MANAGING ARTHRITIS PAIN: MEDICATIONS AND LIFESTYLE CHANGES

This study aims to characterize and contrast the triennial rates at which doctors prescribe PT, determine patient, doctor, and practicing characteristics related to every therapy suggestion, and assess pain relievers, lifestyle counseling, and PT as effective treatments for knee osteoarthritis (OA). We analyzed the National Ambulatory Medical Care Survey. Nonsteroidal anti-inflammatory drugs (NSAID), narcotics prescriptions, physical therapy referrals, and primary care physician visits for knee OA have been determined and evaluated. The average yearly rate after three years of therapy was determined. Using multivariable logistic modeling with adjustments for complicated sample design, we analyzed the relationships among patient, physician, and practice characteristics and treatments. Over time the patients were prescribed physical therapy to improve their lifestyle whereas the percentage of patients who were prescribed NSAIDs or drugs. Physical therapy, lifestyle therapy, and drugs were prescribed at similar rates across time for basic care doctor visits. There was an association between nonclinical characteristics and treatment suggestions, such as provider type, practice setting, and geographic proximity. Physical therapy (PT) and lifestyle counseling (LC) seem underused in patients with knee OA, but prescriptions for pain medication rose over the studied period. The treatment decisions varied due to variables outside of medicine. Increased usage of physical therapy and lifestyle changes, as well as decreased treatment variance for knee OA, are important areas for further study.

Point prevalence audit surveys of respiratory tract infection consultations and antibiotic prescribing in primary care before and during the COVID-19 pandemic in Ireland

BACKGROUND

Respiratory tract infections (RTIs) are the most common reason for prescribing antibiotics in general practice. The COVID-19 pandemic has impacted on antibiotic prescribing and delivery of primary care in Ireland.

OBJECTIVES

To assess the quality of antibiotic prescribing, the impact of the COVID-19 pandemic and identify opportunities for antimicrobial stewardship (AMS) in Ireland.

METHODS

Point prevalence audit surveys for RTI consultations were conducted as part of a European study at three time periods: January-February 2020, March-May 2020 and March-May 2021. Antibiotic prescribing was assessed and comparisons made between the three time periods.

RESULTS

In total, 765 consultations were recorded, which were mainly face to face before the pandemic, but changed to predominantly remote consultations during the pandemic surveys in 2020 and 2021 (82% and 75%). Antibiotics were prescribed in 54% of RTI consultations before the pandemic. During pandemic surveys, this dropped to 23% in 2020 and 21% in 2021. There was a decrease in prescribing of Red (reserve) agents in 2021. Assessment against indication-specific quality indicators showed a high proportion of consultations for bronchitis and tonsillitis resulting in an antibiotic prescription (67% and 85%). Point-of-care testing (POCT) to aid diagnosis of RTIs were utilized in less than 1% of consultations.

CONCLUSIONS

During the COVID-19 pandemic, there was a reduction in antibiotic prescribing. Opportunities identified to support AMS in primary care in Ireland are targeted initiatives to reduce antibiotic prescribing for bronchitis and tonsillitis and introducing POCT to support appropriate antibiotic prescribing.

Recent advances in the green synthesis of Betti bases and their applications: a review

Well-known Betti bases are the products obtained by the one-pot multicomponent reaction of 1-naphthol/2-naphthol, aliphatic/aromatic aldehydes, and secondary amines, and this reaction is known as the Betti reaction. During recent years, due to the unveiling of the pharmacological and synthetic potential of Betti bases, a tremendous increase in the studies reporting novel synthetic methods for the efficient synthesis of Betti bases was observed. This review presents the recent key developments in the green synthesis of the Betti bases and accounts for the significant number of the literature reported during 2019-2022. Both catalyst free as well as the catalyst promoted synthesis (nanocatalyst, biocatalyst, transition metal catalyst, etc.) along with the synthetic applications (catalyst, ligands/chiral auxiliaries, and valuable synthons), optoelectronic applications (fluorescence sensors for phosgene gas, Hg²⁺, and Cr³⁺ detection, quasi-reversible redox potential) and biological properties (anticancer agents, antioxidant, anti-inflammatory agents, antitubercular agents, pesticidal agents, anti-Alzheimer agents, Topoisomerase I inhibitors, YAP-TEAD interaction inhibitors, and DNA binding and cleavage activity) are discussed. There is a surge of interest for the development of the green and efficient Betti reaction for the construction of C-C and C-N bond in a single-step reaction accessing Betti bases as products. Along with key methodological developments for the green synthesis of Betti bases, their applications in synthetic organic chemistry, optoelectronic sensors, advanced materials synthesis, agrochemicals and pharmaceutically active scaffolds, during the period of 2019-2022, have been considered.

A Trinuclear Cobalt Coordination Complex Constructed using Novel Triazine Ligands via One-pot Green Synthesis: Structural Properties and Biological Evaluation

New triazine ligands C3H5N5O (L1) and C5H5N5O3 (H2L2) were synthesised by reacting diaminoguanidine hydrochloride and glyoxylic acid in 1:1 and 1:2 molar ratios, respectively, at 150°C in a green solvent...

Prevalence and risk factors associated with human Intestinal Parasitic Infections (IPIs) in rural and urban areas of Quetta, Pakistan

Intestinal parasitic infections (IPIs) are endemic worldwide and more prevalent in countries with unhygienic conditions. The objective of the research was to identify the prevalence of intestinal parasitic infections in rural and urban areas of Quetta, Balochistan and to check their associated risk factors including; age, gender, educational status, sanitary system and any other immunodeficiency. For this instance 204 stool samples were collected from the urban and rural population of Quetta, Balochistan. The participants with positive results for Intestinal Parasitic Infections were interviewed using close-ended questionnaire. From the findings of this study, it has been revealed that prevalence of Intestinal parasitic infections in rural and urban areas was 21%. Males were found more prevalent (66%) as compared to females (34%) due to higher risk of contacting to outer environment. The prevalence was higher in rural areas (23%). The most prevalent intestinal parasite was Entamoeba histolytica (48%). Other prevailing parasites were Hymenolepis nana (26%), Giardia Intestinalis (17%), Trichomonas hominis (5%) and Trichuris trichiura (5%). The majority of patients were having lower socio-economic (52%) and educational status (48%). Educational status of 48% patients was primary or below primary. Most of the participants with positive results did not have hand washing habit (62%) and didn't have the closed sanitary system (71%). The intestinal parasitic infections were more prevalent among children aged from 1-10 (33%). This may be a result of poor hygiene in children. The study will contribute to lower down the prevalence in the studied areas by the application of different preventive measures in future.

