Municipal solid waste management challenges in developing regions: A comprehensive review and future perspectives for Asia and Africa

The rapid urbanization witnessed in developing countries in Asia and Africa has led to a substantial increase in municipal solid waste (MSW) generation. However, the corresponding disposal strategies, along with constraints in land resources and finances, compounded by unorganized public behaviour, have resulted in ineffective policy implementation and monitoring. This lack of systematic and targeted orientation, combined with blind mapping, has led to inefficient development in many areas. This review examines the key challenges of MSW management in developing countries in Asia and Africa from 2013 to 2023, drawing insights from 170 academic papers. Rather than solely focusing on recycling, the study proposes waste sorting at the source, optimization of landfill practices, thermal treatment measures, and strategies to capitalize on the value of waste as more pertinent solutions aligned with local realities. Barriers to optimizing management systems arise from socio-economic factors, infrastructural limitations, and cultural considerations. The review emphasizes the importance of integrating the study area into the circular economy framework, with a focus on enhancing citizen participation in solid waste reduction and promoting recycling initiatives, along with seeking economic assistance from international organizations.

CEBPA restricts alveolar type 2 cell plasticity during development and injury-repair

Cell plasticity theoretically extends to all possible cell types, but naturally decreases as cells differentiate, whereas injury-repair re-engages the developmental plasticity. Here we show that the lung alveolar type 2 (AT2)-specific transcription factor (TF), CEBPA, restricts AT2 cell plasticity in the mouse lung. AT2 cells undergo transcriptional and epigenetic maturation postnatally. Without CEBPA, both neonatal and mature AT2 cells reduce the AT2 program, but only the former reactivate the SOX9 progenitor program. Sendai virus infection bestows mature AT2 cells with neonatal plasticity where Cebpa mutant, but not wild type, AT2 cells express SOX9, as well as more readily proliferate and form KRT8/CLDN4+ transitional cells. CEBPA promotes the AT2 program by recruiting the lung lineage TF NKX2-1. The temporal change in CEBPA-dependent plasticity reflects AT2 cell developmental history. The ontogeny of AT2 cell plasticity and its transcriptional and epigenetic mechanisms have implications in lung regeneration and cancer.

Novel drug therapy of acute hepatic failure induced in rats by a combination of tadalafil and Lepidium sativum

BACKGROUND

Hepatocyte death and a systemic inflammatory response are the outcome of a complex chain of events mediated by numerous inflammatory cells and chemical mediators. The point of this study was to find out if tadalafil and/or Lepidium sativum (L. sativum) could help people who have been exposed to carbon tetrachloride (CCL4) and are experiencing acute moderate liver failure. This was especially true when the two were used together.

METHOD AND MATERIALS

To cause mild liver failure 24 h before sacrifice, a single oral dosage of CCL4 (2.5 mL/kg b.w.) (50% in olive oil) was utilized. Furthermore, immunohistochemical expression of nuclear factor kappa B (NF-κB) as well as histological abnormalities were performed on liver tissue.

RESULTS

The results showed that tadalafil and/or L. sativum, especially in combination, performed well to cure acute mild liver failure caused by CCL4. This was demonstrated by a decrease in NF-κB expression in the liver tissue and an improvement in organ damage markers observed in the blood and liver tissues. Furthermore, such therapy reduced interleukin1 beta (IL-1β) and tumor necrosis factor-alpha (TNF-α) levels in the liver tissue. It's worth noting that the tested combination resulted in greater liver improvement.

CONCLUSIONS

According to the findings, tadalafil and L. sativum, particularly in combination, have the ability to protect the liver from the negative effects of CCL4 exposure. Because of its capacity to improve liver function, restore redox equilibrium, and decrease inflammatory mediators, it is a prospective option for mitigating the negative effects of common environmental pollutants such as CCL4.

