Spermidine constitutes a key determinant of motility and attachment of Salmonella Typhimurium through a novel regulatory mechanism

Spermidine is a poly-cationic molecule belonging to the family of polyamines and is ubiquitously present in all organisms. Salmonella synthesizes, and harbours specialized transporters to import spermidine. A group of polyamines have been shown to assist in Salmonella Typhimurium's virulence and regulation of Salmonella pathogenicity Inslad 1 (SPI-1) genes and stress resistance; however, the mechanism remains elusive. The virulence trait of Salmonella depends on its ability to employ multiple surface structures to attach and adhere to the surface of the target cells before invasion and colonization of the host niche. Our study discovers the mechanism by which spermidine assists in the early stages of Salmonella pathogenesis. For the first time, we report that Salmonella Typhimurium regulates spermidine transport and biosynthesis processes in a mutually inclusive manner. Using a mouse model, we show that spermidine is critical for invasion into the murine Peyer's patches, which further validated our in vitro cell line observation. We show that spermidine controls the mRNA expression of fimbrial (fimA) and non-fimbrial adhesins (siiE, pagN) in Salmonella and thereby assists in attachment to host cell surfaces. Spermidine also regulated the motility through the expression of flagellin genes by enhancing the translation of sigma-28, which features an unusual start codon and a poor Shine-Dalgarno sequence. Besides regulating the formation of the adhesive structures, spermidine tunes the expression of the two-component system BarA/SirA to regulate SPI-1 encoded genes. Thus, our study unravels a novel regulatory mechanism by which spermidine exerts critical functions during Salmonella Typhimurium pathogenesis.

Audit of Otological Diseases in Otolaryngology-Head and Neck Surgery Outpatient Department of a Tertiary Level Hospital

To find out the otological disease pattern of the patients attended at the Otolaryngology-Head & Neck Surgery outpatient department (OPD) of a tertiary level hospital, Dhaka, Bangladesh and to aware the people about the consequences of Ear diseases, necessity of prevention and early management. This study was done in the Otolaryngology-Head & Neck Surgery OPD of Shaheed Suhrawardy Medical College Hospital, Dhaka, Bangladesh from July 2014 to December 2014. Data were collected retrospectively from hospital record which were recorded by Resident Surgeon during his consultation of referral patients. Total 3686 patients were included in the study and data were analyzed. Out of 3686 OPD patients male were 1947(52.82%) and female 1739(47.17%), ratio 1.12:1. In age groups 11 to 40-year age group patients were more, among them 11-20 (17.25%), 21-30 (21.51%) and 31-40 (21.62%). 47.97% of the patients were presented with Ear diseases. Among the ear conditions CSOM (Chronic suppurative otitis media) were 19.96%, ASOM (Acute Suppurative Otitis Media) 2.54%, OME (Otitis media with effusion) 5.31%, Otomycosis 9.25%, Furunculosis 1.81%, Otosclerosis 0.57%, Foreign body ear 1.68%, Rupture TM (Tympanic membrane) 1.27% and Wax 4.74%. Prevalence of Ear diseases are more in Bangladesh like other developing countries. Most of the ear diseases can be managed in the local hospitals. For the proper management physicians working in those hospitals need training and adequate instruments. District hospitals and medical college hospitals should be well equipped with proper instruments and trained ENT surgeons.

Prevalence, Risk Factors and Microbiological Profile of Orthopaedic Surgical Site Infection in North-Eastern Peninsular Malaysia

Introduction

The devastating outcome of orthopaedic surgical site infections (SSI) are largely preventable if its risk factors, causative organisms and antimicrobial susceptibility patterns in the regional area are known.

Materials and methods

We conducted a retrospective study to address the lack of epidemiological and microbiological data on orthopaedic SSI in Malaysia. All the 80 patients diagnosed and treated for microbiologically proven orthopaedic SSIs in a tertiary hospital in Malaysia from April 2015 to March 2019 were included in a 1:2 case control study.

Results

The prevalence of SSI in clean and clean-contaminated surgeries was 1.243%, which is consistent with most of the studies worldwide, but is low compared to other studies done in Malaysia. The most common type of orthopaedics SSI were internal fixation infections (46.25%), superficial SSIs (25.2%) and Prosthetic joint infections (18.75%). Obesity and tobacco use were found to be significant risk factors of orthopaedic SSI. The most common perioperative prophylaxis used was IV cefuroxime. Majority of the cases (86.5%) received prolonged prophylactic antibiotics. The most common causative agent was Staphylococcus aureus (31.25%), followed by Pseudomonas aeruginosa (26.25%) and Enterobacter spp (7.5%). Methicillin-resistant Staphylococcus aureus (MRSA) accounted for 20% of the S. aureus infections. Up to 19.4% of the Gram-negative organisms are multidrug resistant. The higher rate of isolation of organisms resistant to the prophylactic antibiotics being used may be related to the prolonged use of prophylactic antibiotics, which exerted selective pressure for the acquisition of resistant organisms.

Conclusion

Despite its relatively low prevalence in our local institution and worldwide, the prevention of SSI in orthopaedic practice is crucial to avoid morbidity, mortality and high healthcare cost. This may be achieved by control of modifiable risk factors such as obesity and tobacco use, appropriate use of prophylactic antibiotics and implementation of good surgical and infection control practices.

Prediction of long-term survival after gastrectomy using random survival forests

BACKGROUND

No well validated and contemporaneous tools for personalized prognostication of gastric adenocarcinoma exist. This study aimed to derive and validate a prognostic model for overall survival after surgery for gastric adenocarcinoma using a large national dataset.

METHODS

National audit data from England and Wales were used to identify patients who underwent a potentially curative gastrectomy for adenocarcinoma of the stomach. A total of 2931 patients were included and 29 clinical and pathological variables were considered for their impact on survival. A non-linear random survival forest methodology was then trained and validated internally using bootstrapping with calibration and discrimination (time-dependent area under the receiver operator curve (tAUC)) assessed.

RESULTS

The median survival of the cohort was 69 months, with a 5-year survival of 53.2 per cent. Ten variables were found to influence survival significantly and were included in the final model, with the most important being lymph node positivity, pT stage and achieving an R0 resection. Patient characteristics including ASA grade and age were also influential. On validation the model achieved excellent performance with a 5-year tAUC of 0.80 (95 per cent c.i. 0.78 to 0.82) and good agreement between observed and predicted survival probabilities. A wide spread of predictions for 3-year (14.8-98.3 (i.q.r. 43.2-84.4) per cent) and 5-year (9.4-96.1 (i.q.r. 31.7-73.8) per cent) survival were seen.

CONCLUSIONS

A prognostic model for survival after a potentially curative resection for gastric adenocarcinoma was derived and exhibited excellent discrimination and calibration of predictions.