Prevalence of diabetic nephropathy and subsequent cardiovascular outcomes: a nationwide study of 74,014 patients with type 2 diabetes

Background

Nonsteroidal, selective mineralocorticoid receptor antagonists (MRAs) have been shown to reduce cardiovascular events among patients with diabetic nephropathy, a clinical syndrome characterized by persistent albuminuria. However, prior reports have suggested a substantial underuse of MRAs among eligible patients. In real-life, it is unknown how many have urinary excretion of albumin measured, and the cardiovascular outcomes among type 2 diabetes (T2D) patients with versus without albuminuria is relatively unknown.

Purpose

To identify candidates eligible for treatment with MRAs and compare the risk of cardiovascular events in real-life T2D patients with albuminuria versus without albuminuria.

Methods

Using the Danish nationwide registers, we identified all patients ≥18 years old with prevalent T2D at index date 1st January 2015 with an albumin-creatinine ratio (ACR) and a creatinine level measured within 365 days prior to the index date. For each patient, the last ACR and estimated glomerular filtration rate (eGFR) registered prior to the index date were used. eGFR was calculated using the CKD-EPI formula. The patients were separated into two groups consisting of patients with T2D with ACR ≥30 mg/g (albuminuria) or ACR<30 mg/g (no albuminuria), respectively. Outcomes for both groups were analyzed as time-to-event as a composite cardiovascular outcome of heart failure (HF), myocardial infarction (MI), stroke, and all-cause death and each component of the composite endpoint was analyzed individually. In both groups, we estimated the 4-year absolute risk of the cardiovascular outcome and the risk of experiencing HF, MI, and stroke.

Results

A total of 158,904 patients with T2D were identified and of those 74,014 patients (47%) had urinary ACR analyzed within the last year. Of those who had ACR analyzed 29,581 (40%) patients had albuminuria. The absolute 4-year risk of the composite cardiovascular outcome in patients with albuminuria and no albuminuria was 28.6% (95% confidence interval (CI): 28.1–29.1) versus 18.7% (95% CI: 18.4–19.1), respectively. The absolute 4-year risk for the individual components were HF 7.0% (95% CI: 6.7–7.3), MI 4.4% (95% CI: 4.2–4.6), and stroke 7.6% (95% CI: 7.3–7.9) for patients with albuminuria, versus HF 4.0% (95% CI: 3.8–4.2), MI 3.2% (95% CI: 3.1–3.4), and stroke 5.5% (95% CI: 5.3–5.7) for patients with no albuminuria.

Conclusion

In Denmark, only 47% of patients with T2D had ACR analyzed within a year indicating lack of adherence to the national T2D guidelines. A total of 40% of those who had albuminuria analyzed were eligible for treatment with MRAs based on trial inclusion criteria, and the absolute 4-year risk of experiencing a cardiovascular event was significant. However, patients with no albuminuria still displayed a substantial risk of experiencing a composite event of HF, MI, stroke, and all-cause death. Our analyses may have implications for implementation of new MRAs in patients with T2D.

Funding Acknowledgement

Type of funding sources: None.

Study of Serum Troponin-I Level in Non-diabetic Hyperglycemic ST Elevation Myocardial Infarction Patients

The most common cause of premature death in developing countries like Bangladesh is ischaemic heart disease. Cardiac troponin-I (cTnI) is 100 percent tissue specific for the myocardium which has been shown to be a very sensitive and specific biomarker for acute myocardial infarction. As acute myocardial infarction is a stressful condition so, plasma glucose level may also increase in this condition which is stress hyperglycemia and also plasma glucose level may be used for prediction of outcome as it is a cheap and easy available test. The aim of the study is to investigate the impact of the elevation of troponin-I level with plasma glucose level of non-diabetic patients in ST-elevation myocardial infarction. This study which was comparative type of analytical and cross- sectional study carried out in the Department of Physiology, Mymensingh Medical College, Mymensingh, Bangladesh from January 2021 to December 2021. Data was collected from Cardiology Department of Mymensingh Medical College Hospital, Mymensingh. A total number of 70 subjects participated in this study and were grouped as normoglycemic ST elevation myocardial infarction- Control group (Group I) and non-diabetic hyperglycemic ST elevation myocardial infarction- Study group (Group II). The results were calculated and analyzed by using SPSS. Serum troponin-I was measured by Fluorescence Immunoassay (FIA) and plasma glucose estimated by GOD-PAP method. Data were expressed in mean±SD and statistical significance of difference among the groups were calculated by unpaired Student's 't' test. The correlation between different parameter was done by Pearson's correlation coefficient test. In this study, the result suggests that there is significant positive association between serum troponin-I and plasma glucose level in study group (hyperglycemic non-diabetic STEMI) in comparison to control group (normoglycemic STEMI). So, by this study we recommend that routine estimation of these parameters is important for prevention of complications related to acute myocardial infarction.