CEBPA restricts alveolar type 2 cell plasticity during development and injury-repair

Cell plasticity theoretically extends to all possible cell types, but naturally decreases as cells differentiate, whereas injury-repair re-engages the developmental plasticity. Here we show that the lung alveolar type 2 (AT2)-specific transcription factor (TF), CEBPA, restricts AT2 cell plasticity in the mouse lung. AT2 cells undergo transcriptional and epigenetic maturation postnatally. Without CEBPA, both neonatal and mature AT2 cells reduce the AT2 program, but only the former reactivate the SOX9 progenitor program. Sendai virus infection bestows mature AT2 cells with neonatal plasticity where Cebpa mutant, but not wild type, AT2 cells express SOX9, as well as more readily proliferate and form KRT8/CLDN4+ transitional cells. CEBPA promotes the AT2 program by recruiting the lung lineage TF NKX2-1. The temporal change in CEBPA-dependent plasticity reflects AT2 cell developmental history. The ontogeny of AT2 cell plasticity and its transcriptional and epigenetic mechanisms have implications in lung regeneration and cancer.

CEBPA restricts alveolar type 2 cell plasticity during development and injury-repair

Cell plasticity theoretically extends to all possible cell types, but naturally decreases as cells differentiate, whereas injury-repair re-engages the developmental plasticity. Here we show that the lung alveolar type 2 (AT2)-specific transcription factor (TF), CEBPA, restricts AT2 cell plasticity in the mouse lung. AT2 cells undergo transcriptional and epigenetic maturation postnatally. Without CEBPA, both neonatal and mature AT2 cells reduce the AT2 program, but only the former reactivate the SOX9 progenitor program. Sendai virus infection bestows mature AT2 cells with neonatal plasticity where Cebpa mutant, but not wild type, AT2 cells express SOX9, as well as more readily proliferate and form KRT8/CLDN4+ transitional cells. CEBPA promotes the AT2 program by recruiting the lung lineage TF NKX2-1. The temporal change in CEBPA-dependent plasticity reflects AT2 cell developmental history. The ontogeny of AT2 cell plasticity and its transcriptional and epigenetic mechanisms have implications in lung regeneration and cancer.

287 Retrospective Review of a Single Surgeon 5-Year Experience of Paediatric Breast Reconstruction - Challenges, Experience, and the Increasing Role of Lipofilling

Aim

This case series reviews the presentation, clinical and surgical management of paediatric breast cases undertaken by a single surgeon. The series demonstrates the powerful role of lipomodelling when used with breast reshaping techniques to achieve good outcomes and avoid the need to commit young patients to breast implants.

Method

Retrospective analysis of paediatric breast referrals to a single surgeon at a regional plastic surgery breast reconstruction unit over a 5-year period.

Results

In a 5-year period, 15 cases which presented in childhood to a tertiary paediatric centre were referred on to our regional plastic surgery breast reconstruction unit. Two patients underwent correction of breast hypoplasia secondary to Poland's syndrome. Nine patients presented for breast asymmetry with associated tuberous deformity. One patient had maldevelopment of a breast secondary to a burn's contracture. Two patients presented with gigantomastia and one patient with juvenile fibroadenomas.

Conclusions

Paediatric breast abnormalities represent a small but important caseload for a breast reconstructive surgeon. This case series demonstrates the need for careful assessment and an individualised surgical plan for each patient. The surgical plan must achieve a satisfactory outcome whilst minimising the need for further procedures as the patient grows. It is the senior surgeon's preference to avoid breast implant-based reconstruction where possible. In all but one case lipomodelling combined with reshaping of the native tissue was used to good effect.

Acaricidal Properties of Four Neem Seed Extracts (Azadirachta indica) on the Camel Tick Hyalomma dromedarii (Acari: Ixodidae)

Tick infestation remains one of the major health problems that affect the productivity and comfort of camels. The control of ticks mainly relies on using chemical acaracides. Limited information is available on the potential benefits and activity of various neem extracts on Hyalomma ticks. The present study investigated the acaricidal activity of neem seed extracts at different concentrations against developmental stages of the camel tick Hyalomma dromedarii in comparison to Butox and diazinon. The acaricidal activity of three extracts, namely, hexane extract (HE), methyl chloride extract (MCE), and methanol extract (ME), of neem seeds (Azadirachta indica) were tested at varying concentrations of 5, 10, 15, and 20% on engorged H. dromedarii female ticks at days 1, 3, 5, 7, 12, 16, 20, 28, 37, and 43 after treatment (DPT). Interestingly, results of applying different neem seed extracts to engorged H. dromedarii female ticks showed that the most effective extract was hexane at concentration 20%, causing 100% mortality at 1st day post-application, while methanol extract at 20% and dichloromethane extract at 20% caused the death of all ticks at 28th day posttreatment as compared to Butox® 5.0 and Diazinon-60, which resulted in mortality of all ticks at 3 and 5 DPT, respectively. In addition, no mortality was reported with the application of aqueous extract (AE), which served as the control group. Furthermore, the neem hexane extract exhibited high efficacy against reproductive performance of female ticks, whereas no fertility or oviposition was reported at all of their concentrations. Additionally, no hatchability occurred using all neem extracts, except the aqueous extract, which showing no effect. In the present study, larvae responded more rapidly to the plant extracts, whereas mortality of all larvae was recorded at 24 h after treatment with 5% hexane. Taken together, this study pointed out that the acaricidal effect of hexane extract of neem seeds was more effective and could be economically used for controlling H. dromedarii ticks.

