Differential capacity of phragmites ecotypes in remediation of inorganic contaminants in coastal ecosystems: Implications for climate change

Remediating inorganic pollutants is an important part of protecting coastal ecosystems, which are especially at risk from the effects of climate change. Different Phragmites karka (Retz) Trin. ex Steud ecotypes were gathered from a variety of environments, and their abilities to remove inorganic contaminants from coastal wetlands were assessed. The goal is to learn how these ecotypes process innovation might help reduce the negative impacts of climate change on coastal environments. The Phragmites karka ecotype E1, found in a coastal environment in Ichkera that was impacted by residential wastewater, has higher biomass production and photosynthetic pigment content than the Phragmites karka ecotypes E2 (Kalsh) and E3 (Gatwala). Osmoprotectant accumulation was similar across ecotypes, suggesting that all were able to successfully adapt to polluted marine environments. The levels of both total soluble sugars and proteins were highest in E2. The amount of glycine betaine (GB) rose across the board, with the highest levels being found in the E3 ecotype. The study also demonstrated that differing coastal habitats significantly influenced the antioxidant activity of all ecotypes, with E1 displaying the lowest superoxide dismutase (SOD) activity, while E2 exhibited the lowest peroxidase (POD) and catalase (CAT) activities. Significant morphological changes were evident in E3, such as an expansion of the phloem, vascular bundle, and metaxylem cell areas. When compared to the E3 ecotype, the E1 and E2 ecotypes showed striking improvements across the board in leaf anatomy. Mechanistic links between architectural and physio-biochemical alterations are crucial to the ecological survival of different ecotypes of Phragmites karka in coastal environments affected by climate change. Their robustness and capacity to reduce pollution can help coastal ecosystems endure in the face of persistent climate change.

Cardiovascular Risk Scoring of Hospitalized Chronic Kidney Disease Patients by Framingham Risk Score

Patients with chronic kidney disease (CKD) are more likely to have complications due to cardiovascular diseases (CVD). This cross sectional descriptive study was conducted in the Department of Medicine and Nephrology, Chittagong Medical College (CMC), Chittagong, Bangladesh from June to December, 2014 and was performed to estimate the risk of cardiovascular events according to Framingham's Risk Score of CKD patients. In this research, 100 patients who was diagnosed as CKD and admitted in the Chittagong Medical College Hospital were enrolled. Estimated glomerular filtration rate (eGFR) was calculated with the MDRD formula. Cardiovascular risk factors were analyzed by Framinghams criteria and after compilation data were analyzed by SPSS-18.0. Among 100 patients, most of patients were under 60 years of age where males (56.0%) were more than females (44.0%). Framingham Cardiovascular Risk Score revealed that most of the male were at high risk group compared to female. Regarding different components of lipid profile with Framingham risk score, higher risk group had high mean total cholesterol (212.17mg/dl) and also low mean HDL level (38.58mg/dl). Patient with different stages of CKD with cardiovascular risk showed stage 5 CKD was 80%, stage 4 was 15.0% and rest 5 was at stage 3 and most were in low risk group (56.0%). There were significant positive correlations found in between age and serum total cholesterol level with the cardiovascular risk scoring but not with HDL and eGFR. The predominant cardiovascular risk factors were age, male gender, smoking and high serum total cholesterol.

Relative biochemical and physiological docking of cucumber varieties for supporting innate immunity against Podosphaera xanthii

Powdery mildew in cucumber is caused by the Podosphaera xanthii. No strategy for improving disease resistance can be successful in the absence of thorough insights into the physiological and biochemical responses of cucumber plants to powdery mildew. Therefore, a field experiment was executed to evaluate five commercial cucumber varieties (V1: Dynasty, V2: Long green, V3:Desi Kheera, V4:Thamin II, V5:Cucumber 363) for their inherent immunity to powdery mildew. Upon inoculating cucumber plants with Podosphaera xanthii, we noted differential responses among the varieties. Compared to other varieties, V1 and V2 showed higher values (P ≤ 0.05) for chlorophyll-a under control and pathogen-attacked plants respectively. The minimum value of anthocyanin content (-53.73%) was recorded in V3 as compared to other varieties post pathogen infection. All pathogen-infected cucumber varieties showed a considerable (P ≤ 0.05) loss in flavonoid content except V2. The maximum destruction for Phenolics under powdery mildew (179%) were recorded in V4, whereas V1 exhibited maximum phenolic content under control conditions. In pathogen-infected plants, the minimum AsA was recorded in V5 as compared to all other varieties. Pathogen invasion impacted significantly (P ≤ 0.05) the activity of superoxide dismutase (SOD). Besides, cucumber plants after pathogen inoculation resulted in a considerable (P ≤ 0.05) increase of peroxidase (POD) activity in V1 (5.02%), V2 (7.5%), and V3 (11%) in contrast to V4. Our results confirmed that cucumber varieties perform differently, which was brought on by distinct metabolic and physiological modifications that have an impact on growth and development. The changes in different attributes were correlated with cucumber resistance against powdery mildew. The results would help us fully harness the potential of these varieties to trigger disease management initiatives and defense responses.

Antibacterial Effects of Chloroform Henna (Lawsonia inermis) Leaf Extracts against Two Nosocomial Infection Causing Pathogens: Gram-positive Staphylococcus aureus and Gram-negative Klebsiella pneumoniae: A Comparative Study

Evaluation of the in vitro antibacterial activity of Chloroform extracts isolated from Henna (Lawsonia inermis) leaf against two nosocomial infection causing pathogens, gram-positive Staphylococcus aureus and gram-negative Klebsiella pneumoniae. This interventional study was carried out for the period of January 2021 to December 2021 in the Department of Pharmacology and Therapeutics in collaboration with the Department of Microbiology, Mymensingh Medical College, Bangladesh. The antibacterial activity was tested at different concentrations of Chloroform Henna leaf extracts by using disc diffusion and broth dilution method. The extract was prepared by using solvents chloroform and 0.1% Dimethyl sulfoxide (DMSO). The test microorganisms were also tested for their activity against a standard antibiotic Ciprofloxacin by broth dilution method and the result was compared with that of Chloroform extracts. Chloroform Henna Extracts (CHE) were used initially in nine different concentrations (2.5, 5, 10, 20, 50, 100, 200, 500 and 1000 mg/ml). Among different concentrations of the CHE, 100mg/ml and above concentrations showed inhibitory effect against Staphylococcus aureus and Klebsiella pneumoniae. The MIC for Staphylococcus aureus and Klebsiella pneumoniae were 100 and 200mg/ml in CHE respectively. The MIC of Ciprofloxacin was 1μg/ml against Staphylococcus aureus and 1.5μg/ml against Klebsiella pneumoniae. The MIC of Ciprofloxacin was the lowest in comparison to MICs of CHE for the test organisms. This study showed that Chloroform Henna extracts demonstrated antibacterial effects against food borne pathogens. It is clearly observed that there is definite antibacterial effect of the Chloroform extract of Henna leaves (Lawsonia inermis) against Staphylococcus aureus and Klebsiella pneumoniae.

Nerium oleander could be used for sustainable management of traffic-borne elemental-enriched roadside soils

Metal pollutants released from motor vehicles are deposited in roadside environments. Metals are non-biodegradable and biomagnify in the food chain causing significant health hazards at all levels of the ecosystem. Hence, management of contaminated roadside verges is critically important and should be kept in mind while planning specific management strategies of such areas. Native vegetation could help to decontaminate heavy metal polluted soils in the best sustainable way. Therefore, this study was designed to assess the potential of Nerium oleander to accumulate heavy metals commonly released by automobiles such as Pb, Cd, Ni, and Zn along with various C and N compounds from five different locations along a busy road in Punjab, Pakistan, during summer and winter seasons. N. oleander showed the ability to absorb C, N, and heavy metals Pb and Cd; the maximum concentration of Pb and Cd was 8.991 mg kg-1 and 0.599 mg kg-1, respectively. These pollutants negatively affected photosynthetic pigments, gas exchange attributes, soluble proteins, and free amino acids. But antioxidant activity of N. oleander was found to be increased in both seasons. The metal accumulation in the plant was higher in the summer though. We highly recommend that by growing N. oleander at roadside verges for decontamination of vehicular pollutants could lead to sustainable management of these corridors.

