Trace element intake and dietary status of nuts consumed in Pakistan: study using INAA

Five nuts, namely almond, cashew nuts, peanuts, pine nuts and pistachio, commonly consumed in Pakistan, were analyzed for their inorganic element contents. Instrumental neutron activation analysis (INAA) methodology, using different irradiation, cooling and counting protocols, was adopted to determine Al, Br, Ca, Cl, Co, Cs, Eu, Fe, Hg, K, La, Mg, Mn, Mo, Na, Rb, Sc, Se, Sr and Zn. The investigated nuts were found to contain substantial amounts of Ca, Cl, Fe, Mg, K, Na and Zn. Dietary intake of the essential inorganic elements present in these nuts, as compared to the recommended dietary allowance, has also been calculated. This has further substantiated the nutrient role of nuts in the prevention of cardiovascular disease, as in addition to their established efficacy in improving the lipid profile, they are a rich source of cardioprotective trace elements such as magnesium, zinc, iron and calcium. Toxic elements were present in very low concentrations in nuts.

Utilisation of a low power reactor for instrumental neutron activation analysis of 40 elements in coal

Coal is mostly used as an energy source for power generation and in local brick kilns in Pakistan, which causes environmental pollution problems due to the release of toxic constituents. Elemental characterisation provides useful information regarding the nature of environmental pollutants to which coal workers and adjacent terrain are exposed and circumscribes different elements as they exist in the coal. Instrumental Neutron Activation Analysis employing a low power Miniature Neutron Source Reactor has been used for the determination of 40 major, minor, and trace elements in coal. Bituminous, sub-bituminous and lignite coal varieties of Pakistan were analysed which show that bituminous coal from Salt Range contains lower amount of toxic elements. The quality of the analysed data has been assured by a simultaneous analysis of the IAEA and NBS/NIST Certified Reference Materials. The data will be useful for extrapolating the extent of elemental emission through the combustion of these coals. Enrichment factors calculated for these elements in coal show high values for As, Br, Cl, Dy, Hg, Mo, Sb, and Se, indicating difference in geochemistry and growth environment of the coal deposits. Elemental concentrations of our coal varieties have been compared with those of other countries.

Assessment of air quality of two metropolitan cities in Pakistan: Elemental analysis using INAA and AAS

For the assessment of air quality of two cities in Pakistan, Instrumental Neutron Activation Analysis (INAA) and Atomic Absorption Spectrometry (AAS) have been used. In all 26 elements were determined in suspended particulate matter (SPM) and soil samples. The SPM levels from different locations of Rawalpindi and Lahore indicate unhealthy to hazardous air quality much above the World Health Organization (WHO) guidelines. Metrological conditions and nature of soil that contains clay components mainly contribute to the inventory of the SPM elements of these cities. The calculated enrichment factors (EF) also indicate the dominance of the soil components. Contributions of inorganic elements due to heavy traffic with automotive exhaust and other commercial activities in this area have been identified. Areas of Qurtaba Chowk and Bank Square in Lahore in particular showed high EF for lead depicting burning of the automotive fuel and road dust. The accuracy and precision of the work has been maintained through the concurrent use of IAEA Reference Materials.

Are endothelial microparticles potential markers of vascular dysfunction in the antiphospholipid syndrome?

Vascular dysfunction is key to the development of thrombosis in the antiphospholipid syndrome. This has been largely demonstrated by the upregulation of various cell surface and intracellular signalling molecules, as well as proinflammatory cytokine release from activated endothelial cells. Endothelial microparticles (EMP) are a further marker of endothelial activation but have been less extensively studied. We summarise evidence suggesting that these microparticles may be critical effectors of thrombosis in the antiphospholipid syndrome. There is evidence that levels of EMP are raised in patients with circulating antiphospholipid antibodies and that these EMP may be prothrombotic. The balance between markers of endothelial dysfunction (including EMP and circulating endothelial cells) and markers of repair such as circulating endothelial progenitor cells may be abnormal in patients with APS but this has not been proved and requires further study.