Psychometric properties of the Malay inventory for the perception of Muslims with hearing impairment

OBJECTIVE

The aims of this study are to measure the psychometric properties of the newly developed preliminary version of hearing impairment inventory for religious duties for Muslim adults, i.e., the Inventori Persepsi Bagi Muslim Yang Memiliki Masalah Pendengaran (IPM3P), and to produce a final version of IPM3P.

METHODS

The preliminary version of IPM3P that is used to investigate the perception of Muslim adults with hearing impairment towards Islamic understanding and practice has been tested in this study. The preliminary version of IPM3P consists of three domains (obligation, practice, and difficulty) with 59 items in total. Four phases of validity and reliability testing involved were: i) Content validation, ii) Pretesting, face validity and proofreading, iii) Pilot study, and iv) Psychometric evaluation.

RESULTS

The final version of IPM3P consists of 36 items. The findings from the present study suggest that the final version of IPM3P has excellent psychometric properties manifested by: i) good content validity, ii) excellently pretested, iii) good face validity, iv) good construct validity shown by principal component analysis and convergent validity, and v) good discriminant validity showed by divergent validity.

CONCLUSION

IPM3P shows good potential to be used as a tool in investigating perception of Muslim adults towards Islamic understanding and practice.

O14: RANDOM FOREST MODELS FOR PREDICTING SURVIVAL AFTER OESOPHAGECTOMY

Introduction

For patients with oesophageal cancer, producing accurate prediction models for survival after oesophagectomy has proved challenging. We investigated whether Random Survival Forests (RSF), a novel machine learning method, could produce an accurate prognostic model for overall survival after oesophagectomy.

Method

The study used data from the National Oesophago-Gastric Cancer Audit and included patients diagnosed with oesophageal adenocarcinoma or squamous cell carcinoma between 2012 and 2018 in England and Wales and who underwent a curative oesophagectomy with adequate lymphadenectomy (15 LN) and survived to discharge (n=6198). Missing data was handled using multiple imputation and the data was split into training and validation cohorts. 13 variables were selected for inclusion using Random Forest variable importance and used to train the final model. The same variables were used to develop a traditional Cox regression model.

Result

Median survival was 53 months in both cohorts. The final RSF model had good discrimination in the validation cohort with a C-index of 0.757(0.755-0.759), exceeding the Cox model; 0.748(0.746-0.750). At 3 years post-surgery, overall survival was 56.2%. The RSF yielded a mean predicted survival of 55.8%(IQR 29.5%-81.7%) compared to 55.4%(40.0%-77.7%) for the Cox model. The most important variables were lymph node involvement and pT/ypT stage, however other variables including neoadjuvant treatment completion and surgical complications were also found to be important.

Conculsion

A Random Forest survival model provided better performance in predicting survival after curative oesophagectomy. This will allow more personalised predictions to be delivered clinicians and patients.

Take-home message

Random Forest survival models can accurately predict post-operative prognosis after oesophagectomy.

Oesophageal cancer: The effect of early nutrition support on clinical outcomes

BACKGROUND AND AIMS

Malnutrition is prevalent in oesophageal cancer. Evidence for the use of nutrition support and prehabilitation in this cohort is variable. The aim of this study was to examine the effect of early nutrition support and functional measures of nutritional status on post-operative outcomes in adult patients with oesophageal cancer.

METHODS

Retrospective review of adults with oesophageal cancer undergoing oesophagectomy (n = 151). Early nutrition support was defined as: oral or enteral nutrition supplementation during neoadjuvant treatment. Late nutrition support defined as: oral or enteral nutrition supplementation prescribed post-operatively. Nutrition outcome measures were; percentage weight loss from 3 to 6 months prior to diagnosis, peri- and post-operatively, and pre-operative assessment of handgrip-strength (HGS).

RESULTS

Pre-operative weight loss ≥10% was a significant predictor of mortality at 1 year (OR 2.84, 95%CI 1.03-7.83, p = 0.04) independent of tumour stage, adjuvant treatment, age and gender. Adults prescribed early nutrition support during neoadjuvant treatment experienced less weight loss at 12-months post-oesophagectomy compared to adults prescribed late oral nutrition support (p=<0.05). Pre-operative HGS measurements were not a useful predictor of postoperative complications (p = 0.2), length of stay (p = 0.9) or 90-day mortality (p = 0.6).

CONCLUSIONS

Pre-operative weight loss ≥10% was associated with mortality. Early nutrition support was associated with less weight loss at 12-months post-operatively. Pre-operative HGS measures did not have prognostic value as a stand-alone measure. Future work should investigate the efficacy of early nutrition support in reducing both pre- and post-operative weight loss to improve nutritional status and surgical outcomes as part of a multimodal prehabilitation programme in adults with oesophageal cancer.

Development of hearing impairment inventory for religious duties of Muslim adult

OBJECTIVE

This study is a preliminary work to develop a Malay version questionnaire named 'Inventori Persepsi bagi Muslim yang Memiliki Masalah Pendengaran (IPM3P)' to assess the perception on Islamic understanding and practice among Muslim adults with hearing impairment.

METHODS

The scale development involved three phases: i) generation of domains based on the literature, ii) generation of sub-domains based on literature review and Islamic panel survey, and iii) generation of items.

RESULTS

Preliminary version of IPM3P consists of 59 items was produced, representing three domains: Obligation (18 items), Practice (21 items), and Difficulty (20 items), and seven sub-domains ('Ibadah', 'Aqidah', 'Muamalat', 'Tasawwuf', 'Akhlak','Da'wah', and 'Sirah').

CONCLUSION

The preliminary version of IPM3P needs to be psychometrically tested. This pioneering study may become an impetus towards more research pertaining to understanding the effect of hearing loss towards religious life in the future in Malaysia.

