An analytic study of the trends in perinatal and neonatal mortality rates in the State of Qatar over a 30-year period (1977 to 2007): a comparative study with regional and developed countries

OBJECTIVE

This study was designed to analyze the trends and differences in perinatal and neonatal mortality rates in the State of Qatar over a period of 30 years (1977 to 2007), to examine the causes of neonatal deaths and compare them with some regional Gulf states and developed world countries.

STUDY DESIGN

This is a retrospective study conducted in the Women's Hospital, Hamad Medical Corporation, State of Qatar from 1977 to 2007.

METHOD

The study included all perinatal and neonatal deaths for the period 1977 to 2007, which were monitored through registers of the Neonatal Intensive Care Unit (NICU), Women's hospital. Cause of death was determined using information from hospital records, including discharge certificates. There is a national database in the Department of Preventive Medicine that records all deaths through death certificates. The missing information for the early years was collected from this database. All causes of deaths were classified in accordance with criteria based on the International Classification of Disease tenth revision (ICD-10).

RESULT

There was a notable peak in neonatal (14.1), early neonatal (12.5) and perinatal (24.7) mortality rates in 1977. There was a second peak in neonatal (12.1) and late neonatal (7.5) mortality rates in 2000. Over a period of three decades (1977 to 2007), there was a significant decline in mortality rates (P<0.0001). By 2007, the neonatal mortality rate had decreased from 14.1 to 5.1; the early neonatal mortality rate had a dramatic fall from 12.5 to 2.3; and perinatal mortality came down from 24.7 to 10.3. There was no notable reduction in the late neonatal mortality rate in 2007 (2.8) compared with that in 1980 (3.0). The still-birth (8), neonatal (5), early neonatal (2.3) and perinatal (10.3) mortality rates in Qatar were very close to the rates found in developed countries, but lower than the rates in Bahrain and Saudi Arabia. Similar to developed countries, prematurity was the leading cause of neonatal death in Qatar (42.6%), followed by congenital anomalies (28%).

CONCLUSION

This study revealed that there was a sharp significant decline in neonatal and perinatal mortality rates during the study period in Qatar. The stillbirth, neonatal and perinatal mortality rates in Qatar are comparable with those in some of the developed countries and were lower than those in some of the Gulf countries. The proportion of underweight live births was found constant during the study period. Prematurity was the leading cause of neonatal death, followed by congenital anomalies.

Sedative and anxiolytic effects of different fractions of the Commelina benghalensis Linn

The present study was designed to investigate sedative and anxiolytic properties of the four different fractions (chloroform, pet ether, n-butanol and hydromethanol soluble fractions, coded as CFCB, PECB, NBCB and HMCB, respectively) of the aerial parts of Commelina benghalensis using rodent behavioral models, such as hole cross, open field and thiopental sodium induced sleeping time tests for sedative property and elevated plus-maze (EPM) test for anxiolytic potential, respectively. All fractions, at the doses of 200 mg/kg, p.o. and 400 mg/kg, p.o., displayed dose dependent suppression of motor activity, exploratory behavior (in hole cross and open field tests) and prolongation of thiopental induced sleeping time in mice; maximum effect was shown by chloroform (CFCB) and pet ether (PECB) fractions. In EPM test, chloroform (CFCB) and pet ether (PECB) fractions with similar doses significantly (p < 0.05) increased exploration to and time spent by the treated mice in EPM open arms in a way similar to that of diazepam while the effect of NBCB and HMCB fractions on entry to and time spent in open arms was not found to be statistically significant. These findings provide in vivo evidence that aerial parts of C. benghalensis in general, and chloroform (CFCB) and pet ether (PECB) soluble fraction has significant sedative and anxiolytic effects. Furthermore, these results may justify the scientific basis for the use of this plant in traditional medicine as a modality for anxiety and related disorders.

