Impact of resveratrol and zinc on biomarkers of oxidative stress induced by Trichinella spiralis infection

Trichinellosis is a re-emerging worldwide foodborne zoonosis. Oxidative stress is one of the most common detrimental effects caused by trichinellosis. In addition, Trichinella infection poses an infinite and major challenge to the host's immune system. Resistance and side effects limit the efficiency of the existing anti-trichinella medication. Given that concern, this work aimed to investigate the anti-helminthic, antioxidant, anti-inflammatory and immunomodulatory effects of resveratrol and zinc during both phases of Trichinella spiralis infection. Sixty-four Swiss albino mice were divided into four equal groups: non-infected control, infected control, infected and treated with resveratrol, and infected and treated with zinc. Animals were sacrificed on the 7th and 35th days post-infection for intestinal and muscular phase assessments. Drug efficacy was assessed by biochemical, parasitological, histopathological, immunological, and immunohistochemical assays. Resveratrol and zinc can be promising antiparasitic, antioxidant, anti-inflammatory, and immunomodulatory agents, as evidenced by the significant decrease in parasite burden, the significant improvement of liver and kidney function parameters, the increase in total antioxidant capacity (TAC), the reduction of malondialdehyde (MDA) level, the increase in nuclear factor (erythroid-derived 2)-like-2 factor expression, and the improvement in histopathological findings. Moreover, both drugs enhanced the immune system and restored the disturbed immune balance by increasing the interleukin 12 (IL-12) level. In conclusion, resveratrol and zinc provide protection for the host against oxidative harm and the detrimental effects produced by the host's defense response during Trichinella spiralis infection, making them promising natural alternatives for the treatment of trichinellosis.

Acetazolamide loaded-silver nanoparticles: A potential treatment for murine trichinellosis

Trichinellosis is a global food-borne disease caused by viviparous parasitic nematodes of the genus Trichinella. Due to the lack of effective, safe therapy and the documented adverse effects of traditional therapy, this study aimed to evaluate the therapeutic effect of acetazolamide-loaded silver nanoparticles (AgNPs) on murine trichinellosis. Fifty male Swiss albino mice were divided into five groups of ten mice each: Group I, normal control group; Group II, infected with T. spiralis and not treated; Group III, infected and given AgNPs; Group IV, infected and treated with acetazolamide; and Group V, infected and treated with acetazolamide-loaded AgNPs. Mice were infected orally with 250 larvae. The efficacy was assessed by counting T. spiralis adults and larvae, measuring serum total antioxidant capacity, and observing the histopathological and ultrastructural alterations. Acetazolamide-loaded AgNPs treatment exhibited the highest percentage of reduction (84.72% and 80.74%) for the intestinal adults and the muscular larvae of T. spiralis-infected animals, respectively. Furthermore, during the intestinal and muscular phases, the serum of the same group had the best free-radical scavenging capacity (antioxidant capacity), which reduced tissue damage induced by oxidative stress. Histopathologically, the normal intestinal and muscular architecture was restored in the group treated with acetazolamide-loaded AgNPs, in addition to the reduced inflammatory infiltrate that alleviated inflammation compared to infected animals. Our results confirmed the marked destruction of the ultrastructural features of T. spiralis adults and larvae. Acetazolamide-loaded AgNPs are a promising therapy against T. spiralis infection.

Serum Leptin Correlates with Obesity But Does Not Differ Between Gestational Diabetes and Normal Glucose Tolerance during 24-28 Weeks of Gestation

Leptin is an adipocytokine secreted by adipocytes which positively correlates with obesity. It is considered as a potential mediator for precipitating Gestational diabetes mellitus (GDM) which is more evident during 24-28 weeks of gestation. This study was conducted to see serum leptin level during 24-28 weeks of gestation in GDM at the Department of Endocrinology, BSMMU, Bangladesh from March 2019 to August 2020. Pregnant women (N=108) were challenged with 75gm oral glucose (OGTT) at 24-28 weeks of gestation and divided into GDM [n=45, age: 27.80±3.98 years, mean±SD; BMI: 27.88 (24.46-30.43) kg/m², median Interquartile range (IQR)] and normal glucose tolerance [NGT; n=62, age: 26.19±5.30 years, mean±SD; BMI: 25.80 (23.65-28.42) kg/m², median (IQR)] on basis of WHO-2013 diagnostic criteria. Fasting serum leptin and glucose were measured by ELISA and glucose oxidase method respectively. No statistically significant difference was found between GDM and NGT for leptin [26.05(16.92-50.55) vs. 23.50(14.95-38.30) median (IQR), p=0.360]. It was also not different statistically between GDM and NGT either for age groups (p=NS for all) or for Asian categories of BMI subgroups (p=NS for all). However, it was higher in subjects with BMI ≥23kg/m² than that with BMI ≤23kg/m² for both GDM [16.65 (6.39, 35.75) vs. 28.35 (19.60, 51.10) median (IQR), p=0.114] and NGT [14.65(9.19, 19.60) vs. 26.00 (17.30, 43.40) median (IQR), p=0.002]. It was also statistically similar in the GDM subgroups divided by Asian BMI cut-off (p=NS). BMI correlated with leptin in NGT (r=0.495, p<0.001) but not in GDM (r=0.177, p=0.251) and regression analysis revealed BMI (kg/m²) as predictor for high leptin (p=0.008). ROC curve analysis for leptin showed AUC for GDM was 0.553 (p=0.360) suggesting it as a poor predictor. It is concluded that fasting leptin in 24-28 weeks of gestation better relates with BMI but does not differ between GDM and NGT anddoes not seem to be a good predictor for GDM. Further study is required to make a comment on its prediction over GDM.

