Enhancing specimen collection skills for dried blood spots through an immersive virtual learning environment: a cross-sectional study

OBJECTIVE

The quality of dried blood spot (DBS) specimens impacts newborn screening (NBS) results, hence proper training is crucial for DBS specimen collection. To address this, a training module for Allied Health Professionals (AHPs) and nurses was created on Moodle, a virtual learning environment (VLE). The purpose of this research was to determine the feasibility and effectiveness of this module.

METHODOLOGY

Participants were trained on-site (March to December 2019), through online training sessions (January to June 2020), and the two training strategies were compared. Data analysis included the total number of participants, cost-effectiveness, trainer engagement, and the number of unacceptable samples collected by nurses/AHPs trained by the two strategies.

RESULTS

A total of 55 nurses/AHPs were trained on-site, while 79 nurses/AHPs completed the online module and received certificates through online VLE-based training. The trainer engagement and cost were more for onsite training. After online training, the specimen rejection rate was reduced from 0.84% (44 rejected out of 5220 total specimens collected) to 0.38% (15/3920).

CONCLUSIONS

This study shows that using VLE-based DBS specimen collection training is feasible and effective for training nurses and AHPs.

An impactful prospective study on pulmonary tuberculosis in geriatric populations besides its clinical outcomes and implications in the Indian subcontinent

OBJECTIVE

Geriatric populations are most at risk for the tuberculosis pandemic, and as people age, the rate of infection rises steadily and drastically. Geriatric individuals frequently experience diagnostic challenges with a wide range of comorbidities, but employing all available standard and novel methods to diagnose any infection is crucial. The prophylactic and therapeutic management for the geriatric population presents a significant difficulty and challenge in assessing an appropriate and effective therapeutic outcome due to prolonged drug therapy and adverse drug reactions. The present study aims to determine the prevalence of tuberculosis in the geriatric population in the Indian subcontinent, its risk factors, clinical outcomes, and adherence to the medication.

PATIENTS AND METHODS

A prospective observational investigation was conducted in a tertiary care Hospital in Erode, Tamil Nadu, India, from April 2021 to September 2022. A total of 1,014 patients were screened, and 176 participants were selected. The participants were then subjected to medication adherence evaluation, and clinical data was collected.  The statistical analysis was performed using SPSS version 20.0.

RESULTS

Among 176 participants, 135 (76.70%) were old (65-74 age), 37 (21.02%) were very old (75-84 age) TB patients, and 4 (2.27%) patients were extremely old TB patients (>85). Medication adherence was improved from baseline to the end of the study (p≤0.000). 110 patients completed the treatment (62.5%). 41 patients were cured in between treatments (23.29%), 13 patients died during the treatment (7.38%), 9 patients lost their follow-up (5.11%), 3 patients failed to respond to the treatment (1.70%).

CONCLUSIONS

The effectiveness of therapy critically depends on the patient's medication adherence to anti-TB therapy. In addition to having a higher likelihood of therapy failure, elderly patients did not appropriately respond to the treatment and completely recovered from the infection even after effective pharmacotherapy.

Assessment of Serum Homocysteine Level to Predict Early Prognosis of Ischaemic Stroke

Cerebrovascular disease is the third most familiar cause of mortality worldwide and in Bangladesh. The reported prevalence of stroke in Bangladesh is 0.3%. Age, high serum glucose, elevated admission blood pressure, fever, large infarction size, and hyperhomocysteinemia has been reported to be risk factor for early post-stroke neurological deterioration. Early serum homocysteine level estimation can predict the early prognosis of ischemic stroke. In a developing country like Bangladesh, an earlier stroke outcome prediction for guiding therapeutic approach is essential. This study aimed to specify the role of estimating serum homocysteine during the early phase of acute ischemic stroke to assume an early prognosis that would guide- a management plan, the need to stay in the hospital and the need for intervention. This cross-sectional descriptive study was performed at the Department of Medicine, Mymensingh Medical College Hospital, Bangladesh from October 2021 to April 2022. Radiologically confirmed all ischemic stroke patients admitted at the Department of Medicine, Mymensingh Medical College Hospital, during the study period fulfilling the inclusion and exclusion criteria were included in this study. Non-probability purposive sampling technique was used. Data was collected using a pre-designed case record form. Quantitative data were represented as mean and standard deviation and qualitative data as frequency and percentage. The comparison was made by Chi-square test and independent samples t-test using SPSS (version 26.0). During the study period, among 716 stroke patients, 59 ischemic stroke patients were included in this study. The mean age of the patients was 64.0±11.72 years. After 72 hours of supportive treatment, early neurological outcomes were observed using NIHSS scoring. Out of 59 patients, the condition of 45(76.0%) patients improved or remained stable (END-) and the state of 14(24.0%) patients worsened (END+). Elderly age-raised temperature and elevated blood glucose level are known to increase infarction size, but only elevated temperature (p value 0.009) has statistical significance in this study. The mean homocysteine level ±SD was 20.22±6.95μmol/L, which is above the normal (<15μmol/L). The level was above average for both outcome groups. Serum homocysteine level was significantly higher in END(+) group (31.59±2.98μmol/L) than END(-) group (16.69±2.66μmol/L) and p value was <0.001.

The study of healthcare professionals' perspective towards the quality of diabetic care services in Abha

OBJECTIVE

The aim of this study was to investigate the relationship between organizational characteristics and diabetes care from the perspective of health care professionals (HCPs) in Abha, Kingdom of Saudi Arabia.

SUBJECTS AND METHODS

A cross-sectional, self-reported survey of healthcare professionals was done. The study comprised a total of 106 HCPs from various departments involved with diabetes patient clinics or service providers. The electronic data collecting form was used to gather the data.

RESULTS

The study revealed a stronger association between the availability of bed facilities and better glycemic control. Moreover, the majority of HCPs believes that urbanization and sedentary lifestyles are the main contributors to the rise of diabetes mellitus in Saudi Arabia. Depending on organizational features, the regulations that are available for monitoring defaulter patients and running continuous medical education (CME) programs are vastly different. The main cause of the reported lack of medications for managing diabetic care was described as being a problem with the central medical supply store's drug supply, which was influenced by the type of health sector.

CONCLUSIONS

Facilitating change at all levels, including patient education, HCPs education, and organizational development, can improve the quality of treatment. The current study can provide insight into the focus of interventional strategies to deliver diabetes patients with high-quality patient care.

Variations in Total Protein and Amino Acids in the Sequenced Sorghum Mutant Library

Sorghum (Sorghum bicolor) is the fifth most important cereal crop worldwide; however, its utilization in food products can be limited due to reduced nutritional quality related to amino acid composition and protein digestibility in cooked products. Low essential amino acid levels and digestibility are influenced by the composition of the sorghum seed storage proteins, kafirins. In this study, we report a core collection of 206 sorghum mutant lines with altered seed storage proteins. Wet lab chemistry analysis was conducted to evaluate the total protein content and 23 amino acids, including 19 protein-bound and 4 non-protein amino acids. We identified mutant lines with diverse compositions of essential and non-essential amino acids. The highest total protein content in these lines was almost double that of the wild-type (BTx623). The mutants identified in this study can be used as a genetic resource to improve the sorghum grain quality and determine the molecular mechanisms underlying the biosynthesis of storage protein and starch in sorghum seeds.

Silicon-Induced Morphological, Biochemical and Molecular Regulation in Phoenix dactylifera L. under Low-Temperature Stress

Climate changes abruptly affect optimum growth temperatures, leading to a negative influence on plant physiology and productivity. The present study aimed to investigate the extent of low-temperature stress effects on date palm growth and physiological indicators under the exogenous application of silicon (Si). Date palm seedlings were treated with Si (1.0 mM) and exposed to different temperature regimes (5, 15, and 30 °C). It was observed that the application of Si markedly improved fresh and dry biomass, photosynthetic pigments (chlorophyll and carotenoids), plant morphology, and relative water content by ameliorating low-temperature-induced oxidative stress. Low-temperature stress (5 and 15 °C), led to a substantial upregulation of ABA-signaling-related genes (NCED-1 and PyL-4) in non Si treated plants, while Si treated plants revealed an antagonistic trend. However, jasmonic acid and salicylic acid accumulation were markedly elevated in Si treated plants under stress conditions (5 and 15 °C) in comparison with non Si treated plants. Interestingly, the upregulation of low temperature stress related plant plasma membrane ATPase (PPMA3 and PPMA4) and short-chain dehydrogenases/reductases (SDR), responsible for cellular physiology, stomatal conductance and nutrient translocation under silicon applications, was observed in Si plants under stress conditions in comparison with non Si treated plants. Furthermore, a significant expression of LSi-2 was detected in Si plants under stress, leading to the significant accumulation of Si in roots and shoots. In contrast, non Si plants demonstrated a low expression of LSi-2 under stress conditions, and thereby, reduced level of Si accumulation were observed. Less accumulation of oxidative stress was evident from the expression of superoxide dismutase (SOD) and catalase (CAT). Additionally, Si plants revealed a significant exudation of organic acids (succinic acid and citric acid) and nutrient accumulation (K and Mg) in roots and shoots. Furthermore, the application of Si led to substantial upregulation of the low temperature stress related soybean cold regulated gene (SRC-2) and ICE-1 (inducer of CBF expression 1), involved in the expression of CBF/DREB (C-repeat binding factor/dehydration responsive element binding factor) gene family under stress conditions in comparison with non Si plants. The current research findings are crucial for exploring the impact on morpho-physio-biochemical attributes of date palms under low temperature and Si supplementation, which may provide an efficient strategy for growing plants in low-temperature fields.

