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.

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the study of the liver (APASL)

The Asian Pacific Association for the Study of the Liver (APASL) set up a working party on acute-on-chronic liver failure (ACLF) in 2004, with a mandate to develop consensus guidelines on various aspects of ACLF relevant to disease patterns and clinical practice in the Asia-Pacific region. Experts predominantly from the Asia-Pacific region constituted this working party and were requested to identify different issues of ACLF and develop the consensus guidelines. A 2-day meeting of the working party was held on January 22-23, 2008, at New Delhi, India, to discuss and finalize the consensus statements. Only those statements that were unanimously approved by the experts were accepted. These statements were circulated to all the experts and subsequently presented at the Annual Conference of the APASL at Seoul, Korea, in March 2008. The consensus statements along with relevant background information are presented in this review.

Hepatitis E virus is a leading cause of acute-on-chronic liver disease: experience from a tertiary centre in Bangladesh

BACKGROUND

Acute-on-chronic liver failure (ACLF) is common in Bangladesh. Acute viral E hepatitis is sporadically encountered in this country each year, with a rising incidence in the rainy season. This study aimed to identify the etiology of ACLF in Bangladesh.

METHODS

In this retrospective study, 69 ACLF patients were included. They presented to our department at the Bangabandhu Sheikh Mujib Medical University in Dhaka. History of diseases was recorded and appropriate investigations were conducted in all patients.

RESULTS

Acute hepatitis E virus (HEV) infection was positive in 21.7% (15/69) of the patients, while 14.5% (10/69) had septicemia. Upper gastrointestinal tract hemorrhage was seen in 4.3% of the patients (3/69), while another 4.3% (3/69) had a positive history for alcohol or drugs. None of the patients tested positive for hepatitis A virus infection and no evidence of hepatitis B virus flare was found in any patient. No specific cause for ACLF could be identified.

CONCLUSIONS

Acute HEV infection is a leading cause of ACLF in Bangladesh. Many patients were thought to have decompensation of cirrhosis, but subsequently were recognized as having ACLF by a retrospective review according to the definition of the Asian Pacific Association for the Study of the Liver Working Party Meeting on ACLF in New Delhi in early 2008.

HEV infection as an aetiologic factor for acute hepatitis: experience from a tertiary hospital in Bangladesh

Acute hepatitis is seen sporadically round the year in Bangladesh. The incidence of acute viral hepatitis E increases after floods as this allows sewerage contamination of piped and groundwater. The aim of this retrospective study was to assess the burden of hepatitis E virus (HEV infection) in Bangladesh. Patients attending the Hepatology Unit III of the Bangabandhu Sheikh Mujib Medical University, during June 2004-December 2006, were included in the study. All viral markers were tested by enzyme-linked immunosorbent assay. The study population was divided in four groups. Group 1 included 144 patients with acute viral hepatitis. The inclusion criteria were: nausea and/or vomiting, loss of appetite, serum bilirubin >200 micromol/L, raised serum transaminases, and prothrombin time >3 seconds prolonged beyond control value. In Group 2, there were 31 pregnant women with acute viral hepatitis. All the patients had prodrome, icterus, raised serum bilirubin and raised serum transaminase levels. Group 3 included 23 patients presenting with fulminant hepatic failure. In Group 4, 69 patients with cirrhosis of liver were included. They presented with features of decompensation for the first time. The inclusion criteria were: patients with established cirrhosis with jaundice and/or ascites and/or hepatic encephalopathy. In Group 1, 58.33% of the 144 patients had acute viral hepatitis E. In Group 2, 45.16% of the pregnant women also had acute viral hepatitis E. HEV was responsible for 56.52% cases of fulminant hepatic failure in Group 3. In 21.7% cases in Group 4, decompensation of cirrhosis was due to HEV. Acute viral hepatitis E in the third trimester of pregnancy and HEV-induced fulminant hepatic failure were associated with 80% of mortality despite the best possible care. In this clinical context, acute viral hepatitis E is the leading cause of wide spectrum of liver disease ranging from severe acute viral hepatitis, fulminant hepatic failure, to decompensation of liver in cirrhotics in Bangladesh. Sewerage contamination of piped water following floods may contribute to the higher incidence of HEV infection.

Epidemiology of hepatitis B virus in Bangladeshi general population

BACKGROUND

Hepatitis B virus (HBV) is encountered sporadically the year round in Bangladesh. It results in a wide range of liver diseases, with asymptomatic acute hepatitis at one end to hepatocellular carcinoma (HCC) at the other end of the spectrum.

METHODS

All 1018 individuals of different age groups and sex with varied religious, educational and social backgrounds were tested for HBsAg by ELISA. The positive samples were further tested by ELISA for HBeAg. Before testing, blood samples were preserved at -20 degree centigrade. The study was conducted in a semi-urban location on the outskirts of Dhaka.

RESULTS

Of the 1018 individuals, 5.5% tested positive for HBsAg. None were tested positive for anti-HCV. Among the HBsAg-positive population, 58.93% were HBeAg-positive and the rest 41.07% HBeAg-negative. There was a male predominance and those who were tested positive were mostly between 16 and 50 years of age. Major risk factors for exposure to HBV appeared to be injudicious use of injectable medications, treatment by unqualified, traditional practitioners, mass-vaccination against cholera and smallpox, barbers and body piercing.

CONCLUSION

HBV remains a major cause of morbidity and mortality in Bangladesh and we have a long way to go before we may bid farewell to this deadly menace.

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.

Etiology of fulminant hepatic failure: experience from a tertiary hospital in Bangladesh

BACKGROUND

Fulminant hepatic failure (FHF) is not uncommon in our clinical practice in Bangladesh. There was a rise in acute hepatitis E virus (HEV) in Bangladesh after the 2004 floods. At that time, most of the country was under water for more than a month, leading to sewage contamination of the water supply. The aim of this study was to investigate the etiology of FHF in Bangladesh.

METHODS

In this retrospective study, 23 patients with FHF who presented with severe impairment of hepatocellular function (i.e. encephalopathy, coagulopathy and jaundice) within 6 months of onset of symptoms were included. There were 17 men and 6 women, aged from 18 to 32 years. Four of the women were pregnant. Patients were tested for markers for common hepatotrophic viruses. A relevant history was taken and the Patient Record Book of the Unit was reviewed.

RESULTS

56.52% patients (13/23) had HEV infection, and all were anti-HEV IgM-positive tested by ELISA. HBV infection was detected in 34.78% patients (8/23), all of whom were tested positive for either HBsAg or anti-HBs IgM by ELISA. 8.7% patients (2/23) had a positive history for intake of alcohol and/or drugs.

CONCLUSIONS

Acute HEV infection is the leading cause of FHF in Bangladesh. Sewage contamination of the water supply following floods contributes to a higher incidence of HEV infection. HBV infection is also important.