In ovo injection of black cumin (Nigella sativa) extract on hatching and post hatch performance of thermally challenged broiler chickens during incubation

The objective of this study was to investigate the effects in ovo injection of black cumin (BC) extract on chick's quality and response of thermally challenged broiler chickens. A total of 700 hatching eggs of broiler chickens (Marshall) were assigned to 7 treatments of 100 eggs each and incubated using the conventional protocol (37.8°C) for the first 10 d and then exposed to a high temperature (39.6°C) for 6 h daily from day 10 until day 18 of the incubation. At embryonic day 17.5, the eggs were randomly allotted to 7 treatment groups, viz.: eggs without in ovo injection (WA), eggs injected with 0.9% saline solution (SA), 3 mg ascorbic acid (AA), 2 mg BC (TB), 4 mg BC (FB), 6 mg BC (SB), and 8 mg BC (EB) extracts. Experiment was laid out in a Completely Randomized Design. After hatching, the chicks were reared separately according to in ovo treatments for 8 wk. Data were collected on hatchability, chick quality, internal organs, growth performance, plasma superoxide dismutase, malondialdehyde, and triiodothyronine (T₃). The results showed that the hatchability of the eggs in the AA group was similar to that of SB eggs and higher than that of the other treatment groups. The intestinal weights of SB and EB birds were significantly higher (P < 0.05) than those of TB, SA, and WA. The final weights of the birds of SB and AA were higher (P < 0.05) than those of other treatments. The feed conversion ratio of the birds of TB and FB was comparable to that of EB and WA but higher than that of SB and AA. At hatch, the creatinine of the birds in SA and WA was similar to that of EB, FB, and TB but higher (P < 0.05) than that of AA and SB. Also, the plasma malondialdehyde, T₃, and superoxide dismutase of SB and AA birds were better (P < 0.05) than those of the control groups. Overall, it was concluded that 6 mg of BC extract improved the antioxidant status and posthatch performance of thermally challenged broiler chickens.

Machine learning to predict early recurrence after oesophageal cancer surgery

BACKGROUND

Early cancer recurrence after oesophagectomy is a common problem, with an incidence of 20-30 per cent despite the widespread use of neoadjuvant treatment. Quantification of this risk is difficult and existing models perform poorly. This study aimed to develop a predictive model for early recurrence after surgery for oesophageal adenocarcinoma using a large multinational cohort and machine learning approaches.

METHODS

Consecutive patients who underwent oesophagectomy for adenocarcinoma and had neoadjuvant treatment in one Dutch and six UK oesophagogastric units were analysed. Using clinical characteristics and postoperative histopathology, models were generated using elastic net regression (ELR) and the machine learning methods random forest (RF) and extreme gradient boosting (XGB). Finally, a combined (ensemble) model of these was generated. The relative importance of factors to outcome was calculated as a percentage contribution to the model.

RESULTS

A total of 812 patients were included. The recurrence rate at less than 1 year was 29·1 per cent. All of the models demonstrated good discrimination. Internally validated areas under the receiver operating characteristic (ROC) curve (AUCs) were similar, with the ensemble model performing best (AUC 0·791 for ELR, 0·801 for RF, 0·804 for XGB, 0·805 for ensemble). Performance was similar when internal-external validation was used (validation across sites, AUC 0·804 for ensemble). In the final model, the most important variables were number of positive lymph nodes (25·7 per cent) and lymphovascular invasion (16·9 per cent).

CONCLUSION

The model derived using machine learning approaches and an international data set provided excellent performance in quantifying the risk of early recurrence after surgery, and will be useful in prognostication for clinicians and patients.

0190 Impact of Menopause-Related Sleep Fragmentation on Daytime Sleepiness and Neurobehavioral Performance: Results of an Experimental Model

Introduction

Cognitive performance may be adversely affected during the menopause transition from hot flash-induced sleep fragmentation even without changes in sleep duration. We examined the effects of experimentally-induced sleep fragmentation without shortened sleep duration on daytime sleepiness and neurobehavioral performance in women in a high and low estradiol (E2) state.

Methods

Seven pre-menopausal women (29.4 ± 3.8 years) participated in two 6-day inpatient studies repeated in a high-E2 (mid-to-late follicular phase) then low-E2 state (gonadotropin-releasing hormone agonist-induced E2 suppression - similar to levels during menopause) ~6 weeks apart. Sleep was uninterrupted on nights 1–2 [8-h time-in-bed (TIB)] and fragmented on nights 3–5 (9-h TIB) using an auditory stimulus delivered every 15 min that sustained wake for 2 minutes, producing 1-h total wake after sleep onset. Wakefulness was confirmed by event-markers during polysomnographically-recorded sleep episodes. Daytime subjective sleepiness (Karolinska Sleepiness Scale; KSS) and neurobehavioral performance (Psychomotor Vigilance Task; PVT) were assessed every 2–3 hours on study days 2–5. The effects of study day and E2 state on KSS scores and PVT measured reaction time (RT) and attentional failures (RT&gt;500ms) were examined using linear mixed models.

Results

Participants reported feeling sleepier (+10%), had longer RTs (+22ms), and more attentional failures (+53%) after sleep fragmentation than after uninterrupted sleep (all p&lt;0.001). While there was no main effect of E2 state, there was a differential effect of sleep fragmentation by E2 state on PVT, but not sleepiness, such that the increase in RT and attentional failures in response to sleep fragmentation was only observed in the high-E2 state (p&lt;0.001).

Conclusion

Eight hours of total sleep time may not be sufficient to maintain subjective sleepiness and PVT performance levels when sleep is not consolidated. These findings have important implications for understanding the role of sleep and E2-modulated cognitive impairment during the menopause transition.

Support

This work was supported by the NIH: 5R01 AG053838-02 (HJ) and K24-HL105664 (EBK).

Vitamin D Profile in Juvenile Idiopathic Arthritis Patients in a Tertiary Care Hospital in Bangladesh

There are multi-factorial causes of decrease in bone mass in Juvenile Idiopathic Arthritis (JIA) patients who correlate with the duration of active disease. By measuring the vitamin D level we can assess the deficiency or insufficiency earlier and can predict the risk of osteoporotic bone fracture & can give appropriate supplementation of vitamin D & calcium. This study was done to determine the status of serum 25(OH)D in patients with JIA and to see the relationship among various subtypes and disease duration. In this cross sectional study 30 (Thirty) newly diagnosed cases of JIA attending the pediatric rheumatology clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from July 2014 to December 2015 were included. Thirty age and sex matched control were selected and serum 25(OH)D was measured in cases and controls. Among JIA patients, 60% and among controls 33% had hypo-vitaminosis D. In JIA group the mean level of serum 25(OH)D was lower than control group and the result is statistically significant in cases of poly-articular JIA and systemic JIA (SJIA). There is significant difference of the mean values of vitamin D levels in JIA and control groups for the cases of hypo-vitaminosis D. Level of serum 25(OH)D significantly decreased as disease duration continue increased. More than half of JIA patients had hypo-vitaminosis D. It is more significant in cases of poly-articular JIA and systemic JIA (SJIA). There was negative relationship between serum 25(OH)D level and disease duration.