Mitigation of lead toxicity in Vigna radiata genotypes by silver nanoparticles

Heavy metal (HM) contamination of the soil through anthropogenic activities influences the living systems and drastically impacts food chain. This study examined the application of silver nanoparticles (AgNPs) in two genotypes (G1 and G2) of Mung bean (Vigna radiata) for ameliorating the Pb toxicity. Different doses of Pb (0, 25, 50 μM) were differentially tackled by AgNPs with the aim of ameliorating the plant attributes. Both genotypes displayed statistically significant quantitative and qualitative modulations for Pb tolerance. In G2, the most prominent increase in plant height (43.79%), fresh biomass (49.56%) and total chlorophyll (20%) was observed at L2 (AgNPs 10 mg/L) in comparison with the control. Overall, photosynthetic rate was increased by 26% in G2 at L6 (AgNPs 25 mg/L + Pb 25 μM). In addition, the results presented 78.5% increase in water use efficiency of G2 while G1 experienced a maximum internal CO₂ concentration (209.8%) at L8 (Pb 50 μM). AgNPs triggered balanced uptake of minerals and improved growth of Vigna genotypes. 50 μM Pb was most hazardous and caused maximum reduction in growth of Vigna plants along with a significant suppression in photosynthetic activity, increase in MDA (199.7%) in G1 and H₂O₂ (292.8%) in G2. In comparison to control, maximum superoxide dismutase (376%), peroxidase (659.8%) and catalase (9.3%) activity was observed in G2 at L11. The application of AgNPs substantially enhanced plant growth and helped them in surviving well in absence as well as presence of Pb. G2 genotype exhibited substantial tolerance capability and revealed less impairment in the studied attributes than G1 and treatment of AgNPs i.e. 25 mg/L was the best level that yielded best results in both genotypes. The results demonstrate that AgNPs mediate response(s) of plants under Pb stress and particularly contributed to HM tolerance of plants and thus showing great promise for use in phytoremediation.

Community empowerment and mental wellbeing: longitudinal findings from a survey of people actively involved in the big local place-based initiative in England

BACKGROUND

Community empowerment initiatives are receiving increased interest as ways of improving health and reducing health inequalities.

PURPOSE

Longitudinally examine associations between collective control, social-cohesion and mental wellbeing amongst participants in the Big Local community empowerment initiative across 150 disadvantaged areas of England.

METHODS

As part of the independent Communities in Control study, we analysed nested cohort survey data on mental wellbeing (Short Warwick Edinburgh Mental Wellbeing Scale-SWEMWBS) and perceptions of collective control and social-cohesion. Data were obtained in 2016, 2018 and 2020 for 217 residents involved in the 150 Big Local areas in England. Adjusted linear mixed effect models were utilized to examine changes in SWEMWBS over the three waves. Subgroup analysis by gender and educational level was conducted.

RESULTS

There was a significant 1.46 (0.14, 2.77) unit increase in mental wellbeing score at wave 2 (2018) but not in wave 3 (2020) (0.06 [-1.41, 1.53]). Across all waves, collective control was associated with a significantly higher mental wellbeing score (3.36 [1.51, 5.21]) as was social cohesion (1.09 [0.19, 2.00]). Higher educated participants (1.99 [0.14, 3.84]) and men (2.41 [0.55, 4.28]) experienced significant increases in mental wellbeing in 2018, but lower educated participants and women did not.

CONCLUSION

Collective control and social cohesion are associated with better mental wellbeing amongst residents engaged with the Big Local initiative. These health benefits were greater amongst men and participants from higher educational backgrounds. This suggests that additional care must be taken in future interventions to ensure that benefits are distributed equally.

Interactions and effects of microplastics with heavy metals in aquatic and terrestrial environments

Contamination of waters and soils with microplastics (MPs) is an emerging environmental issue worldwide. MPs constitute a cocktail of various additives and polymers besides adsorbing toxic heavy metals from the environment. This co-occurrence of MPs with heavy metals poses a threat to the health of organisms and is poorly understood. Ingestion of MPs contaminated with heavy metals may also result in subsequent transfer of heavy metals up in the food chain. MPs surfaces play a crucial role in the adsorption of heavy metals. Aged/biofouled MPs facilitate greater adsorption of metals and certain microplastic (MP) polymers adsorb some metals more specifically. External factors involved in the process of adsorption/accumulation of heavy metals are the solution pH, salinity, and the concentration of relevant heavy metals in the media. Desorption greatly depends upon pH of the external solution. This is more concerning as the guts/digestive systems of organisms have low pH which could enhance the desorption of toxic metals and making them accumulate in their bodies. The aim of this article is to discuss the abundance, distribution, adsorption, and desorption behavior of MPs for heavy metals, and their combined toxic effects on flora and fauna based on the limited research on this topic in the literature. There is an overarching need to understand the interactions of MPs with heavy metals in different ecosystems so that the extent of ecotoxic effects they pose could be assessed which would help in the environmental regulation of these pollutants.

Foliar architecture and physio-biochemical plasticity determines survival of Typha domingensis pers. Ecotypes in nickel and salt affected soil

Six ecotypes of Typha domingensis Pers. Jahlar (E₁), Sheikhupura (E₂), Sahianwala (E₃), Gatwala (E₄), Treemu (E₅) and Knotti (E₆) from different ecological regions were collected to evaluate the leaf anatomical and biochemical attributes under different levels of salinity and nickel stress viz; L₀ (control), L₁ (100 mM + 50 mg kg^-1), L₂ (200 mM + 100 mg kg^-1) and L₃ (300 mM + 150 mg kg^-1). Presence of salt and Ni in rooting medium consistently affected growth, anatomical and physio-biochemical attributes in all Typha ecotypes. Discrete anatomical modifications among ecotypes such as reduced leaf thickness, increased parenchyma area, metaxylem cell area, aerenchyma formation and improved metaxylem vessels were recorded with increasing dose of salt and Ni. The minimum anatomical damages were recorded in E₁ and E₆ ecotypes. In all ecotypes, progressive perturbations in ionic homeostasis (Na⁺, K⁺, Cl^-, N) due to salt and metal toxicity were evident along with reduction in photosynthetic pigments. Maximum enhancement in Catalase (CAT), Superoxide dismutase (SOD), Peroxidase (POD) and modulated Malondialdehyde (MDA) activity was recorded in E₁ and E₆ as compared to other ecotypes. Accumulation of large amounts of metabolites such as total soluble sugars, total free amino acids content in Jahlar, Knotti, Treemu and Sahianawala ecotypes under different levels of salt and Ni prevented cellular damages in T. domingensis Pers. The correlation analysis exhibited a close relationship among different levels of salinity and Ni with various plant attributes. PCA-Biplot verified our correlational analysis among various attributes of Typha ecotypes. An obvious separation of Typha characters in response to different salinity and Ni levels was exhibited by PC1. We recommend that genetic potential of T. domingensis Pers. To grow under salt and Ni stresses must be investigated and used for phytoremediation and reclamation of contaminated soil.