Knowledge, beliefs, and attitudes among general population towards bipolar disorders: a cross-sectional report from the Southern region of Saudi Arabia

OBJECTIVE

The aim of this study was to understand the impact of demographic characteristics and to describe the gender differences in knowledge, beliefs, and attitudes towards bipolar disorders among common residents in the Southern region of Saudi Arabia.

SUBJECTS AND METHODS

This cross-sectional survey was conducted between January 2021 and March 2021. The survey was conducted among the common residents in the southern region of the Kingdom of Saudi Arabia. The data were collected by using a structured, self-administered, validated questionnaire comprised of a dichotomous type of questions along with Likert scale.

RESULTS

There is a significant difference in the distribution of knowledge scores between male and female study participants (p=0.000). No significant gender differences have been identified in beliefs and attitudes toward bipolar disorder (p=0.229) and in overall score (p=0.159). The traumatic event was reported as the major cause of bipolar disorder. The age group and employment status were found to be the major predictor of knowledge, beliefs, and attitudes about bipolar disorder.

CONCLUSIONS

Although the knowledge awareness rate on bipolar disorder is high among public in the Southern region, there is a vast scope for improving it. Education should be disseminated to promote mental health awareness and improve attitudes and beliefs on bipolar disorders and reduce stigma and discrimination against patients with bipolar disorders.

Contriving multi-epitope vaccine ensemble for monkeypox disease using an immunoinformatics approach

The current global outbreak of monkeypox (MPX) disease, caused by Monkeypox virus (MPXV), has resulted in 16 thousand infection cases, five deaths, and has been declared a global health emergency of international concern by the World Health Organization. Given current challenges in the safety of existing vaccines, a vaccine to prevent MPX infection and/or onset of symptoms would significantly advance disease management. In this context, a multi-epitope-based vaccine could be a well-suited approach. Herein, we searched a publicly accessible database (Virus Pathogen Database and Analysis Resource) for MPXV immune epitopes from various antigens. We prioritized a group of epitopes (10 CD8+ T cells and four B-cell epitopes) using a computer-aided technique based on desirable immunological and physicochemical properties, sequence conservation criteria, and non-human homology. Three multi-epitope vaccines were constructed (MPXV-1–3) by fusing finalized epitopes with the aid of appropriate linkers and adjuvant (beta-defensin 3, 50S ribosomal protein L7/L12, and Heparin-binding hemagglutinin). Codon optimization and in silico cloning in the pET28a (+) expression vector ensure the optimal expression of each construct in the Escherichia Coli system. Two and three-dimensional structures of the constructed vaccines were predicted and refined. The optimal binding mode of the construct with immune receptors [Toll-like receptors (TLR2, TLR3, and TLR4)] was explored by molecular docking, which revealed high docking energies of MPXV-1–TLR3 (–99.09 kcal/mol), MPXV-2–TLR3 (–98.68 kcal/mol), and MPXV-3–TLR2 (–85.22 kcal/mol). Conformational stability and energetically favourable binding of the vaccine-TLR2/3 complexes were assessed by performing molecular dynamics simulations and free energy calculations (Molecular Mechanics/Generalized Born Surface Area method). In silico immune simulation suggested that innate, adaptive, and humoral responses will be elicited upon administration of such potent multi-epitope vaccine constructs. The vaccine constructs are antigenic, non-allergen, non-toxic, soluble, topographically exposed, and possess favourable physicochemical characteristics. These results may help experimental vaccinologists design a potent MPX vaccine.

Aroma Profile and Biological Effects of Ochradenus arabicus Essential Oils: A Comparative Study of Stem, Flowers, and Leaves

The present analysis explores the chemical constituents and determines the in vitro antimicrobial, antidiabetic, and antioxidant significance of the essential oils (EOs) of the stem, leaves, and flowers of Ochradenus arabicus for the first time. The EOs of the flowers presented seventy-four constituents contributing to 81.46% of the total EOs, with the major compounds being 24-norursa-3,12-diene (13.06%), 24-norursa-3,12-dien-11-one (6.61%), and 24-noroleana-3,12-diene (6.25%). The stem EOs with sixty-one compounds contributed 95.95% of the total oil, whose main bioactive compounds were (+)-camphene (21.50%), eremophilene (5.87%), and δ-selinene (5.03%), while a minimum of fifty-one compounds in the leaves’ EOs (98.75%) were found, with the main constituents being n-hexadecanoic acid (12.32%), octacosane (8.62%), tetradecanoic acid (8.54%), and prehydro fersenyl acetone (7.27%). The antimicrobial activity of the EOs of O. arabicus stem, leaves, and flowers was assessed against two bacterial strains (Escherichia coli and Streptococcus aureus) and two fungal strains (Penicillium simplicissimum and Rhizoctonia solani) via the disc diffusion assay. However, the EOs extracted from the stem were found effective against one bacterial strain, E. coli, and one fungal strain, R. Solani, among the examined microbes in comparison to the standard and negative control. The tested EOs samples of the O. arabicus stem displayed a maximum potential to cure diabetes with an IC50 = 0.40 ± 0.10 µg/mL, followed by leaves and flowers with an IC50 = 0.71 ± 0.11 µg/mL and IC50 = 10.57 ± 0.18 µg/mL, respectively, as compared to the standard acarbose (IC50 = 377.26 ± 1.20 µg/mL). In addition, the EOs of O. arabicus flowers had the highest antioxidant activity (IC50 = 106.40 ± 0.19 µg/mL) as compared to the standard ascorbic acid (IC50 = 73.20 ± 0.17 µg/mL) using the 2,2-diphenyl-1-picrylhydrazyl (DPPH) assay. In the ABTS assay, the EOs of the same sample (flower) depicted the utmost potential to scavenge the free radicals with an IC50 = 178.0 ± 0.14 µg/mL as compared with the ascorbic acid, having an IC50 of 87.34 ± 0.10 µg/mL the using 2,2-Azino-Bis-3-Ethylbenzothiazoline-6-Sulfonic acid (ABTS) assay. The EOs of all parts of O. arabicus have useful bioactive components due to which they present antidiabetic and antioxidant significance. Furthermore, additional investigations are considered necessary to expose the responsible components of the examined biological capabilities, which would be effective in the production of innovative drugs.

Role of oxidative stress in angiogenesis and the therapeutic potential of antioxidants in breast cancer

The escalation of cancer cases globally, especially breast cancer, is of concern. Angiogenesis is hallmark of cancer pathogenesis and plays an important role in cancer progression and metastasis. Pro-angiogenic agents, secreted by tumor cells, form new blood vessels, and produce reactive oxygen species (ROS). ROS promote angiogenesis via two major pathways: namely Vascular Endothelial Growth Factor (VEGF) dependent and non-VEGF dependent pathways. As a consequence of unbalanced ROS overproduction and low antioxidants levels, oxidative stress occurs and promotes angiogenesis in breast cancer tissues. Thus, the potential use of antioxidants as a preventive therapy in breast cancer. Preclinical studies depict that vitamins A and E may counter oxidative stress resulting in reduction of metastasis and viability of breast cancer. Furthermore, clinical studies demonstrate a decline in breast cancer risk in postmenopausal women upon the consumption of antioxidants. Herein, we discuss various pro-angiogenic agents that may play an important role in breast cancer angiogenesis. Moreover, the contribution of oxidative stress in inducing the angiogenic process is extensively reviewed here. Furthermore, the findings of pre-clinical and clinical studies on the use of antioxidants, namely vitamins A and E, in breast cancer are deliberated upon, along with the role of angiogenesis in cancer therapy.

Assessment of knowledge and practice of mammography and breast self-examination among the general female population in Asir region of KSA

OBJECTIVE

Breast cancer is the most common malignancy in Kingdom of Saudi Arabia (KSA) and an increasing burden in terms of incidence, morbidity and mortality. It accounts for about 28.7% of all new cancers in women. In 2015, the Saudi cancer registry shows that breast cancer was graded first among women and it accounts for 16.7% of all cancers reported among Saudi nationals. This study was designed to assess breast cancer screening knowledge and practices among women in the Asir region, Kingdom of Saudi Arabia.