Oxidative stress in Strongylus spp. infected donkeys treated with piperazine citrate versus doramectin

Background:

Parasitic infection is one of the main problems in equidae, particularly donkeys.

Aim:

This study evaluated the oxidative stress in donkeys infected with Strongylus spp by determining the correlation between antioxidants levels; malondialdehyde (MDA), total antioxidant capacity (TAC), and the severity of parasitic infection. It also compared the therapeutic efficacy of piperazine citrate as an oral anthelmintic drug and Doramectin as an injectable one.

Methods:

The study was conducted on 40 donkeys naturally infected with Strongylus spp. These donkeys were divided into two groups (20 donkeys each) according to treatment; One group was treated with piperazine citrate (P_ipTG) and the other with doramectin (D_oraTG). Thorough clinical examination, hematological, biochemical, and parasitological assays were performed before (Day 0) and after treatment (Days 7, 14, 21, and 28). All data were statistically analyzed by independent-sample t-test or paired t-test.

Results:

In both groups, mean values of MDA were significantly reduced, while those of TAC were significantly elevated after treatment on days 7, 14, 21, and 28. These significant changes were reported after treatment between P_ipTG and D_oraTG in favor of D_oraTG. Serum concentrations of MDA were significantly reduced, while those of TAC were significantly elevated for D_oraTG treatment group when their values were compared with those of P_ipTG either on days 7, 14, 21, or 28. Significant correlations were reported in P_ipTG and D_oraTG. Negative significant correlations were reported between fecal egg count (FEC) and each of whole blood picture indices (RBCS, Hb, and PCV), serum TAC and faecal egg count reduction percentage FECR%. A positive correlation was seen between FEC and MDA. MDA exhibited a negative correlation with both blood picture and TAC; hence, TAC was positively correlated with these blood picture indices in both P_ipTG and D_oraTG. In P_ipTG, anthelmintic resistance (R) was present on days 7 and 14, while it was suspected (S) at day 21 then it was absent (N) at day 28. In D_oraTG, anthelmintic resistance was suspected (S) on day 7, then it became absent (N) on days 14, 21, and 28 post therapy.

Conclusion:

The immunological status of the infected donkeys had greatly improved after treatment. The therapeutic efficacy of injectable doramectin was more efficient than that of oral piperazine citrate in Strongylus spp. infected donkeys.

Role of insulin, insulin sensitivity, and abomasal functions monitors in evaluation of the therapeutic regimen in ketotic dairy cattle using combination therapy with referring to milk yield rates

Background:

Ketosis is one of the most critical metabolic disorders that occur in dairy cows after parturition due to negative energy balance around calving.

Aim:

The study evaluated a specific therapeutic regimen of ketosis in Holstein dairy cattle by using the combination therapy including hormones, corticosteroids, propylene glycol, and vitamin B12 as well as the use of milk yield rates, insulin, insulin sensitivity, and abomasal functions monitors as diagnostic biomarkers for the recovery of ketotic cows either pre-therapy (0 days) or post-therapy (7 and 14 days).

Methods:

This study was conducted on ketotic cattle (n = 20) belonged to different dairy farms in Cairo and Giza governorates, Egypt. The diseased cows were undergoing clinical and biochemical investigations for the estimation of serum insulin. Quantitative Insulin Sensitivity Check Index (RQUICKI) and abomasal functions monitor mainly serum levels of gastrin, pepsinogen, and chloride.