Diagnosis and therapy in neuromuscular disorders: diagnosis and new treatments in mitochondrial diseases

Mitochondrial disease enters the differential diagnosis of a wide range of CNS and PNS presentations. Respiratory chain ATP production is under bigenomic genetic control. Adult mitochondrial diseases are mainly caused by mutations in mitochondrial DNA (mtDNA), and nuclear gene defects usually present with more severe childhood phenotypes. Recently, mutations in certain nuclear genes--for example POLG, MFN2 and OPA1, have been associated with an increasing number of adult-onset phenotypes. Achieving an accurate diagnosis can be complex and requires the coordinated interplay of clinical assessment, muscle histochemistry, muscle respiratory chain enzymology and genetics. Factors influencing the transmission and expression of mtDNA defects are not fully defined, presenting difficulties in calculating accurate recurrence risks for patients. Curative therapy exists for primary coenzyme Q(10) deficiency. For certain mtDNA mutations new therapeutic strategies, including resistance training, have the potential to reduce mutant mtDNA load. Allogeneic stem cell transplant may produce benefit in the nuclear recessive mitochondrial disorder mitochondrial neurogastrointestinal encephalomyopathy and should be considered in this nuclear driven multiple mtDNA deletion disorder. Supportive therapies in a multidisciplinary team environment are essential to reduce morbidity and mortality.

Antimicrobial and cytotoxic activity of the alkaloids of Amlaki (Emblica officinalis)

Alkaloids are important sources of drug that's why we have conducted our research to find out the biological activity of the alkaloids of a plant that is the Amlaki. Alkaloids were extracted from the methanolic extract of the fresh ripe fruits of Amlaki (Emblica officinalis) through solvent-solvent partitioning method with n-hexane and chloroform. The chloroform soluble fraction of the crude methanolic extract of the ripe fruits of Amlaki containing alkaloids was subjected to antimicrobial activity and brine shrimp lethality bioassay for observing cytotoxic activity. The chloroform soluble fraction of the methanolic extract exhibited significant antimicrobial activity against some Gram positive and Gram negative pathogenic bacteria and strong cytotoxicity having a LC50 of 10.257 +/- 0.770 microg mL(-1). It is concluded that the chloroform soluble fraction of the ripe fruits of Amlaki containing alkaloids are biologically active.

Acute cytomegalovirus hepatitis in immunocompetent host

BACKGROUND

In inmunocompetent hosts, cytomegalovirus (CMV) infection is generally asymptomatic. It may however present as infectious mononucleosis. Serious complications have rarely been reported. We report three cases of acute CMV hepatitis in immunocompetent men for the first time from Bangladesh. All three presented to us with features of acute hepatitis of variable duration preceded by prodrome. Other probable causes of acute hepatitis were ruled out and none had any clinical stigmata of cirrhosis. All the three patients underwent uneventful recovery. Although more common in the immunocompromised, CMV can occasionally produce symptomatic hepatitis in the immunocompetent host. Disease is self limiting, but supportive measures are needed.

A new antispoofing approach for biometric devices

The deployment of fingerprint sensors is increasingly becoming common and has now gained high user acceptance. However, fingerprint sensors are susceptible to spoofing using artificial materials or in worst case to the dismembered fingers. Fake/gummy fingerprints have shown to fool most commercial fingerprint systems. This paper proposes a new method of anti-spoofing using reliable liveness detection. The proposed method of liveness detection is based on the principle of pulse oximetry and involves the source of light originating from a probe at two wavelengths. The light is partly absorbed by haemoglobin, by amounts which differ depending on whether it is saturated with oxygen or deoxygenated haemoglobin. We then perform the computations for the absorption at two wavelengths to estimate the proportion of haemoglobin which is oxygenated. The computed percentage of oxygen in the blood, along with the heart pulse rate, determines the liveness of the enrolled biometric. Our experimental results demonstrate that the developed prototype can successfully thwart the spoof attacks (including those based on dismembered fingers).

Prevalence of Mycoplasma genitalium in health clinic attendees complaining of vaginal discharge in Bangladesh

The objective of the study was to determine the prevalence of Mycoplasma genitalium in a sample of health clinic attendees complaining of vaginal discharge. A subsample of 399 vaginal and cervical swabs was randomly selected from 2579 samples collected during a study to determine the causes of vaginal discharge in women attending primary health-care clinics in Dhaka, Bangladesh. Cervical samples were tested for M. genitalium by polymerase chain reaction. In addition, the samples were tested for Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, bacterial vaginosis and candida. M. genitalium was detected in three samples (0.8%; 95% confidence interval: 0.00–1.6). The prevalence of C. trachomatis, N. gonorrhoeae T. vaginalis, bacterial vaginosis and candida was 1.3, 3.8, 8, 23.25 and 32.5%, respectively. Two women with M. genitalium were co-infected with T. vaginalis or candida. This is the first study to document the existence of M. genitalium in Bangladesh. Although the prevalence of this infection is low in the population tested, further research into this pathogen in other Bangladeshi populations is justified.