Mi-RNA-93 and Mi-RNA-152 in the Diagnosis of Type 2 Diabetes and Diabetic Retinopathy

Background and Aim: Diabetes mellitus (DM) is a chronic disorder with diabetic retinopathy (DR) as one of its main microvascular outcomes, being a prime cause of vision loss. Dysregulation of microRNAs (miRNAs) has been associated with some diabetic microvascular complications such as diabetic retinopathy. This hypothesised changes in the serum of miR-93 and miR-152 in diabetes and diabetic retinopathy.

Methods: The study cohort consisted of 80 healthy volunteers, 80 type 2 diabetic patients, and 80 diabetic retinopathy patients, of whom 40 had proliferative (PDR) and 40 non-proliferative retinopathy (NPDR). Serum fasting and 2-hour postprandial glucose (2hPP), glycated haemoglobin (HbA1c), fasting insulin, and HOMA-IR were evaluated by routine methods, miR-93 and miR-152 expression by quantitative real-time PCR.

Results: FBG, 2hPP, fasting insulin, HOMA-IR, and miR-152 showed an increasing trend across groups while miR-93 showed a decreasing trend (all p < 0.001). Binary logistic regression analysis for prediction of DR found that the most significant were miR-152 (OR 1.37, 95% CI: 1.18–1.58, <0.001), BMI (1.13, [1.07–1.31], p = 0.004), duration of disease (1.29 [1.04–1.6] p = 0.018), and miR-152 (0.01, [0.0–0.47] p = 0.019). The most significant predictors of PDR were miR-152 (OR = 1.47, 95% CI: 1.12–1.92, p = 0.005), HOMA-IR (2.66 [1.30–5.45] p = 0.007), and miR-93 (0.25 [0.07–0.86] p = 0.028).

Conclusion: MiR-93 and miR-152 can differentiate patients with diabetes and those with DR. Both miRNAs might be potential biomarkers for diabetes and diabetic retinopathy, and specifically for proliferative diabetic retinopathy.

Association of GH polymorphisms with growth traits in buffaloes

Members of the somatotrophic axis, especially GH and IGF1, are essential for growth. The association between GH polymorphisms and growth traits was numerously studied in cattle; however, no data are available for such association studies in buffalo. Therefore, this study was conducted to screen for polymorphisms in the GH gene and to study their putative association with growth traits in 200 Egyptian buffaloes. Polymerase chain reaction single-strand conformation polymorphism and sequencing were applied to look for polymorphisms in 3 loci spanning all exons and introns of buffalo GH. The C (MspI+) >T (MspI-) SNP in intron3, which is well known in cattle, was not detected in the examined buffaloes. However, 2 missense mutations were detected in exon5: one previously detected p.Leu153Val SNP, with very low frequencies for the mutant (Val) allele and one novel p.Asn174His SNP. At weaning age, the p.Leu153Val SNP was significantly associated with weaning body weight and gain with the positive effect of the wild allele (Leu) and higher GH serum, mRNA, and protein levels in animals with Leu/Asn and Leu/His haplotypes. At yearling age, the 2 SNPs associated with yearling weight and gain with positive effect for the mutant (Val and His) alleles with increased GH, and IGF1 serum, mRNA, and protein and GHR mRNA and protein levels in animals with Val/Asn haplotype. Therefore, the selection of Egyptian buffaloes with the Val/Asn haplotype could improve the growth traits of Egyptian buffaloes at yearling age which is the target age for perfect growing.

Dietary supplementation with avilamycin and Lactobacillus acidophilus effects growth performance and the expression of growth-related genes in broilers

Context The use of antibiotics in poultry production is appropriate; however, it brings a high risk of dissemination of antibiotic-resistant strains of pathogenic and non-pathogenic bacteria and their further transmission to humans via the food chain. Aims The effects of supplementation with Lactobacillus acidophilus (a probiotic) or avilamycin (an in-feed antibiotic growth promoter), on growth performance, digestibility, plasma lipid levels, and the expression of certain growth-related genes were investigated. Methods In total, 135 15-day-old broiler chicks were divided into three groups (n = 45): a control group and two treatment groups. Each treatment group was then further divided into three replicates (15 birds each). The control group was fed a basal diet; the second group received basal diet supplemented with avilamycin (0.1 g/kg); the third group received basal diet plus L. acidophilus (0.1 g/kg). Growth performance (bodyweight, feed intake and feed-conversion ratio) was measured. Digestibility and gene expression were measured at the end of the experiment. Key results Greatest bodyweight gain was achieved in the L. acidophilus-fed chicks, which were significantly (P &lt; 0.05) heavier than the control chicks and the avilamycin-fed chicks. Addition of avilamycin or L. acidophilus to the diet also significantly improved feed efficiency (P &lt; 0.05) compared with the control. Although the digestibility of dry matter, crude protein and crude fibre significantly improved in the two experimental groups compared with the control, ether extract was not affected. In addition, plasma total cholesterol, triglyceride and low-density-lipoprotein cholesterol levels were significantly (P &lt; 0.05) decreased whereas plasma high-density-lipoprotein cholesterol was significantly (P &lt; 0.05) increased in the L. acidophilus group compared with the control. Expression of the genes for growth hormone secretagogue receptor (GHSR), insulin-like growth factor 1 (IGF-1) and insulin-like growth factor 1 receptor (IGF1R) was remarkably upregulated in the skeletal muscles of the two experimental groups. Conclusions Supplementation with L. acidophilus (0.1 g/kg) in the broiler diet had positive effects on growth, feed intake, feed efficiency, digestibility, and plasma lipid levels of the broilers. Implications Lactobacillus acidophilus might be a more useful additive in broiler feed than antibiotic growth promoters such as avilamycin.

