-irradiated Cadra cautella. The pathogen, irradiation, and their combinations significantly affected the insects by increasing their mortality and developmental periods, reducing the pupal and adult survival (%), and the adult longevity and reproductive potential were also significantly reduced. It was observed that irradiation-pathogen combinations produced additive to synergistic effects on C. cautella.

Pathology of the appendix

An audit of 3374 appendectomy specimens in 2578 Saudi and 796 non-Saudi nationals revealed a diagnosis rate of 74.7% of inflamed appendix, a normal appendix range of 7.8% to 22.5% with the higher rate of normal appendix found among females. The finding of high incidence of schistosomal appendicitis among Egyptian males is not surprising given the high incidence of schistosomiasis among Egyptians in general. The alternate diagnoses, which include such conditions as neoplasm, mucocele, other inflammatory conditions such as periappendicitis, and parasitic infestations, are not different from findings in the reported literature.

The changing pattern of malignant neoplasms among females in Asir region of Saudi Arabia

OBJECTIVE

The study was undertaken to compare the frequencies of the various types of malignant neoplasms affecting females in the Asir Region of Saudi Arabia during the years 1996-1998, to the experience of a previous report (1987 to 1989) in the same population with rapid advancing health care services.

METHODS

A retrospective descriptive approach was adopted. Histopathological records of Asir Central Hospital were reviewed to extract data on female malignant neoplasms seen in the years January 1996-December 1998. The cancer from various sites were ranked based on their percentage (crude relative) frequencies, and compared with the previous report (1987-1989).

RESULTS

Of the 274 cases of histologically confirmed female malignant diseases, the breast (22%), skin (9%) and thyroid (7%) were the leading sites. This ranking contrasts with the previous finding (1987-1989) which involved the skin, breast and non-Hodgkin's lymphoma, in descending order of frequencies. The frequency of gynecological malignancies was relatively higher than in the previous report.

CONCLUSION

There may be a need to review the pattern of malignancies in the female population in this region from time to time in order to concurrently update planning on preventive and treatment measures.