MATERIALS AND METHODS

A cross-sectional study recruiting 1,021 female participants was performed. The variables included breast cancer knowledge, socio-demographic features, breast self-examination knowledge and practice. Descriptive statistics was used to compare and analyze the collected data while chi-square test was used to check the statistical significance among the selected variables. Saudi married women from Asir region were the participants of this cross-sectional study.

RESULTS

Our findings suggested that participants had a satisfactory level of knowledge about breast self-examination and mammograms at a rate of > 90% and 44.76% respectively. Over 90% of participants had good breast self-exam knowledge, however, only 6.37% was always performed breast self-examination. Similarly, nearly 40% of participants performed mammograms, while 40.5% were unaware. Leaflets and doctors were the primary sources of information for participants regarding the information of breast cancer screening.

CONCLUSIONS

Breast self-examination is a crucial approach to the timely detection of breast cancer and is subsequently critical for effective treatment. From the findings of this study we concluded that most women in the Asir region have a good awareness of breast cancer screening methods. However, either screening of self-examination or mammogram for breast cancer was not carried out thoroughly and regularly. This means that we must continue to emphasize the importance of primary health care in the earliest stages of breast cancer.

Biodiversity of commercially important finfish species caught by mid-water and bottom trawls from two different coasts of Arabian Sea: Threats and conservation strategies

This study was conducted to estimate the diversity and the occurrence of commercially important finfish species collected by twenty fish sampling site of Sindh and Baluchistan coasts of the Arabian Sea in Pakistan from January to December 2019. Additionally, physicochemical characteristics of seawater were analyzed from these selected sites and found to be within suitable ranges required for fish growth and survive. A total of 81287 fish individuals were collected and identified as 49 species belonging to 26 families in our study. The most diversified family was Sparidae (13 species) followed by Carangidae and Lutjanidae (4 species), Mullidae, Serranidae, Ariidae (3 species), and Sciaenidae (2 species). The remaining 20 families were represented by only one species. The values of Shannon diversity index calculated for the four selected habitats revealed that high fish diversity was reported at Sonmiani Coast (H'=1.81), while less at Ormara Coast (H'=0.23). Likewise, Evenness index (E) was high at Sonmiani Coast (E=0.50) and less fish diversity was reported at Ormara Coast (E=0.06). Reducing risks to threatened marine species in coastal habitats also requires conservation actions at multiple scales. Thus, it was concluded that our study could be valuable in providing the more information's regarding to the diversity of finfish species and their occurrence along the Pakistan Coast. Further, to better understand the effects, regular monitoring and conservation measures should be taken to mitigate the influence of anthropogenic activities and protect finfish diversity from further decline.

Machine learning based decipherment of Cell Population Data: a promising hospital front-door screening tool for COVID-19

Introduction/Objective

Key challenges against early diagnosis of COVID-19 are its symptoms sharing nature and prolong SARS-CoV-2 PCR turnaround time. Hither machine learning (ML) tools experienced by routinely generated clinical data; potentially grant early prediction.

Methods/Case Report

Routine and earlier diagnostic data along demographic information were extracted for total of 21,672 subsequent presentations. Along conventional statistics, multilayer perceptron (MLP) and radial basis function (RBF) were applied to predict COVID-19 from pre-pandemic control. Three feature sets were prepared, and performance evaluated through stratified 10-fold cross validation. With differing predominance of COVID-19, multiple test sets were created and predictive efficiency was evaluated to simulate real-fashion performance against fluctuating course of pandemic. Models validation was also inducted in prospective manner on independent dataset, equating framework forecasting to conclusions from PCR.

Results (if a Case Study enter NA)

RBF model attained superior cross entropy error 20.761(7.883) and 20.782(3.991) for Q-Flags and Routine Items respectively while MLP outperformed for cell population data (CPD) parameters with value of 6.968(1.259) for ‘training(testing)’. Our CPD driven MLP framework in challenge of lower (<5%) COVID-19 predominance affords greater negative predictive values (NPV >99%). Higher accuracy (%correct 92.5) was offered during prospective validation using independent dataset. Sensitivity analysis advances illusive accuracy (%correct 94.1) and NPV (96.9%). LY-WZ, Blasts/Abn Lympho?, ‘HGB Interf?’, and ‘RBC Agglutination?’ are among novel enlightening study attributes.

Conclusion

CPD driven ML tools offer efficient screening of COVID-19 patients at presentation to hospital to backing early expulsion and directing patients’ flow-from amid the initial presentation to hospital.

Phosphorus supplementation modulates nitric oxide biosynthesis and stabilizes the defence system to improve arsenic stress tolerance in mustard

The interaction of mineral nutrients with metals/metalloids and signalling molecules is well known. In the present study, we investigated the effect of phosphorus (P) in mitigation of arsenic (As) stress in mustard (Brassica juncea L.). The study was conducted to investigate potential of 30 mg P·kg^-1 soil P supplement (diammonium phosphate) to cope up with the adverse effects of As stress (24 mg As·kg^-1 soil) in mustard plants Supplementation of P influenced nitric oxide (NO) generation, which up-regulated proline metabolism, ascorbate-glutathione system and glyoxalase system and alleviated the effects of on photosynthesis and growth. Arsenic stress generated ROS and methylglyoxal content was scavenged through P-mediated NO, and reduced As translocation from roots to leaves. The involvement of NO under P-mediated alleviation of As stress was substantiated with the use of cPTIO (NO biosynthesis inhibitor) and SNP (NO inducer). The reversal of P effects on photosynthesis under As stress with the use of cPTIO emphasized the role of P-mediated NO in mitigation of As stress and protection of photosynthesis The results suggested that P reversed As-induced oxidative stress by modulation of NO formation, which regulated antioxidant machinery. Thus, P-induced regulatory interaction between NO and reversal of As-induced oxidative stress for the protection of photosynthesis may be suggested for sustainable crops.

Gut microbiota of animals living in polluted environments are a potential resource of anticancer molecules

Cancer is a prominent cause of morbidity and mortality worldwide, in spite of advances in therapeutic interventions and supportive care. In 2018 alone, there were 18·1 million new cancer cases and 9·6 million deaths indicating the need for novel anticancer agents. Plant-based products have often been linked with protective effects against communicable and non-communicable diseases. Recently, we have shown that animals such as crocodiles thrive in polluted environments and are often exposed to carcinogenic agents, but still benefit from prolonged lifespan. The protective mechanisms shielding them from cancer could be attributed to the immune system, and/or it is possible that their gut microbiota produce anticancer molecules. In support, several lines of evidence suggest that gut microbiota plays a critical role in the physiology of its host. Here, we reviewed the available literature to assess whether the gut microbiota of animals thriving in polluted environment possess anticancer molecules.

Gut microbiome and human health under the space environment

The gut microbiome is well recognized to have a pivotal role in regulation of the health and behaviour of the host, affecting digestion, metabolism, immunity, and has been linked to changes in bones, muscles and the brain, to name a few. However, the impact of microgravity environment on gut bacteria is not well understood. In space environments, astronauts face several health issues including stress, high iron diet, radiation and being in a closed system during extended space missions. Herein, we discuss the role of gut bacteria in the space environment, in relation to factors such as microgravity, radiation and diet. Gut bacteria may exact their effects by synthesis of molecules, their absorption, and through physiological effects on the host. Moreover we deliberate the role of these challenges in the dysbiosis of the human microbiota and possible dysregulation of the immune system.

Molecular characterization of Orientia tsutsugamushi causing scrub typhus among febrile patients in north-central Bangladesh

Scrub typhus is a mite-borne rickettsial disease caused by Orientia tsutsugamushi, which is endemic in Asia Pacific region. In this study, infection rate and molecular epidemiologic traits of O. tsutsugamushi was investigated in Mymensingh, located in north-central Bangladesh. Among the blood samples from 453 febrile patients who visited Mymensingh medical college hospital in 2018, the 47 kDa protein gene of O. tsutsugamushi was detected in 78 samples (17.2%) by nested PCR. Phylogenetic analysis of the O. tsutsugamushi 56 kDa protein gene (18 samples) revealed a predominance of Karp-related genotype (89%), while the remaining belonged to Gilliam genotype. Samples of the Karp-related genotype mostly clustered with those of China, Taiwan, Thailand and India, etc., in emergent subgroups clades 2 and 4, which were distinct from clade 1, including prototype Karp strains. Among the 18 samples, three variable domains (VD) of 56 kDa type-specific antigen had different types of sequence diversity; VDI contained two or three repeats of eight amino acid units, while VDII and VDIII had amino acid substitution, deletion or insertion. The present study documented a potentially high prevalence of genetically diverse O. tsutsugamushi in north-central Bangladesh.