Rabies on the Indian subcontinent

The Indian subcontinent comprises Afghanistan, Bangladesh, Bhutan, India, Nepal, the Maldives, Myanmar, Pakistan and Sri Lanka. In all of these countries, except the Maldives, rabies is endemic. An estimated 59,000 people die from rabies each year; 45% of these deaths occur on the Indian subcontinent and approximately 33% take place in India. The majority of these deaths are attributable to dog bites, and those most affected are children and the poor. Access to post-exposure prophylaxis is limited and costly, the supply of immunoglobulins and vaccines can be irregular and public awareness of rabies is low. Moreover, the vaccination of domestic dogs is not widely implemented. There is a need for increased laboratory capacity and expertise across the continent, as well as better data, improved surveillance and more user-friendly and economical diagnostic tests. An animal birth control programme has met with mixed success in India. However, a greater focus on mass dog vaccination could eliminate the disease at its source, reducing the large burden of mortality for at-risk communities. In this paper, the authors examine the situation in each of the countries on the Indian subcontinent, discuss current needs, obstacles and progress, and examine future strategies, with the objective of eliminating dog-mediated rabies from the subcontinent by 2030.

Role of Red Cell Distribution Width to Platelet Ratio in Predicting Hepatic Fibrosis in Chronic Hepatitis B

Hepatitis B virus (HBV) infection is a serious global health problem. Globally more than 2 (Two) billion people are infected with Hepatitis B virus and about 400 million people are chronic carriers who are at risk of death from liver cirrhosis and liver cancer that kill more than one million people globally each year. Prevalence of HBV infection in Bangladesh is 2.3 to 9.7% and approximately 10 million people are harboring the virus as carrier. HBV infection is increasing at an alarming rate in Bangladesh due to lack of health education, poverty, illiteracy and lack of hepatitis B vaccination. This cross sectional study was carried out in the Department of Clinical Pathology, in collaboration with Department of Hepatology and Department of Pathology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from September 2013 to August 2014 to assess the role of Red cell distribution width to platelet ratio (RPR) as a non invasive marker in predicting hepatic fibrosis in chronic hepatitis B patients. Total 40 patients with chronic hepatitis B virus infection who fulfilled the criteria of chronic hepatitis B were included in this study. In this study, majority of the patients belonged to 20-29 years, most of the patients were male and HBeAg negative .Histopathology was gold standard to identify the stages of hepatic fibrosis. We also measured RDW and Platelet count by automated haematology analyzer when platelet count was rechecked manually; RDW to platelet ratio was calculated to see the correlation between RPR with different stages of hepatic fibrosis. In chronic hepatitis B patients a positive and significant correlation was found between RPR and stages of hepatic fibrosis and Spearman's correlation coefficient for RPR was 0.749 which was positive and highly significant (p<0.001). Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of RDW to Platelet ratio (RPR) was 62.86%, 80%, 95.65%, 23.53% and 65% respectively. To assess the diagnostic performance of RPR we also used receiver-operating curve (ROC). The area under ROC was 0.889 for identification of hepatic fibrosis. This data revealed that RPR is strongly associated with stages of hepatic fibrosis in chronic hepatitis B patients. As such RPR may be a useful diagnostic tool for assessing the hepatic fibrosis in chronic hepatitis B patients.

Enteroinsular hormones in two siblings with Donohue syndrome and complete leptin deficiency

The main biochemical hallmark of the rare and lethal condition of Donohue syndrome (DS) is hyperinsulinemia. The roles of the gut and other pancreatic hormones involved in glucose metabolism, satiety and energy expenditure have not been previously reported in DS. Two siblings with genetically confirmed DS and extremely low weight underwent a mixed meal (MM) test where pancreatic hormones insulin, C-peptide, glucagon, active amylin, pancreatic polypeptide (PP) as well as gut hormones active glucagon-like peptide 1 (GLP-1), glucose-dependent insulinotropic peptide (GIP), ghrelin, peptide YY (PYY) and leptin were analyzed using a Multiplex assay. Results were compared to those of 2 pediatric controls. As expected, concentrations of insulin, C-peptide and amylin were very high in DS cases. The serum glucagon concentration was undetectable at the time of hypoglycemia. GIPs concentrations were lower in the DS, however, this was not mimicked by the other incretin, GLP-1. Ghrelin concentrations were mainly undetectable (<13.7 pg/mL) in all participants. DS cases had higher PYY and dampened PP concentrations. Leptin levels remained completely undetectable (<137.0 pg/mL). Patients with DS have extremely high amylin levels, completely undetectable serum glucagon and leptin levels with abnormal satiety regulating hormone PP with a relatively normal ghrelin response during a MM test. The low serum GIP might be acting as physiological brake on insulin secretion. The undetectable serum leptin levels suggest the potential of using leptin analogues as therapy for DS patients.

Educating medical students in oral health care: current curriculum and future needs of institutions in Malaysia and Australia

Poor oral health has been associated with compromised general health and quality of life. To promote comprehensive patient management, the role of medical professionals in oral health maintenance is compelling, thus indicating the need for educational preparation in this area of practice. This study aimed to determine the extent of training in oral health in Malaysian and Australian medical schools. An audio-recorded semi-structured phone interview involving Academic Programme Directors in Malaysian (n = 9, response rate=81.8%) and Australian (n = 7, response rate = 35.0%) medical schools was conducted during the 2014/2015 and 2014 academic years, respectively. Qualitative data was analysed via thematic analysis, involving coding and grouping into emerging themes. Quantitative data were measured for frequencies. It was found that medical schools in Malaysia and Australia offered limited teaching of various oral health-related components that were mostly integrated throughout the curriculum, in the absence of structured learning objectives, teaching methodologies and assessment approaches. Barriers to providing oral health education included having insufficient expertise and overloaded curriculum. As medical educators demonstrated support for oral health education, collaboration amongst various stakeholders is integral to developing a well-structured curriculum and practice guidelines on oral health management involving medical professionals.

Piezoresistive Effect in Plasma-Doping of Graphene Sheet for High-Performance Flexible Pressure Sensing Application

This paper presents a straightforward plasma treatment modification of graphene with an enhanced piezoresistive effect for the realization of a high-performance pressure sensor. The changes in the graphene in terms of its morphology, structure, chemical composition, and electrical properties after the NH₃/Ar plasma treatment were investigated in detail. Through a sufficient plasma treatment condition, our studies demonstrated that plasma-treated graphene sheet exhibits a significant increase in sensitivity by one order of magnitude compared to that of the unmodified graphene sheet. The plasma-doping introduced nitrogen (N) atoms inside the graphene structure and was found to play a significant role in enhancing the pressure sensing performance due to the tunneling behavior from the localized defects. The high sensitivity and good robustness demonstrated by the plasma-treated graphene sensor suggest a promising route for simple, low-cost, and ultrahigh resolution flexible sensors.