Efficacy of Vitamin C in Lowering Serum Uric Acid

The objective of the study was to determine the efficacy of vitamin C in reducing serum uric acid (UA). This study was a double-blind placebo-controlled randomized trial conducted in the Department of Rheumatology, Bangabandhu Sheikh Mujib Medical University (BSMMU) Dhaka, Bangladesh from July 2007 and August 2008. Study participants were included from out patient department (OPD) of Rheumatology of BSMMU suffering from various Rheumatological problems other than gouty arthritis. All of the participants were non-smokers, non-alcoholics, and randomized to take either placebo or vitamin C (500 mg/day) for 12 weeks. A total of 98 subjects were enrolled in the study; 71 completed the trial, with 34 in the placebo group and 37 receiving vitamin C. Serum uric acid levels were not significantly reduced in the experimental group and they increased in the placebo group. In the vitamin C group, the mean change was -0.32mg/dl [95% confidence interval -0.73, 0.77], whereas in the placebo group, the mean change was +0.12mg/dl [95% confidence interval was -0.22, 0.47]. Subgroups were defined by sex, body mass index, and quartiles of baseline serum uric acid levels. In a subgroup analysis, vitamin C lowered serum uric acid significantly in those who had comparatively higher baseline uric acid levels. Although vitamin C did not lower serum uric acid significantly, participants with higher baseline serum uric acid levels experienced a significant uric acid lowering effect, but as the sample size was very small, it is difficult to draw any definitive conclusion.

Systematic review and meta-analysis of the performance of clinical risk assessment instruments for screening for osteoporosis or low bone density

We performed a systematic review and meta-analysis of the performance of clinical risk assessment instruments for screening for DXA-determined osteoporosis or low bone density. Commonly evaluated risk instruments showed high sensitivity approaching or exceeding 90% at particular thresholds within various populations but low specificity at thresholds required for high sensitivity. Simpler instruments, such as OST, generally performed as well as or better than more complex instruments.

INTRODUCTION

The purpose of the study is to systematically review the performance of clinical risk assessment instruments for screening for dual-energy X-ray absorptiometry (DXA)-determined osteoporosis or low bone density.

METHODS

Systematic review and meta-analysis were performed. Multiple literature sources were searched, and data extracted and analyzed from included references.

RESULTS

One hundred eight references met inclusion criteria. Studies assessed many instruments in 34 countries, most commonly the Osteoporosis Self-Assessment Tool (OST), the Simple Calculated Osteoporosis Risk Estimation (SCORE) instrument, the Osteoporosis Self-Assessment Tool for Asians (OSTA), the Osteoporosis Risk Assessment Instrument (ORAI), and body weight criteria. Meta-analyses of studies evaluating OST using a cutoff threshold of <1 to identify US postmenopausal women with osteoporosis at the femoral neck provided summary sensitivity and specificity estimates of 89% (95%CI 82-96%) and 41% (95%CI 23-59%), respectively. Meta-analyses of studies evaluating OST using a cutoff threshold of 3 to identify US men with osteoporosis at the femoral neck, total hip, or lumbar spine provided summary sensitivity and specificity estimates of 88% (95%CI 79-97%) and 55% (95%CI 42-68%), respectively. Frequently evaluated instruments each had thresholds and populations for which sensitivity for osteoporosis or low bone mass detection approached or exceeded 90% but always with a trade-off of relatively low specificity.

CONCLUSIONS

Commonly evaluated clinical risk assessment instruments each showed high sensitivity approaching or exceeding 90% for identifying individuals with DXA-determined osteoporosis or low BMD at certain thresholds in different populations but low specificity at thresholds required for high sensitivity. Simpler instruments, such as OST, generally performed as well as or better than more complex instruments.

Antimicrobial resistance and in vitro biofilm-forming ability of Enterococci spp. isolated from urinary tract infection in a tertiary care hospital in Dhaka

The biofilm mode of life conveys a survival advantage to the microorganism associated with it. Biofilm on an indwelling urinary catheter consists of adherent microorganisms, their extra cellular products, and host components deposited on the catheter and thus biofilm on urinary catheters results in persistent infections that are resistant to antimicrobial therapy. This study was done during the period of January 2010 to December 2010. Fifty nine enterococci isolated from 1203 urine samples were speciated by conventional microbiological methods and examined for their ability to form biofilm by microtitre plate assay and antimicrobial susceptibility testing by disc diffusion method for 10 clinically relevant antibiotics respectively. Biofilm producing Enterococci were more frequently found in catheterized than in non catheterized patient (p<0.004). Enterococcus faecium showed increased resistantance to multiple antibiotic than Enterococcus faecalis. Significant relationship was found between biofilm production with antibiotic resistance to amoxicillin, co-trimoxazole, ciprofloxacin, gentamycin, cefotaxime, and cefuroxime. This study demonstrated a high propensity among the isolates of Enterococci to form biofilm and a significant association of biofilms with multiple drug resistance. DOI: http://dx.doi.org/10.3329/bmrcb.v40i1.20320 Bangladesh Med Res Counc Bull 2014; 40: 6-9

Keto-Steroids, I Conversion of Diosgenin to 6 β-Methylpregn-4-ene-6 α,20-diol-3,16-dione

The reaction of diosgenin (1) with hydrogen peroxide/formic acid was investigated. As a result of this work, 5 α (25 R)-spirostane-3 β,5,6 β-triol (2) was prepared in 79% yield and 5 α-pregnane-3 β,5,6 β,16 β,20 α-pentol (3) in 80% yield. The pentol (3) was oxidised to 5 α-pregnane-3 β,5,10 β,20 α-tetrol-6-one (5) without forming its 16 β,20 α-isopropylidenedioxy derivative (4). Reaction of product 5 with CH3Mgl to give 6-methylpregnane derivative was unsuccessful. Therefore, product 7 was oxidatively degraded by H2O2/HCOOH to the 10-keto pregnane derivative (13) and its structure was proved through its transformation to 6 β-methylpregn-4-ene-6 α,20 α-diol-3,16-dione (15).