Frequency Of Non-Diabetic Renal Disease In Type 2 Diabetes Mellitus Patients Undergoing Renal Biopsy

BACKGROUND

Diabetes mellitus has become a major emerging health concern. Its burden, estimated to be 451 million in 2017, has been projected to rise to 693 million by 2045. This will bring a rise in the prevalence of its associated complications. There is a wide spectrum of non-diabetic renal disease (NDRD) known to be present in diabetic patients with variable prevalence. However, the majority of diabetes mellitus (DM) patients with renal disease are yet not biopsied and the diagnosis of diabetic nephropathy (DN) is presumed on clinical grounds.

METHODS

It is a retrospective cross-sectional study. We selected a total of 126 cases of renal biopsies with a history of type 2 diabetes mellitus. Demographic data was collected from the medical records and pathology reports while all cases were evaluated by reviewing the archived slides.

RESULTS

Patients were categorized into group 1 with isolated NDRD, group 2 showing NDRD mixed with DN and group 3 with isolated DN. Thirty-four (27%) cases had isolated NDRD (group 1), 14 (11%) had NDRD mixed with DN and 78 (62%) patients had isolated DN. NDRD, either alone or in combination with DN, was found to be present in 48 patients with an overall prevalence of 38%.

CONCLUSION

Our study concludes that NDRD is frequent in type 2 diabetes mellitus patients. Renal biopsy remains the key diagnostic tool in such cases, providing crucial information for proper management of the underlying pathology.

Mnemonic Techniques: Characteristics, Educational Suitability and Research Prospects in the Field of Anatomy

The outcome of using different mnemonic techniques have been established through several researches from the ancient time but systematic researches in the field of Anatomy like how and why different mnemonic techniques work better than others are still sketchy. This is likely lead to incomprehensive understanding of how particular mnemonics may work better than others in specific situation and how the exact potentials of mnemonics be objectively understand. For medical undergraduates, even though many things have to be understood, sometimes it is very important to retain a piece of information by memorization and later recall it. A way of easing memorization is using a mnemonic device.

CD117/c-KIT Expression in Phyllodes Tumor of the Breast and Its Correlation With Morphology and Clinical Outcome

Introduction

Breast phyllodes tumor’s (PT) clinical behavior is difficult to predict on histology. There is limited amount of data available on the role of biological markers. The objective of this study was to assess the expression of CD117 (c-KIT) in PT of the breast and its relationship with morphology and clinical outcome.

Methods

A total of 78 patients having available clinical records between 2004 and 2014 with breast PT were retrieved from the cancer registry at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore and were followed up. Immunohistochemical studies were performed on all the cases using mono­clonal antibody CD117 (DAKO A4502) using Leica Bond-Max automated biosystem (Leica Biosystems, Melbourne, Australia). Staining proportion and intensity of both epithelial and stromal elements were analyzed. Evaluation of the protein expression was determined and scored.

Results

Patients’ mean age was 45.13 ± 11.4 years. Thirty-nine (50.0%) patients had tumor on right side, 38 (48.7%) had on left and only one (1.3%) was bilateral. Thirty-two (41.0%) patients had benign PT, 21 (26.9%) had borderline and 25 (32.1%) had malignant PT. Negative CD117 expression was observed in 20 (62.5%), eight (38.0%) and 12 (48.0%) of benign, borderline and malignant PTs, respectively. Positive CD117 expression was observed in 12 (37.5%) benign, 13 (61.9%) borderline and 13 (52.0%) malignant PTs. There was insignificant association between CD117 expression with respect to tumor sub-type, patient’s age and clinical behavior (p-value > 0.05).

Conclusion

CD117 expression was not found to be associated with tumor type and was not associated with increased risk of recurrence in this sample of patients. Further work is needed to better understand the prognostic value of CD117 expression in breast PTs.

Chest Radiography in the Evaluation of Mitral Valvular Disease and it's Correlation with Echocardiography

This study is aimed to find out various clinical, radio-graphical and echocardiographic variables to predict mitral valvular disease and their correlation with Echocardiography. This cross-sectional observational study was conducted in the Department of Radiology and Imaging, in collaboration with Department of Cardiology, Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from January 2017 to December 2018. Total 50 consecutive cases enrolled in this study who was the patients of mitral valvular disease. Both chest radiograph and echocardiograph were done for each patient. There were 76% female and 26% male with a female-male ratio 3.16:1 with mean±SD (41.54±12.44). About 42% patients had previous history of rheumatic fever. The most common x-ray findings of heart were increased central density (90%) followed by enlargement in transverse diameter (88%), straightening of the left border (88%), widening of the carina (86%), full pulmonary conus (84%) and double contour of right border (76%). About 47(94%) patients confirmed mitral valvular heart disease on echocardiography. The prominent findings included left atrium was predominantly severely dilated (50%), severely reduced mitral valve orifice area (68%), mild mitral regurgitation (46%) and mild pulmonary hypertension (38%). And overall sensitivity, specificity, PPV, NPV and accuracy of chest radiograph in the detection of mitral valvular heart disease were 85.11%, 66.67%, 97.56%, 14.89% and 84%, respectively. These findings suggest that chest radiograph could be used as an adjunct tool with echocardiography.

Physiological homeostasis for ecological success of Typha (Typha domingensis Pers.) populations in saline soils

The natural capacity of plants to endure salt stress is largely regulated by multifaceted structural and physio-biochemical modulations. Salt toxicity endurance mechanism of six ecotypes of Typha domingensis Pers. was evaluated by analyzing photosynthesis, ionic homeostasis, and stomatal physiology under different levels of salinity (0, 100, 200 and 300 mM NaCl). Typha populations were collected across different areas of Punjab, an eastern province in Pakistan. All studied attributes among ecotypes presented differential changes as compared to control. Different salt treatments not only affected gas exchange attributes but also shown significant modifications in stomatal anatomical changes. As compared to control, net photosynthetic rate, transpiration rate, total chlorophyll contents and carotenoids were increased by 111%, 64%, 103% and 171% respectively, in Sahianwala ecotype among all other ecotypes. Similarly, maximum water use efficiency (WUE), sub stomatal CO2 concentration, sodium (Na+) and chloride (Cl-) contents were observed in Sahianwala (191%, 93%, 168%, 158%) and Knotti (162%, 75%, 146%, 182%) respectively, as compared to the others ecotypes. Adaxial and abaxial stomatal areas remained stable in Sahianwala and Knotti. The highest abaxial stomatal density was observed in Gatwala ecotype (42 mm2) and maximum adaxial stomatal density was recorded in Sahianwala ecotype (43 mm2) at 300 mM NaCl salinity. The current study showed that Typha ecotypes responded varyingly to salinity in terms of photosynthesis attributes to avoid damages due to salinity. Overall, differential photosynthetic activity, WUE, and changes in stomatal attributes of Sahianwala and Knotti ecotypes contributed more prominently in tolerating salinity stress. Therefore, Typha domingensis is a potential species to be used to rehabilitate salt affected lands for agriculture and aquatic habitat.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s12298-021-00963-x.

Collective control, social cohesion and health and well-being: baseline survey results from the communities in control study in England

BACKGROUND

Area-based initiatives (ABIs) are receiving renewed interest as a part of the 'place-based public health' approaches to reducing health inequalities.

PURPOSE

Examine associations between collective control, social cohesion and health amongst residents involved in the Big Local (BL) ABI.

METHODS

Survey data on general health, mental well-being, perceptions of individual and collective control and social cohesion was obtained in 2016 for 1600 residents involved in the 150 BL ABI areas in England, and 862 responded-a response rate of >50%. Adjusted mean differences and adjusted odds ratios (ORs) were calculated using random effect linear and generalized estimating equation models. Subgroup analysis by gender and educational level was conducted.

