A novel homozygous TSGA10 missense variant causes acephalic spermatozoa syndrome in a Pakistani family

BACKGROUND

Acephalic spermatozoa syndrome is a rare type of teratozoospermia causing male infertility due to detachment of the sperm head and flagellum, which precludes fertilization potential. Although loss-of-function variations in several genes, including TSGA10, have been associated with acephalic spermatozoa syndrome, the genetic cause of many cases remains unclear.

RESULTS

We recruited a Pakistani family with two infertile brothers who suffered from acephalic spermatozoa syndrome. Through whole-exome sequencing (WES) followed by Sanger sequencing, we identified a novel missense variant in TSGA10 (c.1112T > C, p. Leu371Pro), which recessively co-segregated with the acephalic spermatozoa syndrome within this family. Ultrastructural analyses of spermatozoa from the patient revealed that 98% of flagellar cross-sections displayed abnormal axonemal ultrastructure, in addition to the head-flagellum detachment. Real-time quantitative PCR analysis revealed almost no detectable TSAG10 mRNA and western blot analysis also failed to detect TSAG10 protein in patient's sperm samples while TSGA10 expression was clearly detected in control samples. Consistently, immunofluorescence analysis demonstrated the presence of TSGA10 signal in the midpiece of sperm from the control but a complete absence of TSGA10 signal in sperm from the patient.

CONCLUSION

Altogether, our study identifies a novel TSGA10 pathogenic variant as a cause of acephalic spermatozoa syndrome in this family and provides information regarding the clinical manifestations associated with TSGA10 variants in human.

Plasma GDNF levels in spinal dysraphism and its relation with neurological impairment in children: A point of care study

AIMS

GDNF plays a crucial role in the stimulation of recovery, neuroplasticity and synaptic reorganization after spinal cord injury providing neuroprotection and neuroregeneration. Plasma GDNF levels are upregulated in cases of spina bifida owing to the intrauterine damage of the exposed spinal cord. Our aim was to compare the plasma GDNF levels in patients of spina bifida with non-spina bifida cases and assess the correlation with neurological impairment at one year of follow up.

METHODS

Single centre prospective analysis of cases of spina bifida from 2020 to 2022 at presentation and after one year of follow up post-surgery. Cases with hernia and hydrocele without any other disorders were recruited into the control group. Plasma GDNF levels were assessed with immunoassay kits and compared with neurological involvement.

RESULTS

85 cases were included in the study. GDNF levels were elevated in cases compared to controls (mean 6.62 vs 1.76) with significant p value (<0.01). Same was observed for open and closed defects (mean 7.63 vs 4.86: p < 0.01). At follow up of 52 cases post-surgery cases with neurogenic bladder with abnormal urodynamic studies, sphincter involvement and motor impairment had significantly elevated baseline levels of GDNF compared with those who did not have this neurological impairment (p < 0.01).

DISCUSSION

The neurotrophic factor up-regulation can reflect an endogenous attempt at neuroprotection against the biochemical and molecular cascades triggered by the spinal cord damage. This upregulation can be represented as important biochemical markers of severe spinal cord damage and can be associated with severity of spine injury in MMC patients. Our results are in keeping with these findings, that, there were increased levels of plasma GDNF levels in cases of spinal dysraphism compared to control population. Also, the type of lesion reflecting the severity whether a closed or an open dysraphism, showed significant difference in levels between them suggesting, yet again, more damage in open defect as expected. The levels were higher with involvement of bladder, sphincter and lower limb power.

CONCLUSION

There is significant elevation of plasma GDNF levels in cases of spina bifida and this elevation is proportional to the degree of spinal damage and hence the neurological impairment. GDNF levels are a good predictor for assessing the severity of the lesion and thus the outcome in these cases. Additional prospective and long-term studies with a larger cohort are needed for a better understanding of neurotrophin pattern modulation in MMC.

Role of non-contrast CT component of prostate-specific membrane antigen PET/CT scan in the detection of peripheral zone prostate cancer

OBJECTIVE

The aim of this study was to look for feasibility of non-contrast CT (NCCT) in detecting peripheral zone prostate cancer (PCa).

METHODS

A retrospective analysis included 50 biopsy-proven PCa patients between April 2019 and March 2022 who underwent staging whole body prostate-specific membrane antigen (PSMA)/CT prior to treatment. The control subjects were 50 randomly selected adult male patients who underwent PET/CT for non-prostate malignancy during the same time period. Two readers independently calculated the Hounsfield unit (HU) of normal peripheral zone, central zone, and corresponding PSMA avid focus in cases.

RESULTS

No significant difference was seen in the mean HU value of normal peripheral zone between cases and controls. Significant difference in the mean HU was seen between the PSMA avid focus in cases (40.1 ± 6.2) and normal peripheral zone of cases (28.2 ± 7.0) and controls (27.7 ± 5.8). No significant difference was found between the mean HU values of high-grade PCa and non-high-grade PCa. Receiver operating characteristic (ROC) curve analysis revealed a mean HU cut-off of ≥35 for detecting PCa with a sensitivity and specificity of 86% and 90%, respectively, between cases and controls (AUC 0.88).

CONCLUSION

Detection of clinically significant PCa is possible on routinely performed NCCT scans. Radiologists should routinely look for and convey these findings to facilitate further work-up and early detection of PCa.

ADVANCES IN KNOWLEDGE

Our study adds to the knowledge that NCCT scans performed for unrelated indications can serve as a screening tool for clinically significant PCa.

Ammonia gas treatment in low cost biological reactor

Ammonia gas contributes to a number of environmental and human health concerns. The use of chalk, a cheap alkalinity source may reduce costs for biological systems. This research studies a closed liquid flow reactor to treat ammonia gas using chalk as biomass media and alkalinity source with high value calcium nitrate fertilizer production. The proposed reactor showed complete ammonia gas removal at high rate (500 mg N/L/day) and with low cost; where chalk dissolution and ammonia gas absorption contributed to alkalinity in the water for nitrification. High calcium ion concentration (up to 10,000 mg Ca2+ as CaCO3/L) showed only minor effects on ammonia absorption and nitrification rate.

Identification of Four Novel Candidate Genes for Non-syndromic Intellectual Disability in Pakistani Families

Intellectual disability, a genetically and clinically varied disorder and is a significant health problem, particularly in less developed countries due to larger family size and high ratio of consanguineous marriages. In the current genetic study, we investigate and find the novel disease causative factors in the four Pakistani families with severe type of non-syndromic intellectual disability. For genetic analysis whole-exome sequencing (WES) and Sanger sequencing was performed. I-TASSER and Cluspro tools were used for Protein modeling and Protein-protein docking. Sanger sequencing confirms the segregation of novel homozygous variants in all the families i.e., c.245 T > C; p.Leu82Pro in SLC50A1 gene in family 1, missense variant c.1037G > A; p.Arg346His in TARS2 gene in family 2, in family 3 and 4, nonsense mutation c.234G > A; p.Trp78Term and missense mutation c.2200G > A; p.Asp734Asn in TBC1D3 and ANAPC2 gene, respectively. In silico functional studies have found the drastic effect of these mutations on protein structure and its interaction properties. Substituted amino acids were highly conserved and present on highly conserved region throughout the species. The discovery of pathogenic variants in SLC50A1, TARS2, TBC1D1 and ANAPC2 shows that the specific pathways connected with these genes may be important in cognitive impairment. The decisive role of pathogenic variants in these genes cannot be determined with certainty due to lack of functional data. However, exome sequencing and segregation analysis of all filtered variants revealed that the currently reported variants were the only variations from the respective families that segregated with the phenotype in the family.