Hydroxylation of ⊿5-Steroids with N-Bromosuccinimide to 5α,6β-Diols

The reaction of N-bromosuccinimide with ⊿5 -steroids such as, diosgenin, cholesterol, stigmasterol and dehydroisoandrosterone were studied. It was found that NBS in a solvent mixture of acetone, water and acetic acid (8:1:0.1) oxidises the olefinic bond of all the previous steroidal compounds to the corresponding transglycollic, 5α,6β-di-hydroxylic products in about 60% yield at room temperature.

Performance of risk assessment instruments for predicting osteoporotic fracture risk: a systematic review

We systematically reviewed the literature on the performance of osteoporosis absolute fracture risk assessment instruments. Relatively few studies have evaluated the calibration of instruments in populations separate from their development cohorts, and findings are mixed. Many studies had methodological limitations making susceptibility to bias a concern.

INTRODUCTION

The aim of this study was to systematically review the literature on the performance of osteoporosis clinical fracture risk assessment instruments for predicting absolute fracture risk, or calibration, in populations other than their derivation cohorts.

METHODS

We performed a systematic review, and MEDLINE, Embase, Cochrane Library, and multiple other literature sources were searched. Inclusion and exclusion criteria were applied and data extracted, including information about study participants, study design, potential sources of bias, and predicted and observed fracture probabilities.

RESULTS

A total of 19,949 unique records were identified for review. Fourteen studies met inclusion criteria. There was substantial heterogeneity among included studies. Six studies assessed the WHO's Fracture Risk Assessment (FRAX) instrument in five separate cohorts, and a variety of risk assessment instruments were evaluated in the remainder of the studies. Approximately half found good instrument calibration, with observed fracture probabilities being close to predicted probabilities for different risk categories. Studies that assessed the calibration of FRAX found mixed performance in different populations. A similar proportion of studies that evaluated simple risk assessment instruments (≤5 variables) found good calibration when compared with studies that assessed complex instruments (>5 variables). Many studies had methodological features making them susceptible to bias.

CONCLUSIONS

Few studies have evaluated the performance or calibration of osteoporosis fracture risk assessment instruments in populations separate from their development cohorts. Findings are mixed, and many studies had methodological limitations making susceptibility to bias a possibility, raising concerns about use of these tools outside of the original derivation cohorts. Further studies are needed to assess the calibration of instruments in different populations prior to widespread use.

Effect of tonsillectomy on humoral immunity

Tonsils are one of the important secondary lymphoid organ in immune system. It remains controversial whether tonsillectomy results in decreased serum immunoglobulin level. The purpose of this study was to observe the effect of tonsillectomy on humoral immunity parameters among the patients with tonsillar disease. Total group A 70 patients up to the age of 18 years, who were enrolled for tonsillectomy and 30 age matched children group B were included for comparative study. Serum IgG, IgM and IgA levels were measured in all 70 patients before tonsillectomy and in 56 patients who came for 1st follow-up after one month and 30 patients who came for 2nd follow up after three months of tonsillectomy. Serum IgG, IgM and IgA levels were also measured in group B children. Serum IgG, IgM and IgA levels in patients of group A did not show any significant difference in comparison to group B. One month after tonsillectomy the level of IgG was slightly decreased and IgM and IgA were increased compared to preoperative value but not statistically significant. All IgG, IgM and IgA were also not significantly altered in comparison to group B. Three months after tonsillectomy serum IgG, IgM and IgA level were found decreased in comparison to pre operative value and group B, among which difference of only IgG was significant. After tonsillectomy humoral parameters were found reduced but overall impact on humoral immune status was not significantly altered.

Disease Severity and Microsclerotium Properties of the Sorghum Sooty Stripe Pathogen, Ramulispora sorghi

Ramulispora sorghi causes sooty stripe of sorghum. Disease severity in irrigated and dryland plots was measured for 25 susceptible sorghum genotypes during the 2007 and 2008 growing seasons using a rating scale based upon percent leaf area infected. Disease severity ratings were approximately 1.4 points higher (P < 0.0001) on the rating scale in the irrigated plots than dryland plots for 2007 and 2008. Sooty stripe lesions were collected from each sorghum genotype in irrigated plots and assessed for mean microsclerotium production within lesions, microsclerotium size, and sporogenic germination, with significant differences apparent between genotypes for microsclerotium size (P = 0.01) and sporogenic germination (P = 0.01). There was no relationship between disease severity and microsclerotium production within leaf lesions, microsclerotium size, or sporogenic germination; however, there was a positive and significant correlation between microsclerotia production within a lesion and microsclerotium size (R² = 0.19, P < 0.0001). Although microsclerotia from sorghum lesions varied in structural characteristics and their ability to produce spore masses, these qualities were dependent upon the sorghum genotype from which the microsclerotia were derived, because the R. sorghi population was genetically uniform as determined by internal transcribed spacer sequences and random amplified polymorphic DNA polymerase chain reaction.

Cutaneous sporotricosis

Sporotrichosis, a deep fungal infection caused by Sporothrix schenckii, is a rare disease. Infection acquired by traumatic implantation of fungus to the skin. Our patient a 40 years old woman presented with multiple erythematous, ulcerated, crusted nodules of different size and shape situated over the right little finger to upper arm along the course of the lymphatic in a linear fashion. Microscopic examination and culture of the discharge from the skin lesion was done. Sporothrix schenckii was detected on microscopic examination (Yeast form) and on culture (Mycelial form). The patient was treated with Itraconazole at a dose of 100 mg twice in a day for 6 months. She was clinically cured of the disease by 6 months and then the treatment was stopped. We do not commonly encounter sporotrichosis in our practice. We are therefore, prompted to report the case.