RESULTS

Mental well-being was positively associated with collective control (mean difference: 3.06 units, 1.23-4.90) and some measures of social cohesion ('people in the area are willing to help each other' [mean difference: 1.77 units, 0.75-2.78]). General health was positively associated with other measures of social cohesion (area-belonging [OR: 4.25, 2.26-7.97]).

CONCLUSIONS

Collective control and some aspects of social cohesion were positively associated with better mental well-being and self-rated health amongst residents involved with BL. These positive associations were often greater amongst women and participants with a lower education. Increasing the collective control residents have in ABIs could improve the health effects of ABIs.

Risk factors for non-communicable diseases related to obesity among first- and second-generation Bangladeshi migrants living in north-east or south-east England

BACKGROUND

Obesity is a global burden, which significantly increases the risk of non-communicable diseases (NCDs). More than a quarter of adults in the United Kingdom are obese, but prevalence varies by ethnicity, and South Asians have the largest burden of NCDs. This paper assesses how sex, generation, and region interplay to vary the predisposition to obesity-related (OR) NCDs among UK Bangladeshis.

METHODS

We used National Institute for Health and Care Excellence suggested grading for combining body mass index and waist circumference to define populations at risk of OR-NCDs. Data from 517 adults of Bangladeshi origin from a cross-sectional study (March 2013 to April 2015) were analysed. Male and female participants from London and north-east England were equally sampled including: (1) adult migrants, who came to the UK aged >16 years; (2) child migrants, who came to the UK aged ≤16 years; and (3) second-generation Bangladeshis (who were born and brought up in the UK). A generalised estimating equation using a binomial distribution and a logit link was used to explore the relationship between the binary outcome of being 'at risk of OR-NCDs' and associated factors.

RESULTS

Females, married individuals, those living in London, the second-generation, and those of lower self-assessed financial status, with low acculturation status, or who did not walk daily for at least 20 min were more likely to develop OR-NCDs. A striking sex difference was found with more females prone to OR-NCD risk in the north-east than in London.

CONCLUSIONS

Our study observed important inter- and intra-regional inequality in OR-NCD risk which worsens the health of ethnic minorities and widens inequality.

Impact of COVID-19 on the cerebrovascular system and the prevention of RBC lysis

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) uses Angiotensin- converting enzyme 2 (ACE2) receptors to infect host cells which may lead to coronavirus disease (COVID-19). Given the presence of ACE2 receptors in the brain and the critical role of the renin-angiotensin system (RAS) in brain functions, special attention to brain microcirculation and neuronal inflammation is warranted during COVID-19 treatment. Neurological complications reported among COVID-19 patients range from mild dizziness, headache, hypogeusia, hyposmia to severe like encephalopathy, stroke, Guillain-Barre Syndrome (GBS), CNS demyelination, infarcts, microhemorrhages and nerve root enhancement. The pathophysiology of these complications is likely via direct viral infection of the CNS and PNS tissue or through indirect effects including post- viral autoimmune response, neurological consequences of sepsis, hyperpyrexia, hypoxia and hypercoagulability among critically ill COVID-19 patients. Further, decreased deformability of red blood cells (RBC) may be contributing to inflammatory conditions and hypoxia in COVID-19 patients. Haptoglobin, hemopexin, heme oxygenase-1 and acetaminophen may be used to maintain the integrity of the RBC membrane.

Fetomaternal Outcome of Pregnancy in Women with Tetralogy of Fallot

This prospective study was done to determine fetomaternal outcomes of pregnancy in women with Tetralogy of Fallot (TOF) and carried out in two centres especially in the care of patients with adult congenital heart disease (CHD) from January 2005 to December 2009. Clinical, haemodynamic and obstetric data were reviewed for pregnant women with TOF. Ten (10) pregnant women were identified in the age range 18 to 47 years. Most of the patients were in the age group of 18 to 27 years, 34 to 36 weeks gestational age (in week) and primi gravida (60%). Right-sided aortic arch (20%) and major anomalies of pulmonary collaterals (30%) were common anomalies anatomical association. Normal vaginal delivery was the mode of delivery (70%) in the majority of the patients. Spontaneous abortions were occurred in 3(30%) patients. Primary maternal cardiac events complicating pregnancies were congestive heart failure (20%), arrhythmias and cardiovascular events (10%). Premature labor (40%) was the most common obstetric complication. Premature birth (40%), fetal demise (20%), neonatal death (10%) and cardiac anomaly at birth (10%) were the offspring complications in the study. Women with TOF can go through pregnancy with a low risk to themselves with frequent treatable complications, but there is a high incidence of miscarriage, premature births and low birth weight. An incidence of congenital anomaly in the fetus is higher than that found in the normal population.

Comparison of Placental Growth Factor Levels in Maternal Serum at Early Pregnancy between Normotensive Pregnant Women and Patients with Hypertensive Disorders in Pregnancy

Hypertensive disorder of pregnancy is a major public health problem worldwide. Pre-eclampsia and its complications are frequent causes for maternal and perinatal mortality and morbidity, particularly in developing countries. In preeclampsia some angiogenic factors like PlGF (Placental growth factor), VEGF (Vascular endothelial growth factor) etc. are assumed to be low in maternal serum. This prospective cohort study was carried out including 134 pregnant women with early gestation (15-20wks) attending the Feto-Maternal Medicine OPD of Bangabandhu Sheikh Mujib Medical University (BSMMU) Hospital, Dhaka, Bangladesh from January 2015 to April 2015. Maternal serum was taken for measurement of PlGF by ELISA technique and values were converted to Multiples of Median (MoM) for their specific gestational age. The subjects were regularly followed up till delivery by measuring blood pressure and testing urine for protein by heat coagulation method. Hypertension was diagnosed if blood pressure found to be more than or equal 140/90mm of Hg and preeclampsia was labeled when proteinuria associated with it. Patients' information was kept in a prepared data sheet. The mean age of the patients was 25.7±5.57 years, mean BMI was 22.42±3.23. The incidence of Hypertensive disorder was 6.72% among them Pregnancy Induced Hypertension (PIH) was 2.98% and Preeclampsia (PE) was 3.9%. The mean age of hypertensive patients was 30.6±5.16 years and BMI was 26.92±1.54. The mean value of PlGF in normotensive women was 1.17±0.67 MoM, PIH patients were 0.66±0.41 MoM and PE patients were 0.65±0.30MoM. The comparison of mean values between Normotensive with PIH (p value 0.023) and Normotensive with PE (p value 0.014) both were found significant. From the current study and also from previous studies we can summarize that the level of PlGF become reduced significantly in pregnant women who will later on develop Hypertensive disorders.

EUS-FNA, ancillary studies and their clinical utility in patients with mediastinal, pancreatic, and other abdominal lesions

BACKGROUND

Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is an important modality to obtain tissue diagnosis from mediastinal, pancreatic, and intra-abdominal lesions in close proximity to the pulmonary and gastrointestinal tract. It is considered to be a relatively safe, rapid, and minimally invasive technique with low complication rates.

AIMS

To determine the diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and outcome of EUS-FNA, with histological correlation where applicable.

METHODS

Data of all 1059 consecutive patients who underwent EUS-FNA from 1 January 2005 to 31 December 2017 at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore was reviewed in this retrospective study. The major sites that were targeted for EUS-FNA were pancreatic (423), mediastinal (376), and other abdominal lesions (260).

RESULTS

The average number of passes per patient was 2.22. Rapid on-site evaluation (ROSE) was adequate in 969 patients (91.4%). Concordance between ROSE and final cytology was 99.5%. Follow-up was available in 810 patients (76.4%). The overall diagnostic yield was 94.3%. Ancillary studies, including immunohistochemical stains and flow cytometry, helped to increase the diagnostic yield from 78.1% to 94.3%. The overall sensitivity, specificity, PPV, NPV, and diagnostic accuracy for EUS-FNA were 94.8%, 98.6%, 99.9%, 65.5%, and 95.1%, respectively. Seven of 1059 patients (0.6%) developed complications.