Piezoresistive Effect in Plasma-Doping of Graphene Sheet for High-Performance Flexible Pressure Sensing Application

This paper presents a straightforward plasma treatment modification of graphene with an enhanced piezoresistive effect for the realization of a high-performance pressure sensor. The changes in the graphene in terms of its morphology, structure, chemical composition, and electrical properties after the NH₃/Ar plasma treatment were investigated in detail. Through a sufficient plasma treatment condition, our studies demonstrated that plasma-treated graphene sheet exhibits a significant increase in sensitivity by one order of magnitude compared to that of the unmodified graphene sheet. The plasma-doping introduced nitrogen (N) atoms inside the graphene structure and was found to play a significant role in enhancing the pressure sensing performance due to the tunneling behavior from the localized defects. The high sensitivity and good robustness demonstrated by the plasma-treated graphene sensor suggest a promising route for simple, low-cost, and ultrahigh resolution flexible sensors.

Macrophage Activation Syndrome in Paediatric Rheumatic Diseases

Macrophage activation syndrome (MAS) is a potentially fatal complication of rheumatic disorders, which commonly occurs in systemic juvenile idiopathic arthritis (sJIA).This study was carried out with the aims of describing the clinical features, laboratory findings and outcomes of MAS associated with paediatric rheumatic diseases in the Department of Paediatrics, Bangabandhu Sheikh Mujib Medical University (BSMMU) and compare these results with previous studies on MAS. This retrospective study was conducted in the paediatric rheumatology wing of the Department of Paediatrics, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Clinical and laboratory profile of all the diagnosed cases of MAS were analyzed from the medical records from January 2010 to July 2015. Among 10 MAS patients, 6 were female and 4 were male. Seven patients of systemic JIA, two patients of SLE and one patient with Kawasaki Disease developed MAS in their course of primary disease. Mean duration of primary disease prior to development of MAS was 2.9 years and mean age of onset was 9.1 years. High continued fever and new onset hepatosplenomegaly were the hallmark of the clinical presentation. White blood cell count and platelet count came down from the mean of 16.2 to 10.2×10⁹/L and 254 to 90×10⁹/L. Mean erythrocyte sedimentation rate was dropped from 56 to 29 mm/hr. Six patients had abnormal liver enzyme level (ALT) and 5 had evidence of coagulopathy (prolonged prothrombin time and APTT) at the onset of disease. Hyperferritinnemia were found in all the patients. Bone marrow study was done in 5 patients but features of hamophagocytosis were found only in 2 patients. All patients received intravenous steroid and 3 patients who did not respond to steroid received additional cyclosporine. Mortality rate was 30% in this series. Macrophage activation syndrome is a fatal complication of paediatric rheumatic diseases among which s-JIA was predominant. Early diagnosis and aggressive therapy is essential to reduce the morbidity and mortality of this illness.

Correlation of hyperinsulinemia with hyperandrogenemia in primary infertile women with polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is the most common endocrinopathy among women of the reproductive age and is the most common form of anovulatory infertility. Hyperinsulinemia and hyperandrogenemia are the characteristic features of PCOS, but the association between hyperinsulinemia and hyperandrogenemia is not well established. To find out any causal association between Hyperinsulinemia and hyperandrogenemia, a retrospective study was done on primary infertile women suffering from PCOS in the department of Biochemistry, Bangabandhu Sheikh Mujib Medical University. A total of 80 subjects were selected, among them 60 were cases and 20 were controls. Depending on their body mass index, the cases were divide into two groups, obese (n=30) and non-obese (n=30). Age and BMI matched controls were taken for both age groups. Observations derived from the study suggested that hyperinsulinemia and hyperandrogenemia are characteristic features of PCOS but significant correlation was not found between hyperinsulinemia and hyperandrogenemia. However, we cannot negate any possible association between the two and thereby we recommend further study to be done with a larger sample size.

Poncet's disease (tubercular rheumatism) - a case report

Poncet's disease is a rare condition in childhood. It occurs due to immunological reaction to tubercular protein resulting in reactive arthritis and manifest with polyarthritis associated with features of active tuberculosis. We are reporting a case of Poncet's disease that was initially treated as a case of Juvenile Idiopathic Arthritis (JIA) without any improvement. The diagnosis was made clinically from history and physical findings with supportive radiological findings and confirmed by granulomatous changes on FNAC. Our patient improved dramatically after treatment with anti-tubercular drugs. Though very rare, Poncet's disease should be strongly considered in the differential diagnosis of fever and polyarthritis of obscure cause, especially in tubercular endemic countries like ours.

Panoramic radiography in evaluating the relationship of mandibular canal and impacted third molars in comparison with cone-beam computed tomography

This study evaluated the validity of panoramic radiography and cone beam computed tomography (CBCT) in the assessment of mandibular canal and impacted third molar. In this descriptive-analytical study, 58 mandibular third molars from 42 patients who showed a close relationship between impacted third molar and canal on panoramic radiographs were selected. They were then classified into seven radiographic markers in panoramic radiographs (superimposition, darkening of the root, interruption of the white lines, root narrowing, canal diversion, canal narrowing, and also closed distance in OPG <1mm). The groups of markers were further assessed with CBCT to see presence or absence of contact. The three most common markers seen in panoramic images are superimposition, interruption of white line and root darkening. In CBCT, superimposition marker always presented higher frequency of contact with canal compared to non-contact group. There are 31% of teeth presented with interruption of white lines and there are 29.3% of teeth presented with superimposition. About 55.6% and 35.3% of the impacted mandibular third molars which indicated interruption of white lines and superimposition also indicated contact in the CBCT respectively. Presence or absence of radiological sign in panoramic radiography was not properly predict a close relationship with third molar and it is suggested that in case of tooth-canal overlapping, the patient should be referred for CBCT assessment.

Influence of platelet-rich plasma on dental implants. Osseointegration in well-controlled diabetic patients

The purpose of this study is to evaluate the effect of platelet-rich plasma (PRP) on the osseointegration of dental implants in diabetic patients. A split-mouth design was employed in all 14 patients, with each patient receiving two mini implants. A PRP-coated mini implant was installed in one quadrant as a trial and a plain mini implant was added in the opposite quadrant to serve as a control. Radiographic evaluation was done at 3, 6, and 9 weeks after implant placement. Radiographic density is measured at five points around the implants, repeatedly. Results showed no statistically significant difference between the two groups of implants. The minimally invasive mini implants successfully maintained integration at the end of 9 weeks. There were no cases of implant failure. The results of this study suggest that platelet-rich plasma implant coating has no significant effect in reducing the time for mini implant osseointegration in diabetic patients.