Histopathological Evaluation of Endoscopic Duodenal Biopsies in Children with Coeliac Disease and its Correlation with Tissue Transglutaminase Level

This cross sectional, descriptive study was conducted at Paediatrics department of BSMMU from July 2016 to June 2018 to find out histopathological pattern of Coeliac disease according to Modified Marsh criteria and to correlate it with tissue transglutaminase IgA level. A total of 62 children (age <18 years) attending the Paediatrics department of BSMMU with clinical suspicion of celiac disease were enrolled for the study. Mean age of studied children was 7.87±4.67 years. Ratio of the male and female was 2.27:1. Maximum (66.1%) children came from middle income class family. Out of 62 children, 35.5% (22) were positive for IgA anti-tTG of who female were 11.3% and male 24.2%. Mean duration of symptoms was 44.07±21.77 months in serology positive patients and 34.49±30.52 months in serology negative patients. The age group, 10-14 year showed the highest (50.0%) prevalence of positive anti-tTG. In the tTG positive group mean Hb was 9.6±1.14gm/dl and which is lower than that in tTG negative group (11.7±1.47gm/dl). Among 22 sero-positive patients, histological changes compatible with CD were found in 19 (86.3%) cases and normal in 3 cases. Histological changes were of 3a category of Marsh was found in 12(63.2%) cases, 3b in 4(21.1%) cases and 3c in 3(15.8%) cases. Strong correlation was observed between the serological level of tTGA and histological types of CD by Modified Marsh criteria. In conclusion, screening for celiac disease may be included in diagnostic tests to investigate clinically suspected children and serum tTGA level can be used to predict histopathological severity of coeliac disease.

Assessment of Nutritional Status of Children with Chronic Kidney Disease in a Tertiary Care Level Hospital, Dhaka, Bangladesh

Malnutrition is recognized to be a serious and common complication of chronic kidney disease (CKD) and is associated with increased morbidity and mortality in children. Early identification and swift intervention is the key in the management of malnutrition in CKD. The objective of the study was to determine the prevalence of malnutrition in children with CKD, to see the prevalence of malnutrition according to different anthropometric indices, to see the prevalence of malnutrition in different stages of CKD, to compare the nutritional status of children with CKD according to chronological age and height age. This analytical cross sectional study was done in the Department of Pediatric Nephrology of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from March 2014 to May 2015. Thirty children were enrolled in the study by purposive sampling. Nutritional assessment was done from dietary assessment by 72 hours recall and anthropometric measurements. Anthropometric indices were expressed in Z-scores and percentiles according to both chronological age and height age. Numeric data was analyzed by ANOVA and categorical data was tested by chi-square test. Difference between proportions was tested by Z-test of proportion. P value (<0.05) was considered significant. Data shows that the mean age of the studied population was 10.99±3.5 years with a male predominance. Eighteen (60.0%) children were on hemodialysis and rests on conservative management. Average calorie intake was 74.31±9.34% of estimated energy requirement (EER). The prevalence of malnutrition was 70.0% (95% CI: 53.6-86.4) according to height Z-score (HAZ), 66.7% (95% CI: 45.8-80.2) for weight Z-score (WAZ) and mid upper arm circumference (MUAC) Z-score, according to BMI percentile it was 56.7% (95% CI: 39-74.4), for mid arm muscle circumference (MAMC) the prevalence was 53.3% (95% CI: 35.5-71.1), according to arm muscle area (AMA) and arm fat area (AFA) the prevalence was 50.0% (95% CI: 38.1-67.9) and for triceps skin fold thickness (TST) it was 43.3% (95% CI: 25.5-61). Height was the most affected parameter and triceps skin fold thickness was the least affected parameter. When anthropometric indices were adjusted for height age, the prevalence was 36.7% according to BMI and TST, 30.0% according to AFA, 13.3% according to MUAC, 10.0% each for MAMC and AMA and 3.3% for WAZ. The difference in the prevalence of malnutrition according to this two approach was statistically significant in all parameters accept BMI, TST and AFA. Malnutrition was more associated with advanced stage of CKD. Low calorie intake was associated with low BMI and low serum albumin level. Serum albumin level was low in the present study population. In conclusion, prevalence of malnutrition is very high in children with CKD.

Bone markers and bone mineral density associates with periodontitis in females with poly-cystic ovarian syndrome

INTRODUCTION

Studies suggest an association between poly-cystic ovarian syndrome (PCOS) and chronic periodontitis (CP), both being inflammatory conditions. However, insufficient evidence assesses the impact of this inflammation on bone metabolism and bone turnover markers (BTMs). The present study aimed to determine the association between BTMs, bone mineral density (BMD), and clinical periodontal parameters in PCOS women with CP.

MATERIALS AND METHODS

Three groups, each with 40 newly diagnosed (1) PCOS+CP, (2) PCOS alone, (3) CP alone, and fourth group (n = 20) systemically and periodontally healthy females aged 18-30 years were included in the study. Full mouth clinical periodontal parameters, C-terminal telopeptides of type I collagen (CTX), bone alkaline phosphatase (ALP), BMD and 25-hydroxyvitamin D (VD) were recorded for all.

RESULTS

Low BMD (0.89 ± 0.11 g/cm²), increased CTX levels (2.76 ± 4.64 ng/ml), decreased bone ALP levels (11.09 ± 6.86 ng/ml), higher VD levels (289.02 ± 168.28 nmol/l) and poor clinical periodontal status were observed in PCOS + CP females. BMD-spine showed weak positive correlation with CTX, bone ALP, VD (r = 0.02, r = 0.07, r = 0.15, respectively) in PCOS + CP group. ANCOVA depicted covariates had no confounding effect. Multiple regression model explained 21.0% for BMD-spine and 12.7% for BMD-femur of total variability signifying association with all measured parameters among all groups.

CONCLUSION

Enhanced inflammatory thrust by periodontitis increases CTX levels and decreases bone ALP and BMD levels in women with PCOS. Screening PCOS women for periodontal disease and vice versa may have a direct bearing on overall bone health.

Plant hormone profile and control over isoprene biosynthesis in a tropical tree Ficus septica

Plant hormone signalling and the circadian clock have been implicated in the transcriptional control of isoprene biosynthesis. To gain more insight into the hormonal control of isoprene biosynthesis, the present study measured plant hormone concentrations in jasmonic acid (JA)-treated leaves of our previous model study, examined their relationship with gene expression of isoprene synthase (IspS) and hormone signalling transcription factors. Of the plant hormones, IAA and JA-Ile and their related transcription factors (MYC2 and SAUR21) were significantly correlated with IspS gene expression. Concentrations of cytokinins, isopentenyladenine (iP), trans-zeatin riboside (tZR) and cis-zeatin riboside (cZR), were similarly significantly correlated with IspS expression. However, there was no significant correlation between their related transcription factor (ARR-B) and IspS expression. The circadian clock-related gene PRR7, but not the transcription factor LHY, was highly correlated with IspS expression. These results suggest that the hormonal balance between JA-Ile and IAA plays a central role in transcriptional regulation of IspS through the transcription factors MYC2 and SAUR21, the early auxin responsive genes. The putative cis-acting elements for SAUR on the IspS promoter (TGTCNN and CATATG), in addition to the G-box for MYC2, support the above proposal. These results provide insightful information on the core components of plant hormone-related regulation of IspS under coordination with the circadian clock genes.