Pulmonary drug delivery: Implication for new strategy for pharmacotherapy for neurodegenerative disorders

Innovative drug delivery in the treatment of brain neurodegenerative disorders such as Parkinson's disease (PD) and Alzheimer's disease (AD) has the potential to avoid many unwanted side effects over current medications. Advances in understanding of these diseases and their treatments have led to the search for novel modes of drug delivery. In this review, we have highlighted new strategies and future prospects for pulmonary delivery of drugs for the management of these important neurological disorders. The advancement of knowledge on pulmonary drug delivery will provide novel therapeutic formulations for better management of the PD and AD patients throughout the world.

Acidic and alkaline bottom ash and composted manure blends as a soil amendment

Potential water quality impacts associated with using bottom ash (BA) and composted dairy manure (CM) as a soil amendment were evaluated in this study. Two column studies were conducted to evaluate three blends of acidic BA and CM (BA:CM, v/v) namely, B1ac (95:5), B2ac (90:10), and B3ac (80:20) and three blends of alkaline BA and CM (BA:CM, v/v), namely, B1al (95:5), B2al (90:10), and B3al (80:20) under constant head water table conditions. Samples from standing water (top) and leachate (bottom) were collected at weekly intervals until day 49 to evaluate the effects of different blend ratios and elapsed time on standing water and leachate chemical and physical properties. A higher CM content in both acidic and alkaline blends resulted in higher leachate concentrations for solids and nutrients tested in this study. Alkaline blends had higher standing water and leachate nutrients concentration compared to acidic blends. After day 28, standing water total dissolved solids (TDS) concentrations for all acidic blends was below the USEPA drinking water standard however, TDS value for alkaline blend was always below the standard. Similar trends were also observed for NO3-N and phosphorus (P) concentrations for both blends. Based on these findings, it was concluded that acidic and alkaline blends B1ac, B1al, B2ac and B2al may be considered as a soil amendment material.

Assessment of radiological hazards due to the presence of natural radionuclides in samples of building materials collected from the northwestern areas of Pakistan

Brick, sand, marble and cement are mainly used for the construction of dwellings in Pakistan. Therefore, knowledge of the presence of natural radioactivity in these materials is of great importance in order to assess the radiological hazards associated with them. In this context, specific activities of 226Ra, 232Th and 40K were measured in brick, sand, marble and cement samples collected from different localities of the North West Frontier province and federally administered tribal areas, Pakistan, using a P-type coaxial high-purity germanium spectrometer. In brick samples, the average measured activities for 226Ra, 232Th and 40K were 30 +/- 15, 41 +/- 21 and 523 +/- 182 Bq kg(-1), whereas in sand samples, these values were 19 +/- 9, 30 +/- 15 and 769 +/- 461 Bq kg(-1), respectively. In marble samples, the average specific activities of 226Ra, 232Th and 40K were found to be 18 +/- 19, 18 +/- 21 and 299 +/- 328 Bq kg(-1), whilst in cement samples they were 24 +/- 6, 18 +/- 4 and 244 +/- 29 Bq kg(-1), respectively. Radium equivalent activities were also calculated and were found to be 129 +/- 54, 121 +/- 57, 67 +/- 60 and 68 +/- 9 Bq kg(-1) for brick, sand, marble and cement samples, respectively. The annual average effective doses from these samples were 0.37 +/- 0.15, 0.33 +/- 0.15, 0.20 +/- 0.17 and 0.20 +/- 0.03 mSv, respectively. External and internal hazard indices were less than one for all the samples studied.