Carpenter syndrome: a case report

Carpenter syndrome is a rare hereditary disorder known as Acrocephalopolysyndyctyly (ACPS) type II characterized by acrocephaly, facial dysmorphism, brachedyctyly, syndyctyly, preaxial polydyctyly, obesity, congenital heart disease, cryptorchidism, hypogenitalism, bony abnormalities and umbilical hernia. Carpenter syndrome is autosomal recessive disorder and prenatal diagnosis of this syndrome is possible by ultrasonogram during pregnancy. We reported a case of carpenter syndrome of 2.5 months old female infant of consanguineous parents who was admitted in the paediatric ward of Bangabandhu Sheikh Mujib Medical University (BSMMU) on 30th March 2010. She was diagnosed as a case of Carpenter syndrome having acrocephaly prominent ridge of sagital suture, polydactyly, syndyctyly on history, clinical examination findings and investigation reports.

Mineral homeostasis in children with acute lymphoblastic leukemia before and after chemotherapy

A prospective study was carried out in the Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh to evaluate the pattern of mineral changes in children treated for acute lymphoblastic leukemia (ALL) before and after induction chemotherapy. A total number of 32 children aged 1-14 years of both sexes were evaluated. Serum calcium, phosphate, alkaline phosphatase, albumin and creatinine and urinary creatinine and calcium were estimated in cases and control. The mean calcium level at presentation and post induction was 9.50±1.48 mg/dl and 9.08±1.30 mg/dl. Serum phosphate was higher in preinduction mean of 4.83±2.71 mg/dl than post induction value of 4.75±1.38 mg/dl and it was statistically significant. Serum alkaline phosphatase was higher in the post induction period. It was 324.8±128.17 U/L in pre induction and 331.59±93.97 u/l in post induction period. It was not statistically significant. No statistically significant difference was found in pre and post induction urinary calcium and creatinine.

Acute lymphoblastic leukaemia presenting with severe hypercalcaemia

Acute lymphoblastic leukaemia (ALL) is the most common malignancy in children. Usually ALL children present with pallor, fever, bleeding, infection, lymphadenopathy and hapatosplenomegaly. Very rarely ALL patients may present with hypercalcaemia and osteolytic lesions. A five year old boy was referred and transferred to the paediatric ward of Bangabandhu Sheikh Mujib Medical University, Dhaka with the complaints of pain in the hip joint, generalized pain all over the body and very high calcium level. He was severely pale, the total leukocyte count was normal with normal distribution. Platelet count was also normal. There were some atypical lymphocytes. Radiology showed extensive osteolytic lesions. Considering all these findings, a bone marrow study was done, which was compatible with ALL. Flow-cytometry was also done and it confirmed the diagnosis as common ALL.

Effect of intragastric administration of crude aqueous leaf extract of Anacardium occidentale on gastric acid secretion in rats

The effect of an aqueous leaf extract ofAnacardium occidentale on gastric acid secretion was tested in rats. Twenty (20) Wistar albino rats were used for the gastric acid assay experiment. The rats were divided into 2 groups of 10 each. Gastric acid output was determined by continuous perfusion of rat stomach in urethane anesthetized rats. Control gastric acid output was obtained using 0.9% sodium chloride as perfusate and extract induced gastric acid output was obtained by perfusion with 0.1% solution of Anacardium occidentale Intragastric administration of the extract caused significant increase in mean gastric output (P <0.05). Atropine (5μg/100g,) lM and Cimetidine (5mg/100g), IM. significantly inhibited the extract induced gastric acid secretion via muscarinic and histaminic receptors respectively. Our findings showed that the use of the plant extract as a single anti-gastric ulcer therapy may not involve lowering of acid secretions rather it may be due to its anti Helicobacter pylori effect.

Hexamethonium produces both twitch and tetanic depression without fade in common African toad (Bufo regularis)

The study was designed to investigate the nature of the cholinoceptors at the sciatic nerve-gastrocnemius muscle junction of the common African toad (Bufo regularis). Using myographic technique, the twitch properties of the sciatic-gastrocnemius muscle preparation of the common African toad was studied. Both the twitch height and peak tetanic height were measured as a percentage of control. Hexamethonium at a concentration of 0.1 mM significantly [P<0.05] reduced the mean twitch height from 2.62 cm to 1.0 cm and mean peak tetanic height from 5.38 cm to 4.32 cm. Hexamethonium, however does not produce tetanic fade at the same concentration. We hypothesized that the cholinoceptors of the neuromuscular junction of the common African toad (Bufo regularis) resemble the developing synapse of African clawed toad (Xenopus laevis) and may contain muscarinic M1 autoreceptors at the pre juntional membrane.

Effect of the human leukocyte antigen HLA-DRB1 and anti-cyclic citrullinated peptide on the outcome of rheumatoid arthritis patients

Our objective was to determine whether the presence of the human leukocyte antigen HLA-DRB1 locus is associated with production of anti-cyclic citrullinated peptide antibodies (anti-CCP Abs) and to what extent they are associated with increased susceptibility to and severity of rheumatoid arthritis (RA) in Egyptian patients. Twenty-nine RA patients gave informed consent to participate in a case-control study that was approved by the Ain Shams University Medical Ethics Committee. RA disease activity and severity were determined using the simplified disease activity index and Larsen scores, respectively. We used a wide scale national study on the pattern of HLA typing in normal Egyptians as a control study. Anti-CCP Abs and HLA-DRB1 typing were determined for all subjects. The alleles most strongly associated with RA were HLA-DRB1 [*01 , *04 and *06] (41.4%). RA patients with serum anti-CCP Ab titers above 60 U/mL had a significantly higher frequency of HLA-DRB1*01 (58.3%) and HLA-DRB1*04 alleles (83.3%). Significant positive correlations were found between serum and synovial anti-CCP Ab titer, RA disease activity, and severity (r = 0.87, 0.66 and 0.63, respectively; P < 0.05). HLA-DRB1 SE+ alleles [*01 and *04] were highly expressed among Egyptian RA patients. The presence of these alleles was associated with higher anti-CCP Ab titer, active and severe RA disease. Early determination of HLA-DRB1 SE+ alleles and serum anti-CCP Ab could facilitate the prediction of the clinical course and prognosis of RA when first evaluated leading to better disease control.

An action research on promotion of healthy ageing and risk reduction of chronic disease: a need assessment study among rural elderly Malays, care givers and health professionals

OBJECTIVE

Prior to the development of a healthy ageing and risk reduction of chronic diseases intervention package for older people in Malaysia, a need assessment study was conducted to identify nutritional knowledge status and information needs, as part of an action research process.

DESIGN

A cross sectional study was conducted among 267 elderly people, 54 care givers and 66 health professionals in two rural areas of Peninsular of Malaysia (i.e Sabak Bernam, Selangor and Kuala Pilah, Negeri Sembilan). Information on nutritional knowledge was obtained from an interview based questionnaire for older subjects and caregiver and through self administered questionnaire from the health professionals. Anthropometric and functional measurements were also conducted among elderly subjects.