Association of blood pressure and postural control in older adults with hypertension: an observational study

The study investigated the association of orthostatic hypotension (OH) with functional position change and balance in older adults with hypertension. The presence of OH was assessed with intermittent (OH intermittent) and continuous blood pressure (OH continuous) monitoring. The change in functional position was tested with sitting to standing assessment, balance performance using activity specific balance confidence scale (ABC), and timed up and go test (TUG). Testing unilateral and bilateral standing with and without altered sensory inputs was tested using the Humac balance system. ABC, TUG, and standing up time showed no significant association with OH intermittent and OH continuous. A significant association was found between bilateral standing with eyes closed on foam surface for overall stability index and OH intermittent. Older people with hypertension may be routinely examined for OH and appropriate intervention strategies should be included for comprehensive care.

A Pragmatic Scoring Tool to Predict Hydroxyurea Response Among β-Thalassemia Major Patients in Pakistan

Despite high prevalence and incidence of β-thalassemia in Pakistan, there is very limited work on the use of hydroxyurea (HU) in thalassemia patients in the country. This is the first insight regarding genetic profiling of BCL11A and HU responses in Pakistani β-thalassemia. It correlates single-nucleotide polymorphisms on BCL11A (rs4671393, rs766432) and HBG2 (XmnI), age at first transfusion, and β-globin mutations with HU response in β-thalassemia major (BTM). Of 272 patients treated with HU, 98 were complete responders, 55 partial responders, and 119 nonresponders. Our analysis shows that HU response was significantly associated with patients having IVSI-1 or CD 30 mutation (P<0.001), age at first transfusion >1 year (P<0.001), and with the presence of XmnI polymorphism (P<0.001). The single-nucleotide polymorphisms of BCL11A were more prevalent among responders, but could not show significant association with HU response (P>0.05). Cumulative effect of all 5 predicting factors through simple binary scoring indicates that the likelihood of HU response increases with the number of primary and secondary genetic modifiers (P<0.001). Predictors scoring is a pragmatic tool to foresee HU response in patients with BTM. The authors recommend a score of ≥2 for starting HU therapy in Pakistani patients with BTM.

Effect of Moringa olifera leaves on growth and gut microbiota of Nile tilapia (Oreochromis niloticus)

The study was conducted to evaluate the effect of Moringa olifera on the growth and gut health of Tilapia (Oreochromis niloticus). The feed having 30% crude protein was prepared as an experimental diet with 4%, 8% and 10% M. olifera leaf supplementation, respectively. The control diet was devoid of M. olifera leaves. The 10 weeks feeding trial was carried out on 60 fish in aquaria. Fish was fed @ 3% of body weight twice a day. Diet with the high level of inclusion of M. olifera leaves significantly increased the growth rate, Survival Rate (SR), Specific Growth Rate (SGR) and Feed Conversion Efficiency (FCE) in all treatment groups compared to the control group. Similarly, Feed Conversion Ratio (FCR) gradually decreased and found highly-significant. To check the gut health of the Tilapia, random samples were selected and dissected. Nutrient agar was used as culture media to check the growth of bacteria. Pour Plate Method was used for viable colonies count by colony counter. Through staining method, the different bacteria such as Escherichia coli, Salmonella, Shigella and Pseudomonas aeruginosa were identify abundantly in the intestine of control diet fish but less number present in treatment diets groups. These results showed that M. olifera leaves up to 10% of dietary protein can be used for Nile tilapia for significant growth and healthy gut microbiota of fish.

Limiting amino acids supplementation in low crude protein diets and their impacts on growth performance and carcass composition in Labeo rohita (rohu) adult fish

Ninety days study was conducted in hapas installed in earthen ponds. Fish of an average initial weight (220g) were evenly distributed in triplicate groups within fifteen hapas. Five experimental diets labeled as T1 (25% CP and NRC recommended amino acid level) as control diet, T2 (with 2% low protein and 5% amino acid supplementation), T3 (with 2% low protein and 10% amino acid supplementation), T4 (with 4% low protein and 10% amino acid supplementation) and T5 (with 4% low protein and 20% amino acid supplementation) were prepared. Fish were fed with @3% of their body weight twice a day at 10.00 & 16:00 hour. Significantly higher percent weight gain (420.18 ± 66.84a) and specific growth rate (13499.33±1273.54a) along with improved feed conversion ratio (1.29 ± 0.09b) and hundred percent survivals were recorded during the trial. Furthermore proximate analysis of meat showed significant improvement in the crude protein level (81.77 ± 0.19a) served with diet containing 20% limiting amino acids mixture. Therefore, limiting amino acids can be a source of cost effective feed and use safely in L. rohita diet.

Application of mycogenic silver/silver oxide nanoparticles in electrochemical glucose sensing; alongside their catalytic and antimicrobial activity

The present work describes the biofabrication of highly stable, water-dispersible mycogenic silver/silver (I) oxide nanoparticles (Ag/Ag₂O NPs) alongside its potential applications in non-enzymatic electrochemical glucose sensing and catalytic degradation of methylene blue (MB) dye in presence of reducing agent NaBH₄. These Ag/Ag₂O NPs were fabricated from silver oxide micro powder using endophytic fungus Fusarium oxysporum based environmentally friendly, bio-inspired, top-down approach which is highly reproducible, reliable, and cheap. Bacterial and plant-mediated bottom-up approaches have been previously reported for the production of Ag/Ag₂O NPs. Bacterial methods are not economical as they require expensive sophisticated instruments for separation and purification. Similarly, plant-based means of synthesis are not reliable and reproducible due to geographical and seasonal variability's. UV-Visible spectroscopy, TEM, SAED, FTIR, XRD, TGA, and DSC were used for the characterization and investigation of thermal properties of mycogenic nanoparticles and their antimicrobial activity was evaluated by filter- paper bioassay technique.