Effect of liquid municipal biosolid application method on tile and ground water quality

This study examined bacteria and nutrient quality in tile drainage and shallow ground water resulting from a fall land application of liquid municipal biosolids (LMB), at field application rates of 93,500 L ha(-1), to silt-clay loam agricultural field plots using two different land application approaches. The land application methods were a one-pass AerWay SSD approach (A), and surface spreading plus subsequent incorporation (SS). For both treatments, it took between 3 and 39 min for LMB to reach tile drains after land application. The A treatment significantly (p < 0.1) reduced application-induced LMB contamination of tile drains relative to the SS treatment, as shown by mass loads of total Kjeldahl N (TKN), NH(4)-N, Total P (TP), PO(4)-P, E. coli., and Clostridium perfringens. E. coli contamination resulting from application occurred to at least 2.0-m depth in ground water, but was more notable in ground water immediately beneath tile depth (1.2 m). Treatment ground water concentrations of selected nutrients and bacteria for the study period ( approximately 46 d) at 1.2-m depth were significantly higher in the treatment plots, relative to control plots. The TKN and TP ground water concentrations at 1.2-m depth were significantly (p < 0.1) higher for the SS treatment, relative to the A treatment, but there were no significant (p > 0.1) treatment differences for the bacteria. For the macroporous field conditions observed, pre-tillage by equipment such as the AerWay SSD, will reduce LMB-induced tile and shallow ground water contamination compared to surface spreading over non-tilled soil, followed by incorporation.

Prevalence of chronic kidney disease stages 3-5 among acute medical admissions: another opportunity for screening

BACKGROUND

Early identification of chronic kidney disease (CKD) can help delay or prevent its progression, but the opportunities for systematic screening of patients are not well defined.

AIM

To define the prevalence of CKD Stages 3-5 and related anaemia among acute medical admissions.

DESIGN

Retrospective analysis.

METHODS

We studied all acute medical admissions to a major London teaching hospital during one year. The lowest creatinine, highest haemoglobin (Hb) and average mean corpuscular volume (MCV) were determined for 3 months before and after admission. Patients were categorized as CKD Stages 3-5 if the highest estimated GFR (eGFR) was <60 ml/min/1.73 m2. CKD-related anaemia was diagnosed if these patients had Hb <11 g/dl with normal MCV.

RESULTS

A total of 6073 patients were studied: male 49.0%, age 65.4 +/- 19.6 years (mean +/- SD), creatinine 82.7 +/- 46.7 micromol/l, eGFR 89.1 +/- 32.5 ml/min/1.73 m2, Hb 13.6 +/- 1.73 g/dl, MCV 87.7 +/- 7.2 fl. There was an inverse correlation between eGFR and age (r2 = 0.5; P < 0.001). Males were younger than females (63.5 +/- 18.4 years vs. 67.3 +/- 20.5) and had higher eGFR (93.6 +/- 34.1 vs. 84.7 +/- 30.2 ml/min/1.73 m2; P < 0.001). A total of 743 patients (12.2%) had raised creatinine >110 micromol/l, however using eGFR <60 ml/min/1.73 m2, 1075 patients (17.7%) were identified. The patients were categorized as follows: Stage 3: 950 (15.6%), Stage 4: 100 (1.7%), Stage 5: 25 (0.4%). Ninety-nine (9.2%) of the 1075 patients had normocytic anaemia.

CONCLUSION

We have found a high prevalence of CKD Stages 3-5 (17.7%) among acute medical admissions, of whom 9.2% had a related anaemia. Our findings highlight an important opportunity (amongst the 1.9 million acute medical admissions annually in England) for detecting patients with CKD.

Assessment of the radiological hazards due to naturally occurring radionuclides in soil samples collected from the north western areas of Pakistan

(226)Ra, (232)Th and (40)K were measured in soil samples, these were collected from different localities of the North West Frontier Province and Federally Administered Tribal Areas, Pakistan. In order to measure the specific activities in these samples P-type coaxial high purity germanium based gamma-ray spectrometer was used. Average values of the measured activities of (226)Ra, (232)Th and (40)K were 26 +/- 11, 39 +/- 17 and 485 +/- 177 Bq kg(-1), respectively. Average radium equivalent activity was found to be 122 +/- 42 Bq kg(-1). External and internal hazard indices were also calculated and found to be 0.33 +/- 0.12 and 0.40 +/- 0.14, respectively. Average effective dose received due to gamma rays was 0.34 +/- 0.12 mSv y(-1). Measured natural radioactivity, hazard indices and effective doses received by the population were found within the recommended limits. The aim of this work was to make a baseline data of natural radioactive elements for the soil of the area and to assess it radiological significance if used as a building material for the construction of houses.