Analysis of a non-lethal biallelic frameshift mutation in ZMPSTE24 reveals utilization of alternative translation initiation codons

Restrictive dermopathy (RD) is a lethal condition caused by biallelic loss-of-function mutations in ZMPSTE24, whereas mutations preserving residual enzymatic activity of the ZMPSTE24 protein lead to the milder mandibuloacral dysplasia with type B lipodystrophy (MADB) phenotype. Remarkably, we identified a homozygous, presumably loss-of-function mutation in ZMPSTE24 [c.28_29insA, p.(Leu10Tyrfs*37)] in two consanguineous Pakistani families segregating MADB. To clarify how lethal consequences are prevented in affected individuals, functional analysis was performed. Expression experiments supported utilization of two alternative translation initiation sites, preventing complete loss of protein function consistent with the relatively mild phenotypic outcome in affected patients. One of these alternative start codons is newly formed at the insertion site. Our findings indicate that the creation of new potential start codons through N-terminal mutations in other disease-associated genes should generally be taken into consideration in the variant interpretation process.

Evaluation of Dual Dye Technique for Sentinel Lymph Node Biopsy in Breast Cancer: Two-Arm Open-Label Parallel Design Non-Inferiority Randomized Controlled Trial

INTRODUCTION

Radioisotope and blue dye are standard agents for performing sentinel lymph node (SLN) biopsy in breast cancer. The paucity of nuclear medicine facility poses logistic challenge. This study evaluated performance of radioisotope & methylene blue (MB) with indocyanine green (ICG) and MB for SLNB.

PATIENTS AND METHODS

This randomized controlled trial was conducted from December 2019 to July 2022 comparing SLN identification proportions of radioisotope-blue dye [Group A] with dual dye (MB + ICG; Group B]. Secondary objective included time required and cost effectiveness of performing SLNB. Sample size of 70 (35 in each arm) was calculated. Upfront operable node negative early breast cancer was included in the study. Clinico-demographic data, number & type of SLN, time taken were noted. Cost analysis was done including the equipment, manpower & consumables. Chi-square/Fisher exact test was used to compare proportion between two groups. p value of less than 0.05 was considered to represent statistical significance.

RESULTS

Seventy patients randomized to either group were similar in clinico-demographic and tumor characteristics. SLN identification rate (IR) was 91.43% in group A and 100% in group B. Overall IR of MB, radioisotope and ICG were 91.43%, 91.43% and 100%, respectively. Mean number of SLNs identified were 3 in group A and 4 in group B. Median time required for SLNB was 12 min and 14 min in either group, respectively. Cost of performing SLNB was higher in Group B.

CONCLUSION

SLNB using dual dye is non-inferior to radioisotope-blue dye in upfront operable early breast cancer. Trial registration number Clinical Trial registry India CTRI/2020/02/023503.

Genetic basis of ß-thalassemia in families of pashtun ethnicity in Dera Ismail Khan district of Khyber Pakhtun-Khwa province, Pakistan

OBJECTIVES

The objective of current genetic research was to verify the genetic basis of ß-thalassemia and its pattern of inheritance in families of Pashtun ethnicity in District Dera Ismail Khan, Pakistan.

METHODOLOGY

Blood samples from clinically diagnosed five unrelated ß-thalassemia families were collected and target Sanger Sequencing of HBB gene was done. Moreover, in silico analysis including protein modeling and Protein-Protein docking was aslo performed.

RESULTS AND DISCUSSION

Clinical analysis of patients from family 1,2, 4, and 5 revealed Thalassemia Intermedia, while patient from family 3 was suffering from thalassemia major. The average Hb concentrations between the cases that were severe were found to be a little lower (6.3 mg/dl) than the patients with milder clinical manifestations (7.6 ± 1.4). Genetic analysis in family 1 identified compound heterozygous mutation of HBB (NM_000518) i.e. c.20A>T +c.92 G>A, in family 2 and 4 compound heterozygous mutations c.20A>T + c.27_28insG, in family 3 homozygous mutation c.27_28insG, while in family 5 we identified homozygous mutation c.92 + 5 G>C (IVS-1 + 5 G>C).

CONCLUSION

This study offers an effective incentive to establish a mutation detection as well as prenatal diagnosis (PND) centers at a larger scale in the Pashtun ethnicity residing in District Dera Ismail Khan, Pakistan.

Autosomal recessive variants c.953A>C and c.97-1G>C in NSUN2 causing intellectual disability: a molecular dynamics simulation study of loss-of-function mechanisms

Introduction

Intellectual disability (ID) is a clinically and genetically heterogeneous disorder. It drastically affects the learning capabilities of patients and eventually reduces their IQ level below 70.

Methods

The current genetic study ascertained two consanguineous Pakistani families suffering from autosomal recessive intellectual developmental disorder-5 (MRT5). We have used exome sequencing followed by Sanger sequencing to identify the disease-causing variants.

Results and discussion

Genetic analysis using whole exome sequencing in these families identified two novel mutations in the NSUN2 (NM_017755.5). Family-A segregated a novel missense variant c.953A>C; p.Tyr318Ser in exon-9 of the NSUN2. The variant substituted an amino acid Tyr318, highly conserved among different animal species and located in the functional domain of NSUN2 known as "SAM-dependent methyltransferase RsmB/NOP2-type". Whereas in family B, we identified a novel splice site variant c.97-1G>C that affects the splice acceptor site of NSUN2. The identified splice variant (c.97-1G>C) was predicted to result in the skipping of exon-2, which would lead to a frameshift followed by a premature stop codon (p. His86Profs^*16). Furthermore, it could result in the termination of translation and synthesis of dysfunctional protein, most likely leading to nonsense-mediated decay. The dynamic consequences of NSUN2 missense variant was further explored together with wildtype through molecular dynamic simulations, which uncovered the disruption of NSUN2 function due to a gain in structural flexibility. The present molecular genetic study further extends the mutational spectrum of NSUN2 to be involved in ID and its genetic heterogeneity in the Pakistani population.

Identification of GLI1 and KIAA0825 Variants in Two Families with Postaxial Polydactyly

Polydactyly is a rare autosomal dominant or recessive appendicular patterning defect of the hands and feet, phenotypically characterized by the duplication of digits. Postaxial polydactyly (PAP) is the most common form and includes two main types: PAP type A (PAPA) and PAP type B (PAPB). Type A involves a well-established extra digit articulated with the fifth or sixth metacarpal, while type B presents a rudimentary or poorly developed superfluous digit. Pathogenic variants in several genes have been identified in isolated and syndromic forms of polydactyly. The current study presents two Pakistani families with autosomal recessive PAPA with intra- and inter-familial phenotype variability. Whole-exome sequencing and Sanger analysis revealed a novel missense variant in KIAA0825 (c.3572C>T: p.Pro1191Leu) in family A and a known nonsense variant in GLI1 (c.337C>T: p.Arg113*) in family B. In silico studies of mutant KIAA0825 and GLI1 proteins revealed considerable structural and interactional modifications that suggest an abnormal function of the proteins leading to the disease phenotype. The present study broadens the mutational spectrum of KIAA0825 and demonstrates the second case of a previously identified GLI1 variant with variable phenotypes. These findings facilitate genetic counseling in Pakistani families with a polydactyly-related phenotype.

Development and Evaluation of Essential Oil-Based Nanoemulgel Formulation for the Treatment of Oral Bacterial Infections

Prevalence of oral infections in diabetic patients is a health challenge due to persistent hyperglycemia. However, despite great concerns, limited treatment options are available. We therefore aimed to develop nanoemulsion gel (NEG) for oral bacterial infections based on essential oils. Clove and cinnamon essential oils based nanoemulgel were prepared and characterized. Various physicochemical parameters of optimized formulation including viscosity (65311 mPa·S), spreadability (36 g·cm/s), and mucoadhesive strength 42.87 N/cm²) were within prescribed limits. The drug contents of the NEG were 94.38 ± 1.12% (cinnamaldehyde) and 92.96 ± 2.08% (clove oil). A significant concentration of clove (73.9%) and cinnamon essential oil (71.2 %) was released from a polymer matrix of the NEG till 24 h. The ex vivo goat buccal mucosa permeation profile revealed a significant (52.7-54.2%) permeation of major constituents which occurred after 24 h. When subjected to antimicrobial testing, significant inhibition was observed for several clinical strains, namely Staphylococcus aureus (19 mm), Staphylococcus epidermidis (19 mm), and Pseudomonas aeruginosa (4 mm), as well as against Bacillus chungangensis (2 mm), whereas no inhibition was detected for Bacillus paramycoides and Paenibacillus dendritiformis when NEG was utilized. Likewise promising antifungal (Candida albicans) and antiquorum sensing activities were observed. It was therefore concluded that cinnamon and clove oil-based NEG formulation presented significant antibacterial-, antifungal, and antiquorum sensing activities.