Relation of Serum Iron Level with Serum Zinc Level among Adolescent Girls with Iron Deficiency Anaemia in Bangladesh

Adolescent girls are vulnerable in underdeveloped and developing countries due to having public health problems regarding iron deficiency anaemia. As zinc acts as a cofactor in iron metabolism, so the deficiency of this trace element is associated with iron deficiency anaemia. This study was done to evaluate the changes of serum iron and serum zinc levels among iron deficient anaemic adolescent girls in comparison to healthy adolescent girls in Bangladesh. This prospective type of analytical cross sectional study was carried out in the Department of Physiology, Mymensingh Medical College, Mymensingh, Bangladesh from July 2019 to December 2020. Total number of 140 adolescent girl's age ranged from10-19 years included in this study. Among them, 70 healthy adolescent girls, were taken as control group (Group I). Remaining 70 Adolescent girls with iron deficiency anaemia (IDA) were taken as study group (Group II). Estimation of serum iron was determined by Ferrozine method using Globals iron kit, UK. Serum zinc levels were determined by colorimetric method with reagents. All data were expressed as mean (±SD) and statistical significance of difference among the group I ( healthy adolescent girls) and group II (adolescent girls with iron deficiency anaemia) were calculated by unpaired students' 't' test. Correlation of serum iron with serum zinc was done by Pearson's correlation coefficient test. The mean values (±SD) of serum iron level of Group I and Group II were 69.06±18.11μg/dl & 15.61±9.12μg/dl respectively. Mean values (±SD) of serum iron significantly lower in study group (Group II) in comparison with control group (Group I). The mean (±SD) of serum zinc level of Group I and Group II were 75.48±14.26μg/dl & 33.27±12.94μg/dl respectively. Mean value (±SD) of serum zinc levels were significantly lower in study group (Group II) in comparison with control group (Group I). Serum zinc level was positively correlated with serum iron and that was statistically significant. The deficiency of iron does not occur alone; rather it is typically associated and developed with hypozincemia. The study suggests on supplementing iron along with zinc to correct the deficiency especially in adolescent girls when their metabolic demand is high.

Distribution of subtypes and immunophenotypic characterization of 1379 cases of paediatric acute leukaemia

Objectives:

Acute leukaemia is the most common and highly curable childhood malignancy; subtyping and identification of antigens via immunophenotyping helps in treatment plan as well as minimal residual disease monitoring.

Methods:

This retrospective study was conducted at the Haematology section of the clinical laboratories of Ziauddin University Hospital and The Indus Hospital, Karachi conducted at January 1st, 2012 to December 31^st, 2017. The study included 1379 cases of de novo acute leukemia from 2012 to 2017. Among these, 80% were diagnosed by using four color flowcytometry (FACS Calibur), 9% and 11% via immunohistochemistry on bone marrow trephine biopsy samples and morphological examination respectively.

Results:

The mean age of patients was 7.4 ± 4.3 years while male to female ratio was 1.75:1. Lymphoblastic leukaemia accounted for 77.2% and myeloid leukaemia 21.2%. Amongst lymphoblastic lineage, B-ALL was 80.4% while T-ALL was 19.6%. Among the phenotypic expression of B-ALL, CD79a (99.8%) had the highest positivity. In B-ALL, CD13 (29.8%) was the most common aberrant myeloid marker. Aberrant expression of CD79a observed in 11.1% of T-ALL cases. In non APL AML, aberrant expression of CD79a and CD19 was observed in 6.6% and 5.5% of cases respectively.

Conclusion:

Overall immunophenotypic profile, expression of aberrant phenotypes and subtype distribution in our patients was similar to international literature except for a relatively high frequency of T-ALL which was discordant from the western data.

Peripheral Blood Stem Cell Harvest HPC Count Is an Effective Surrogate Marker for CD34+ Cell Count in Allogeneic Stem Cell Transplant Setting

OBJECTIVE: We assessed the predictive potential of XN-HPC for CD34+ cell count as obtained through Sysmex automated hematology analyzers (XN-1000). METHODS: This study was conducted at the National Institute of Blood Diseases and Bone Marrow Transplantation in 84 donors between December 2012 and December 2017 in the first phase and later validated in 112 donors between December 2017 and December 2018. Sysmex XN-1000 and BD FACS Calibur estimated XN-HPC and CD34+ cells of peripheral blood apheresis product, respectively. Spearman's correlation was assessed between XN-HPC and CD34+ cell count followed by receiver operating characteristic curve calculation to determine the XN-HPC cutoff for a CD34+ count of ≥2 million cells/kg of recipient's body weight RESULTS: There is a moderately positive correlation (P value = .003) between XN-HPC and CD34+ count. Receiver operating characteristic curve analyses demonstrated that a cutoff value for XN-HPC of ≥1·845×10⁶cells/kg of recipient's body weight has a specificity and sensitivity of 100% and 78·2%, respectively, for predicting the CD34+ count of ≥2 million cells/kg of recipient's body weight. This cutoff value of XN-HPC was prospectively validated in 112 donors. The positive predictive value was found to be 100%, while negative predictive value was 17%. CONCLUSION: XN-HPC has a highly promising potential to serve as a cost-effective and time-saving surrogate for CD34+ cell count.