CONCLUSION

EUS-FNA is a very sensitive and specific diagnostic tool with a minimal complication rate. Ancillary studies helped to increase the sensitivity, as well as the diagnostic yield.

Diagnostic yield of sputum induction in patients with pleural tuberculosis at a tertiary care hospital in Karachi

OBJECTIVE: To evaluate the diagnostic yield of acid-fast bacilli (AFB) smear, culture for Mycobacterium tuberculosis and Xpert® MTB/RIF assay in induced sputum (IS) specimens in patients with pleural tuberculosis (TB).DESIGN: A total of 156 patients were evaluated at Jinnah Postgraduate Medical Centre, Karachi, Pakistan, from April 2016 to December 2017. Patients with exudative lymphocytic pleural effusions with normal lung parenchyma on chest radiography were included in the study: 102 were due to tuberculous and 54 due to non-tuberculous infections as diagnosed using thoracoscopic pleural biopsy. IS samples were sent for acid-fast bacilli (AFB) smear, AFB culture and Xpert assay.RESULT: In patients with a clinical diagnosis of TB, mycobacteria were detected in IS AFB smear in 7.8%, AFB culture in 21.6% and Xpert assay in 34.3% of cases. All sputum samples collected from patients with non-tuberculous aetiology were negative.CONCLUSION: Testing IS samples for M. tuberculosis provides another approach to diagnosing pleural TB, especially in settings in which invasive procedures are less accessible. Our study also emphasises the contagiousness of pleural TB, and the need to screen the household contacts of these patients and possible isolation of patients with pleural TB admitted to hospital.

Utility of p63 and p40 in Distinguishing Polymorphous Adenocarcinoma and Adenoid Cystic Carcinoma

Objective:

Adenoid cystic carcinoma and polymorphous adenocarcinoma are primarily the tumor of minor salivary glands. Both show certain morphological similarities, which limit their proper diagnosis in settings where there are obscuring factors and limited biopsy material. However, there is a considerable difference in treatment and prognosis, which raises the need to distinguish these two entities. In this study, we discuss the utility of two immunohistochemical stains, p63 and p40, in different combinations for distinguishing polymorphous adenocarcinoma from adenoid cystic carcinoma.

Materials and Methods:

Two immunohistochemical stains, p63 and p40, were performed on 47 cases of adenoid cystic carcinoma and 23 cases of polymorphous adenocarcinoma.

Results:

36 out of 47 cases of adenoid cystic carcinoma showed p63+ve/p40+ve immunoprofile, followed by p63-ve/p40-ve immunoprofile, which is seen in10 cases of adenoid cystic carcinoma. However, 22 out of 23 cases of polymorphous adenocarcinoma displayed p63+ve/p40-ve immunoprofile. p63-ve/p40+ve is the least frequent observed immunoprofile, which is seen in only one case of adenoid cystic carcinoma.

Conclusion:

On combining all possible immunoprofile combinations, p63+ve/p40-ve immunoprofile appears to be the most sensitive profile for distinguishing polymorphous adenocarcinoma from adenoid cystic carcinoma.

Distribution of HPV-16 and HPV-18 from the Patients Attending At Mymensingh Medical College Hospital by Newly Developed Oncoprotein Detection Assay

Cervical cancer is one of cause of death in women in many developing countries. Persistent infection with Human Papilloma Virus (HPV), primarily high risk types 16 and 18, is recognized as a causal and essential factor for the development of cervical cancer. The objective of this cross sectional observational study is to detect the distribution of HPV-16 and HPV-18 among Onco E6 positive cases. Following universal safety precautions a total of 180 endocervical swabs were collected from Colposcopy clinic of Obstetrics and Gynaecology Department of Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from January 2016 to December 2016. Laboratory work was done in the department of Microbiology, Mymensingh Medical College. E6 strip test is an immunochromatographic test based on the detection of HPV-E6 oncoprotein in cervical swab samples. Onco E6 cervical test was done on 180cases. Among them 60% were VIA positive and 120% were VIA negative. From this VIA positive cases 12(16.25%) were On E6 cervical test positive and from VIA negative cases 3(2.5%) were positive by this On E6 cervical test. From this 12 Onco E6 cervical test positive cases 10(%) were HPV-16 and 2(%) were HPV-18 and from VIA negative cases 3 were only HPV-16 by this test. Histopathological test done on 35 suspected cases and out of 08 cervical carcinoma cases 07 were positive by this Onco E6 cervical test which was also HPV-16 type. It may be concluded that HPV-16 is most prevalent type to cause cervical cancer and by this newly developed protein detection assay will be helpful to reduce over treatment and save many lives.

Study of Vitamin D Deficiency among the Apparently Healthy Population in Jashore, Bangladesh

Globally Vitamin D deficiency is a burning issue for the last two decades. Though the very high prevalence of hypovitaminosis D is worldwide even in the South-East Asia but there is very limited data in Bangladesh. This observational study was designed to assess the status of Vitamin D deficiency among the clinically apparent healthy population in the district of Jessore, Bangladesh from January 2017 to June 2017. Both the male and female clinically healthy participants between the age of 10 and 70 years residing more than 3 years in Jashore were included in this study, while those having renal or liver failure or any other chronic diseases and using drugs that could potentially interfere the metabolism of vitamin D were excluded from the study. Here we leveled serum 25(OH)D concentration of ≤20ngm/dl as deficient, >20-30ngm/dl graded as insufficient and >30ngm/dl graded as sufficient. Among 160 participants 43.1% (n=69) were male and 56.9% (n=91) were female. And 102(63.7%) participants had deficient vitamin D, 50(31.3%) had insufficient vitamin D and only 8(5%) had sufficient vitamin D. The mean serum 25(OH)D levels in our study was 18.60±6.59ngm/dl. The mean serum 25(OH)D level in case of male participants was 19.72±7.10ngm/dl whereas in female the corresponding figure was 17.74±6.07gm/dl and no significant difference observed among the man and women (p=0.059). Sun exposure play a vital role in the vitamin D deficiency and we observed only 1-2 hours/day sun exposure was sufficient for normal vitamin D level (p=0.001). In case of women who used veil had significantly lower level of vitamin D (p=<0.001) due to lack of adequate sun exposure. Urban participants who also had significant low level of vitamin D due to the same reason (p=0.009). There was no deficiency observed in farmers and only 5(3.1%) had insufficient vitamin D. No significant difference observed in deficiency of vitamin D among the different age, sex, education level, skin complexion or BMI. But the obese participants had significant (p=0.041) lower vitamin D level. It was concluded with the high rate of vitamin D deficiency in this small scale study conducting in a district of Bangladesh demands a nationwide survey of vitamin D.