Results:

The milk production rates, cost: benefit analysis ratio, and benefit of the dairy farm in ketotic animals were significantly increased post-treatment. An improvement of insulin sensitivity was stated as serum insulin, and RQUICKI were remarkably increased in post-therapeutic ketotic cows. Monitors of the abomasal function revealed abomasal functions improvement through the significant elevation of blood gastrin and a substantial reduction in serum pepsinogen due to treatment.

Conclusion:

The study revealed high efficacy of the applied therapeutic strategy regime. It led to a high recovery rate and a very low relapse rate for ketosis. An improvement in milk yield rates, insulin sensitivity, and abomasal function monitors was reported. Hypoinsulinaemia was still reported, however, serum insulin was improved.

88 Improving Clinical Effectiveness At Identifying Patients Requiring Advanced Care Plans

Our project was conducted in a district general hospital across five acute geriatric wards. Our team included consultants, registrars, and ward matrons. The project focused on improvement of care for geriatric inpatients, with moderate to severe frailty. Advanced care planning (ACP) columns are displayed on white boards. They indicate whether ACPs are required/initiated for each patient. When previously utilised, ACPs were initiated for 78% of appropriate patients [1]. Following a change in staff and reduction in awareness/education, the ACP column use reduced with fewer ACPs established.

Our goals were to ensure completion of the ACP column, encourage junior doctor/nurse involvement and trigger a greater number of appropriate ACPs initiated Improvement in ACP practice was addressed by daily board round review of appropriate patients for ACP, increasing awareness of ACP triggers and education around discussion content. Interventions consisted of: 1, a flow-chart adjacent to white boards prompting “Do not attempt resuscitation (DNAR)” and ACP processes. This signposted staff to information on ACP triggers and “how to start a conversation”. 2 Involving registrar “champions” on each ward. We explained our intervention to all team members to encourage engagement.

Data from the ACP columns were audited prior to intervention, 2 weeks and 6 weeks after intervention. There was a 54% increase in ACP documentation after 6 weeks across the wards.

The improvement in the use of the ACP column correlated with a greater number of ACPs initiated. This facilitated an increase in consideration of patient wishes towards the end of life. Increasing use of a daily ACP prompts on board rounds triggers an increase in ACP implementation for appropriate patients. Sustainability was achieved by recruitment of ward “ACP champions”. Junior doctors/matrons were more empowered to discuss ACPs. Results were presented at departmental teaching to reinforce the positive impact of the intervention.

Validation of Three Different Sterilization Methods of Tilapia Skin Dressing: Impact on Microbiological Enumeration and Collagen Content

Tilapia fish skin has demonstrated promise as a stable and practical biological dressing to be used in wound and burn management. However, the appropriate sterilization technique of the Tilapia fish skin is crucial before its clinical application. The standard sterilization technique must eliminate harmful pathogens but maintain the structural and biochemical properties that could compromise the dressing function. This study investigated and compared the efficiency of three sterilizing agents; chlorhexidine gluconate 4% (CHG), povidone iodine 10% (PVP-I), and silver nanoparticles (25 μg/mL) (AgNPs), at three different times (5, 10, and 15 min) on Tilapia fish skin based on the microbial count, histological and collagen properties. Among the sterilization procedures, AgNPs showed rapid and complete antimicrobial activity, with a 100% reduction in microbial growth of the fish skin throughout the treated times. Furthermore, AgNPs did not impair the cellular structure or collagen fibers content of the fish skin. However, CHG and PVP-I caused alterations in the collagen content. This study demonstrated that the AgNPs treatment of Tilapia fish skin provided sterile skin while preserving the histological properties and structural integrity. These findings provide an efficient and quick sterilization method suitable for Tilapia fish skin that could be adopted as a biological dressing.