Carbamazepine-induced hyperglycemia: A rare case report

Carbamazepine is a commonly used iminostilbene antiepileptic medication and it is estimated that 46.9% of the total antiepileptic drug overdose in the United Kingdom is because of this drug. The overdose of Carbamazepine can show negative effects on multiple systems, these include neurologic (ataxia, seizures, and altered sensorium), cardiac (tachycardia, hypotension) and metabolic manifestations. We reported a case of a 17-year-old girl had an increase in glucose levels after voluntary ingestion carbamazepine tablets. After ingestion, her gross random blood sugar level was increased, then physician suspected that she might be a Type I diabetic,but HbA1C[glycosylated hemoglobin] levels was found normal.Carbamazepine was discontinued and patient received symptomatic therapy. The patient had decreased levels of blood sugar level,after removal of the drug within the next day after ingestion of carbamazepine. A Naranjo assessment was obtained, indicating a definite relationship between the patient's increased in blood glucose levels and her use of carbamazepine.

An audit of dementia education and training in UK health and social care: a comparison with national benchmark standards

BACKGROUND

Despite people living with dementia representing a significant proportion of health and social care users, until recently in the United Kingdom (UK) there were no prescribed standards for dementia education and training. This audit sought to review the extent and nature of dementia education and training offered to health and social care staff in the UK against the standards described in the 2015 Dementia Training Standards Framework, which describes the knowledge and skills required of the UK dementia workforce.

METHODS

This audit presents national data concerning the design, delivery, target audience, length, level, content, format of training, number of staff trained and frequency of delivery within existing dementia training programmes offered to health and social care staff. The Dementia Training Standards Framework was used as a reference for respondents to describe the subjects and learning outcomes associated with their training.

RESULTS

The findings are presented from 614 respondents offering 386 training packages, which indicated variations in the extent and quality of training. Many training packages addressed the subjects of 'person-centred care', 'communication', 'interaction and behaviour in dementia care', and 'dementia awareness'. Few training packages addressed subjects concerning 'pharmacological interventions in dementia care', 'leadership' and 'end of life care'. Fewer than 40% of The Dementia Training Standards Framework learning outcomes targeted to staff with regular contact with people with dementia or in leadership roles were covered by the reported packages. However, for training targeted at increasing dementia awareness more than 70% of the learning outcomes identified in The Dementia Training Standards Framework were addressed. Many training packages are not of sufficient duration to derive impact; although the majority employed delivery methods likely to be effective.

CONCLUSIONS

The development of new and existing training and education should take account of subjects that are currently underrepresented and ensure that training reflects the Training Standard Framework and evidence regarding best practice for delivery. Lessons regarding the limitations of training in the UK serve as a useful illustration of the challenge of implementing national dementia training standards; particularly for countries who are developing or have recently implemented national dementia strategies.

New barium, strontium and strontium-doped barium squarates: synthesis, crystal structures and DNA/BSA binding, antioxidant and in vitro cytotoxicity studies

A new set of differently hydrated barium and strontium squarates, namely poly[[triaqua(μ-1,2-dioxocyclobut-3-ene-1,2-diolato)barium] monohydrate], {[Ba(C₄O₄)(H₂O)₃]·H₂O}_n (1), poly[[diaqua(μ-1,2-dioxocyclobut-3-ene-1,2-diolato)strontium] monohydrate], {[Sr(C₄O₄)(H₂O)₂]·H₂O}_n (2), and poly[[triaqua(μ-1,2-dioxocyclobut-3-ene-1,2-diolato)barium/strontium(0.85/0.15)] monohydrate], {[Ba_0.85Sr_0.15(C₄O₄)(H₂O)₃]·H₂O}_n (3), is reported. The study of their crystal structures indicates that all the complexes crystallize in the triclinic space group P-1. Complexes 1 and 3 have a rare combination of squarate units coordinated through monodentate O atoms to two different metal atoms and through two bidentate O atoms to three different metal atoms. Furthermore, they have three coordinated water molecules to give a coordination number of nine. The squarate ligands in complex 2 exhibit two different coordination modes: (i) monodentate O atoms coordinated to four different Sr atoms and (ii) two monodentate O atoms coordinated to two different metal atoms with the other two O atoms bidentate to four different Sr atoms. All the compounds decompose to give the respective carbonates when heated to 800 °C, as evidenced by thermogravimetry/differential thermal analysis (TG-DTA), which are clusters of nanoparticles. Complexes 1 and 3 show additional endothermic peaks at 811 and 820 °C, respectively, indicating the phase transition of BaCO₃ from an orthorhombic (α-Pmcn) to a trigonal phase (β-R3m). All three complexes have significant DNA-binding constants, ranging from 2.45 × 10⁴ to 9.41 × 10⁴ M^-1 against EB-CT (ethidium bromide-calf thymus) DNA and protein binding constants ranging from 1.1 × 10⁵ to 8.6 × 10⁵ with bovine serum albumin. The in vitro cytotoxicity of the complexes is indicated by the IC₅₀ values, which range from 128.8 to 261.3 µg ml^-1. Complex 3 shows better BSA binding, antioxidant activity against the DPPH radical and cytotoxicity than complexes 1 and 2.

Frequency of Alpha Thalassaemia in homozygous Beta Thalassaemia paediatric patients and its clinical impact at a blood disease centre in Karachi, Pakistan

OBJECTIVE

To find frequency ofalpha Thalsaemia nhomozygous beta Thalsaemia patients, and to se any difernce infrequency and age ofirst ransfusion and mean haemoglobin concentration.

METHODS

The single-centred, escriptive cros-sectional study was conducted athe National Instiute of Blod Disease and Bone Marow Transplantaion, Karchi, from June 1,2012, to May 31, 2013. Patients of homozygous beta halsaemia, diagnosed by polymerase chain reaction, wer tested for coinheritance of alpha Thalsaemia nd foetal haemoglobin XMN1 polymorphism using polymerase chain reaction. SPS 17 was used for dat anlysi.

RESULTS

Of the 286 patients, 19(41.6%) wer males, and 9(34.6%) showed coinheritance ofalpha thalsaemia. In the coinheritance group, 50(50%) and 1(1%) patients recived 1-20 and 21-40 times transfusions per year espectively, while inthe non-coinheritance group, the coresponding numbers wer 125(67%) and 27(14.%). Overal, 73(25.%) patients had nevr ben transfused, including 38(13.%) patients inthe alpha Thalsaemia group. XMN1 polymorphism was found in 86(41%) ofthe 208 patients who wer tested and anlysed on this count.