Spectral functions of one-dimensional systems with correlated disorder

We investigate the spectral function of Bloch states in a one-dimensional tight-binding non-interacting chain with two different models of static correlated disorder, at zero temperature. We report numerical calculations of the single-particle spectral function based on the Kernel polynomial method, which has an [Formula: see text] computational complexity. These results are then confirmed by analytical calculations, where precise conditions were obtained for the appearance of a classical limit in a single-band lattice system. Spatial correlations in the disordered potential give rise to non-perturbative spectral functions shaped as the probability distribution of the random on-site energies, even at low disorder strengths. In the case of disordered potentials with an algebraic power-spectrum, [Formula: see text] [Formula: see text], we show that the spectral function is not self-averaging for [Formula: see text].

Effectiveness of a brief group psychological intervention for women in a post-conflict setting in Pakistan: a single-blind, cluster, randomised controlled trial

BACKGROUND

Many women are affected by anxiety and depression after armed conflict in low-income and middle-income countries, yet few scalable options for their mental health care exist. We aimed to establish the effectiveness of a brief group psychological intervention for women in a conflict-affected setting in rural Swat, Pakistan.

METHODS

In a single-blind, cluster, randomised, controlled trial, 34 community clusters in two union councils of rural Swat, Pakistan, were randomised using block permutation at a 1:1 ratio to intervention (group intervention with five sessions incorporating behavioural strategies facilitated by non-specialists) or control (enhanced usual care) groups. Researchers responsible for identifying participants, obtaining consent, enrolment, and outcome assessments were masked to allocation. A community cluster was defined as neighbourhood of about 150 households covered by a lady health worker. Women aged 18-60 years who provided written informed consent, resided in the participating cluster catchment areas, scored at least 3 on the General Health Questionnaire-12, and at least 17 on the WHO Disability Assessment Schedule were recruited. The primary outcome, combined anxiety and depression symptoms, was measured 3 months after the intervention with the Hospital Anxiety and Depression Scale (HADS). Modified intention-to-treat analyses were done using mixed models adjusted for covariates and clusters defined a priori. The trial is registered with the Australian New Zealand Clinical Trials Registry, number 12616000037404, and is now closed to new participants.

FINDINGS

From 34 eligible community clusters, 306 women in the intervention group and 306 women in the enhanced usual care (EUC) group were enrolled between Jan 11, 2016, and Aug 21, 2016, and the results of 288 (94%) of 306 women in the intervention group and 290 (95%) of 306 women in the EUC group were included in the primary endpoint analysis. At 3 months, women in the intervention group had significantly lower mean total scores on the HADS than women in the control group (10·01 [SD 7·54] vs 14·75 [8·11]; adjusted mean difference [AMD] -4·53, 95% CI -7·13 to -1·92; p=0·0007). Individual HADS anxiety scores were also significantly lower in the intervention group than in the control group (5·43 [SD 4·18] vs 8·02 [4·69]; AMD -2·52, 95% CI -4·04 to -1·01), as were depression scores (4·59 [3·87] vs 6·73 [3·91]; AMD -2·04, -3·19 to -0·88). No adverse events were reported in either group.

INTERPRETATION

Our group psychological intervention resulted in clinically significant reductions in anxiety and depressive symptoms at 3 months, and might be a feasible and effective option for women with psychological distress in rural post-conflict settings.

FUNDING

WHO through a grant from the Office for Foreign Disaster Assistance.

Out-of-office blood pressure measurement for the diagnosis of hypertension in pregnancy: Survey of Canadian Obstetric Medicine and Maternal Fetal Medicine specialists

Background

Multiple hypertension guidelines recommend out-of-office measurements for the diagnosis of hypertension in non-pregnant adults, whereas pregnancy guidelines recommend in-office blood pressure measurements. The objective of our study was to determine how Canadian Obstetric Medicine and Maternal Fetal Medicine specialists measure blood pressure in pregnancy.

Methods

An email survey was sent to 69 Canadian Obstetric Medicine and Maternal Fetal Medicine specialists in academic centers across Canada to explore the practice patterns of blood pressure measurement in pregnant women.

Results

The response rate was 48%. The majority of respondents (63.6%) preferred office blood pressure measurement for diagnosing hypertension, but relied on home blood pressure readings for ongoing monitoring and management of hypertension during pregnancy (59.4%). The preferred method of out-of-office blood pressure measurement was home monitoring; 24-hour ambulatory blood pressure monitoring was not used due to limited availability and cost.

Conclusions

There is wide practice variation in methods of measuring blood pressure among Canadian specialists managing hypertension in pregnancy.

Adenoma Malignum of the Uterine Cervix: A Case Report

Adenoma malignum (AM) of the uterine cervix, otherwise known as minimal deviation adenocarcinoma, is a rare variant of cervical adenocarcinoma, which represents a diagnostic challenge, due to its benign-resembling histological characteristics. We present a case of 54-year-old nullipara woman presented with menorrhagia for 2 years and that had worsened over the past few months. Transabdominal ultrasound fibroid uterus with cluster of nabothian cysts was in the cervix. Subsequently MRI was done for better characterization and showed intramural myomas in the uterine body. A large ovoid mass containing multiple cystic components in the left side of cervix communicating with a tract to the cervical canal, which was consistent with features of adenoma malignum of the cervix. Then the differential diagnosis was included tunnel cluster nabothian cysts. The patient underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy. The final histopathologic diagnosis revealed adenoma malignum of the cervix and intramural myomas. Subsequently, a review of literature was performed and the results demonstrated that early diagnosis, clinical stage and surgical protocols are the main factors affecting the prognosis of AM. Close follow-up of the cases may provide more information regarding this disease and the efficacy of the available therapeutic methods.

Gut bacteria of cockroaches are a potential source of antibacterial compound(s)

Here, we hypothesized that the microbial gut flora of animals/pests living in polluted environments, produce substances to thwart bacterial infections. The overall aim of this study was to source microbes inhabiting unusual environmental niches for potential antimicrobial activity. Two cockroach species, Gromphadorhina portentosa (Madagascar) and Blaptica dubia (Dubia) were selected. The gut bacteria from these species were isolated and grown in RPMI 1640 and conditioned media were prepared. Conditioned media were tested against a panel of Gram-positive (Methicillin-resistant Staphylococcus aureus, Streptococcus pyogenes, Bacillus cereus) and Gram-negative (Escherichia coli K1, Salmonella enterica, Serratia marcescens, Pseudomonas aeruginosa, Klebsiella pneumoniae) bacteria, as well as the protist pathogen, Acanthamoeba castellanii. The results revealed that the gut bacteria of cockroaches produce active molecule(s) with potent antibacterial properties, as well as exhibit antiamoebic effects. However, heat-inactivation at 95°C for 10 min had no effect on conditioned media-mediated antibacterial and antiamoebic properties. These results suggest that bacteria from novel sources i.e. from the cockroach's gut produce molecules with bactericidal as well as amoebicidal properties that can ultimately lead to the development of therapeutic drugs.

SIGNIFICANCE AND IMPACT OF THE STUDY

The bacteria isolated from unusual dwellings such as the cockroaches' gut are a useful source of antibacterial and antiamoebal molecules. These are remarkable findings that will open several avenues in our search for novel antimicrobials from unique sources. Furthermore studies will lead to the identification of molecules to develop future antibacterials from insects.

Effect of different levels of protein concentrates supplementation on the growth performance, plasma amino acids profile and mTOR cascade genes expression in early-weaned yak calves

Objective

This study evaluated the effects of different levels of protein concentrate supplementation on the growth performance of yak calves, and correlated the growth rate to changes occurring in the plasma- amino acids, -insulin profile, and signaling activity of mammalian target of rapamycin (mTOR) cascade to characterize the mechanism through which the protein synthesis can be improved in early weaned yaks.

Methods

For this study, 48 early (3 months old) weaned yak calves were selected, and assigned into four dietary treatments according to randomized complete block design. The four blocks were balanced for body weight and sex. The yaks were either grazed on natural pasture (control diet) in a single herd or the grazing yaks was supplemented with one of the three protein rich supplements containing low (17%; LP), medium (19%; MP), or high (21%; HP) levels of crude proteins for a period of 30 days.