Evidences of brain and lung invasion of a local water Cryptosporidium parvum isolate in comparison to Iowa strain: serological and immunohistochemical cytokine evaluation

Cryptosporidium spp. is an obligate intracellular parasite that has become a community threat. The pathological consequences of cryptosporidiosis vary not only in different Cryptosporidium species but even among different isolates of the same species. The present study aimed to track the serological and immunohistopathological differences between animals infected by Cryptosporidium parvum "Iowa isolate" (CPI) and Cryptosporidium parvum "water isolate" isolated from a local water supply in Assiut Governorate, Egypt (CPW). Three experimental groups were encountered: negative control group (C), the CPI group and the CPW group; each contains ten Swiss albino mice. Serum cytokine: IL10 and TNF-α were measured. Expression of Cryptosporidium antigen and CD3 in the intestinal, pulmonary and brain tissue were evaluated through immunohistochemical assay. IL10 and TNF-α were elevated in both infected groups, over expression of Cryptosporidium protein and CD3 in the intestinal, pulmonary and brain tissue in CPW infected group compared to Iowa infected one. Multi-organs affection occurred in the CPW indicating more severe pathogenicity and virulence than standard Iowa isolate. The local C. parvum isolate was more virulent than tested Iowa isolate as it spread extra-intestinally to reach brain tissue.

Quantitation and localization of beta-blockers and SSRIs accumulation in fathead minnows by complementary mass spectrometry analyses

Beta-blockers and selective serotonin reuptake inhibitors (SSRIs) enter the environment through the improper disposal of drugs in garbage, sinks, or toilets as well as via excretion after their intended use. Beta-blockers and SSRIs are resistant to biodegradation and highly water soluble, leading to limited removal capabilities by wastewater treatment plants. As a result, these compounds can easily enter the aquatic environment in a biologically active state, posing risks to the behavior, anatomy, and physiology of aquatic organisms through exposure. However, there is insufficient research on the effects of beta-blockers on aquatic vertebrates to have a complete understanding of the impact of beta-blocker pollution on aquatic organisms. Exposing fathead minnows at environmentally-relevant concentrations allows for an accurate representation of how beta-blockers and SSRIs affect and accumulate in aquatic vertebrates. Singular exposures to two beta-blockers and two selective serotonin reuptake inhibitors (SSRIs) at seven days modeled how pollution affects aquatic wildlife during acute exposure events. After exposure, the entire organism was analyzed quantitatively by liquid chromatography mass spectrometry and qualitatively by matrix-assisted laser desorption/ionization mass spectrometry imaging (MALDI-MSI). Imaging allowed for the determination of the part of the organism in which the drugs were accumulating. Results showed that after seven days of exposure there was accumulation of both the beta-blockers and SSRIs in the fathead minnows. This data represents the first application of LC-MS quantitation guided by MALDI-MSI in aquatic toxicology-type research in environmental analytical chemistry.

Hematological Parameters Throughout the First Month of Direct-Acting Antivirus (DAA) Plus Ribavirin for HCV

Introduction

Hematological complications such as neutropenia, thrombocytopenia, and anemia of DAAs/ribavirin in HCV can result in suboptimal outcomes. This study was aimed to investigate the frequency of hematological variations and their impact on the response to DAA therapy. Patients were defined as having hematological abnormalities if they had the presence of either/or a combination of the following hematological parameters at least once during the first month of treatment: drop in (Hb) level, TLC, and PLT count. Pretreatment, Hb, WBC count, and PLT count were not statistically related to the treatment response. However, lower count of all parameters was associated with moderate or advanced hepatic fibrosis stages according to the METAVIR scoring (P < .001). Static analysis showed that drop in Hb, TLC, and PLT count was significantly associated with response to treatment; P < .001, .21, and .41, respectively.

Methods

Fifty-eight patients for treatment of chronic hepatitis were studied. Their hematological parameters including TLC, Hb, and platelet counts were recorded before starting antiviral therapy and then at 3 monthly intervals. All the patients were given DAAS/ribavirin as antiviral therapy. Data were collected over a period of 3 months.

Results

Fifty-eight patients with mean (SD) age of 54.38 (12.67) years were studied. There was a mean hemoglobin (Hb) fall of 1.5 g/dL at the first 4 weeks of antiviral therapy. Mean TLC fell to 1.03 × 10⁹/L in the first month. A similar downward trend was noted in platelet values with a mean fall of 12.3 × 10⁹/mm in the first month of the antiviral therapy. Of the cases, 41.4% developed clinically significant anemia as evidenced by hemoglobin 11 g/dL after 4 weeks of antiviral therapy; this fall was noted only in first 4 weeks of treatment.

Conclusion

Significant hematological abnormalities occurred within the first 4 weeks of antiretroviral therapy. There was significant decrease in hemoglobin level.