RESULTS

It was found that the elderly subjects had poor nutritional knowledge with 43.8% of them classified as having unsatisfactory nutritional knowledge, followed by moderately satisfactory (33.7%), very unsatisfactory (15.7%) and good (6.7%). Talks, counselling sessions with health professionals and electronic media such as television and radio were the most preferred nutrition education sources among elderly subjects and their care givers. The majority of health professionals studied (98.5%) had good nutritional knowledge. Although most of them (93.6%) were involved in management of the elderly, only 45.5% incorporated nutritional information component in this activity. Most of the health professionals used the guidelines for management of elderly patients (63.6%). However, nutritional knowledge was very minimal in these guidelines. Multiple regression analysis indicated that 'level education', involvement in 'social activities', presence of 'hearing problems', the Instrumental Activities of Daily Living (IADL) score, having previous 'nutritional information' and 'participation in healthy eating programme' were the major predictors of nutritional knowledge score among elderly subjects.

CONCLUSION

Based on the above findings it is thus, imperative that an appropriate nutritional intervention package and programme be developed so as to help improve nutritional knowledge and subsequently the nutritional status of the rural elderly Malays.

OIE guidelines on dog population control

At the 73rd General Session the OIE decided to develop guidance for Members on humane methods for the control of stray animal populations. In 2006, an ad hoc Group was convened under the leadership of the OIE Permanent Animal Welfare Working Group. With valuable assistance from the OIE Collaborating Centre on Animal Welfare, a Questionnaire was developed and sent to OIE Members, of which 81 countries submitted responses. In light of this information, the ad hoc Group prepared a first draft report, which notes the importance of controlling stray dog populations to help prevent zoonotic diseases and non-disease related nuisances to society and the environment. In choosing the preferred method of control, the risks to operators must be taken into account, as well as religious, cultural and economic contexts of the country concerned. Depending on the situation, methods requiring individual animal restraint or methods for use at a distance may be recommended. While activities that aim to physically reduce the numbers of stray dogs are important, achievement of the long term goals of dog population control and avoidance of risks to human health depends on the education of dog owners and the general public as to their responsibilities. The draft report notes that sub-national jurisdictions are often those responsible for the control of stray dog populations. The key role played by non-governmental organisations in stray dog management in many countries is acknowledged. The draft report emphasises that the close involvement of veterinarians and of official Veterinary Services, working in collaboration with public health authorities, is necessary to realise long term goals.

An assessment of rabies free status of the Island of Andaman, Nicobar and Lakshadweep: results of the WHO sponsored national multicentric rabies survey

The Islands of Andaman and Nicobar and Lakshadweep have been reported to be rabies free from time immemorial. Recently, a survey of the islands of Andaman and Nicobar & Lakshadweep was done between July and August 2003 to assess their rabies free status. It was revealed that these islands continue to remain rabies free. However, in Andamans the increasing dog population, poor vigil on import of dogs and lack of laboratory surveillance for rabies posed a threat to this status. The Lakshadweep islands, which are free of dogs, however, faced a threat from the lack of vigil on the entry and presence of cats and poor surveillance for rabies in them.

Global perspectives on animal welfare: Asia, the Far East, and Oceania

In Asia and the Far East, livestock undergo major suffering due to malnutrition, overloading, and ill-treatment. At slaughter animals are handled roughly and watch other animals being killed; stunning is not practised. Cruelty to other animals such as elephants, horses, donkeys, bears, dogs, and circus animals has largely been prevented through the efforts of animal welfare organisations. Governments have taken initiatives to establish Animal Welfare Boards and enact laws for the prevention of cruelty to animals, but their efforts are far too limited to be of any significance and financial constraints and lack of personnel inhibit the implementation of the laws that do exist. In New Zealand and Australia, legislation and strong consultation procedures at governmental and community level strive to regulate and improve the welfare of animals in all spheres, but in other Oceanic countries there is a need for both an update in, or establishment of, legislation covering animal welfare. Limited progress has been made due to the status of the Veterinary Services and a lack of resources. Although some public and educational awareness programmes are carried out, increasing exposure to international media and attitudes of visiting tourists suggest that further awareness work needs to be undertaken. To address the problems of animal welfare in developing countries, it would be inappropriate to adopt the international standards that are implemented in the developed countries. Each developing country should evolve its own standards based on its own individual priorities.

Chronic Caffey's disease: an uncommon entity in children

Chronic Caffey's disease in an uncommon condition in children is characterized by an acute inflammatory reaction in the periosteum along with systemic disturbances. A 30 months old boy was reported in the pediatric unit of BSMMU, Dhaka about two and half years back with the complaints of multiple painful soft tissue swelling in different parts of the body since birth and delay in growth and development. The child was found well and alert, moderately pale, febrile with hard, tender swelling of mandible on both sides. There were multiple swellings over the right arm, forearm, both thighs and bowing of the lower limbes. Investigations revealed normal serum calcium and phosphate level with mild elevation of alkaline phosphatase. Radiological findings showed periosteal new bone formation in mandible and long bones. There was diaphyseal expansion of the long bones with expansion of the ribs anteriorly. He was diagnosed as a case of chronic caffey's disease on the basis of history, clinical examination and investigation.

Metabolic pathway analysis web service (Pathway Hunter Tool at CUBIC)

MOTIVATION

Pathway Hunter Tool (PHT), is a fast, robust and user-friendly tool to analyse the shortest paths in metabolic pathways. The user can perform shortest path analysis for one or more organisms or can build virtual organisms (networks) using enzymes. Using PHT, the user can also calculate the average shortest path (Jungnickel, 2002 Graphs, Network and Algorithm. Springer-Verlag, Berlin), average alternate path and the top 10 hubs in the metabolic network. The comparative study of metabolic connectivity and observing the cross talk between metabolic pathways among various sequenced genomes is possible.

RESULTS

A new algorithm for finding the biochemically valid connectivity between metabolites in a metabolic network was developed and implemented. A predefined manual assignment of side metabolites (like ATP, ADP, water, CO(2) etc.) and main metabolites is not necessary as the new concept uses chemical structure information (global and local similarity) between metabolites for identification of the shortest path.

MR-imaging changes of musculoskeletal soft-tissue sarcomas associated with neoadjuvant chemotherapy and hyperthermia

PURPOSE

To evaluate early changes in musculoskeletal soft-tissue sarcomas under neoadjuvant chemotherapy combined with regional hyperthermia (RHT).

PATIENTS AND METHODS

Nineteen consecutive patients with high-grade soft-tissue sarcomas of the musculoskeletal system were treated with neoadjuvant chemotherapy combined with RHT. Patients were imaged, using a high field MR-scanner, before onset of therapy, immediately after one and after four cycles of therapy. The images were evaluated for volume reduction and development of tumour necrosis. In addition, side effects such as surrounding soft-tissue oedema, bleeding and muscle or bone marrow necrosis were analysed.