Results

Results showed that the average daily gain of calves increased (0.14 vs 0.23–0.26 kg; p<0.05) with protein concentrates supplementation. The concentration of plasma methionine increased (p<0.05; 8.6 vs 10.1–12.4 μmol/L), while those of serine and tyrosine did not change (p>0.05) when the grazing calves were supplemented with protein concentrates. Compared to control diet, the insulin level of calves increased (p<0.05; 1.86 vs 2.16–2.54 μIU/mL) with supplementation of protein concentrates. Addition of protein concentrates up-regulated (p<0.05) expression of mTOR-raptor, mammalian vacuolar protein sorting 34 homolog, the translational regulators eukaryotic translation initiation factor 4E binding protein 1, and S6 kinase 1 genes in both Longissimus dorsi and semitendinosus. In contrast, the expression of sequestosome 1 was down-regulated in the concentrate supplemented calves.

Conclusion

Our results show that protein supplementation improves the growth performance of early weaned yak calves, and that plasma methionine and insulin concentrations were the key mediator for gene expression and protein deposition in the muscles.

Moringa oleifera-rich diet and T cell calcium signaling in spontaneously hypertensive rats

Moringa oleifera is a plant whose fruits, roots and leaves have been advocated for traditional medicinal uses. The physicochemical analysis shows that Moringa oleifera contains more dietary polyunsaturated fatty acids (PUFA) than saturated fatty acids (SFA). The consumption of an experimental diet enriched with Moringa oleifera extracts lowered blood pressure in spontaneously hypertensive rats (SHR), but not in normotensive Wistar-Kyoto (WKY) rats as compared to rats fed an unsupplemented control diet. Anti-CD3-stimulated T cell proliferation was diminished in both strains of rats fed the Moringa oleifera. The experimental diet lowered secretion of interleukin-2 in SHR, but not in WKY rats compared with rats fed the control diet. Studies of platelets from patients with primary hypertension and from SHR support the notion that the concentration of intracellular free calcium [Ca(2+)](i) is modified in both clinical and experimental hypertension. We observed that the basal, [Ca(2+)](i) was lower in T cells of SHR than in those of WKY rats fed the control diet. Feeding the diet with Moringa oleifera extracts to WKY rats did not alter basal [Ca(2+)](i) in T cells but increased basal [Ca(2+)](i) in SHR. Our study clearly demonstrated that Moringa oleifera exerts antihypertensive effects by inhibiting the secretion of IL-2 and modulates T cell calcium signaling in hypertensive rats.

Magnetic Resonance Cholangiopancreatography (MRCP) Evaluation of Obstructive Jaundice in Comparison with Endoscopic Retrograde Cholangiopancreatography (ERCP)

This cross sectional study was carried out in the department of Radiology and Imaging in collaboration with Department of Gastroenterology of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from July 2013 to June 2014 to evaluate the efficacy of Magnetic resonance cholangiopancreatography (MRCP) and ERCP in the management of obstructive jaundice and also to determine diagnostic validity accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of MRCP in evaluation of obstructive jaundice. For this purpose, a total of 60 patients with obstructive jaundice who underwent MRCP and Endoscopic retrograde cholangiopancreatography (ERCP) in the above mentioned hospital were enrolled. More than one third (35.0%) patients were in 5th decade and the mean age was 46.2±12.9 years. Male female ratio was 1.1:1. Most (45.0%) of the patients had filling defect, 28.3% had concentric stenosis and 26.7% eccentric stenosis. In MRCP findings more than one third (35.0%) patients had choledocholithiasis followed by 26.7% had cholangiocarcinoma, 10.0% benign CBD stricture and 8.3% had ascariasis. In ERCP findings 31.7% patients had choledocholithiasis followed by 16.7% had cholangiocarcinoma, 13.3% benign CBD stricture and 10.0% ascariasis. All patients had increased serum bilirubin.

Selective Screening for Organic Acidurias and Amino Acidopathies in Pakistani Children

OBJECTIVE

To determine the frequency of organic acidurais (OA) and amino acidopathies (AA) in selected high-risk patients screened in two years.

STUDY DESIGN

Retrospective Observational study.

PLACE AND DURATION OF STUDY

The Aga Khan University Hospital (AKUH), Karachi, from January 2013 to December 2014.

METHODOLOGY

Patients with OA and AA were included in the study and patients with IMDs other than OA and AA were excluded. Amino acids and organic acids were analyzed on high performance liquid chromatography and gas chromatography-mass spectrometry respectively. Clinical data and chromatograms of patients screened for IMDs were reviewed by chemical pathologist and metabolic physician.

RESULTS

Eighty-eight cases (4.7%) were diagnosed including 41 OA (46.5%), 28 AA (31.8%) and 19 others (21.5%) from 1,866 specimens analyzed. Median age of the patients was 1.1 years, with high consanguinity rate (64.8%). Among OA, methyl CoA mutase deficiency was diagnosed in 9 (10.2%) and was suspected in 2 (2.3%) cases. Five (5.7%) cases of MHBD (2-methyl-3-hydroxybutyryl-CoA), 4 (4.5%) each of PPA (propionic aciduria) and HMG-CoA lyase deficiency, 3 (3.4%) cases each of IVA (isovaleric aciduria), multiple carboxylase deficiency, fructose-1, 6-biphosphatase deficiency, fumarase deficiency, GA-1 (glutaric aciduria type 1) and 2 (2.3%) cases of EMA (ethyl-malonic aciduria). AA included 8 (9.1%) cases of MSUD (maple syrup urine disease), 6 (6.8%) cases of CBS (cystathionine beta-synthetase) and UCDs (urea cycle disorders) each, 5 (5.7%) cases of hyperphenylalaninemia and 3 (3.4%) cases of hyperprolinemia were reported. Other inherited metabolic disorders included: 9 (10.2%) cases of intracellular cobalamin defects, 2 (2.3%) cases each of alkaptonuria, Canavan's disease, SUCL (succinate CoA ligase) deficiency, and 1 (1.1%) case each of DPD (dihydropyrimidine) deficiency, GA-2, NKH (non-ketotic hyperglycinemia), AADC (aromatic amino acid decarboxylase) deficiency.

CONCLUSION

This study presents frequency of OA and AA in the high-risk Pakistani pediatric population analyzed locally.

Moringa olifeira Lam. Stimulates Activation of the Insulin-Dependent Akt Pathway. Antidiabetic Effect in a Diet-Induced Obesity (DIO) Mouse Model

We investigated the antidiabetic effect of Moringa olifeira Lam. in a diet-induced obesity (DIO) mouse model. Six mice were randomly selected as normal controls. Moringa olifeira Lam. leaf extract at a dose of 200, 400 or 600 mg/kg body weight, glibenclamide (Glib) at the dose of 10 mg/kg (positive control) and distilled water at 10 ml/kg (control group) were administered orally by gastric intubation, and each group consisted of six mice. Insulinsensitive tissues (liver, skeletal muscle) were collected to investigate antidiabetic effects and examine the plant's molecular mechanisms. Moringa olifeira Lam. leaf extract prevented weight gain. It also reduced blood glucose in DIO mice. Glib and Moringa olifeira Lam. leaf extract, 400 mg/kg, treatments restored insulin levels towards normal values (P < 0.05 versus diabetic control group). Western immunoblot analysis of different tissues, collected at the end of the study, demonstrated that Moringa olifeira Lam. stimulated activation of the insulin-dependent Akt pathway and increased the protein content of Glut 4 in skeletal muscle. The improvement of hepatic steatosis observed in DIO-treated mice was associated with a decrease in the hepatic content of SREBP-1, a transcription factor involved in de novo lipogenesis. The hepatic PPARα protein content in the plant extract- treated mice remained significantly higher than those of the control group (P < 0.05). In conclusion, this study provides the first evidence for direct action of Moringa olifeira Lam. on pancreatic β-cells, enhancing glucose-stimulated insulin secretion. This correlated with hypoglycaemic effects in diabetic mice associated with restored levels of plasma insulin.

A New Model of Master of Philosophy in Physiological Sciences

The objectives of Master of Philosophy (MPhil) in Physiological Sciences are: 1) to describe the new ways in which anatomy, biochemistry and physiology on one hand, and microbiology, pathology and pharmacology on other hand meet their functional requirements through multidisciplinary integrated concepts; 2) to elucidate relationships between cell biology, molecular biology and molecular genetics by connecting dots of how cell functions are driven by molecules and being controlled by genes. This forms the basis of cell, molecular and genetics [CMG] module upon which 7 multidisciplinary modules of Physiological Sciences follow; 3) these 24 credit hours provide the physiological basis for PhD studies as well as faculty development to enhance learning abilities of medical student; 4) the modules constitute Cardio- Respiratory Physiological Sciences, GI and Renal Physiological Sciences, Neurosciences, Endo-Reproductive Physiological Sciences.; 5) it has integrated microbiology, pathology and pharmacology in a unique way through CMG of microbes leading to associated pathology and mechanisms of prescribed drugs; 6) it has additional synopsis and thesis friendly course work leading to comprehensive examinations; 7) the year two deals with research work of 6 credit hours leading to defense of thesis; 8) The MPhil in Physiological Sciences is fundamentally different from what is being offered elsewhere. It prepares and offers a good spring board to dovetail PhD studies as well as faculty and institutional development.