A GHRHR founder mutation causes isolated growth hormone deficiency type IV in a consanguineous Pakistani family

Background

Isolated growth hormone deficiency (IGHD) is caused by a severe shortage or absence of growth hormone (GH), which results in aberrant growth and development. Patients with IGHD type IV (IGHD4) have a short stature, reduced serum GH levels, and delayed bone age.

Objectives

To identify the causative mutation of IGHD in a consanguineous family comprising four affected patients with IGHD4 (MIM#618157) and explore its functional impact in silico.

Methods

Clinical and radiological studies were performed to determine the phenotypic spectrum and hormonal profile of the disease, while whole-exome sequencing (WES) and Sanger sequencing were performed to identify the disease-causing mutation. In-silico studies involved protein structural modeling and docking, and molecular dynamic simulation analyses using computational tools. Finally, data from the Qatar Genome Program (QGP) were screened for the presence of the founder variant in the Qatari population.

Results

All affected individuals presented with a short stature without gross skeletal anomalies and significantly reduced serum GH levels. Genetic mapping revealed a homozygous nonsense mutation [NM_000823:c.G214T:p.(Glu72*)] in the third exon of the growth-hormone-releasing hormone receptor gene GHRHR (MIM#139191) that was segregated in all patients. The substituted amber codon (UAG) seems to truncate the protein by deleting the C-terminus GPCR domain, thus markedly disturbing the GHRHR receptor and its interaction with the growth hormone-releasing hormone.

Conclusion

These data support that a p.Glu72* founder mutation in GHRHR perturbs growth hormone signaling and causes IGHD type IV. In-silico and biochemical analyses support the pathogenic effect of this nonsense mutation, while our comprehensive phenotype and hormonal profiling has established the genotype-phenotype correlation. Based on the current study, early detection of GHRHR may help in better therapeutic intervention.

Urinary tract infection caused by Lactococcus garvieae in a premature neonate: A case report

Lactococcus garvieae is a gram-positive cocci that has primarily been described as a pathogen in various fish species, but has increasingly been reported to cause endocarditis and other infections in humans [1]. Neonatal infection caused by Lactococcus garvieae has not been previously reported. Here we describe a premature neonate who developed a urinary tract infection with this organism and was successfully treated with vancomycin therapy.

Microplastics assessment in Arabian Sea fishes: accumulation, characterization, and method development

Around the globe, plastic has been entering the aquatic system and is ingested by organisms. Identification, optimal digestion method, and characterization of the polymers to trace sources are of growing importance. Hence, the present work investigated microplastics accumulation, digestion protocol efficiency, and characterization of polymers with FTIR analysis in the guts of five fishes (Lethrinus nebulosus, Rastrelliger kanagurta, Acanthopagrus arabicus, Otolithes ruber, and Euryglossa orientalis) from the Karachi coastal area, Arabian Sea. A total of 1154 microplastics (MPs) were ingested by 29 out of 33 fish species (87%). The highest average MP/fish was recorded in Otolithes ruber (54) and the lowest in Rastrelliger kanagurta (19.42). Microfibers were the most abundant shape with the highest numbers (35.52%) as compared to the rest of the MPs identified. Transparent microfibers were recorded as the highest in numbers followed by red, black, blue, and green. In this study, KOH with different concentrations and exposure times along with oxidizing agent hydrogen peroxide was tested (Protocols 3 and 4). Results showed these bases were highly efficient in obtaining optimal digestion of the samples. FTIR analysis confirmed that the majority of the polymers found in the fish guts were polyethylene and polypropylene. This study validated for the first time the presence of these polymers of plastic in marine fish from Pakistan.

Loss-of-function mutations in CFAP57 cause multiple morphological abnormalities of the flagella in humans and mice

Multiple morphological abnormalities of the sperm flagella (MMAF) are the most severe form of asthenozoospermia due to impaired axoneme structure in sperm flagella. Dynein arms are necessary components of the sperm flagellar axoneme. In this study, we recruited 3 unrelated consanguineous Pakistani families with multiple MMAF-affected individuals, who had no overt ciliary symptoms. Whole-exome sequencing and Sanger sequencing identified 2 cilia and flagella associated protein 57 (CFAP57) loss-of-function mutations (c.2872C>T, p. R958*; and c.2737C>T, p. R913*) recessively segregating with male infertility. A mouse model mimicking the mutation (c.2872C>T) was generated and recapitulated the typical MMAF phenotype of CFAP57-mutated individuals. Both CFAP57 mutations caused loss of the long transcript-encoded CFAP57 protein in spermatozoa from MMAF-affected individuals or from the Cfap57-mutant mouse model while the short transcript was not affected. Subsequent examinations of the spermatozoa from Cfap57-mutant mice revealed that CFAP57 deficiency disrupted the inner dynein arm (IDA) assembly in sperm flagella and that single-headed IDAs were more likely to be affected. Thus, our study identified 2 pathogenic mutations in CFAP57 in MMAF-affected individuals and reported a conserved and pivotal role for the long transcript-encoded CFAP57 in IDAs' assembly and male fertility.

A commercial monovalent canine parvovirus vaccine performs better than a commercial combination vaccine in puppies

Thirty puppies were randomly divided in to 3 groups for comparative evaluation of two commercial CPV vaccines. Each group was further subdivided in to < 6 months and < 3 months -old puppies and either vaccinated with a monovalent vaccine: Primodog, a combination vaccine: Duramune or maintained as a non-vaccinated control. Humoral immune response was determined by Hemagglutination Inhibition (HAI) on 21 and 35 -days after vaccination. The geometric mean titer (GMT) induced by Duramune, 21 and 35 -days post-vaccination was GMT 73.3 and 137.2, respectively. Comparatively, Primodog demonstrated higher GMT on 21 and 35 -days after vaccination: 97.0 and 168.9, respectively. The older puppies (< 6 months old) demonstrated higher seroconversion to both vaccines.

HLA B27 in Ankylosing Spondylitis: Differences in Frequency and Relative Risk in American Blacks and Caucasians

Twenty-eight HLA alleles of the A and B loci were determined in 23 American Blacks and 50 Caucasians with primary ankylosing spondylitis (AS). The prevalence of HLA B27 was significantly increased in American Black patients (48 per cent) vs Black controls (two per cent), but was much less than the 94 per cent found in Caucasian patients (controls eight per cent). The lower prevalence of B27 in American Black patients vs Caucasian patients was significant (p < 0.001), and indicated that susceptibility to AS is not as closely associated with B27 in Blacks as in Caucasians. No other HLA antigen was significantly associated with AS in either racial group. Among B27 positive individuals, the relative risk of developing AS was significantly lower in American Blacks than in Caucasians. These data indicate that for diagnostic purposes, the absence of B27 is less important in ruling out AS in Blacks than in Caucasians.

[Medical rehabilitation of children with obstructive uropathy]

Obstructive uropathy in children is predominantly urinary system malformation and one of the leading causes of chronic renal failure. Antenatal ultrasound can detect obstructive uropathy in infants. It is important to conduct diagnostics not only to identify the obstruction level in urinary system, but to assess renal function, renal blood flow and urination. Children are given conservative and surgical treatment methods to restore urodynamics, prevent infectious complications, improve renal blood flow. Currently, there are no principles, approaches and technologies for medical rehabilitation of patients with obstructive uropathy, therefore, the use of selective chromotherapy, which has an activating effect on regional circulation, and sound stimulation improving muscles tone of pelvis and ureters, is pathogenetically reasonable and promising.

OBJECTIVE

To develop technologies of physiotherapy application (sound stimulation, selective chromotherapy) for inclusion in comprehensive medical rehabilitation of children with megaloureter.