RESULTS

Tumour volume reduction was significant after the completion of neoadjuvant therapy (mean 49%, range 5-91%; (p < 0.001). Extent of tumour necrosis was also significantly different before (mean 22%) and after therapy (mean 58%, p < 0.001). Three patients showed strong tumour necrosis already after one cycle of treatment. Tumour volume reduction was not associated with the extent of pre-existing necrosis or necrosis development. The extent of tumour volume before start of therapy did not affect volume reduction or necrosis induction after therapy. Reduction of tumour oedema was significant after therapy (p < 0.001). No side effects were observed during thermochemotherapy.

CONCLUSION

Neoadjuvant chemotherapy combined with RHT resulted in significant tumour volume reduction and induction of tumour necrosis, which can be detected early and monitored closely with MRI.

Effects of transforming growth factor beta-1 and all-trans-retinoic acid on androgen-induced development of neonatal mouse bulbourethral glands in vitro

Effects of transforming growth factor beta-1 (TGF-beta1) and all-trans-retinoic acid (All-trans-RA) on development of bulbourethral glands (BUGs) of neonatal mice were investigated in vitro. BUGs from 0-day-old male mice were cultured for 6 days in serum-free, chemically defined medium containing transferrin and bovine serum albumin, supplemented with 5alpha-dihydrotestosterone (DHT; 10-8 M) and insulin (10 microg/mL) alone or in combination. Prior to culture, BUGs from 0-day-old mice consisted of a simple epithelial rudiment encapsulated by mesenchyme. Epithelial growth and ductal branching occurred in BUGs cultured in medium containing DHT and insulin or DHT alone, but epithelial branching did not occur in BUGs cultured in the presence of insulin alone. Addition of TGF-beta1 at concentrations of > 5 ng/mL (0.2 x 10-9 M) to medium containing both insulin and DHT, inhibited the expected increase in overall size of BUGs, epithelial area and ductal branching in a dose-dependent manner. TGF-beta1 also decreased [3H]-thymidine labelling indices of both epithelium and mesenchyme. TGF-beta1 at 10 ng/mL elicited these inhibitory effects on BUGs cultured in medium containing DHT alone. Addition of All-trans-RA (10-8 to 10-6 M) to the medium containing DHT plus insulin, or DHT alone did not exert significant effects on either overall size of BUGs or epithelial growth and ductal branching. All-trans-RA at 10-6 M decreased the [3H]-thymidine labelling index of mesenchyme of BUGs cultured in medium with DHT plus insulin or DHT alone, but did not decrease the [3H]-thymidine labelling index of epithelium. The present results indicate that TGF-beta1 inhibits androgen-induced epithelial and mesenchymal growth as well as epithelial morphogenesis of BUGs from neonatal mice. Such an inhibitory effect of TGF-beta1 is not mimicked by All-trans-RA at physiological concentrations.

Nutritional status of rural elderly Malays: dietary and biochemical findings

A cross-sectional nutritional survey was carried out on 350 elderly Malays aged 60 and above from 11 randomly selected villages in a rural area on the East Coast of Malaysia. The findings indicated that the mean intakes of energy and all of the nutrients investigated were below the Malaysian Recommended Dietary Allowances, excepts for protein and vitamin C. Nutrients most likely to be inadequate were vitamin A, thiamine, riboflavin, niacin and calcium, with more than 50% of the subjects having estimated intakes of below 2/3 of the recommendations. However, vitamin A status was adequate, with only 2 subjects being biochemically deficient (plasma retinol < or = 0.7 mmol/l). Approximately a third of the subjects had hypoalbuminaemia (plasma albumin < 3.3 g/dl) and anaemia (Haemoglobin < 12 g/dl for men; < 13 g/dl for women). Riboflavin deficiency, as assessed by an erythrocyte glutathione reductase activation coefficient (EGRAC) of more than 1.35 was identified in 77% of the subjects. The prevalence of vitamin E deficiency (plasma a-tocopherol < or = 12 mmol/l) was 27%, with men being at a greater risk. In conclusion, the dietary intakes of these rural elderly Malays was inadequate. Over three quarters of the sample were biochemically deficient in riboflavin, the functional consequences of which need to be further investigated.

Comparison of the incidence of colour blindness between sections of Libyan and Indian populations

Incidence of Red-Green colour blindness was studied in a Libyan population and was then compared with the same in two samples of Indian population. The incidence of the Red-Green colour defect was found to be 2.209% amongst the males and 0.0% amongst the females in the Libyan study. However, the incidence was only 1.841% amongst the ethnic Libyan males. This incidence was comparable with those reported from other African countries like Congo and Uganda. The incidence of Red-Green colour defect amongst the Indian males was found to be 2.295% while it was 0.840% amongst the Indian females.

ESHO quality assurance guidelines for regional hyperthermia

The Technical Committee and the Clinical Committee of the ESHO evaluated the experience of the institutes which are active in clinical regional hyperthermia using radiative equipment. Based on this evaluation, QA guidelines have been formulated. The focus of these guidelines lies on what must be done not on how it should be done. Subjects covered are: treatment planning, treatment, treatment documentation, requirements and characterization of equipment, safety aspects, hyperthermia staff requirements and instrumentation for quality assurance.

Flow cytometric evaluation of transferrin receptor in transitional cell carcinoma

We evaluated flow cytometric (FCM) analysis of transferrin receptor (TFR) expression as a marker for the malignant potential in transitional cell carcinoma (TCC). TCCs from 55 patients were analyzed by FCM using an anti-TFR monoclonal antibody (CD71) and a TCC-specific monoclonal antibody (EH14), which recognizes most TCC cells irrespective of the grade. The cells were divided into subpopulations according to DNA ploidy determined simultaneously. TFR expression correlated well with the grade and the stage of the tumors. TFR expression of the aneuploid tumors was significantly higher than that of the euploid tumors in all subpopulations. EH14 expression did not correlate with the grade or the stage of the tumors. EH14 expression of the aneuploid tumors was significantly higher than that of the euploid tumors in the whole cell population but not in the subpopulations. In moderately differentiated tumors or in T1 tumors, TFR expression was higher in multiple or recurrent tumors than in simple tumors. The cell size or shape were not the primary reasons for the enhanced expression of TFR in the high-grade or the high-stage tumors; instead, overproduction of TFR may take place in these tumors. Clinically, many of the TCC tumors are grouped into G2 or T1 tumors, some of which will be invasive cancers. Quantitative analysis of TFR expression using FCM may be useful to predict the prognosis of these tumors.