Genitourinary Fistula: A Curse to Neglected Pregnancy

Genitourinary fistula is a psychophysiosocial distress that results in prolonged labour. Gradually, it has become a public health issue globally with advancing of its incidence day by day. A handsome number of mothers are also suffering in Bangladesh from genitourinary fistula. This study was done to observe the patterns of presentations of genitourinary fistula and their fetal outcome. One hundred sixteen (116) consecutive patients were enrolled in the study by purposive sampling as a diagnosed case of genitourinary fistula presented in Department of Obstetrics & Gynecology of Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2017 to September 2017. It was a prospective observational cross-sectional study. A pre-structured, interview and observation based, peer reviewed data collection sheet was prepared. Data regarding sociodemographic, clinical and Obstetrical profile were recorded. Statistical analysis was done with SPSS version 23. Data were presented as mean and standard deviation, frequency and percentage with range. The mean age of the respondents was 27.27±4.21 (age range: 20-35 years). The mean height of the respondents was 150.26±13.28cm (range: 133-172cm). Among 106 mothers 69(65.1%) and 25(23.6%) were primiparous and multiparous respectively. On the contrary, 5(4.7%) each were grand multiparous and experienced fistula due to non obstetrics complications like malignancy, hysterectomy and radiotherapy. Mothers had 1, 2 and 3 fistulas in 98(92.5%), 6(5.7%) and 2(1.9%) respectively. Among 106 mothers, 99(93.4%) experienced only urinary incontinence whereas 5(4.7%) experienced fecal incontinence. Only 2(1.9%) experienced both urinary and fecal incontinence. Maximum vesicovaginal fistula was due to obstructed labour (65.09%) which was subsequently followed by trauma (14.15%). Vesicovaginal fistula was the commonest type which was subsequently followed by vesicocervical fistula. Among 106 mothers, 73(68.9%) and 25(23.6%) gave birth, still birth and alive babies respectively. On the contrary, 4(3.7%) neonate experienced death in neonatal period whereas 1(0.9%) each twin deliveries resulted in 'one dead and one alive' and 'Twin alive' respectively. In case of only 3(2.8%) mothers 'no information' regarding fetal outcome could be recorded. Prolonged labour is the principal culprit to develop genitourinary fistulas among which VVF is the commonest variety. Still birth is the frequently evident fetal outcome in case of this clinical disaster of pregnancy.

Phylogeny and comparative modeling of phytochelatin synthase from Chlorella sp. as an efficient bioagent for detoxification of heavy metals

Phytochelatins (PCs) found extensively in algae and plants are important for detoxification of heavy metals from soil and wastewater, and their synthesis is mediated by an enzyme phytochelatin synthase (PCS). In this study, a phylogram was generated to study evolutionary relationships of PCS from various organisms. It was revealed that PCS from green algae and plants are orthologs as both have evolved from a common ancestor. PCS from cyanobacteria appeared in two different clades showing that they have followed different lineages during evolution. Structural modeling was also carried out by building a 3D model of PCS from Chlorella variabilis using software Modeller v9.16. The predicted structure will be helpful for protein engineering strategies and to understand its interactions with other proteins. The biological biosorption capacity of Chlorella vulgaris (a green alga) was determined to remove Cd, Cu and Pb from industrial effluents. The biosorption of three heavy metals from industrial waste water was investigated under various conditions like pH, biomass concentration, contact time and temperature. Bio-removal of heavy metals was carried out by exposing culture of C. vulgaris to water samples of different heavy metal concentrations. The decrease in Cd, Cu and Pb quantities after 1 to 7 days of incubation period were 83%, 84% and 82.5%, respectively. In view of this, Chlorella spp. could be used on a large scale to detoxify heavy metals and clean up contaminated environments.

Inequalities in mental health and well-being in a time of austerity: Follow-up findings from the Stockton-on-Tees cohort study

In response to the 2007/8 financial crisis and the subsequent ‘Great Recession’, the UK government pursued a policy of austerity, characterised by public spending cuts and reductions in working-age welfare benefits. This paper reports on a case study of the effects of this policy on local inequalities in mental health and wellbeing in the local authority of Stockton-on-Tees in the North East of England, an area with very high spatial and socio-economic inequalities. Follow-up findings from a prospective cohort study of the gap in mental health and wellbeing between the most and least deprived neighbourhoods of Stockton-on-Tees is presented. It is the first quantitative study to use primary data to intensively and longitudinally explore local inequalities in mental health and wellbeing during austerity and it also examines any changes in the underpinning social and behavioural determinants of health. Using a stratified random sampling technique, the data was analysed using linear mixed effects model (LMM) that explored any changes in the gap in mental health and wellbeing between people from the most and least deprived areas, alongside any changes in the material, psychosocial and behavioural determinants. The main findings are that the significant gap in mental health between the two areas remained constant over the 18-month study period, whilst there were no changes in the underlying determinants. These results may reflect our relatively short follow-up period or the fact that the cohort sample were older than the general population and pensioners in the UK have largely been protected from austerity. The study therefore potentially provides further empirical evidence to support assertions that social safety nets matter - particularly in times of economic upheaval.

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First quantitative study to use primary data to intensively and longitudinally explore local inequalities in mental health and wellbeing during austerity.

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Also examines any changes in the material, psychosocial and behavioural determinants.

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Finds that the large gap in mental health between the two areas remained constant over the 18-month study period, whilst there were no changes in the underlying determinants.

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The stability of inequalities in mental health and wellbeing during austerity may have been because the sample was older than the general population and pensioners in the UK have largely been shielded from austerity.

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Discusses the importance of universal benefits in the context of health inequalities and austerity.

Efficacy and Safety of Intravaginal Misoprostol for Mid-trimester Medical Termination of Pregnancy

Misoprostol has been widely used in Obstetrics and Gynecology for cervical priming, medical abortion and induction of labour. The purpose of the present study was to evaluate the efficacy and safety of intravaginal misoprostol in mid-trimester medical termination of pregnancy. This non-randomized clinical trial was carried out in the Department of Obstetrics and Gynecology at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from July 2007 to June 2008 for a period of one year. Primi- or multigravid women with 13 to 28 weeks of singleton pregnancy, fetal congenital malformation and missed abortion who were selected for medical termination of pregnancy were included in this study. Women with spontaneous labour, low laying placenta, ruptured membrane with or without chorioamnionitis, acute bronchial asthma, glaucoma, history of hypersensitivity of PGs, uncontrolled hypertension, cardiac disease, jaundice, renal disease were excluded from this study. The selected patients received 200μg of misoprostol 6 hourly pervaginally upto 48 hours. The outcome variables were induction of delivery time, number of doses within 48 hours, result of induction, surgical evacuation, bleeding after induction, requirement of blood transfusion and Dinoprostone gel; side effect & complication of misoprostol were recorded. A total number of 30 women were recruited for this study. Delivery within 24 and 48hours were 43.3% cases and 38.3% cases respectively. Surgical evacuation was needed in 23.33% cases. Cramping (26.7%), had nausea (10.0%), vomiting (10.0%) and fever (26.7%) were reported. Out of all respondents 90.0% had average and 10.0% had more than average bleeding. For termination of pregnancy 200μg of intravasinat misoprostol are safe and effective in mid-trimester.

Ovarian Endometrioid Adenocarcinoma Arising in Endometriosis: A Case Report

Malignant transformation of ovarian endometriosis was first described in 1925 by Sampson; later on it has been described in extragonadal regions by few authors also. Ovarian endometrioid and clear cell carcinoma are highly associated with endometriosis. Here we present a case of malignant transformation of ovarian endometrioma into endometrioid adenocarcinoma and review the clinical and pathological features of these tumors. A 45-years old infertile woman diagnosed as a case of bilateral chocolate cyst with pelvic endometriosis underwent total hysterectomy with bilateral salpingo-oophorectomy. A solid portion was also identified in the right sided cyst, histology of which revealed a well-differentiated endometrioid adenocarcinoma grade-II with foci of squamous morules and keratin pearls. Her pre-operative CA-125 level was within normal range. Women with endometriosis should be considered at an increased risk for the development of ovarian cancer even with normal CA-125 level.