MATERIAL AND METHODS

Clinical observations and special examinations have been performed in 90 children with megaloureter aged from 1 to 10 years. The patients were divided into 2 groups: 30 children (study group) received sound stimulation combined with selective chromotherapy; 30 children (the 1st comparison group) - sound stimulation; 30 children (the 2nd comparison group) - selective chromotherapy (blue spectrum). General clinical methods, ultrasound of kidneys and bladder with Doppler monitoring of intrarenal blood flow, functional methods of bladder examination were used.

RESULTS

The positive effects of separate and combined application of sound stimulation and selective chromotherapy on clinical and laboratory indicators, urodynamics of urinary tract and renal blood flow in children with megaloureter after surgery have been revealed. The efficacy of selective chromotherapy use in children with megaloureter and comorbid neurologic bladder dysfunction has been proven.

CONCLUSION

Modern technologies for the application of physiotherapy, namely selective chromotherapy and sound stimulation, to include them in the comprehensive medical rehabilitation of children with megaloureter, have been developed for the first time and their high efficacy has been proven.

[The high-intensity pulsed magnetic therapy in the medical rehabilitation of children. (Literature review)]

In recent decades, a promising area of physiotherapy has been intensively developed In Russia and abroad - magnetic therapy, based on the use of various types of magnetic fields for preventive, curative and rehabilitative purposes. The use of high-intensity pulsed magnetotherapy is promising. The effectiveness of the method in a number of diseases of childhood, which has an active stimulating effect on the state of the neuromuscular apparatus, has been proven.

Successful Pregnancy with SLE-associated Antiphospholipid Syndrome: A Case Report

Pregnancy in women with systemic lupus erythematosus (SLE) is associated with an increased risk of adverse maternal and fetal outcomes. Risk is significantly increased when SLE pregnancy is complicated by anti-phospholipid syndrome (APS). Here, we present a case of a 21 year-old multi-gravid lady with SLE- associated APS who was diagnosed as such when she presented with multisystem flare at her 16 weeks of gestation. At presentation she had fever, multiple joint pain in both upper and lower limbs, loss of hair, history of recurrent oral ulcer, skin rash over hand and feet. Physical examination and laboratory evaluation were consistent with an active SLE flare. A diagnosis of antiphospholipid syndrome (APS) was made based on her clinical presentation and laboratory findings. The reported patient had APS secondary to SLE. She had all the risk factors that would confer a remarkably high risk of pregnancy morbidity: positive anti-SSA(RO) antibody and lupus anticoagulant, history of one neonatal death due to congenital heart block and two consecutive first trimester pregnancy loss. Multidisciplinary management approach with appropriate intervention and close monitoring can bring a successful outcome.

Evaluation of HE4 as a prognostic biomarker in uterine cervical cancer. Cancer Treat Res Commun 2023;34:100672. [PMID: 36525756 DOI: 10.1016/j.ctarc.2022.100672]

INTRODUCTION

Uterine cervical cancer (UCC) is the fourth most common health problem worldwide among women. Currently available biomarkers CA125, CA199, and CEA for diagnosis or prognostic evaluation of UCC have not got widespread acceptance.

METHOD

Whole blood samples of 64 patients with UCC were collected along with 63 healthy females and tested for serum levels of HE4 (sHE4). A cut-off value for positive result 64.0 pmol/L was set. Statistical analysis of different clinical variables was done.

RESULT

Serum level of HE4 has a significant role in the diagnosis of uterine cervical cancer. Its level increases with age, higher parity (P < 0.05), stage (P < 0.16), tumor size, and parametrial invasion. Negative result was seen with vaginal invasion, lymph node involvement & cases which had recurrence. Various histological types showed variable results. So the serum level of HE4 (sHE) level may play a role in the diagnosis & therapeutic monitoring of UCC. But the prognostic evaluation needs further studies.

CONCLUSION

sHE4 is useful in the diagnosis of cervical cancer, but its prognostic significance is under the question marks. It may be associated with higher values in higher stages. Higher parity of the patient is associated with higher level of HE4 in UCC.

Mutation screening of multiple Pakistani MCPH families revealed novel and recurrent protein-truncating mutations of ASPM

Autosomal primary microcephaly (MCPH) is a heterogenetic disorder that affects brain's cerebral cortex size and leads to a reduction in the cranial vault. Along with the hallmark feature of reduced head circumference, microcephalic patients also exhibit a variable degree of intellectual disability as well. Genetic studies have reported 28 MCPH genes, most of which produce microtubule-associated proteins and are involved in cell division. Herein this study, 14 patients from seven Pashtun origin Pakistani families of primary microcephaly were analyzed. Mutation analysis was performed through targeted Sanger DNA sequencing on the basis of phenotype-linked genetic makeup. Genetic analysis in one family found a novel pathogenic DNA change in the abnormal spindle microtubule assembly (ASPM) gene (NM_018136.4:c.3871dupGA), while the rest of the families revealed recurrent nonsense mutation c.3978G>A (p.Trp1326*) in the same gene. The novel reported frameshift insertion presumably truncates the protein p.(Lys1291Glyfs*14) and deletes the N-terminus domains. Identification of novel ASPM-truncating mutation expands the mutational spectrum of the ASPM gene, while mapping of recurrent mutation c.3978G>A (p.Trp1326*) will aid in establishing its founder effect in the Khyber Pakhtunkhwa (KPK) inhabitant population of Pakistan and should be suggestively screened for premarital counseling of MCPH susceptible families. Most of the recruited families are related to first-degree consanguinity. Hence, all the family elders were counseled to avoid intrafamilial marriages.

Molecular epidemiology and phylogenetic analysis of Tams I gene of Theileria annulata in Khyber Pakhtunkhwa, Pakistan

Theileriosis is a hemoparasitic disease that affects a wide range of different animal species and is caused by various species of Theileria. This study aimed to determine the molecular epidemiology of Theileria annulata through microscopy and PCR, in crossbred cattle in some districts of Khyber Pakhtunkhwa, Pakistan. For this study, a total of 384 blood samples were collected from cattle in the Peshawar (n=120), Charsadda (n=94), Nowshera (n=84), and Swabi (n=86) districts. Microscopy and PCR were used to determine the overall prevalence of theileriosis, which was found to be 15.8 and 22.6%, respectively. Theileria annulata was detected in blood samples through PCR in the study area, and the target gene i.e., Tams 1, of positive samples was sequenced. The sequences in the current study revealed high sequence homology (ranging from 96 to 100%) with Tams 1 sequences of neighboring countries present in the NCBI database. Season, breed, age, and sex were found to be important risk factors among the several risk factors examined, whereas, among different clinical manifestations, lymphadenopathy showed a strong association with theileriosis. According to Cohen's kappa and ROC analysis, microscopy was proven to be a fair diagnostic test for detecting theileriosis in cattle, and may be used in combination with molecular techniques for screening a large number of animals.

A secure healthcare 5.0 system based on blockchain technology entangled with federated learning technique

In recent years, the global Internet of Medical Things (IoMT) industry has evolved at a tremendous speed. Security and privacy are key concerns on the IoMT, owing to the huge scale and deployment of IoMT networks. Machine learning (ML) and blockchain (BC) technologies have significantly enhanced the capabilities and facilities of healthcare 5.0, spawning a new area known as "Smart Healthcare." By identifying concerns early, a smart healthcare system can help avoid long-term damage. This will enhance the quality of life for patients while reducing their stress and healthcare costs. The IoMT enables a range of functionalities in the field of information technology, one of which is smart and interactive health care. However, combining medical data into a single storage location to train a powerful machine learning model raises concerns about privacy, ownership, and compliance with greater concentration. Federated learning (FL) overcomes the preceding difficulties by utilizing a centralized aggregate server to disseminate a global learning model. Simultaneously, the local participant keeps control of patient information, assuring data confidentiality and security. This article conducts a comprehensive analysis of the findings on blockchain technology entangled with federated learning in healthcare. 5.0. The purpose of this study is to construct a secure health monitoring system in healthcare 5.0 by utilizing a blockchain technology and Intrusion Detection System (IDS) to detect any malicious activity in a healthcare network and enables physicians to monitor patients through medical sensors and take necessary measures periodically by predicting diseases. The proposed system demonstrates that the approach is optimized effectively for healthcare monitoring. In contrast, the proposed healthcare 5.0 system entangled with FL Approach achieves 93.22% accuracy for disease prediction, and the proposed RTS-DELM-based secure healthcare 5.0 system achieves 96.18% accuracy for the estimation of intrusion detection.