This is the first study that deals with innovative programmes in research, learning and education in the field of physiological sciences. This broad-based MPhil would make its recipients competent, critical, confident and productive learner. This is a completely unique design of a curriculum that has no comparable examples elsewhere. Our mission is to educate graduate students in the field of Physiological Sciences such that they have a complete grasp over the broad-based integrated concepts of basic health sciences. Upon completion of their education, the students will be able to use the duality of imagination and skepticism. Hence, the students will contribute to their fields by unfolding their creative energy.

Improving management of type 2 diabetes in South Asian patients: a systematic review of intervention studies

OBJECTIVES

Optimal control of type 2 diabetes is challenging in many patient populations including in South Asian patients. We systematically reviewed studies on the effect of diabetes management interventions targeted at South Asian patients with type 2 diabetes on glycaemic control.

DESIGN

Systematic review of MEDLINE, EMBASE and CINAHL databases for randomised controlled trials (RCTs) and pre-post-test studies (January 1990 to February 2014). Studies were stratified by where interventions were conducted (South Asia vs Western countries).

PARTICIPANTS

Patients originating from Pakistan, Bangladesh or India with type 2 diabetes.

PRIMARY OUTCOME

Change in glycated haemoglobin (HbA1c). Secondary end points included change in blood pressure, lipid levels, anthropomorphics and knowledge.

RESULTS

23 studies (15 RCTs) met criteria for analysis with 7 from Western countries (n=2532) and 16 from South Asia (n=1081). Interventions in Western countries included translated diabetes education, additional clinical care, written materials, visual aids, and bilingual community-based peers and/or health professionals. Interventions conducted in South Asia included yoga, meditation or exercise, community-based peers, health professionals and dietary education (cooking exercises). Among RCTs in India (5 trials; n=390), 4 demonstrated significant reductions in HbA1c in the intervention group compared with usual care (yoga and exercise interventions). Among the 4 RCTs conducted in Europe (n=2161), only 1 study, an education intervention of 113 patients, reported a significant reduction in HbA1c with the intervention. Lipids, blood pressure and knowledge improved in both groups with studies from India more often reporting reductions in body mass index and waist circumference.

CONCLUSIONS

Overall, there was little improvement in HbA1c level in diabetes management interventions targeted at South Asians living in Europe compared with usual care, although other outcomes did improve. The smaller studies in India demonstrated significant improvements in glycaemic and other end points. Novel strategies are needed to improve glycaemic control in South Asians living outside of India.

A Comprehensive Study on Mo/CdTe Metal-Semiconductor Interface Deposited by Radio Frequency Magnetron Sputtering

Metal-semiconductor (MS) junction between Mo and CdTe, which is one of the fundamental issues for CdTe based solar cell, has been investigated for films deposited on different substrates. XRD pattern of Mo/CdTe films on the polyimide (PI) substrate shows a strong preferential orientation of MoTe2 in (100) at 2θ = 29.44 degrees, which becomes less apparent as deposition time of CdTe increases. However, on soda lime glass (SLG) no such XRD reflection pattern is observed. Moreover, from EDX measurement, Mo-Te compound also identifies MoTe2 at Mo/CdTe interface on PI substrate, which is not present on SLG. Bulk carrier concentration of Mo/CdTe films on PI substrate for lower deposition time of CdTe is found 1.42 x 10(18) cm(-3), which is almost equal to MoTe2. Thereafter, it decreases as CdTe growth time increases. The type of unintentionally formed MoTe2 on PI substrate is found to be n-type in nature. Lattice constants of a = 6.5 Å for CdTe and a = 3.52 Å for MoTe2 are found from nanostructure study by TEM.

Effect of Sn Doping on the Properties of Nano-Structured ZnO Thin Films Deposited by Co-Sputtering Technique

In this study, tin doped zinc oxide (ZnO:Sn) nano-structured thin films were successfully deposited by co-sputtering of ZnO and Sn on top of glass substrate. The effect of Sn doping on the microstructure, phase, morphology, optical and electrical properties of the films were extensively investigated by means of XRD, EDX, SEM, AFM, Hall Effect measurement, and UV-Vis spectrometry. The results showed that the undoped ZnO film exhibited preferred orientation along the c-axis of the hexagonal wurtzite structure. With increase of Sn doping, the peak position of the (002) plane was shifted to the higher 20 values, and ultimately changed to amorphous structure. The absorption edge was shifted to blue region which confirmed the excitonic quantum confinement effect in the films. Consequently, improved surface morphology with optical bandgap, reduced average particle size, reduced resistivity, enhanced Hall mobility and carrier concentration were observed in the doped films after vacuum annealing. Among all of the as-deposited and annealed ZnO:Sn films investigated in this study, annealed film doped with 8 at.% of Sn concentration exhibited the best properties with a bandgap of 3.84 eV, RMS roughness of 2.51 nm, resistivity of 2.36 ohm-cm, and Hall mobility of 83 cm2 V(-1) s(-1).

The Relationship between Total Water Intake and Cognitive Control among Prepubertal Children

BACKGROUND

Cognitive control (also known as executive function) encompasses mental processes that underlie goal-directed behavior, and it enables us to adjust our behavior according to changing environmental demands. Previous research among children has demonstrated that aerobic fitness and obesity have contrasting and selective effects on cognitive control. However, the relationship between water intake and childhood cognitive control remains inadequately studied. This study investigated the relationship between total water intake and cognitive control among prepubertal children (8-9-year olds).

METHODS

Children between 8 and 9 years of age (n = 63) performed a modified flanker task to assess cognitive control related to inhibition (ability to resist distractions and maintain focus). Diet was measured using 3-day food records. Total water was defined as water consumed from drinking water, beverages, and food.

RESULTS

A comparison of task performance across the median intake of total water revealed that children above the median exhibited shorter reaction times across multiple conditions of the flanker task, requiring variable amounts of cognitive control. Further, after adjustment of age, IQ, socioeconomic status, weight status, and aerobic fitness level, the proportion of intake comprised of water (%TW) was negatively correlated with reaction time interference, that is, the ability to maintain task performance when task conditions demanded greater inhibition.

CONCLUSIONS

These results indicate an association between water intake and cognitive control using a task that modulates inhibition. Specifically, higher water intake correlated with greater ability to maintain task performance when inhibitory demands are increased. Future work is needed to determine the mechanism by which water influences cognitive control among children.

Diabetes in the young: a population-based study of South Asian, Chinese and White people

AIMS

Rates of diabetes mellitus in the young have not been quantified on a population level, particularly in South Asian and Chinese populations, which bear high rates of diabetes. We determined the incidence of diabetes (Type 2 diabetes and diabetes using insulin only) and rates of hospitalizations among South Asian, Chinese and White people aged 5-29 years with newly diagnosed diabetes.

METHODS

People with newly diagnosed diabetes (1997-2006) in British Columbia, Canada were identified using population-based administrative data and pharmacy databases. Age-standardized incidence rates were calculated for people with diabetes prescribed insulin only and those with Type 2 diabetes. They were followed for up to 8 years for all hospitalizations and diabetes-related complications.

RESULTS

There were 712 South Asians, 498 Chinese and 6176 White people aged 5-29 years with diabetes. Most youth with diabetes had Type 2 diabetes (South Asian 86.4%; Chinese 87.1% and White 61.8%). The incidence of diabetes on insulin only was highest in White people compared with the other groups. The incidence of Type 2 diabetes was highest in South Asians, particularly in 20-29-year-olds, with rates 2.2 times that of White people and 3.1 times that of Chinese people. Hospitalization and diabetes-related complications were uncommon in all groups.

CONCLUSION

The incidence of Type 2 diabetes is higher than previously estimated among youth and is now surpassing diabetes on insulin only. Significant reductions in Type 2 diabetes screening ages in South Asians need to be considered and prevention efforts are urgently required in childhood and adolescence. Global estimates need to consider the epidemic of Type 2 diabetes in the young.

Application of SCAR markers linked with mungbean yellow mosaic virus disease-resistance gene in Pakistan mungbean germplasm

Mungbean yellow mosaic virus disease (MYMVD) caused by single-stranded DNA begomovirus is the most prominent threat to the mungbean crop in Pakistan. Mungbean genotypes consisting of 127 varieties/lines were screened for MYMVD under natural field conditions. No genotypes were found to be immune or highly resistant against MYMVD. Genotypes showing resistant and tolerant responses in field screening trials were screened using sequence characterized amplified region (SCAR) markers linked with the MYMVD-resistance gene. SCAR markers amplified the desired band only in the resistant and tolerant genotypes, while no amplification was observed in susceptible genotypes. SCAR markers will be useful for future breeding and varietal developmental programs and mungbean genotypes can be screened on the molecular level.