Geographical inequalities in health in a time of austerity: Baseline findings from the Stockton-on-Tees cohort study

Stockton-on-Tees has the highest geographical inequalities in health in England with the life expectancy at birth gap between the most and deprived neighbourhoods standing at over 17 years for men and 11 years for women. In this study, we provide the first detailed empirical examination of this geographical health divide by: estimating the gap in physical and general health (as measured by EQ. 5D, EQ. 5D-VAS and SF8PCS) between the most and least deprived areas; using a novel statistical technique to examining the causal role of compositional and contextual factors and their interaction; and doing so in a time of economic recession and austerity. Using a stratified random sampling technique, individual-level survey data was combined with secondary data sources and analysed using multi-level models with 95% confidence intervals obtained from nonparametric bootstrapping. The main findings indicate that there is a significant gap in health between the two areas, and that compositional level material factors, contextual factors and their interaction appear to be the major explanations of this gap. Contrary to the dominant policy discourse in this area, individual behavioural and psychosocial factors did not make a significant contribution towards explaining health inequalities in the study area. The findings are discussed in relation to geographical theories of health inequalities and the context of austerity.

Urdu translation and validation of shorter version of Positive Affect and Negative Affect Schedule (PANAS) on Pakistani bank employees

OBJECTIVE

To translate, adapt and validate shorter version of positive affect and negative affect scale on Pakistani corporate employees.

METHODS

This cross-sectional study was conducted in the twin cities of Islamabad and Rawalpindi from October 2014 to December 2015. The study was completed into two independent parts. In part one, the scale was translated by forward translation. Then it was pilot-tested and administered on customer services employees from commercial banks and the telecommunication sector. Data of the pilot study was analysed by using exploratory factor analysis to extract the initial factor of positive affect and negative affect scale. Part two comprised the main study. Commercial bank employees were included in the sample using convenient sampling technique. Data of the main study was analysed using confirmatory factor analysis in order to establish construct validity of positive affect and negative affect scale.

RESULTS

There were145 participants in the first part of the study and 495 in the second. Results of confirmatory factor analysis confirmed the two-factor structure of positive affect and negative affect scale suggesting that the scale has two distinct domains, i.e. positive affect and negative affect.

CONCLUSIONS

The shorter version of positive affect and negative affect scale was found to be a valid and reliable measure.

OncoE6 Positivity among VIA Positive Suspected Cases from Colposcopy Clinic of Mymensingh Medical College Hospital, Mymensingh

Cervical cancer is a major world health problem for women. It is the fourth most leading cause of death in women around the world. High risk HPV DNA has been shown to be present in 99.7% of cervical cancers worldwide. Oncoprotein E6 and E7 play an important role in the development of cervical cancer which can be detected by OncoE6 cervical test. This Cross sectional observational study was performed to detect E6 Oncoprotein from cervical swab by OncoE6 cervical test. Following universal safety precautions a total of 47 endocervical swabs were collected from Colposcopy clinic of Obstetrics and Gynaecology department of Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from January 2015 to December 2015. Laboratory work was done in the department of Microbiology, Mymensingh medical college. E6 strip test is an immunochromatographic test based on the detection of HPV-E6 oncoprotein in cervical swab samples. The swab specimen was treated with lysis solution and conditioning solution. Then the specimen solution was clarified by centrifugation. After that the sample solution was transferred into Detector mAb vial, wash solution vial and finally into developing solution vial. The test unit was then placed on a reading guide. Positive result was indicated by the appearance of purple colored test line. Out of 47 specimens 21(44.68%) were OncoE6 positive by OncoE6 cervical test. Among 21 positive cases 19(90.48%) were HPV-16 and 2 were (9.52%) HPV-18. Histopathologically out of 22 cervical carcinoma cases 20(90.90%) were positive by this test. Based on the findings of the present study, it may be concluded that screening with HPV E6 may minimize the overtreatment as well as the colposcopy referral. So it can be used as primary screening to aid colposcopy and to identify real disease. HPV based screening may help to control cervical cancer in Bangladesh. As HPV is a sexually transmitted infection; so, male screening method should be established.

Morphokinetic analysis of human embryo development and its relationship to the female age: a retrospective time-lapse imaging study

Time-lapse imaging technique has provided embryologists with a unique chance of studying the embryo morphokineticsto select the most viable embryos for implantation in the field of IVF (In vitro fertilization).The conventional method of morphological evaluations has proved that maternal age affects the human embryo quality. This retrospective study carried out at Islamabad Clinic Serving Infertile Couples, Islamabad, Pakistan mainly focuses on the effect of female age on human embryo morphokinetics. A total number of 200 patients undergoing ICSI treatment cycles at the clinic were selected for the study and divided into five age groups (&lt; 26, 26-30, 31-35, 36-40, and &gt; 40 years). Embryo culture was done at 37°C, 6% CO2 and 5% oxygen for 5-6 days. Ten time-points were selected for kinetic analysis. The number of retrieved, matured, fertilized and cleaved oocytes showed highly significant difference (P≤ 0.0001) when compared among different age groups. There was no significant difference in average morphokinetic time-points among young versus old women.Whereas timely cleaved embryos showed significant difference in tPNa i.e. time for pronuclear appearance (P≤ 0.001), t4 and t5 i.e. time for 4 and 5-cell cleavage (P≤ 0.05)among different age groups. The clinical pregnancy rates showed a decline with increasing age. These results indicate the effect of female age on time-lapse embryo morphokinetic parameters. In future the addition of time-lapse analysis in routine IVF can help to improve the success rate by selecting the most viable embryos for uterine transfer.

Clinical Profile and Outcome of Intracranial Meningioma in Apollo Hospitals Dhaka

Background: A meningioma is a tumor that arises from the meninges- the membranes that surround the brain and spinal cord.Objective: This is a retrospective analysis of the recorded data of patients managed for intracranial meningiomas between January 2007 and June 2015 at Apollo Hospital, Dhaka.Methodology: Demographic data was analyzed for all but only patients who had surgery and histological diagnosis were analyzed for outcome.Results: This study shows that meningiomas had female preponderance. Majority cases were above 50 years of age. Convexity is the most common anatomical location of meningioma. Most common symptoms were headache (70%) followed by seizure in 34.3% of patients. 90% of the cases were benign. Malignant meningioma was 1.4% and recurrence was found in 1.4% of cases. Six patients with histological grades I, II and III meningi- omas were sent for stereotactic radiotherapy after incomplete tumor resection or for residual tumour. Total removal was done in 80% cases and the mortality was 1.4%, in patient who had poor GCS score on admission.Pulse Vol.9 January-December 2016 p.22-26

Motor impairment and skeletal mineralization in children with cerebral palsy

OBJECTIVE

To evaluate the bone mineral density and the effect of motor impairment on bone mineral density in children with cerebral palsy.

METHODS

The cross-sectional study was conducted at the Armed Forces Institute of Rehabilitation Medicine, Rawalpindi, Pakistan, from January 2013 to January 2015. Children diagnosed with cerebral palsy were sampled by non-probability purposive sampling from the Cerebral Palsy clinic. On the basis of Gross Motor Function Classification level of motor impairment, the children were divided into mild Cerebral Palsy (level 1 & 2) and moderate to severe Cerebral Palsy (level 3-5) groups. Bone mineral density z-score was measured at lumbar spine with Dual Energy X-Ray Absorptiometry at L1-L4 lumbar vertebra. Data was analysed using SPSS 20.

RESULTS

Of the total 108 children selected, 18(16.6%) had to be excluded due to poor nutrition status or deranged serum chemistry, while in 4(3.7%) children Dual Energy X-ray Absorptiometry scan was not done on technical grounds. Of the remaining 86(79.6%) children, 39(45.3%) were males and 47(54.7%) were females. The overall mean age was 6.08±2.89 years and mean bone mineral density z-score was -2.16±0.62. Statistically significant difference was found in bone mineral density z-scores of moderate to severe compared to mild Cerebral Palsy group (p<0.05). Significant difference in bone mineral density z-scores was also found among different levels of Gross Motor Function Classification system of motor impairment (p<0.05).

CONCLUSIONS

Cerebral Palsy children had low bone mineral density z-score, especially those who were non-ambulatory.