295 SPEP IT UP! DEVELOPING AN ALGORITHM FOR ABNORMAL SERUM PLASMA ELECTROPHORESIS RESULTS IN HIP FRACTURE PATIENTS

Background

Hip fracture is a common manifestation of osteoporosis. All patients who sustain a hip fracture should receive a specialist bone health assessment, including Serum Protein Electrophoresis (SPEP) because plasma cell disorders such as multiple myeloma are an important differential diagnosis. SPEP results can be challenging to interpret without training and expertise. We aimed to review the proportion of abnormal SPEP results in hip fracture patients and used a newly developed algorithm to assess urgency of referral to haematology.

Methods

The Orthogeriatrics and Haematology teams collaborated to develop an algorithm to help facilitate decision making in hip fracture patients with abnormal SPEP results. A retrospective study was then conducted using data from the local Hip Fracture Database from Quarters 1 and 3 in 2020, and the hospital electronic laboratory system. The algorithm was used to retrospectively determine which patients warranted haematology review. The electronic appointment system was then accessed to review whether those who warranted haematology referral had appointments on the system.

Results

Of 270 hip fracture presentations, 19 duplicate records were excluded. Five patients had no data and three patients had passed away. Of the remaining 243 patients, 193 (79.42%) had SPEP’s sent. Abnormalities were detected in 116 patients (47.74%). According to the SPEP referral pathway, two patients warranted routine referral and one patient required an urgent referral, none of whom appeared to have been referred to haematology. Two patients who did not warrant haematology referral were already under haematology for different conditions.

Conclusion

Not all patients who sustain acute osteoporotic fractures with an abnormal SPEP result require haematology referral. The need for an urgent or routine haematology can be guided by the SPEP result along with other clinical features. With the introduction of this pathway, it is proposed that all hip fracture patients will be triaged in a timely, appropriate, and consistent manner.

Community- vs. hospital-based management of multidrug-resistant TB in Pakistan

BACKGROUND Multidrug-resistant TB (MDR-TB) treatment takes 18-24 months and is complex, costly and isolating. We provide trial evidence on the WHO Pakistan recommendation for community-based care rather than hospital-based care.METHODS Two-arm, parallel-group, superiority trial was conducted in three programmatic management of drug-resistant TB hospitals in Punjab and Sindh Provinces, Pakistan. We enrolled 425 patients with MDR-TB aged >15 years through block randomisation in community-based care (1-week hospitalisation) or hospital-based care (2 months hospitalisation). Primary outcome was treatment success.RESULTS Among 425 patients with MDR-TB, 217 were allocated to community-based care and 208 to hospital-based care. Baseline characteristics were similar between the community and hospitalised arms, as well as in selected sites. Treatment success was 74.2% (161/217) under community-based care and 67.8% (141/208) under hospital-based care, giving a covariate-adjusted risk difference (community vs. hospital model) of 0.06 (95% CI -0.02 to 0.15; P = 0.144).CONCLUSIONS We found no clear evidence that community-based care was more or less effective than hospital-based care model. Given the other substantial advantages of community-based care over hospital based (e.g., more patient-friendly and accessible, with lower treatment costs), this supports the adoption of the community-based care model, as recommended by the WHO.

Exome Sequencing Identified Molecular Determinants of Retinal Dystrophies in Nine Consanguineous Pakistani Families

Inherited retinal dystrophies (IRDs) are a heterogeneous group of degenerative disorders of the retina. Retinitis Pigmentosa (RP) is a common type of IRD that causes night blindness and loss of peripheral vision and may progress to blindness. Mutations in more than 300 genes have been associated with syndromic and non-syndromic IRDs. Recessive forms are more frequent in populations where endogamy is a social preference, such as Pakistan. The aim of this study was to identify molecular determinants of IRDs with the common presentation of night blindness in consanguineous Pakistani families. This study included nine consanguineous IRD-affected families that presented autosomal recessive inheritance of the night blindness phenotype. DNA was extracted from blood samples. Targeted exome sequencing of 344 known genes for retinal dystrophies was performed. Screening of nine affected families revealed two novel (c.5571_5576delinsCTAGATand c.471dup in EYS and SPATA7 genes, respectively) and six reported pathogenic mutations (c.304C>A, c.187C>T, c.1560C>A, c.547C>T, c.109del and c.9911_11550del in PDE6A, USH2A, USH2A, NMNAT1, PAX6 and ALMS1 genes, respectively) segregating with disease phenotype in each respective family. Molecular determinants of hereditary retinal dystrophies were identified in all screened families. Identification of novel variants aid future diagnosis of retinal dystrophies and help to provide genetic counseling to affected families.

An exceptional biallelic N-terminal frame shift mutation in ZMPSTE24 leads to non-lethal progeria due to possible utilization of a downstream alternative start codon

Biallelic mutations in ZMPSTE24 are known to be associated with autosomal recessive mandibuloacral dysplasia with type B lipodystrophy (MADB) and lethal restrictive dermopathy (RD), respectively. Disease manifestation is depending on the remaining enzyme activity of the mutated ZMPSTE24 protein. To date, complete loss of function has exclusively been reported in RD cases. In this study, we identified a novel N-terminal homozygous frameshift mutation (c.28_29insA) in a consanguineous family segregating with MADB. An in-depth analysis of the mutated sequence revealed, that the one base pair insertion creates a novel downstream in-frame start codon, which supposedly serves as an alternative translation initiation site (TIS). This possible rescue mechanism would explain the relatively mild clinical outcome in the studied individuals. Our findings demonstrate the necessity for careful interpretation of N-terminal variants potentially effecting translation initiation.

Corona Virus Disease 2019 (COVID-19) Diagnostic Tests: A Glimpse

Mass testing for COVID-19 infection is one of the core measures in tackling the global spread of the disease. Testing is vital to diagnose and estimate cases, attack rates and case fatality rates- critical data for policy-making. As COVID-19 continues to spread globally, the demand for more extensive laboratory testing and innovative technology increases. However, countries around the world have been struggling to keep up pace with the worldwide demand to expand testing strategy. The pandemic evolves, so does our knowledge and understanding of diagnostic tests of COVID-19. Here we aim to review major challenges related to COVID-19 diagnostic tests and future development. So, the ongoing urgency and demand for tests would certainly steer the rapid uptake of novel techniques, which in turn would boost our understanding of diagnostic tests for COVID-19.

Identification of SCAR markers for genetic authentication of Dendrobium nobile Lindl

Dendrobium nobile Lindl. is an orcid plant with important medicinal values. This is a colourful houseplant, and also a popular herb in traditional Chinese medicine (TCM). The variants of this plant from different geographic regions might be high, and in this study, we aimed to develop specific sequence characterized amplified region (SCAR) markers for the identification of specific variant of this plant. Different cultivars of D. nobile were collected from nine different places of China, and one cultivar from Myanmar. DNA materials were extracted from the plant samples, random amplified polymorphic DNA (RAPD) were developed, cloned and sequenced for the development of SCAR markers. We have developed four SCAR markers, which are specific to the cultivar from Luzhou China, and clearly distinguishable (genetically) from other cultivars. These SCAR markers are deposited in GenBank (accession number MZ417502, MZ484089, MZ417504 and MZ417505). Four SCAR markers for D. nobile are effective molecular technique to genetically identify the different cultivars or species, and this method is applicable for genetic characterization and identification of other plant species too.

Impact of COVID-19 pandemic on quality of partner relationship and sexual activity among COVID positive males: a cross sectional study

OBJECTIVE

Our aim was to assess sexual activity, partner relationships among males who had been infected with COVID-19, to study the impact of COVID-19 infection on partner relationship and to find out the association between partner and sexual relationship during lockdown.