Stability of antibiotics in drinking water: An advanced approach towards the impacts of water quality parameters on doxycycline bioavailability

Objective:

This study was considered to explore the possible impacts of drinking water quality from different sources on the bioavailability of doxycycline.

Materials and Methods:

Sixty-four tap and ground drinking water samples collected from poultry farms were scrutinized for their water quality limits (TH, pH, total dissolved solids, electrical conductivity, Cl⁻, Ca⁺², Na⁺, and Mg⁺²) and heavy metals concentrations (Zn, Fe, Cu, and Ni). An in vitro study was conducted by adding the therapeutic concentrations of doxycycline to all tested water samples, and allowed to interact for 1 h, 3 h, 5 h, and 8 h followed by re-estimation of doxycycline concentrations after each contact time using thin layer chromatography.

Results:

The therapeutic concentration of doxycycline was decreased in tap water samples by 1.92%, 9.63%, 22.42%, and 30.83% for the aforementioned contact times, respectively, while the corresponding reduction percentages in ground water samples were 2.14%, 17.14%, 28.57%, and 40.09%. However, the control samples had never showed any recorded decrease in their doxycycline concentrations overall contact times. All measured concentrations of doxycycline were significantly lower in tap and ground water than those of control at all times of contact. Both pH, Mg⁺² showed significant positive correlations with decreasing values of doxycycline in water.

Conclusion:

Different drinking water sources reduce the concentrations of doxycycline in vitro in a time dependent manner, which can be attributed to their different physico-chemical parameters, i.e., pH and Mg⁺² ions. This emphasizes the role of water quality on the stability of antibiotics concentrations administrated via drinking water.

Analysis of beta-blocker bioconcentration in brown planaria (Girardia dorotocephala) and its effects on regeneration

Production, distribution, and disposal of pharmaceutical products, including beta-blockers, have become a global issue. Beta-blockers are known to persist in the environment months after their release and may result in the disruption of the homeostatic system in non-target organisms. Here, we study the bioconcentration of three of the most commonly used beta-blockers and their effect on the regeneration of Girardia dorotocephala, a freshwater brown planarian. Acute toxicity tests determined LC₅₀s for acebutolol, metoprolol, and propranolol to be 778 mg/L, 711 mg/L, and 111 mg/L, respectively. The quantification and analysis of beta-blocker bioconcentration during acute exposure were performed by liquid chromatography-tandem mass spectrometry (LC-MS/MS). After 4 days of exposure to beta-blockers, the bioconcentration drastically decreased for all three beta-blockers at all exposure levels, suggesting that an effective mechanism to reduce uptake or excrete beta-blockers could be present. Additionally, Girardia dorotocephala were cut proximal to the head and the quality of regeneration was documented from each fragment daily. No significant difference was visually observed after 2 weeks of regeneration between the brown planarians placed in beta-blocker solution and those placed in control solution.

Antiprotozoal activity of silver nanoparticles against Cryptosporidium parvum oocysts: New insights on their feasibility as a water disinfectant

Cryptosporidium is a protozoan of extremely medical and veterinary impact; whose oocysts donate a considerable resistant to the water treatment processes. Therefore, this study aimed to explore the impacts of silver nanoparticles (AgNPs) on count and viability of the Cryptosporidium parvum (CP) isolated from different tap water samples. The oocysts were exposed to AgNPs at different dosages of 0.05, 0.1 and 1 ppm for several contact times (30 min to 4 h). The results showed a significant decrease in oocyst count and viability in a dose-dependent manner. Additionally, AgNPs at a conc. of 1 ppm for 30 min and 0.1 ppm for 1 h reduced the oocysts by 97.2 and 94.4%, respectively. Comparatively, there was a noticeable increase in the oocyst's viability at 2 and 4 h, which emphasized that the time of contact between AgNPs and CP was not a major influencing factor for successful application of AgNPs in the nano-water treatment.

Do diabetic patients receiving conventional dialysis solutions benefit from peritoneal dialysis?

AIM

The study aimed to evaluate the impact of glucose-based peritoneal dialysis solutions (GBPDS) on diabetic patients on maintenance peritoneal dialysis.