Relatedness of Macrophomina phaseolina isolates from tallgrass prairie, maize, soybean and sorghum

Agricultural and wild ecosystems may interact through shared pathogens such as Macrophomina phaseolina, a generalist clonal fungus with more than 284 plant hosts that is likely to become more important under climate change scenarios of increased heat and drought stress. To evaluate the degree of subdivision in populations of M. phaseolina in Kansas agriculture and wildlands, we compared 143 isolates from maize fields adjacent to tallgrass prairie, nearby sorghum fields, widely dispersed soybean fields and isolates from eight plant species in tallgrass prairie. Isolate growth phenotypes were evaluated on a medium containing chlorate. Genetic characteristics were analysed based on amplified fragment length polymorphisms and the sequence of the rDNA-internal transcribed spacer (ITS) region. The average genetic similarity was 58% among isolates in the tallgrass prairie, 71% in the maize fields, 75% in the sorghum fields and 80% in the dispersed soybean fields. The isolates were divided into four clusters: one containing most of the isolates from maize and soybean, two others containing isolates from wild plants and sorghum, and a fourth containing a single isolate recovered from Solidago canadensis in the tallgrass prairie. Most of the sorghum isolates had the dense phenotype on media containing chlorate, while those from other hosts had either feathery or restricted phenotypes. These results suggest that the tallgrass prairie supports a more diverse population of M. phaseolina per area than do any of the crop species. Subpopulations show incomplete specialization by host. These results also suggest that inoculum produced in agriculture may influence tallgrass prairie communities, and conversely that different pathogen subpopulations in tallgrass prairie can interact there to generate 'hybrids' with novel genetic profiles and pathogenic capabilities.

Typhoid Fever

Typhoid fever is one of the most common febrile illnesses encountered by the physicians in Bangladesh. Diagnosis is not difficult but has lately become a challenge due to changed clinical pattern of the disease, lack of adequate facilities for blood, stool, urine culture, excessive reliance on nonspecific Widal test and non availability of any reliable rapid diagnostic tests. Further, the indiscriminate and injudicious use of antibiotics for treating fever in undiagnosed febrile illnesses early has created problems to the physicians to reach to a diagnosis later on. This has also led to the emergence of high level resistance to many of the commonly used antibiotics in our country. Ciprofloxacin is often used empirically for treating the disease though there is already a high level resistance. In case the organism is in-vitro sensitive to ciprofloxacin but resistant to nalidixic acid, a much higher dose of drug is required to maintain the MIC which is 10 times higher than usual. Third generation cephalosporins (ceftriaxone and cefixime) are still the effective drugs for treating typhoid fever. The drug needs to be used in proper dose and duration to prevent emergence of resistance. Azithromycin though advocated by many as an alternative to ciprofloxacin in resistant cases, has recently lost its credibility due to emergence of resistance. We should not rely on Widal test in diagnosing typhoid fever. In a suspected case, the patient should not be prescribed any antibiotic without sending blood sample for culture sensitivity.

Comparison of PCR method with the culture method for identification of gonococci from endocervical swabs

Gonococcal infection remains still a major cause of morbidity among sexually active individuals. Diagnosis of the infection in a female case is more difficult than that in a male. This was a prospective study among 269 female commercial sex workers (CSWs) to screen them for gonococcal infection, comparing the rapid method of identification of gonococci by polymerase chain reaction (PCR) with the selective culture method. A total of 92 (34.2%) CSWs were identified positive for Neisseria gonorrhoeae by combination of the two methods. The PCR method identified 87 of the specimens to harbour cppB gene of N. gonorrhoeae, whereas culture method identified 83 specimens showing colonies of gonococci. Taking into consideration of the total positive cases (92), the PCR method showed a sensitivity of 94.57%, whereas sensitivity of culture method was 90.22%. The selective culture method appears to be the most applicable in the identification of gonococci from clinical specimens, particularly in the less resourceful countries like Bangladesh.

Primary drug resistance pattern of mycobacterium tuberculosis in Dhaka, Bangladesh

One thousand two hundred and eighty one clinically suspected untreated patients with pulmonary tuberculosis were studied from an urban tuberculosis clinic in Dhaka. Majority of the 1281 patients (77.6%) were from the age group of 14 to 44 years. Sputum, 106 (8.3%) were found positive for mycobacteria (both by Ziehl-Neelsen smear staining and culture to consider those as confirmed cases of mycobacterial infection. Out of these 106 cases, 101 (95.3%) were identified as M. tuberculosis and the rest 5 (4.7%) as Non-tuberculous Mycobacteria (NTM). Among the 101 M. tuberculosis strains, 30 (29.7%) were resistant to at least one drug; 16 (15.8%); to isoniazid, 11 (10.9%) to rifampicin, 07 (6.9%) to streptomycin, 03 (2.9%) to ethambutol and 04 (3.9%) to pyrazinamide. Multi-drug resistant tuberculosis (MDR-TB) was found in 5 (4.95%) cases. 5 (4.95%) cases were resistant to two drugs and 3 (2.97%) cases to three drugs. Ciprofloxacin was tested against 30 strains of M. tuberculosis; 2 (6.67%) of which were resistant. This is the first report of ciprofloxacin resistant Mycobacterium tuberculosis from Bangladesh. All the 5 strains of NTM tested for said 5 anti-tuberculous drugs, were found resistant to more than one.

Effect of endodontic irrigation solutions on microhardness of root canal dentine

OBJECTIVES

This study was undertaken to evaluate the effect of several endodontic irrigation solutions on the microhardness of root canal dentine.

METHODS

Eighteen freshly extracted maxillary incisors were used in this experiment. The crowns of teeth were sectioned at the cemento-enamel junction. The root canals were instrumented to an apical size #50 file, and irrigated with saline solution. The prepared roots were divided equally into two groups each of nine roots. Each root was sectioned transversely into cervical, middle and apical segments. The three sections of each root were separately mounted in a metal chuck with acrylic resin. The coronal dentine surfaces of the root segments were polished. The microhardness of the dentine was measured for the purposes of control data at 500 microns and 1 mm from the pulpo-dentinal interface. The canal portions in the root segments included in the first group were irrigated with 3% H2O2 and 5% NaOCl solutions used alternatively, while 17% EDTA solution was the irrigation used in the second group. One millilitre of each solution/segment was applied for 60 s exposure time. After irrigation, dentine microhardness was re-assessed and compared with the control values obtained before the irrigation treatment. Data were statistically analysed using ANOVA and Scheffe's test.