MATERIALS AND METHODS

A cross sectional study was conducted in Saudi Arabia through social media platforms via online questionnaire between December 1, 2020 and January 31, 2021 among 871 participants after a pilot study among 20 participants of which 497 were included in the study. Statistical analysis was conducted using SPSS version 20.0 (IBM Inc., Armonk, NY, USA). Responses were presented as frequencies and percentages and the association was studied using Chi squared test/Fisher's exact test. The value of p ≤ .05 was considered significant.

RESULTS

Out of the total study participants, nearly 85% of them belonged to the age range of 18 to 39 years, more than half of the participants were married. In the six months prior to the study being conducted, 268 respondents (53.9%) did not have sexual relationships. Respondents with positive COVID-19 infection reported that their partner lived with them in the same house during home isolation and was also found to be significantly associated with having intact sexual relationships in the last six months of the lockdown period (p-value < .001). Moreover, respondents who reported having good relationships with their partners during the pandemic were found to be significantly associated with having intact sexual relationships during the pandemic lockdown (p-value < .001).

CONCLUSIONS

Among the COVID-19-positive respondents, sexual activity and partner relationships were largely found to be intact during the pandemic lockdown period.

In Silico Analysis of the L-2-Hydroxyglutarate Dehydrogenase Gene Mutations and Their Biological Impact on Disease Etiology

The L-2-hydroxyglutarate dehydrogenase (L2HGDH) gene encodes an important mitochondrial enzyme. However, its altered activity results in excessive levels of L-2-hydroxyglutarate, which results in diverse psychiatric features of intellectual disability. In the current study, we executed an in-silico analysis of all reported L2HGDH missense and nonsense variants in order to investigate their biological significance. Among the superimposed 3D models, the highest similarity index for a wild-type structure was shown by the mutant Glu336Lys (87.26%), while the lowest similarity index value was shown by Arg70* (10.00%). Three large active site pockets were determined using protein active site prediction, in which the 2nd largest pocket was shown to encompass the substrate L-2-hydroxyglutarate (L2HG) binding residues, i.e., 89Gln, 195Tyr, 402Ala, 403Gly and 404Val. Moreover, interactions of wild-type and mutant L2HGDH variants with the close functional interactor D2HGDH protein resulted in alterations in the position, number and nature of networking residues. We observed that the binding of L2HG with the L2HGDH enzyme is affected by the nature of the amino acid substitution, as well as the number and nature of bonds between the substrate and protein molecule, which are able to affect its biological activity.

In Silico Analysis Identified Putative Pathogenic Missense nsSNPs in Human SLITRK1 Gene

Human DNA contains several variations, which can affect the structure and normal functioning of a protein. These variations could be single nucleotide polymorphisms (SNPs) or insertion-deletions (InDels). SNPs, as opposed to InDels, are more commonly present in DNA and may cause genetic disorders. In the current study, several bioinformatic tools were used to prioritize the pathogenic variants in the SLITRK1 gene. Out of all of the variants, 16 were commonly predicted to be pathogenic by these tools. All the variants had very low frequency, i.e., <0.0001 in the global population. The secondary structure of all filtered variants was predicted, but no structural change was observed at the site of variation in any variant. Protein stability analysis of these variants was then performed, which determined a decrease in protein stability of 10 of the variants. Amino acid conservation analysis revealed that all the amino acids were highly conserved, indicating their structural and functional importance. Protein 3D structure of wildtype SLITRK1 and all of its variants was predicted using I-TASSER, and the effect of variation on 3D structure of the protein was observed using the Missense3D tool, which presented the probable structural loss in three variants, i.e., Asn529Lys, Leu496Pro and Leu94Phe. The wildtype SLITRK1 protein and these three variants were independently docked with their close interactor protein PTPRD, and remarkable differences were observed in the docking sites of normal and variants, which will ultimately affect the functional activity of the SLITRK1 protein. Previous studies have shown that mutations in SLITRK1 are involved in Tourette syndrome. The present study may assist a molecular geneticist in interpreting the variant pathogenicity in research as well as diagnostic setup.

UHPLC, ATR-FTIR analysis of Nymphoides indica rhizome extract and determination of antioxidant & antibiofilm potential

The aim of the study was to perform comprehensive phytochemical analysis, UHPLC, ATR-FTIR profiling and evaluation of various biological activities of N. Indica rhizome. The phytochemical analysis indicated presence of alkaloids, saponins, and triterpenes. In the antioxidant assay, the methanolic (IC50 40.3±0.04) and chloroform fractions (IC50 40.05±0.21) showed highest DPPH inhition. Like wise, methanolic fraction showed highest FRAP value (756.2±0.06) followed by chloroform (225.0±0.04) and ethyl acetate fractions (193.0±0.21). In the antimicrobial assays, chloroform (MIC < 0.156 mg/ml) and methanol fractions (MIC 0.625 mg/ml) fractions showed significant inhibition of Klebsiella pneumoniae. Also a significant antibiofilm of biofilm formation was recorded by chloroform (IC50 1.73 mg/ml) and ethyl acetate fractions (IC50 1.76 mg/ml). It was concluded that the N. Indica rhizome posess antioxidant, antimicrobial and antibiofilm potential, that may be attributed to high flavonoid contents.

Activity of Fosfomycin Against The Spectrum of Uropathogens Causing Cystitis

Background:

Urinary tract infections (UTIs) are the most frequent bacterial infections, commonly seen in females. High degree of antimicrobial resistance in uropathogens has challenged the use of therapeutic agents. Fosfomycin which is an old antibiotic with distinctive characteristics, seems to be a promising novel therapeutic agent with a good bactericidal activity towards multi-drug resistant (MDR) uropathogens.

Objective:

The main objective of the study is to evaluate the antibacterial activity of fosfomycin among uropathogens causing cystitis.

Methods:

The study was carried out between 2017-2018. A total of 2060 UTI suspects from outpatient department (OPDs) and inpatient department (IPDs) were screened. Out of 2060 screened patients 1658 were IPD patients and 402 were OPD patients. Patient’s midstream urine samples were collected aseptically and processed according to standard protocols. The frequency of extended-spectrum-beta lactamases (ESBLs) producer and carbapenem resistance were estimated respectively. Cultures with significant growth of uropathogens were identified and minimum inhibitory concentration (MIC) to fosfomycin was determined by agar dilution (AD) and by E-test methods.

Results:

184 out of 2060 (8.9%) urine samples showed significant growth of uropathogens. Uropathogenic Escherichia coli (UPEC) (64%,118/184) was found to be the mostly isolated uropathogen. Among these Gram-negative uropathogens, 80% were ESBLs producers, 43.2% were carbapenem-resistant and 78% isolates were found to be MDR. The fosfomycin susceptibility for UPEC was 95% by AD method.

Conclusions:

This study suggests that Fosfomycin is reasonably effective and can be used in the treatment of MDR uropathogens along with uncomplicated UTIs.

The molecular genetics of UV-Sensitive syndrome: A rare dermal anomaly

Ultraviolet-sensitive syndrome is a rare skin disorder characterised by heterogeneous phenotypic spectrum of skin freckling, telangiectasia and acute sunburn. It usually has an autosomal recessive pattern. So far, only 18 patients from nine different families (Japanese, French, Israeli, Iranian and Pakistani) have been reported in scientific literature. Its precise prevalence is still unknown, but, according to an estimate, its prevalence ratio is 1:100,000 worldwide. Until now, only three genes have been reported to be involved in the syndrome; the Excision Repair Cross-Complementing, Group 6, the Excision Repair Cross-Complementing, Group 8 and the UV-Stimulated Scaffold Protein A (UVSSA). Among these genes, the last one is reported to be more prevalent among different ethnicities, including Pakistani. Physiologically, most of the syndrome genes are involved in the transcription-coupled nucleotide excision pathway. In order to reduce the disease severity, the patients are advised to use medicated skin moisturisers or sun-blocks, sunglasses and gloves, while going out in the sun to avoid sun exposure. The current narrative review was planned to discuss the molecular genetics and the mutational spectrum of the syndrome, and to describe the differential diagnosis of various related disorders in order to facilitate clinical researchers.