CONCLUSIONS

Alpha thalsemia was presnt inmore than one-third homozygous beta halsemia patients.

Hydroxyurea Treated β-Thalassemia Children Demonstrate a Shift in Metabolism Towards Healthy Pattern

Augmentation of fetal hemoglobin (HbF) production has been an enduring therapeutic objective in β-thalassemia patients for which hydroxyurea (HU) has largely been the drug of choice and the most cost-effective approach. A serum metabolomics study on 40 patients with β-thalassemia prior to and after administration of HU was done along with healthy controls. Treated patients were divided further into non-responders (NR), partial (PR) and good (GR) per their response. 25 metabolites that were altered before HU therapy at p ≤ 0.05 and fold change >2.0 in β-thalassemia patients; started reverting towards healthy group after HU treatment. A prediction model based on another set of 70 HU treated patients showed a good separation of GR from untreated β-thalassemia patients with an overall accuracy of 76.37%. Metabolic pathway analysis revealed that various important pathways that were disturbed in β-thalassemia were reverted after treatment with HU and among them linoleic acid pathway was most impactfully improved in HU treated patients which is a precursor of important signaling molecules. In conclusion, this study indicates that HU is a good treatment option for β-thalassemia patients because in addition to reducing blood transfusion burden it also ameliorates disease complications by shifting body metabolism towards normal.

Celiac Disease in Children with Chronic Diarrhoea Attending At Paediatric Gastroenterology and Nutrition Department of BSMMU

This descriptive, cross sectional study was conducted at Bangabandhu Sheikh Mujib Medical University from July 2012 to July 2015 to see the occurrence of celiac disease in children with chronic diarrhea. A total of 62 children (age <18 years) attending the Paediatric Gastroenterology and Nutrition department of BSMMU with chronic diarrhoea were enrolled for the study. Mean age of studied children was 7.87±4.67 years. Ratio of the male and female was 2.27:1. Maximum (66.1%) children came from middle income class family. Out of 62 children with chronic diarrhea, 35.5% (22) were positive for IgA anti-tTG of whom female were 11.3% and male 24.2%. Mean duration of diarrhoea was 44.07±21.77 months in serology positive patients and 34.49±30.52 months in serology negative patients. The age group, 10-14 year showed the highest (50%) prevalence of positive anti-tTG. In the tTG positive group mean Hb was 9.6±1.14gm/dl and which is lower than that in tTG negative group (11.7±1.47gm/dl). Among 22 seropositive patients, histological changes compatible with CD were found in 19 (86.3%) cases and normal in 3 cases. Histological changes were of 3c category of Marsh was found in 3(15.8%) cases, 3b in 4(21.1%) cases and 3a in 12(63.2%) cases. In conclusion, Screening for celiac disease may be included in diagnostic tests for evaluating chronic diarrhoea in children.

Gliomatosis Cerebri: A Rare Brain Tumor

Gliomatosis Cerebri is a rare brain tumor. There is diversity of presentation in cases due to the nature of its diffuse involvement. Very recently, on February 2016 in the department of Paediatric Neurology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh we encountered a 10 years old boy who initially mimicked as tuberculoma of brain but later on diagnosed as Gliomatosis Cerebri on the basis of brain MRI and brain biopsy. Prognosis is always very gloomy regardless of the treatment strategy adopted. The boy died within one year after confirmation of diagnosis even after getting adequate medical management and radiation therapy.

A comparative study of hepatitis B virus X protein mutants K130M, V131I and KV130/131MI to investigate their roles in fibrosis, cirrhosis and hepatocellular carcinoma

Hepatitis B virus (HBV) genomic mutations A1762T, G1764A and AG1762/1764TA cause production of HBV X protein (HBx) mutants, namely K130M, V131I and KV130/131MI. These mutations are important biomarkers for the development of cirrhosis and hepatocellular carcinoma (HCC) in chronic HBV patients. This study comparatively analyses the impact of intracellular expression of HBx mutants on HCC cell line Huh7. It was found that expression of KV130/131MI induced: cell proliferation, altered expression of cell cycle regulatory genes in favour of cell proliferation, intracellular reactive oxygen species (ROS) production and mitochondrial depolarization. KV130/131MI may be directly involved in host cell proliferation and hepatocarcinogenesis via altering expression of cell cycle regulatory genes. KV130/131MI may also play pivotal roles in fibrosis and cirrhosis via inducing ROS production and mitochondrial depolarization. Furthermore, these might be the possible reasons for higher occurrence of AG1762/1764TA as compared to A1762T and G1764A in cirrhosis and HCC patients.

Seafood pathogens and information on antimicrobial resistance: A review

Seafood-borne diseases are a major public health hazard in the United States and worldwide. Per capita, seafood consumption has increased globally during recent decades. Seafood importation and domestic aquaculture farming has also increased. Moreover, several recent outbreaks of human gastroenteritis have been linked to the consumption of contaminated seafood. Investigation of seafood-borne illnesses caused by norovirus, and Vibrio, and other bacteria and viruses require a concrete knowledge about the pathogenicity and virulence properties of the etiologic agents. This review explores pathogens that have been associated with seafood and resulting outbreaks in the U.S. and other countries as well as the presence of antimicrobial resistance in the reviewed pathogens. The spectrum of such resistance is widening due to the overuse, misuse, and sub-therapeutic application of antimicrobials in humans and animals.

Tannery effluent effect on the haematological parameters of freshwater fish, Channa punctatus

The present investigation was undertaken to evaluate the tannery effluent toxicity stress symptoms in fish blood during a long term of exposure period. The effect of tannery effluent on various haematological parameters were evaluated exposing fresh water fish, C. punctatus to different concentration i.e., [Control, 5% Tannery effluent (TE), 10% TE and 20% TE] of tannery effluent. Exposed of fish to tannery effluent showed a significant decrease in the haemoglobin (Hb) content (9.16± 0.08), red blood cells (3.32 ± 0.12), packed cell volume (34.66 ± 0.33) and mean corpuscular haemoglobin (MCH) values, whereas significant increase in the white blood cells (WBC), erythro-cyte sedimentation rate (ESR) and clotting time was recorded with increase in exposure periods as compared to control respectively. Hb, RBC and MCHC values showed fluctuating results. The haematological parameters were decreases from 15th days of exposure periods to 45th days of exposure period. The decrease in haematological parameters clearly indicates that the exposed fishes have become anemic due to tannery effluent exposure.