RESULTS

The results showed that, irrigation with either H2O2/NaOCl or EDTA decreased the microhardness value of root dentine. Irrigation with EDTA gave more reduction of dentine hardness compared to H2O2/NaOCl irrigation. The reduction of KHN of dentine following the irrigation treatment was statistically significant (p < 0.05) at both levels of hardness measurement.

CONCLUSIONS

Both H2O2/NaOCl and EDTA irrigating solutions significantly reduced the microhardness of root canal dentine.

Third stage of labor: analysis of duration and clinical practice

OBJECTIVES

Our purpose was to record gestational age-specific data for third-stage duration of labor, frequencies of retained placentas (undelivered at 30 minutes), manual removal of the placenta, and hemorrhage.

STUDY DESIGN

Included were 45,852 singleton deliveries > or = 20 weeks' gestation from 1984 to 1992. Odds ratios, 95% confidence intervals, and actuarial life analysis with censoring of cases with manual placenta removal were performed.

RESULTS

The frequency of retained placentas (2.0% overall) was markedly increased among gestations < or = 26 weeks (odds ratio 20.8, 95% confidence interval 17.1 to 25.4) and < 37 weeks (odds ratio 3.0, 95% confidence interval 2.6 to 3.5) compared with term. The frequency of manual removal (3.0% overall) was increased among gestations < or = 26 weeks (odds ratio 9.2, 95% confidence interval 7.5 to 11.4) and < 37 weeks (odds ratio 2.8, 95% confidence interval 2.4 to 3.1) compared with term. Hemorrhage (3.5% overall) was increased among subjects with manual placenta removal (odds ratio 10.4, 95% confidence interval 9.1 to 11.9); hemorrhage was also increased among gestations < or = 26 weeks (odds ratio 3.0, 95% confidence interval 2.3 to 4.0) and < 37 weeks (odds ratio 1.2, 95% confidence interval 1.01 to 1.3) compared with term. The frequency of hemorrhage peaked by 40 minutes regardless of gestational age. Life-table analysis predicted 90% of placentas would spontaneously deliver by 180 minutes for gestations at 20 weeks, 21 minutes at 30 weeks, and 14 minutes at 40 weeks; the predicted frequency of retained placentas was 42% higher than the recorded incidence.

CONCLUSIONS

The duration of the third stage decreases and the frequencies of hemorrhage and manual removal decrease with increasing gestational age. Hemorrhage was associated with manual placental removal. Life-table analysis indicated that manual removal of placentas shortened the duration of the third stage of labor, especially among preterm deliveries. A prospective trial is needed to determine whether manual placental removal can reduce hemorrhage among prolonged third stages.

Hyperinsulinemia and insulin resistance are associated with preeclampsia in African-Americans

There is evidence that hyperinsulinemia and insulin resistance play a role in the development of hypertension. Accordingly, in our ongoing longitudinal study of pregnancy-induced hypertension, we have measured fasting levels of insulin and glucose at 18 to 25 weeks gestation in 140 nulliparous African-American women followed prospectively to delivery. To test the hypothesis that hyperinsulinemia may be related to the development of preeclampsia, discriminant analysis of mean arterial pressure (MAP), fasting plasma insulin levels, insulin to glucose ratios, and left lateral forearm vascular resistance were examined as predictors of preeclampsia. Statistical analysis controlled for two factors known to be related to insulin levels, gestational age and pregestational body mass index. Gestational hypertensives were not different with regard to blood pressure and metabolic factors from normals and thus were placed in the control group. Women who subsequently developed preeclampsia had mean (+/- SE) fasting plasma insulin levels of 51.0 +/- 12.0 microU/mL at 20 weeks and controls had values of 29.0 +/- 2.8. Only MAP [F(4,135) = 8.8, P < .01] and insulin [F(1,135) = 6.5, P < .05] were related to the development of preeclampsia [F(4,135) = 4.39, R2 = 11.5%]. The finding that elevated second-trimester insulin levels characterize the subsequent development of preeclampsia with control for increased MAP supports the hypothesis that hyperinsulinemia and associated insulin resistance may contribute to the pathogenesis of preeclampsia.

Effect of alcohol on platelet-activating factor acetylhydrolase activity in pregnant and nonpregnant mice

Platelet-activating factor (PAF) induces platelet aggregation and hypotension. It has been implicated in embryonic implantation, fetal lung maturation, and parturition. Alcohol abuse is associated with platelet dysfunction, chronic hypertension, and alcohol-related birth defects. We hypothesized that alcohol may cause, in part, these effects by increasing the activity of PAF-acetylhydrolase (PAF-AH), thereby decreasing PAF concentration. Pregnant mice were given 3.5 g/kg of alcohol orally twice daily from gestation days 7-17. PAF-AH was measured on gestation days 5, 14, and 19 in pregnant females. Nonpregnant females were treated and sampled at parallel time intervals. Pair-fed and untreated control groups were also used. The maternal plasma PAF-AH decreased with gestational age in the untreated controls. Alcohol significantly increased PAF-AH levels in both the pregnant and nonpregnant animals. PAF deficiency might contribute to the tocolytic action of alcohol, as well as some alcohol-related pregnancy complications.