[Medical rehabilitation for children with scoliosis]

The article presents a literature review on the prevalence, relevance, social significance, and principles of medical rehabilitation of children with different types of scoliosis in scoliotic disease. The current classification, diagnostics features, and clinical course of the disease are addressed. Current approaches to the choice of medical rehabilitation methods for scoliotic disease in children are described: therapeutic exercise, hydrokinesiotherapy, massage, physiotherapeutic treatment, kinesiotaping, and corseting. Special consideration is given to postoperative management and stages of medical rehabilitation of children with scoliosis, including resort treatment.

A novel protein truncating mutation in L2HGDH causes L-2-hydroxyglutaric aciduria in a consanguineous Pakistani family

BACKGROUND

L-2-hydroxyglutaric aciduria (L2HGA) is a rare neurometabolic disorder that occurs due to accumulation of L-2-hydroxyglutaric acid in the cerebrospinal fluid (CSF), plasma and urine. The clinical manifestation of L2HGA includes intellectual disability, cerebellar ataxia, epilepsy, speech problems and macrocephaly.

METHODS

In the present study, we ascertained a multigenerational consanguineous Pakistani family with 5 affected individuals. Clinical studies were performed through biochemical tests and brain CT scan. Locus mapping was carried out through genome-wide SNP genotyping, whole exome sequencing and Sanger sequencing. For in silico studies protein structural modeling and docking was done using I-TASSER, Cluspro and AutoDock VINA tools.

RESULTS

Affected individuals presented with cognitive impairment, gait disturbance, speech difficulties and psychomotor delay. Radiologic analysis of a male patient revealed leukoaraiosis with hypoattenuation of cerebral white matter, suggestive of hypomyelination. Homozygosity mapping in this family revealed a linkage region on chromosome 14 between markers rs2039791 and rs781354. Subsequent whole exome analysis identified a novel frameshift mutation NM_024884.3:c.180delG, p.(Ala62Profs*24) in the second exon of L2HGDH. Sanger sequencing confirmed segregation of this mutation with the disease phenotype. The identification of the most N-terminal loss of function mutation published thus far further expands the mutational spectrum of L2HGDH.

Anti-hyperglycemic and anti-hyperlipidemic effects of a methanolic extract of Debregeasia salicifolia in Alloxan-induced diabetic albino mice

Diabetes mellitus (DM), an endocrine syndrome characterized by high blood glucose levels due to abrogated insulin activity. The existing treatments for DM have side effects and varying degrees of efficacy. Therefore, it is paramount that novel approaches be developed to enhance the management of DM. Therapeutic plants have been accredited as having comparatively high efficacy with fewer adverse effects. The current study aims to elucidate the phytochemical profile, anti-hyperlipidemic, and anti-diabetic effects of methanolic extract D. salicifolia (leaves) in Alloxan-induced diabetic mice. Alloxan was injected intraperitoneally (150 mg kg-1, b.w), to induced diabetes in mice. The mice were divided into three groups (n=10). Group 1 (normal control) received normal food and purified water, Group II (diabetic control) received regular feed and clean water and group III (diabetic treated) received a methanolic extract of the plant (300 mg kg-1) for 28 days with a typical diet and clean water throughout the experiment. Blood samples were collected to checked serum glucose and concentration of LDL, TC, TG. The extract demonstrated significant antihyperglycemic activity (P<0.05), whereas improvements in mice's body weight and lipid profiles were observed after treatment with the extract. This study establishes that the extract has high efficacy with comparatively less toxicity that can be used for DM management.

682 Pre-clinic mpMRI Prostate for Suspected Localised Significant Prostate Cancer – Incidental Findings and Outcomes

Aim

Two week wait pathways demand rapid investigation of patients with suspected prostate cancer. To facilitate this, mpMRI prostate imaging is now routinely organised for patients whom meet specific criteria, without prior physical review by an urologist. We sought to establish what incidental findings were amongst this patient group and whether management was affected.

Method

All patients referred between 1/4/2019 – 30/4/20 on a suspected prostate cancer pathway to the Leicester General Hospital were included with those coded to have had pre-clinic MRI selected.

Results

During this period 1487 patients were referred on the pathway of which 482 were coded as having has pre-clinic MRI. 8 patients were excluded due to incorrect coding leaving 474 to be analysed. 121 patients had incidental findings mentioned in the report, of these a higher proportion did not have prostate cancer (69%). There were just 11 (2%) significant findings that required further investigation or intervention. These included colorectal lesions, primary bone lesions, suspected bladder cancers and urinary tract calculi. Of this group 3 patients had prostate cancer. Of note 13% of these patients were noted to have diverticular disease and 6% had herniae noted although none required emergent treatment. In this series 32% of patients were confirmed to have prostate cancer with 67.1% of MRI scan reported as PIRADS 3-5.

Conclusions

Pre-clinic MRI prostate facilitates rapid investigation for suspected prostate cancer. There is a small chance of establishing a significant incidental finding which is slightly more common in the non-cancer group.

Review: Markers and proxies to monitor ruminal function and feed efficiency in young ruminants

Developing the rumen's capacity to utilise recalcitrant and low-value feed resources is important for ruminant production systems. Early-life nutrition and management practices have been shown to influence development of the rumen in young animals with long-term consequences on their performance. Therefore, there has been increasing interest to understand ruminal development and function in young ruminants to improve feed efficiency, health, welfare, and performance of both young and adult ruminants. However, due to the small size, rapid morphological changes and low initial microbial populations of the rumen, it is difficult to study ruminal function in young ruminants without major invasive approaches or slaughter studies. In this review, we discuss the usefulness of a range of proxies and markers to monitor ruminal function and nitrogen use efficiency (a major part of feed efficiency) in young ruminants. Breath sulphide and methane emissions showed the greatest potential as simple markers of a developing microbiota in young ruminants. However, there is only limited evidence for robust indicators of feed efficiency at this stage. The use of nitrogen isotopic discrimination based on plasma samples appeared to be the most promising proxy for feed efficiency in young ruminants. More research is needed to explore and refine potential proxies and markers to indicate ruminal function and feed efficiency in young ruminants, particularly for neonatal ruminants.

Hyperhomocysteinemia as an Independent Risk Factor for Coronary Heart Disease. Comparison with Conventional Risk Factors

The present study was designed to evaluate the strength of association of raised plasma homocysteine concentration as a risk factor for coronary heart disease independent of conventional risk factor. It was a case control study conducted at Punjab Institute of Cardiology Lahore. A total of 210 subjects aged 25 to 60 years comprising of 105 newly admitted patients of CHD as cases and 105 age and sex matched healthy individuals with no history of CHD as control were recruited for the study. Fasting blood samples were obtained from cases and controls. Plasma homocysteine was analyzed by fluorescence polarization immunoassay (FPIA) method on automated immunoassay analyzer (Abbott IMX). Total cholesterol, triglyceride and HDL cholesterol were analyzed using calorimetric kit methods. The concentration of LDL cholesterol was calculated using Friedewald formula. The patients were also assessed for traditional risk factors such as age, sex, family history of CVD, hypertension, smoking and physical activity, and were compared with control subjects. The collected data was entered in SPSS version 24 for analysis and interpretation.The mean age in controls and experimental groups were 43.00± 8.42 years and 44.72± 8.59 years with statistically same distribution (p- value= 0.144). The mean plasma homocysteine for cases was 22.33± 9.22 µmol/L where as it was 12.59±3.73 µmol/L in control group. Highly significant difference was seen between the mean plasma level of homocysteine in cases and controls (p˂0.001).Simple logistic regression indicates a strong association of coronary heart disease with hyperhomocysteinemia (OR 7.45), which remained significantly associated with coronary heart disease by multivariate logistic regression (OR 7.10, 95%C1 3.12-12.83, p=0.000). The present study concludes that elevated levels of Plasma homocysteine is an independent risk factor for coronary heart disease independent of conventional risk factors and can be used as an indicator for predicting the future possibility for the onset of CVD.