CD36 AA genotype is associated with decreased lipid taste perception in young obese, but not lean, children

BACKGROUND/OBJECTIVE

Obesity is an alarming threat for all age groups, including children. Fat overconsumption is one of the factors that directly influences this pathology. Recent studies have suggested that a common variant in the CD36 gene, that is, single-nucleotide polymorphism (SNP) rs1761667-A allele, that reduces CD36 expression, associates with high oral fat detection thresholds in some obese subjects. The objective was to assess fatty acid sensitivity in relation to CD36 SNP in young lean and obese children.

SUBJECTS/METHODS

We studied lingual detection thresholds for emulsions, containing oleic acid, in Algerian children (n=116, age=8±0.5 years) who were divided into two groups: obese (n=57; body mass index (BMI) z-score=2.513±0.490) and lean children (n=59; BMI z-score=-0.138±0.601) by alternative-forced choice method. To correlate the lipid taste perception thresholds with CD36 SNP, the children were genotyped for A/G SNP rs1761667 in 5'UTR region of CD36 by using PCR and restriction fragment length polymorphism.

RESULTS

We noticed significantly higher CD36 A-allele frequency (P=0.036) in young obese children compared with leans. CD36 A-allele was associated with higher lipid taste perception thresholds than G-allele in obese children, but not in lean controls. Moreover, waist circumference was positively correlated with reduced fat taste sensitivity in these children.

CONCLUSIONS

CD36 SNP A-allele, being present both in young lean and in obese children, is associated with high threshold for fatty acid taste sensitivity only in obese children.

Prescribing patterns and adherence to medication among South-Asian, Chinese and white people with type 2 diabetes mellitus: a population-based cohort study

AIM

To determine the prescribing of and adherence to oral hypoglycaemic agents, insulin, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and statin therapy among South-Asian, Chinese and white people with newly diagnosed diabetes.

METHODS

The present study was a population-based cohort study using administrative and pharmacy databases to include all South-Asian, Chinese and white people aged ≥ 35 years with diabetes living in British Columbia, Canada (1997-2006). Adherence to each class of medication was measured using proportion of days covered over 1 year with optimum adherence defined as ≥ 80%.

RESULTS

The study population included 9529 South-Asian, 14 084 Chinese and 143 630 white people with diabetes. The proportion of people who were prescribed angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, statin or oral hypoglycaemic agents was ≤ 50% for all groups. South-Asian and Chinese people had significantly lower adherence for all medications than white people, with the lowest adherence to angiotensin-converting enzyme inhibitor treatment (South-Asian people: adjusted odds ratio 0.37, 95% CI 0.34-0.39; P<0.0001; Chinese people: adjusted odds ratio 0.50, 95% CI 0.47-0.54; P<0.0001) and statin therapy (South-Asian people: adjusted odds ratio 0.47, 95% CI 0.41 - 0.53, P < 0.0001; Chinese people: adjusted odds ratio 0.72, 95% CI 0.67 - 0.77; P<0.0001) compared with white people.

CONCLUSION

Adherence to evidence-based pharmacotherapy was substantially worse among the South-Asian and Chinese populations. Care providers need to be alerted to the high levels of non-adherence in these groups and the underlying causes need to be investigated.

Miliary nodules in a patient of allergic bronchopulmonary aspergilosis

Allergic bronchopulmonary aspergilosis (ABPA) is immunological pulmonary disease caused by hypersensitivity of aspergillus fumigatus usually occurs in patients with chronic asthma, cystic fibrosis and bronchiactasis. This disease may present with divers radiological presentation like; fleeting pulmonary opacities, bronchiactasis, mucoid impaction, perihilar opacity (hailer lymphadenopathy), and lung mass or pleural effusion. We describe the case of a 30 year old housewife who presented with progressive dysponea, low grade fever, dry cough, weight loss and miliary nodule in chest radiograph and high-resolution CT (HRCT) in a tertiary level hospital of Bangladesh. A diagnosis of ABPA was established on the basis of sputum routine microscopy and culture examination for fungus (Aspergillus).

Comparison of creatinine clearance estimates with routine measured creatinine clearance in hospitalized chronic kidney disease patients

The aim of this study was to determine the correlation between endogenous creatinine clearance (BSA adjusted), the Modification of Diet in Renal Disease (MDRD) and Cockcroft-Gault (BSA adjusted) equations in a Bangladeshi population with chronic kidney disease. It was an observational study conducted from July 2011 to January 2012 in the department of Medicine of Mymensingh Medical College Hospital, Mymensingh, Bangladesh. A total of 50 cases with diagnosed Chronic kidney disease (CKD) patients participated in this study. Results are expressed as mean and standard deviation (SD). Pearson correlation coefficient (r) was used to compare the results of conventional creatinine clearance on 24 hour urine collection (BSA adjusted) and creatinine clearance calculated by Cockcroft-Gault creatinine clearance (BSA adjusted) and MDRD creatinine clearance (ml/min/1.73m²) equation. Among 50 patients 30(60%) were male and 20(40%) were female. Mean age of the cases was 43±12.96 years with age range from 18 to 65 years. Mean creatinine clearance measured on 24 hours urine collection (BSA adjusted) was 13.86±8.72ml/min per 1.73m². Mean BSA adjusted Cockcroft-Gault creatinine clearance and MDRD creatinine clearance were 27.68±11.26 and 24.46±11.05ml/min per 1.73m² respectively. There was a positive correlation between both the Modification of Diet in Renal Disease (r=0.951, p<0.05) equation and the Cockcroft-Gault (r=0.948, p<0.05) equation with measured creatinine clearance; the former being statistically superior comparing the correlation coefficients. The creatinine based formulas with their inherent property of convenience and cost effectiveness can be a useful tool for monitoring the progression of disease.

Bilateral hypertrophic olivary nucleus degeneration on magnetic resonance imaging in children with Leigh and Leigh-like syndrome

OBJECTIVE

Bilateral hypertrophic olivary degeneration on brain MRI has been reported in a few metabolic, genetic and neurodegenerative disorders, including mitochondrial disorders. In this report, we sought to analyse whether bilateral symmetrical inferior olivary nucleus hypertrophy is specifically associated with mitochondrial disorders in children.

METHODS

This retrospective study included 125 children (mean age, 7.6 ± 5 years; male:female, 2.6:1) diagnosed with various metabolic and genetic disorders during 2005-2012. The routine MRI sequences (T1 weighted, T2 weighted and fluid-attenuated inversion-recovery sequences) were analysed for the presence of bilateral symmetrical olivary hypertrophy and central tegmental tract or dentate nuclei signal changes. The other imaging findings and the final diagnoses were noted.

RESULTS

The cohort included patients with Leigh and Leigh-like syndrome (n = 25), other mitochondrial diseases (n = 25), Wilson disease (n = 40), Type 1 glutaric aciduria (n = 14), maple syrup urine disease (n = 13), giant axonal neuropathy (n = 5) and L-2 hydroxy glutaric aciduria (n = 3). Bilateral inferior olivary nucleus hypertrophy was noted in 10 patients, all of whom belonged to the Leigh and Leigh-like syndrome group.

CONCLUSION

Bilateral hypertrophic olivary degeneration on MRI is relatively often, but not routinely, seen in children with Leigh and Leigh-like syndrome. Early detection of this finding by radiologists and physicians may facilitate targeted metabolic testing in these children.

ADVANCES IN KNOWLEDGE

This article highlights the occurrence of bilateral hypertrophic olivary nucleus degeneration on MRI in children with Leigh and Leigh-like syndrome, compared with other metabolic disorders.

Serum magnesium in hospital admitted diabetic patients

Magnesium depletion has a negative impact on glucose homeostasis and insulin sensitivity in diabetic patients. Low plasma magnesium concentration is a highly specific indicator of poor magnesium status. This case control study was conducted in Mymensingh Medical College Hospital, Bangladesh, from May 2011 to April 2012. This study was done to assess the serum magnesium level in diabetic and non-diabetic patients and to find out the association between serum magnesium, blood glucose and duration of diabetes mellitus. Serum magnesium concentrations were determined in 50 diabetics and 50 age and sex matched non-diabetic patients or attendants for controls. Among the case and control group 32 were male and 18 were female. Mean age of control group was 54.42±2.33 and study group was 55.78±2.43 years. Duration of diabetes of case group in which 50% of patients have diabetes for up to 4 years, 18% of patients have diabetes for 5-9 years, 5% of patients have for 10-14 years and 2% of patients have diabetes for 15 years and above. Serum magnesium concentrations below the normal reference range for study group was 44% and control group was 6%. The mean serum magnesium level of study group was 0.70±0.01mmol/L and that of control group was 0.83±0.02mmol/L. So, the difference in serum magnesium level between two groups were statistically highly significant (p = 0.001). Correlation between FBS and SML of study group, which is negative (r = - 0.182). There is opposite relation among the characteristics as r is negative. And also correlation between 2HAFB and SML of study group, which is negative (r = - 0.06). There is opposite relation among the characteristics as r is negative.