Hemostasis and diagnosis of preeclampsia

The diagnosis of preeclampsia, with all of its consequences, is at times difficult to establish, especially when the patient has underlying chronic hypertension and is not known from prior prenatal care visits. Many screening tests have been proposed. These should be sensitive, relatively specific, easy to perform, of low cost, and have a reasonable interval from prediction to disease onset. Laboratory assays would obviously be useful. We evaluated hemostasis tests for the diagnosis of preeclampsia, and compared fibronectin, antithrombin III and alpha 2-antiplasmin in 48 preeclamptics and 86 control nulliparas. Receive operator characteristic (ROC) curve analysis suggested that fibronectin is the most effective of these tests. A similar analysis comparing the results of previous studies using serum iron, angiotensin infusion, urinary calcium/creatinine ratio, the rollover test and uric acid suggested a possible role for fibronectin in the diagnosis of preeclampsia. While not ideal, there seems to be, at present, no other, easy to perform laboratory test that outperforms fibronectin in predicting preeclampsia.

Birth weight-length ratios, ponderal indexes, placental weights, and birth weight-placenta ratios in a large population

BACKGROUND

Birth weight (BW)/length ratios, ponderal indexes, placental weights, and BW/placental weight ratios have been correlated with perinatal morbidity and mortality.

METHODS

Cross-sectional survey of live-born, structurally normal, singleton neonates delivered at a tertiary care center in Detroit, Mich, from 1984 through 1991. Subjects were included if dating based on menstrual dates and ultrasonographic estimations agreed with Ballard examination to within 2 weeks.

RESULTS

Of 33,138 neonates, 26,983 (81.4%) were black. While all indexes significantly increased with advancing gestational age, only placental weights (without prior draining of blood, blotting the placenta dry, or trimming the membranes or cord) and BW/length ratios significantly increased beyond 40 weeks' gestation. Multivariate analysis of variance revealed that placental weights, BW/placenta ratios, and BW/length ratios were significantly related to gender and ethnicity, but ponderal index was not. Placental weights were larger, and BW/placenta ratios were smaller than studies that trimmed the placentas before weighing.

CONCLUSIONS

All indexes were gestational age dependent, but ponderal index and BW/placenta ratios do not increase beyond 40 weeks' gestation. Except for ponderal index, interpretation of these indexes should be specific for ethnicity, gender, and manner of placental preparation.

Platelet activating factor-acetylhydrolase activity following chorionic villus sampling and amniocentesis

OBJECTIVE

Platelet activating factor (PAF) is essential for embryonic development and is a potent vasodilator. It increases vascular permeability and stimulates prostaglandin E2 (PGE2) production. Platelet activating factor-acetylhydrolase (PAF-AH), the enzyme that degrades PAF, is synthesized by decidual macrophages. The aim of this study was to test the hypothesis that chorionic villus sampling (CVS) and/or amniocentesis might cause an increase in maternal PAF-AH activity.

METHODS

Maternal plasma PAF-AH activity was evaluated before and after genetic amniocentesis (N = 13) and transcervical CVS (N = 29). A control group (N = 9) was evaluated to study the effects of venipuncture.

RESULTS

Chorionic villus sampling caused a significant elevation in PAF-AH activity (P < .0005). No changes were noted in PAF-AH activity in the amniocentesis or the control group.

CONCLUSIONS

Chorionic villus sampling causes subclinical release of PAF-AH, possibly from the decidual macrophages. Increased PAF-AH activity might result in decreased PAF levels, which might lead to vasoconstriction in the placental circulation due to lack of the vasodilator effects of PAF and possibly PGE2. This mechanism might explain the increased risk for fetal limb reduction noted with CVS performed at very early gestational ages.

A gestational-age-independent model of birth weight based on placental size

A placental weight (P) to birth weight (W) relationship, W = P1.5 x constant (A), was presented in 1966. However, based on histological and theoretical studies, placental efficiency increases proportionally to the square of the gestational age in weeks. The purpose of this study was to develop and validate a gestational-age-independent model of birth weight based on P2. Data were prospectively entered into a computerized database for liveborn, structurally normal neonates at a tertiary, urban center. 29,989 neonates had gestational ages based on menstrual dating, ultrasound and Ballard examination, 81.4% were African American. The 'best fit' of W = A x P1.5 had errors in predicting the mean birth weight by at least 10% from 24 to 33 weeks of gestation. In contrast, there was significant improvement (p < 0.05) when the model W = 0.0071 x P2 was used; errors of greater than 10% only occurred at 28 and 43 weeks of gestation. This model had similar accuracy when stratified according to gender or ethnicity. A gestational-age-independent model of mean birth weight can be based upon the square of placental weight. We hypothesize that this model may have utility in understanding disorders of intrauterine fetal growth.

Fibrinolytic parameters in women undergoing ovulation induction

OBJECTIVE

The purpose of this study was to evaluate the effect of elevated levels of circulating estradiol on the clotting and fibrinolytic system in patients undergoing controlled ovarian hyperstimulation.

STUDY DESIGN

Fifty-two patients undergoing controlled ovarian hyperstimulation with human menopausal gonadotropins or urofollotropin were asked to participate. Blood for hemostasis parameters was obtained on the days that patients returned for estradiol sampling. Sample days were identified as cycle days 1 to 5 (baseline), 6 to 9, and 10 to 14. Each factor was analyzed by repeated-measures analysis of variance and correlation analysis.

RESULTS

A significant decline was observed for tissue plasminogen activator antigen and plasminogen activator inhibitor type 1 activity from baseline to cycle days 10 to 14. As serum estradiol levels increased throughout each phase (maximum mean estradiol 739.8 pg/ml), a significant linear decrease was observed for both tissue plasminogen activator antigen and plasminogen activator inhibitor type 1 activity, whereas thrombin-antithrombin III complexes did not change significantly. A significant positive correlation was also observed for plasminogen activator inhibitor activity and tissue plasminogen activator antigen level over all cycle days examined.

CONCLUSION

Down-regulation of the fibrinolytic system was observed as estradiol levels increased. However, thrombin formation did not change, thus suggesting that elevated circulating estradiol alone does not predispose to a thromboembolic event.