METHODS

In this cross-sectional study we compared the influence of long term use of GBPDS on sixteen parameters related to the peritoneal glucose load, hydration status, inflammation, blood pressure, lipid profile and left ventricular mass in 45 stable PD patients (20 diabetic and 25 non-diabetic) receiving GBPDS.

RESULTS

At 24 months HbA1c, peritoneal glucose load index (PGLI), fluid overload (FO), plasma BNP, hsCRP and IL-6 levels, WBC count, blood pressure, triglycerides, LDL-C and left ventricular mass index (LVMI) were higher in diabetic patients compared to non-diabetic subjects (P ≤ 0.04). Of 16 tested variables, 14 had deteriorated at 24 months in diabetic patients. PGLI values > 3 g/kg/day or FO > 1.0 L were associated with abnormal values of HbA1c, plasma BNP, CRP and plasma IL-6 levels. 60% of diabetic patients had PGLI > 3g/kg/day compared to 32% of non-diabetic patients (P < 0.001). Seventy per cent of diabetic patients had FO > 1.0 L compared to 28% of non-diabetic patients (P < 0.001). Only 12% of diabetic patients had nocturnal blood pressure dipping compared to 45% of non-diabetics (P = 0.03). 57.8% of the studied patients had increased LVMI. Diabetic patients had higher LVMI values compared to non-diabetics (P < 0.001). The presence of DM was found to be the most powerful predictor for the development of LVH (P < 0.001).

CONCLUSION

Utilization of GBPDS in diabetic PD patients may be associated with substantial adverse consequences affecting glycemic control, hydration status, lipid profile, inflammation, blood pressure control and LVM.

Promoting social inclusion through Unified Sports for youth with intellectual disabilities: a five-nation study

BACKGROUND

Although the promotion of social inclusion through sports has received increased attention with other disadvantaged groups, this is not the case for children and adults with intellectual disability who experience marked social isolation. The study evaluated the outcomes from one sports programme with particular reference to the processes that were perceived to enhance social inclusion.

METHOD

The Youth Unified Sports programme of Special Olympics combines players with intellectual disabilities (called athletes) and those without intellectual disabilities (called partners) of similar skill level in the same sports teams for training and competition. Alongside the development of sporting skills, the programme offers athletes a platform to socialise with peers and to take part in the life of their community. Unified football and basketball teams from five countries--Germany, Hungary, Poland, Serbia and Ukraine--participated. Individual and group interviews were held with athletes, partners, coaches, parents and community leaders: totalling around 40 informants per country.

RESULTS

Qualitative data analysis identified four thematic processes that were perceived by informants across all countries and the two sports to facilitate social inclusion of athletes. These were: (1) the personal development of athletes and partners; (2) the creation of inclusive and equal bonds; (3) the promotion of positive perceptions of athletes; and (4) building alliances within local communities.

CONCLUSIONS

Unified Sports does provide a vehicle for promoting the social inclusion of people with intellectual disabilities that is theoretically credible in terms of social capital scholarship and which contains lessons for advancing social inclusion in other contexts. Nonetheless, certain limitations are identified that require further consideration to enhance athletes' social inclusion in the wider community.

In-vitro prediction of bioavailability following extravascular injection of poorly soluble drugs: an insight into clinical failure and the role of delivery systems

Objectives

To investigate the feasibility of using an in-vitro model to simulate the incidence of post-injection drug precipitation (PDP), and to identify the roles of drug properties and delivery systems in its occurrence.

Methods

A literature review on incomplete absorption following extravascular injection (subcutaneous and intramuscular) was conducted. Six model drugs in nine different formulations were studied for an in-vitro/in-vivo correlation. A rapid in-vitro dilution method using a 96-well plate was used for predicting PDP by dilution with a physiological buffer. New formulations based on hydroxypropyl-β-cyclodextrin (CD), with and without co-solvents or pH control, were developed and tested on the in-vitro model.

Key findings

The occurrence of precipitation detected from the in-vitro dilution model appeared to be correlated with clinical reports and animal studies. The formulation components played an important role in determining the potential for drug precipitation on dilution or pH neutralization. CD was found to reduce the tendency for precipitation. The addition of co-solvents may reduce the effect of CD, depending on the solvent used.

Conclusions

The in-vitro model can be used as a cost-effective screening tool in injectable formulation development for safe and effective delivery of poorly soluble drugs. PDP can be circumvented with a well-designed formulation.