Construct validation of emotional labor scale for a sample of Pakistani corporate employees

OBJECTIVE

To translate, adapt and validate emotional labour scale for Pakistani corporate employees.

METHODS

This study was conducted in locale of Rawalpindi and Islamabad from October 2014 to December 2015, and comprised customer service employees of commercial banks and telecommunication companies. It comprised of two independent parts. Part one had two steps. Step one involved translation and adaptation of the instrument. In the second step psychometric properties of the translated scale were established by administering it to customer services employees from commercial banks and the telecommunication sector. Data of the pilot study was analysed by using exploratory factor analysis to extract the initial factor of emotional labour. Part two comprised the main study. Commercial bank employees were included in the sample by using convenient sampling technique. SPSS 20 was used for data analysis.

RESULTS

There were 145 participants in the first study and 495 in the second study . Exploratory factor analysis initially generated three-factor model of emotional labour which was further confirmed by confirmatory factor analysis suggesting that emotional labour had three distinct dimensions, i.e. surface acting, deep acting and genuine expressions of emotions.

CONCLUSIONS

The emotional labour scale was found to be a valid and reliable measure.

Inequalities in mental health and well-being in a time of austerity: Baseline findings from the Stockton-on-Tees cohort study

Since 2010, the UK has pursued a policy of austerity characterised by public spending cuts and welfare changes. There has been speculation - but little actual research - about the effects of this policy on health inequalities. This paper reports on a case study of local health inequalities in the local authority of Stockton-on-Tees in the North East of England, an area characterised by high spatial and socio-economic inequalities. The paper presents baseline findings from a prospective cohort study of inequalities in mental health and mental wellbeing between the most and least deprived areas of Stockton-on-Tees. This is the first quantitative study to explore local mental health inequalities during the current period of austerity and the first UK study to empirically examine the relative contributions of material, psychosocial and behavioural determinants in explaining the gap. Using a stratified random sampling technique, the data was analysed using multi-level models that explore the gap in mental health and wellbeing between people from the most and least deprived areas of the local authority, and the relative contributions of material, psychosocial and behavioural factors to this gap. The main findings indicate that there is a significant gap in mental health between the two areas, and that material and psychosocial factors appear to underpin this gap. The findings are discussed in relation to the context of the continuing programme of welfare changes and public spending cuts in the UK.

Accuracy of diagnosis of solid pseudopapillary tumor of the pancreas on fine needle aspiration: A multi-institution experience of ten cases

Introduction:

Solid pseudopapillary tumor of the pancreas (SPTP) is a neoplasm of uncertain origin and indolent biologic behavior with distinctive morphological features occurring predominantly in young women. This tumor has an excellent prognosis compared to neuroendocrine and acinar cell carcinoma, which are close differential diagnoses based on morphology, hence making it crucial to diagnose SPTP correctly.

Objectives:

To discuss the cytomorphological features of 10 cases of SPTP reported in two institutions and to evaluate the diagnostic accuracy of endoscopic ultrasound (EUS) guided fine needle aspiration (FNA) cytology in establishing the diagnosis of SPTP.

Methods:

Ten diagnosed cases of SPTP were retrieved from the computerized endoscopy and pathology databases of our two tertiary care institutions. Nine patients had subsequent histological follow-up available. Eight patients underwent EUS-FNA while one patient each had ultrasound and computed tomography-guided FNA. The rapid on-site evaluation was carried out in all 10 cases, and additional material was retained for cell block preparation. Immunohistochemical (IHC) stains ranging from synaptophysin, progesterone receptor, chromogranin, β-catenin, CD10, and NSE were applied on cell blocks. Histological sections of all resected specimens were reviewed, and findings were correlated with those obtained by FNA.

Results:

Adequate material was obtained in all ten cases. IHC stains helped to confirm the cytological impression of SPTP. Histological examination of resection specimens, available in 9/10 cases, confirmed the cytological diagnosis.

Conclusions:

FNA particularly that obtained with EUS guidance is an effective tool in the accurate diagnosis of SPTP.

Metabolic risk factor-profile in patients on treatment with second generation antipsychotics

The second generation antipsychotic agents, although exhibit superior safety profile, is associated with metabolic adverse effects including weight gain, diabetes mellitus and hyperlipidaemia. These adverse effects are not only the risk factors for cardiovascular disease and diabetes mellitus but may also impair patient's adherence to treatment. However, different member of second generation antipsychotics differ. in their extent of metabolic adverse effects. The aim of the study was to evaluate the association between olanzapine, risperidone or quetiapine treatment and body mass index, blood pressure, diabetes mellitus and hyperlipidaemia in patients with Schizophrenia and Bipolar Disorder. Forty-four cases of Schizophrenia and Bipolar Disorder diagnosed with DSM-IV criteria were selected according to inclusion and exclusion criteria. Body weight, body mass index and blood pressure were measured at baseline, at the end of 4th, 8th and 12th weeks of treatment. Blood samples were collected to measure blood glucose and serum lipid profile at baseline and at the end of 4th, 8th and 12th weeks in the study group receiving treatment (olanzapine 20-30 mg/day, risperidone 4-16 mg/day and quetiapine 300-800 mg/day) after overnight fasting. Therapeutic use of olanzapine and risperidone in Schizophrenia and Bipolar Disorder for a period of 4th, 8th and 12th weeks was associated with significant increase in body weight and body mass index. Quetiapine did not cause significant changes in body weight and body mass index after 4 and 8 weeks. However, after 12 weeks treatment, body mass index increased significantly. Olanzapine, risperidone and quetiapine increased the blood glucose level significantly after 8 and 12 weeks treatment. Olanzapine and risperidone elevated the serum cholesterol, triglyceride and low density lipoprotein levels significantly after 4, 8 and 12 weeks. But quetiapine showed no significant change in lipid profile. However, olanzapine and risperidone significantly increased triglyceride level after 8 and 12 weeks. Amongst three drugs, quetiapine treatment increased high density lipoprotein level. Our study revealed that quetiapine treatment is associated with less risk of dyslipidaemia.

Study on oxidative stress and antioxidant level in patients of acute myocardial infarction before and after regular treatment

In acute myocardial infarction (AMI), lack of oxygen delivery to myocardium leads to generation of reactive oxygen species (ROS) which play an important role in the pathogenesis of AMI. Endogenous anti-oxidants protect the myocardial tissues from the deleterious effect of free radical mediate injury. The study evaluates the extent of oxidative stress and antioxidant status against ROS in AMI patients and amelioration of oxidative stress after regular treatment and also assesses the association between oxidative stress and risk factors for atherosclerosis like dyslipidemia and diabetes mellitus (DM). The study was conducted on 72 AMI patients and age and sex matched 18 healthy controls. Patients were assigned to four groups, AMI without dyslipidemia or DM, with dyslipidemia, with DM and with both dyslipidemia and DM. Plasma malondialdehyde (MDA) and GSH content and vitamin E levels were determined on admission into hospital and on the 5th day of treatment. Plasma MDA level increased significantly (p < 0.001) and erythrocyte GSH and plasma vitamin E levels were decreased (p < 0.001) in all the groups of patients as compared to control. On the 50th day of regular treatment MDA level reduced (p < 0.001) and GSH and vitamin E levels increased (p < 0.001) in patients. The plasma MDA level was significantly higher (p < 0.001) in patients with both dyslipidemia and DM or with only DM in comparison to patients without dyslipidemia and DM. The difference in the GSH level between patients with risk factors and without risk factors was not significant. It may be conclude that an imbalance exists between oxidant and antioxidant molecules in AMI patients which shift towards oxidative side and regular treatment restores this balance. There may be some association between oxidative stress in AMI and risk factors like dyslipidemia and diabetes mellitus.