Thrombosis and hormone replacement therapy in postmenopausal women

OBJECTIVE

The effects of postmenopausal hormone replacement therapy on thrombosis remain controversial. We tested the hypothesis that estrogen or progesterone has no significant effect on thrombosis by means of newly developed markers of blood clotting, specifically prothrombin fragment 1 + 2, a marker of factor Xa generation, and thrombin-antithrombin III complex, a marker of thrombin generation.

STUDY DESIGN

A prospective study that included 106 women, 68 postmenopausal women on hormone replacement therapy and 38 postmenopausal controls, was performed. Plasma levels of prothrombin fragment 1 + 2 and thrombin-antithrombin III complex were measured by enzyme-linked immunosorbent assay. Multivariate analysis of the covariance was used for statistical analysis, controlling for patient's age because the hormone replacement therapy group was older.

RESULTS

There were no statistically significant differences between the hormone replacement therapy and control groups in either of the clotting parameters measured. A comparison of the levels of prothrombin fragment 1 + 2 and thrombin-antithrombin III complex in patients receiving estrogen alone or estrogen plus progestin also revealed no differences.

CONCLUSIONS

Current doses of postmenopausal hormone replacement therapy do not appear to enhance in vivo clotting. Thromboembolic complications among postmenopausal women receiving hormone replacement therapy may therefore be secondary to congenital or other acquired coagulation defects.

A comparative study of two low-dose combined oral contraceptives: results from a multicenter trial

A comparative multicenter clinical trial of two low-dose combined oral contraceptives (OCs) was conducted in Malaysia, Egypt, Thailand, and Mexico. Efficacy, safety and acceptability were investigated in women taking either a norgestrel-based (NG) OC or a norethindrone acetate-based (NA) OC. This paper includes analysis of 892 women, all of whom were at least 42 days but within 26 weeks postpartum and randomly allocated to one of the above OCs. Follow-up visits were scheduled at 1, 4, 8 and 12 months after admission. Baseline sociodemographic characteristics were similar for both groups, as well as compliance. There were nine unintended pregnancies reported; eight of these occurring in the NA group. Adverse experiences were minor with headaches and dizziness being the most common complaints; frequency of reports was similar in both groups. The group taking the NG-based OC had significantly (p < .05) fewer menstrual-related complaints. Discontinuations due to menstrual problems were significantly more common among NA users (primarily amenorrhea). Discontinuations in the NG group were primarily for other personal reasons, e.g. unable to return to the clinic. There was also a significant difference between the two groups for the 11-month gross cumulative life table discontinuation rates due to menstrual problems (p < .01); the NA group had the higher rate.

Amniotic fluid acetylcholinesterase is found in gastroschisis but not omphalocele

Amniotic fluid acetylcholinesterase (ACHE) has been used to evaluate neutral tube defects. It has also been detected in ventral wall defects. However, the role of ACHE to differentiate between omphalocele and gastroschisis has not been established. We examined amniotic fluid ACHE in 16 pregnancies complicated by gastroschisis and 8 by omphalocele. One ruptured omphalocele was excluded. ACHE was negative in all 7 omphaloceles and either positive or suspicious in all gastroschises (chi 2 = 17.3, p < 0.0001). Amniotic fluid ACHE may be useful to differentiate between omphalocele and gastroschisis.

Amniotic fluid platelet factor 4 and beta-thromboglobulin as markers of structural abnormalities

Platelet factor 4 (PF4) and beta-thromboglobulin (BTG) are unique markers of irreversible platelet activation. We measured PF4 and BTG in amniotic fluid from 102 genetic amniocenteses, in which 78 had normal amniotic fluid alpha-fetoprotein (AFP) levels with normal pregnancies, and 24 had high amniotic fluid AFP levels with abnormal pregnancies. PF4 and BTG were significantly higher in the abnormal pregnancy/elevated amniotic fluid AFP group (p < 0.002 in each case) and correlated with AFP expressed as multiples of the median (p < 0.05 and p < 0.0001, respectively). Our results are compatible with passage of PF4 and BTG across fetal membranes and/or enhanced fetal platelet activation in fetuses with structural anomalies and elevated AFP.

Amniotic fluid platelet factor 4 and beta-thromboglobulin

Platelet activating factor (PAF), a powerful platelet activator, has been identified in human embryos and fetuses, and may induce fetal lung maturation. The potential effect of PAF on fetal platelets as indicated by release of beta-thromboglobulin (BTG) and platelet factor 4 (PF4) has not been investigated. We measured BTG and PF4 in amniotic fluid from 78 genetic and 35 pulmonary maturity amniocenteses. BTG and PF4 were higher in the genetic amniocentesis samples (p < 0.001 in each case) than in the lung maturity samples. BTG and PF4 did not correlate with the pulmonary maturity parameters as measured by the lecithin to sphingomyelin ratio and phosphatidylglycerol concentration. Our findings suggest a fetal origin of BTG and PF4 in amniotic fluid.

Markers for endothelial injury, clotting and platelet activation in preeclampsia

The etiology of disseminated intravascular coagulation (DIC) in preeclampsia is not well understood. We measured plasma levels of fibronectin (FN), which may reflect endothelial cell injury, fibrinopeptide A (FPA), a specific marker of clotting, platelet counts (PLC) and mean platelet volumes (MPV), as well as beta-thromboglobulin (beta TG) and platelet factor 4 (Pf4), products of irreversible platelet activation in 24 preeclamptic patients and 24 controls matched for age, gestational age, labor status, and parity. In preeclampsia, FN and FPA were significantly elevated while PLC were significantly decreased (P less than 0.0001, less than 0.05 and less than 0.01, respectively). beta TG, Pf4, and MPV values did not show significant differences. These findings support the hypothesis that endothelial injury, clotting activation and platelet consumption are increased in preeclampsia. However, the much closer association of preeclampsia with FN levels as compared to FPA, beta TG, Pf4, suggests that endothelial injury is a more basic mechanism of preeclampsia than clotting or platelet activation.