Chronic allograft nephropathy score before sirolimus rescue predicts allograft function in renal transplant patients

Chronic allograft nephropathy (CAN) is a major indication for initiation of sirolimus (SRL) in renal transplantation (TX) to prevent deterioration of renal function. We evaluated whether the CAN score at time of sirolimus rescue (SRL-R) predicts renal allograft function. CAN score is the sum of the following 4 categories: glomerulopathy (cg, 0-3), interstitial fibrosis (ci, 0-3), tubular atrophy (ct, 0-3), and vasculopathy (cv, 0-3). This is a retrospective cohort study of renal transplant recipients from July 2001 to March 2004. Immunosuppression consisted of preconditioning with rabbit anti-thymocyte globulin or alemtuzumab and maintenance with tacrolimus (TAC) monotherapy with spaced weaning, if applicable, SRL-R was achieved by conversion from TAC, or by addition to reduced doses of TAC. Ninety patients received SRL. Thirty-three of these patients met the inclusion criteria of the following: (1) receipt of SRL for >6 months, and (2) follow-up of > or =6 months. There were 16 patients in the low-CAN (0-4) group and 17 patients in the high-CAN (>4) group. Cockcroft-Gault (C-G) glomerular filtration rate (GFR) was calculated at SRL-R and at 1, 3, 6, and 12 months. The DeltaGFR was significantly better in the low-CAN group at 1, 3, and 6 months. A trend toward an improved DeltaGFR was present at 12 months in the low-CAN group (P = .16). CAN scoring at the time of SRL-R predicts recovery of renal allograft function (as measured using DeltaGFR), and should be used in preference to biochemical markers (Cr and C-G GFR), which may not be reliable predictors.

Studies on Johne's Disease in Egyptian Cattle

Johne's disease (JD) or paratuberculosis is a serious problem of cattle industry worldwide. For a long period of time, Egypt was considered to be free of JD. In the present study, 2150 Egyptian cattle were examined clinically for JD. Among these, samples from 160 cows were investigated for the presence of Mycobacterium avium ssp. paratuberculosis using various laboratory methods including direct microscopic examination, faecal culture and polymerase chain reaction (PCR). According to the data obtained by the culture method, positive results could be observed for 75 cows from three of five investigated districts in Egypt. Comparably investigated samples from 40 cows of one known positive flock from Hesse, Germany yielded positive reactions for 20 cows. The present study is the first description of JD in Egypt.

An alternative technique for revision arthrodesis of the rheumatoid wrist: a case report

Few studies address the problem of failed rheumatoid wrist arthrodesis. We report a case of this difficult complication that was treated with a new technique of arthrodesis, which includes both the ulnocarpal and radiocarpal sites with 2 intramedullary nails and an ulnar ostectomy.

Infected internal iliac artery aneurysm: a case report

Isolated internal iliac aneurysms are rare, and although most are of atherosclerotic origin the cause may also be congenital, traumatic, associated with pregnancy or infectious. A 56-year-old man presented with a swollen, painful left lower limb. Within a few days, weakness of the limb developed with fever and an acute abdomen with free air on x-ray. At emergency laparotomy a small perforation was found in the ascending colon. Examination of the left iliac fossa revealed a ruptured left internal iliac artery aneurysm. Extra-anatomic cross-femoral bypass grafting was done to revascularize the left lower extremity. The patient recovered without complication. At discharge the weakness had improved but knee flexion and extension were weak. Culture of the aneurysm contents grew Staphylococcus aureus and Pseudomonas aeruginosa. The authors discuss the presentation and management of infected internal iliac artery aneurysms.

Une synthèse hautement stéréosélective de diènes conjugués (E)

A general method for the preparation of (E) terminal conjugated dienes was developed by the flash thermolysis of 2-substituted 2,5-dihydrothiophene-1,1-dioxides generated by a retro Diels–Alder reaction. This process allows the obtention of conjugated dienes, bearing or not a functionality (alcohols, esters), with an excellent stereoisomeric purity (in general higher than 98%). An application to the synthesis of (E)-9,11-dodecadien-1-yl acetate, the major component of the sex pheromone of Diparopsiscastanea, shows the generality and the efficacy of this method.