β-Thalassemia Patients Revealed a Significant Change of Untargeted Metabolites in Comparison to Healthy Individuals

β-Thalassemia is one of the most prevalent forms of congenital blood disorders characterized by reduced hemoglobin levels with severe complications, affecting all dimensions of life. The mechanisms underlying the phenotypic heterogeneity of β-thalassemia are still poorly understood. We aimed to work over metabolite biomarkers to improve mechanistic understanding of phenotypic heterogeneity and hence better management of disorder at different levels. Untargeted serum metabolites were analyzed after protein precipitation and SPE (solid phase extraction) from 100 β-thalassemia patients and 61 healthy controls using GC-MS. 40 metabolites were identified having a significance difference between these two groups at probability of 0.05 and fold change >1.5. Out of these 40 metabolites, 17 were up-regulated while 23 were down-regulated. PCA and PLS-DA model was also created that revealed a fine separation with a sensitivity of 70% and specificity of 100% on external validation of samples. Metabolic pathway analysis revealed alteration in multiple pathways including glycolysis, pyruvate, propanoate, glycerophospholipid, galactose, fatty acid, starch and sucrose metabolism along with fatty acid elongation in mitochondria, glycerolipid, glyoxylate and dicarboxylate metabolism pointing towards the shift of metabolism in β-thalassemia patients in comparison to healthy individuals.

Application of Antimicrobial Agents via Commercial Spray Cabinet To Inactivate Salmonella on Skinless Chicken Meat

Salmonella enterica subsp. enterica serovar Typhimurium is a food safety concern for raw poultry products. New and innovative application methods of antimicrobials for the reduction of Salmonella in poultry and poultry products are essential. The aim of this study was to determine the efficacy of three antimicrobial compounds against Salmonella on raw chicken meat when applied individually and in combination using a commercial spray cabinet. Raw chicken thigh meat inoculated with 5 log CFU/g Salmonella Typhimurium ATCC 53647 was passed through a spray cabinet while being sprayed with 5% lauric arginate (LAE), 0.8% vinegar solution (VS), near-neutral electrolyzed water, or deionized water. The following three experiments were carried out: (i) exposure times of 0, 15, 30, 45, and 60 s, (ii) storage at 4°C for 0, 1, 2, and 3 days after a 60-s exposure, and (iii) a combination of treatment with LAE and VS followed by storage at 4°C for 0, 1, 2, and 3 days. Analysis of variance and the Tukey test were used to determine mean significant differences (P < 0.05). The experiment was carried out in duplicate for each replicate (n = 3 × 2). In comparing individual antimicrobials, the 60-s treatment time resulted in the greatest reduction of Salmonella Typhimurium, with LAE achieving the greatest reduction (2.07 log), followed by VS, near-neutral electrolyzed water, and deionized water (0.63, 0.56, and 0.53 log, respectively). After 3 days of storage, LAE significantly (P < 0.05) reduced Salmonella Typhimurium, by 1.28 log. The combination of VS and then LAE resulted in a significantly (P < 0.05) greater reduction than using LAE followed by VS (1.61 and 0.93 log, respectively). The results of this study suggest that LAE is a viable compound to reduce Salmonella Typhimurium on raw chicken meat and that the order of application of antimicrobial agents plays a vital role.

Incidence of Buxtonella sulcata in bovines in R.S. Pura, Jammu

Incidence of Buxtonella sulcata was recorded as 20.9 % in bovines (n = 374) of R.S. Pura, Jammu with cattle showing higher infection rate (23.6 %) than the buffaloes (18.5 %). The infection was significantly (p < 0.0001) higher in young animals (33.1 %) than the adults (13.9 %). Animals with diarrhoeic faeces had a significantly higher (p < 0.0001) infection rate (38.5 %) than the animals with normal faeces (9.9 %), suggesting the influence of protozoan on the incidence of diarrhoeal symptoms in bovines.

Mother’s / care giver’s health seeking behaviour during childhood illness in an urban slum of Dhaka city

Objectives: To determine the health seeking behaviour of mothers / care givers of children under 5 years of age during their illnesses.Materials and methods: A descriptive cross-sectional study was conducted among 439 mothers/ care givers of under 5 year old children in an urban slum area of Dhaka city from September 2013 to February 2014. Data were collected through face-to-face interview by using a structured pre-tested questionnaire. The collected data were analyzed using SPSS version 20.0. All analyzed data were presented in the form of percentages. Chi-square test was applied wherever applicable.Results: Out of 439 mothers / care givers, most (90%) of them sought health care services during their children’s illness. [A statistically significant association was found between mother’s /care giver’s education and sought health care services during illness of children (p=0.055). In the study, 200 (50%) of the respondents consulted drug sellers of medicine shops during their children’s illness. Others went to medical college hospital (34.6%), Government hospitals (13.5%), consulted a private practitioners (11%) and NGO facilities (6.3%). Forty (9.1%) respondents did not seek any health care with multiple reasons or responses. Majority (27, 67.5%) waited for self recovery, 21 (52.5%) had lack of money, 5 (12.5%) did not receive any advice to receive treatment. Four (10%) respondents said that the health care facility was too far to receive treatment and 3 (7.5%) respondents did not feel that treatment was necessary. [Health seeking behaviour of the mothers / care givers was statistically highly significant in educated person. They took the child to Govt. hospital (p=0.001) during illness. The relationship between health seeking behaviour and monthly family income of the respondents was statistically significant. The respondents took their child to medical college hospital (p=0.040) and also consulted drug sellers (p=0.038) during illness of the child.]Conclusion: Health education and behaviour change communication activities can be undertaken in the slum for mothers / care givers about early recognition of childhood illness and on the importance of seeking early treatment.Pulse Vol.7 January-December 2014 p.5-15