Habitat selection by Asiatic black bear (Ursus thibetanus) in Siran and Kaghan Valleys, Pakistan

Asiatic black bear is present in variety of habitats like broad-leaves and coniferous forests, extending form sea level to 4300m elevation and change their habitat for food purpose seasonally. The present study was conducted at Kaghan and Siran Valleys, District Mansehra, Khyber Pakhtunkhwa, Pakistan to assess habitat of black bear. Line transect method was used for observation of bear signs. Twelve meter circular radius plots were selected for the concern vegetation's i.e. (trees, shrubs and herbs) and three to six plots were placed in each transect. At the result of sign survey, thirteen different categories of bear signs were recorded and encounter rate was calculated for each sign. A total of 1858 signs were observed during field surveys. Total (81%) coniferous species were recoded among trees, with the highest appearance of Pinus wallichiana (34.22%) and Spruce spp (27.76%), similarly broad leaves trees (18.56%) were also recoded from habitat plots. Most of the signs were encountered in bushy areas, whereas high number of Viburnum Spp (60.29%) was present. It is indicated that black bear prefers blend of Coniferous Trees, Viburnum and Ferns Species; probably because these plants provide enough food, protection, and meticulous shelter because more than 80% of habitat composed of these three species. Currently habitat destruction and increase in human population are the up-growing issues for wild animals (especially Asiatic black bear), which is highly sensitive to such problems. High levels of conservation efforts are recommended for the protection of black bear habitat and to avoid human interference in their territory.

Effect of postpartum collection time and colostrum quality on passive transfer of immunity, performance, and small intestinal development in preweaning calves

This study evaluated the effects of postpartum collection time and quality of colostrum fed to calves on the failure of passive transfer, growth, and small intestine development in the first 5 wk of life. Newborn calves (Holstein-Friesian × Jersey) were identified at birth and collected either early (E; within 12 h postpartum; n = 20) or late (L; 18-24 h postpartum; n = 20) and fed either high-quality colostrum [HQC, first milking colostrum with Brix% = 23 ± standard deviation (SD) 2] or low-quality colostrum (LQC, mixed colostrum and transition milk with Brix% = 12 ± 1) to create 4 treatments: E-HQC, E-LQC, L-HQC, and L-LQC (n = 10/treatment). After collection, calves (body weight = 32.3 ± 4.6 kg/calf) were fed either HQC or LQC (7.5% of their arrival body weight per feed) for the first 3 (L calves) or 4 feedings (E calves). All calves were then managed and fed similarly using automatic feeders which recorded individual intake of milk replacer and calf starter. Blood samples were taken at d 1 (after collection from dams but before colostrum feeding), 4, 14, and 35 of age to analyze selected metabolites. All calves were killed at d 35 ± 2 of age and histomorphology of duodenum, jejunum, and ileum was evaluated. At collection, 75% of E calves and 58% of L calves had serum total protein ≤52 g/L. At d 4 of age, calves fed HQC had greater serum total protein than calves fed LQC; however, failure of passive transfer (serum total protein ≤52 g/L) incidence did not differ between HQC and LQC. Collection time did not affect the scouring duration, but the amount of electrolyte used to treat sick calves was lower in L versus E calves, whereas feeding HQC versus LQC lowered both the scouring duration and electrolyte use to treat sick calves. Calves fed HQC had a greater total surface area of the duodenum (+23%) and jejunum (+17%) compared with LQC calves. Duodenal crypts were deeper in E-LQC calves than E-HQC and L-HQC calves, whereas L-LQC calves were intermediate. Villus height to crypt depth ratio in duodenum, jejunum, and ileum was greater in HQC than LQC calves. A trend toward greater average daily gain was observed in HQC versus LQC calves (667 vs. 590 g/d) but the average daily gain was not influenced by collection time. Serum IGF-1 at d 4 was higher in HQC versus LQC calves and this might have contributed to greater average daily gain and small intestine development. Calves fed HQC had higher feed conversion ratios (FCR; total body weight gain/total dry matter intake) compared with LQC calves, and L calves had higher FCR compared with E calves. In conclusion, in comparison to feeding LQC, feeding HQC reduced the scouring duration, enhanced surface area of duodenum and jejunum, and improved FCR during the first 5 wk of calf age. Postpartum collection time of calves did not affect small intestine development, but L calves had higher FCR and required a lesser volume of electrolytes to treat scours compared with E calves during the first 35 d of life.

Phytochemicals induce apoptosis by modulation of nitric oxide signaling pathway in cervical cancer cells

OBJECTIVE

Nitric Oxide (NO) is produced by NO synthases (NOS) and is a key signaling molecule that regulates tumorigenesis, both aiding and alleviating it. Elevated NO levels are cytotoxic to cancer cells, making NOS an important target for cancer treatment. In the present study, the modulatory effects of the phytochemicals, quercetin, sulforaphane, genistein, and epigallocatechin-3-gallate on NO pathway and apoptosis were shown in HeLa cervical cancer cells.

MATERIALS AND METHODS

Fluorescent microscopy and flow cytometry were used to assess apoptosis. A Griess assay was used to quantitatively measure NO, quantitative PCR array was used to assess the expression levels of genes involved in the NO signaling pathway, and immunocytochemistry was used to determine NOS protein expression. The functional association among the modulated genes was evaluated using network biology analysis, gene set enrichment, and KEGG pathway analysis.

RESULTS

Treatment with the phytochemicals elevated NO levels in HeLa cells and modulated various genes involved in nitric oxide biosynthesis, superoxide metabolism, and oxidative stress, including NOS1, NOS2, NOS3, ALOX12, and SOD2, with a concomitant increase in NOS2 and NOS3 protein expression levels; also, the phytochemicals were found to induce apoptosis.

CONCLUSIONS

These results suggest that the phytochemical-induced cell death is partially attributed to the activation of the NO pathway and upregulation of pro-oxidant ROS generators. Further experimental studies are required to explore this mechanistic association of NO signaling pathway activation and induction of apoptosis in other types of cancer.

[Medical rehabilitation of children with bronchial asthma]

Medical rehabilitation of children suffering from bronchial asthma is based on the complex use of natural therapeutic factors, drug, non-drug therapy and other methods in order to achieve control over the disease and long-term remission. The use of non-drug technologies is necessary taking into account the pathogenesis of the bronchial asthma development and is aimed at relieving bronchospasm, reducing the activity of allergic inflammation in the bronchi, improving their drainage function, strengthening the respiratory muscles and increasing exercise tolerance. When carrying out rehabilitation measures it is important to observe the basic principles of medical rehabilitation. An individual medical rehabilitation program is drawn up taking into account the assessment of the child's clinical condition at each stage with the diagnosis of the initial rehabilitation status, the establishment of a rehabilitation diagnosis and an assessment of the rehabilitation potential. The article presents the data of the analysis of scientific publications and our own research allowing to draw up an algorithm for the formation of an individual program of medical rehabilitation for children with bronchial asthma.

Alopecia-mental retardation syndrome: Molecular genetics of a rare neuro-dermal disorder

Alopecia-mental retardation syndrome (APMR) is a rare autosomal recessive neuro-dermal disorder. It is characterized by heterogeneous phenotypic features, that is, absence of hair on the scalp, eyelashes, and eyebrows and mild to severe intellectual disability. So far, approximately 14 families (i.e., Iranian, Pakistani, and Swiss) with APMR have been reported in the scientific literature. Its precise prevalence is still unknown, but according to a predictive estimate, it prevails with the ratio of 1 in 1,000,000 persons worldwide. Until now, only four loci (two characterized and two uncharacterized) have been reported to be involved in APMR. The pathogenic variants in alpha-2-HS-glycoprotein [AHSG; APMR1 (MIM#203650)] and lanosterol synthase [LSS; APMR4 (MIM#618840)] are the characterized genetic factors associated with APMR. Among them, AHSG was reported in a consanguineous Iranian family and LSS gene in a Swiss origin family, while the remaining two uncharacterized loci, that is, APMR2 and APMR3, are reported in the Pakistani population. The current mini-report discusses the molecular genetics and mutational spectrum of APMR syndrome, its differential diagnosis from related disorders, and prediction of plausible candidate genes in two uncharacterized loci.