Development of insulin delivery systems

Delivery system of insulin is vital for its acceptance and adherence to therapy for achieving the glycemic targets. Enormous developments have occurred in the delivery system of insulin during the last twenty years and each improvement was aimed at two common goals: patients convenience and better glycemic control. Till to date, the various insulin delivery systems are: syringes/vials, injection aids, jet injectors, transmucosal delivery, transdermal delivery, external insulin infusion pump, implantable insulin pumps, insulin pens and insulin inhalers. Syringe/vial is the oldest and conventional method, still widely used and relatively cheaper. Modern plastic syringes are disposable, light weight with microfine needle for patients convenience and comfort. Oral route could be the most acceptable and viable, if the barriers can be overcome and under extensive trial. Insulin pen device is an important milestone in the delivery system of insulin as it is convenient, discrete, painless, attractive, portable with flexible life style and improved quality of life. More than 80% of European diabetic patients are using insulin pen. Future digital pen will have better memory option, blood glucose monitoring system, insulin dose calculator etc. Insulin infusion pump is a good option for the children, busy patients with flexible lifestyle and those who want to avoid multiple daily injections. Pulmonary route of insulin delivery is a promising, effective, non-invasive and acceptable alternative method. Exubera, the world first insulin inhaler was approved by FDA in 28 January 2006. But due to certain limitations, it has been withdrawn from the market in October 2007. The main concern of inhaled insulin are: long term pulmonary safety issues, cost effectiveness and user friendly device. In future, more acceptable and cost effective insulin inhaler will be introduced. Newer avenues are under extensive trial for better future insulin delivery systems.

Region-specific effects of N,N'-dodecane-1,12-diyl-bis-3-picolinium dibromide on nicotine-induced increase in extracellular dopamine in vivo

BACKGROUND AND PURPOSE

Systemic administration of N,N'-dodecane-1,12-diyl-bis-3-picolinium dibromide (bPiDDB), an antagonist of nicotinic acetylcholine receptors (nAChRs) attenuated the nicotine-induced increase in dopamine levels in nucleus accumbens (NAcc).

EXPERIMENTAL APPROACH

Using in vivo microdialysis, we investigated the effects of local perfusion of the novel nAChR antagonist bPiDDB into the NAcc or ventral tegmental area (VTA) on increased extracellular dopamine in NAcc, induced by systemic nicotine. We also examined the concentration-dependent effects of bPiDDB on the acetylcholine (ACh)-evoked response of specific recombinant neuronal nAChR subtypes expressed in Xenopus oocytes, using electrophysiological methods.

KEY RESULTS

Nicotine (0.4 mg kg(-1), s.c.) increased extracellular dopamine in NAcc, which was attenuated by intra-VTA perfusion of mecamylamine (100 microM). Intra-VTA perfusion of bPiDDB (1 and 10 microM) reduced nicotine-induced increases in extracellular dopamine in NAcc. In contrast, intra-NAcc perfusion of bPiDDB (1 or 10 microM) failed to alter the nicotine-induced increase in dopamine in NAcc. Intra-VTA perfusion of bPiDDB alone did not alter basal dopamine levels, compared to control, nor the increased dopamine in NAcc following amphetamine (0.5 mg kg(-1), s.c.). Using Xenopus oocytes, bPiDDB (0.01-100 microM) inhibited the response to ACh on specific combinations of rat neuronal nAChR subunits, with highest potency at alpha3beta4beta3 and lowest potency at alpha6/3beta2beta3.

CONCLUSIONS AND IMPLICATIONS

bPiDDB-Sensitive nAChRs involved in regulating nicotine-induced dopamine release are located in the VTA, rather than in the NAcc. As bPiDDB has properties different from the prototypical nAChR antagonist mecamylamine, further development may lead to novel nAChR antagonists for the treatment of tobacco dependence.