Risk factors of non-alcoholic fatty liver disease

This case control study was carried out in Mymensingh Medical College Hospital, Mymensingh, Bangladesh and Dhaka Medical College Hospital, Dhaka, Bangladesh from November 2010 to October 2011 to find out the risk factors of non-alcoholic fatty liver disease. A total of 90 participants (45 cases and 45 controls) were included. A higher proportion of patients with age >45 years were found in case group compared to control (51.1% vs. 15.6%). The mean age was significantly higher in case group 49.8±12.6 years. Males demonstrated their predominance in both case (62.2%) and control (68.9%) groups, although the two groups did not differ in terms of sex distribution. Body mass index demonstrates that 26.7% of patients in case group were of normal weight, 46.7% overweight and 26.7% obese. In the control group, two-thirds (68.9%) of the patients were of normal weight and 24.4% overweight and 7.8% obese. Diabetes and hypertension were significantly present in the case group than those in control counterparts 75.6% vs. 15.6% and 86.7% vs. 15.6 % respectively. The mean fasting blood glucose, ALT, total cholesterol and triglycerides were significantly higher in case group compared to control group 7.8±1.3 vs. 5.4±2.5mmol/L (p<0.001); 39.1±12.4 vs. 30.3±14.1IU/L, (p=0.002); 239.9±14.3 vs. 183.3±11.4mg/dl, (p<0.001) and 183.6±12.5 vs. 133.5±16.0mg/dl, (p<0.001) respectively. However, no significant difference was observed between the case and the control groups in terms of HDL cholesterol (35.9±1.2 vs. 38.0±1.1mg/dl, p=0.203). Majority of the patients in case group (88.9%) exhibited increased echogenicity of liver on ultrasonogram as opposed to 15.6% in the control group.

Prediction of oesophageal varices in cirrhosis of liver patients by serum ascitic albumin gradient

This hospital based observational study was carried out to evaluate the relation between serum ascitic albumin gradient and oesophageal varices in cirrhosis of liver disease patient. This was a hospital based observational study on 50 cases of diagnosed cirrhosis of liver disease patients in department of medicine of Mymensingh medical college Hospital, Mymensingh, Bangladesh from 8th January 2012 to 07th July 2012 for a period of 6 months. The study showed age frequency 5(10%) were from 21-30 years, 15(30%) were from 31-40 years 15(30%) were from 40-50years, and 15(30%) were from ≥51 years of age. Out of 50 patients, 38(76%) were male and 12(24%) were female patients. The etiology of liver cirrhosis was hepatitis B virus in 22(44%), hepatitis C virus in 4(8%), alcohol in 1(2%) and others in 23(46%) patients. Twenty four (48%) patients had SAAG value 1.1-1.49, 21(42%) patients had SAAG value 1.5-1.99, 5(10%) patients had Serum Ascitic Albumin Gradient (SAAG) value >2.0 and 16(32%) patients had no oesophageal varices, 11(22%) patients had small straight varices (F1) esophageal varices, 18(36%) patients had less than one-third of the esophageal lumen (F2) oesophageal varices, 5(10%) patients had more than one-third of the esophageal lumen (F3) esophageal varices. The degree of SAAG demonstrate significant statistical association with presence or absence of oesophageal varices (p=0.023) and grades of the oesophageal varices (p=0.001) in patients with cirrhosis of liver disease. So, it was predicted that the presence of oesophageal varices in cirrhosis of liver disease patients with high SAAG without performing endoscopy of upper GIT.

A case of Gaucher's disease progressing to liver cirrhosis

We are going to present a 17 year old female with Gaucher's disease. The patient presented with fever, cough, respiratory distress & abdominal heaviness. There was mild pallor, redness of palm of hands & raised temperature. Liver was hugely enlarged along with splenomegaly. X-ray chest showed non specific bronchiectatic change in both lungs. Ultrasonography of abdomen revealed marked hepatosplenomegaly with no ascites. Bone marrow examination showed cellular marrow with plenty of megakaryocytes. Most of the cells were smear cells & there was histiocytes proliferation & infiltration of bone marrow by small atypical cells. Histologically, lipid was found in hepatocytes in moderate amount. The portal areas showed high lipid contents in macrophages. Different clinical findings & incidental diagnosis of lipid storage disease submerged us in diagnostic dilemma. We give conservative treatment with antibiotic cefuroxime, syrup lactulose & vitamins and this patient was improved.

Pattern of poisoning in a tertiary level hospital

This cross sectional observational study was carried out in the Department of Medicine, Mymensingh Medical College Hospital over a period of 4 months from January 2012 to April 2012 to assess the clinico-epidemiological condition of different types of poisoning and to evaluate immediate hospital outcome. Suspected case of poisoning aged 12 years or above of either sex was included. Patients of paediatric age group, having other co-morbid condition and died before clinical evaluation were excluded. This study revealed that rural people (76.9%), aging 20-30 years (46.3%) were mostly affected in poisoning. Patients belong to low socioeconomic group (65.3%), illiterate (26.5%) and educated up to primary level (29.9%) were mostly identified. Regarding the occupation this study showed student (30.6%) and farmer (25.2%) were predominantly involved. In this series organophosphorus compound (63.9%) poisoning was in the top of the list followed by benzodiazepine (6.8%). Suicidal attempt (81.6%) was found as a motive of poisoning in maximum cases. Among the precipitating factors quarrel with spouse, girl or boy friend (46.9%) were significant in number. In this study outcome was measured as complete recovery (92.5%) and death (3.4%).

The etiologic role of human papillomavirus in penile cancers: a study in Vietnam

Background:

We investigated the aetiologic role of human papillomavirus (HPV) in 120 penile squamous cell carcinomas (PSCCs) from Vietnam.

Methods:

Human papillomavirus DNA was detected by PCR using SPF10 primers and a primer set targeting HPV-16 E6. The INNO-LiPA HPV genotyping kit was used to determine genotype. Human papillomavirus-16 viral load and physical status were determined by real-time PCR. P16^INK4A protein expression was investigated by immunohistochemistry.

Results:

Human papillomavirus DNA was detected in 27 of 120 (23%) PSCCs. The most frequently detected genotype was HPV-16 (24 of 27 cases, 89%). In 16 of 18 (89%) HPV-16-positive cases, the HPV DNA was considered to be integrated into the host genome. The geometric mean of the HPV-16 viral load was 0.4 copies per cell. P16^INK4A overexpression was significantly related to PSCCs infected with high-risk HPV (P=0.018) and HPV-16 copy numbers (P<0.001).

Conclusion:

Human papillomavirus-16 DNA integration and p16^INK4A overexpression in high-risk HPV detected PSCCs suggested an aetiologic role of high-risk HPV in the development of PSCCs.

Comparison of computed tomographic and cytopathological findings in the evaluation of adult orbital mass

An observational study was conducted to demonstrate the role of Computed Tomographic (CT) scan to detect clinically suspected adult orbital mass in 47 patients which could not be differentiated clinically. The CT findings were compared and correlated with the findings of fine needle aspiration cytology (FNAC) or histopathology. CT diagnosis of optic nerve sheath meningioma were 12 cases, among them only nine cases confirmed cytopathologically as meningioma and rest three as lymphoma. Among ten cases of hemangioma, eight cases were confirmed cytopathologically as cavernous hemangioma and rest two were pseudotumor and chronic inflammatory lesion. Seven cases diagnosed as pseudotumor in CT were confirmed cytopathologically. Seven cases diagnosed as paranasal sinus masses with orbital extension (nasopharyngeal angiofibroma) in CT were confirmed cytopathologically. Among three cases of thyroid ophthalmopathy diagnosed in CT, only two cases confirmed cytopathologically and rest one cytopathologic diagnosis was not possible due to inadequate tissue supply during FNAC. Two cases of chronic inflammatory lesion diagnosed in CT, also confirmed cytopathologically. Two cases of metastatic lesion diagnosed in CT, also confirmed cytopathologically. Two cases of lacrimal gland tumor diagnosed in CT, also confirmed cytopathologically i.e., pleomorphic adenoma. Two cases of melanoma diagnosed in CT, only one confirmed cytopathologically and rest one cytopathologic diagnosis was not possible due to frank blood came out during FNAC. Pseudotumors were subsequently diagnosed the non-diagnostic cases on the basis of clinical and radiological findings. It is evident from these findings that CT is a useful modality in the diagnosis of adult orbital masses.