Prevalence, patterns and knowledge of effects on health of smoking among medical students in Pakistan

A questionnaire survey was conducted among all medical students with at least 2 years of medical education studying at 3 medical colleges in Punjab, Pakistan. Of the 1529 respondents (544 males and 985 females), 21.5% were ever smokers (smoked at least once in their lifetime): 9.1% current smokers (including 5.7% daily smokers), 0.7% ex-smokers and 11.7% occasional smokers. The proportions of ever smokers among males and females were 48.3% and 6.7% respectively, and of current smokers were 23.2% and 1.3%. The proportion of males and females smoking daily was 14.7% and 0.7%. The proportion of nonsmokers who knew about the addictive and harmful nature of cigarette smoking was higher than that among the smokers.

Kerosene lamp "Kupi": lights the house, but may bring darkness to life

In terms of mortality and morbidity, childhood burn comprises a significant public health problem in Bangladesh, especially in rural poor families who use kerosene-lamp "Kupi" for lighting and traditional mud-made open oven for cooking. They lack optimum safety measures. A total of 100 patients in the age group of 01 to 15 years who got admitted into the burn unit of Dhaka Medical College Hospital during the first half of 2005 were enrolled in the study. Data on socio-demographic variables and information on events and consequences of burn were extracted and analyzed. The results identified flame burn from kerosene lamp "Kupi" as the major cause and source of burn in affected children. Both electrical burn and burn by ash were seen to happen in older male and toddler boys respectively. There were 02 deaths in the series; both were females and were the victims of massive flame burn-one from Kupi and other form oven fire during cooking. Pediatric burn imposes stress on the physique, psyche and socio-economic status of the affected personnel and families. Effective measures are needed to prevent this unfortunate injury in children which is preventable to a large extent.

Serious infections in British patients with systemic lupus erythematosus: hospitalisations and mortality

This retrospective study determined the prevalence and nature of hospitalisations secondary to infection, and examined the mortality from infection in our large British cohort of patients with systemic lupus erythematosus (SLE). Casenote and database information of 104 consecutive patients attending the UCLH specialised SLE clinic were reviewed for the number of hospitalisations due to infection and the clinical and serological features of affected patients. Cohort mortality data were examined to identify deaths secondary to infectious diseases. Infection serious enough to result in hospitalisation occurred in 15% of the patients in the selected sample of our whole cohort. Six patients had more than one admission due to infection, with pneumonia being the most frequent. Typical bacterial pathogens were most commonly identified. A significant association between admissions for infection and nephritis ( P < 0.05 by Chi-square) was identified; however, the use of high dose prednisolone or other immunosuppressants did not increase the risk for infection requiring hospitalisation ( P > 0.5 by Chi-square) in our study. Between 1978 and 2007, 17 of 67 (25%) deaths in our SLE cohort of 470 patients were because of infection. Patients who died from infectious causes were more likely to have existing or previous renal disease than those who died from non-infectious causes ( P < 0.01 by Chi-square). The majority who died from infection were on high dose prednisolone plus at least one other immunosuppressive agent and had serologically active disease. The study highlights the significant problem of infection in British patients with SLE. Early recognition and treatment of infectious diseases in these patients together with considered use of immunosuppressant medications and vaccinations may help to reduce the impact of these complications.

Community management of intellectual disabilities in Pakistan: a mixed methods study

BACKGROUND

Pakistan has one of the highest reported rates of childhood intellectual disabilities (ID) in the world. Prevalence estimates vary from 19.1/1000 for serious ID to 65/1000 for mild ID.

METHODS

We surveyed carers of persons with ID (n = 100) using quantitative and qualitative instruments. We conducted in-depth interviews of carers (n = 16) and key primary health providers (n = 10). We also carried out focus groups (n = 7). Data were triangulated and interpreted in light of peer reviewed literature.

RESULTS

There was a delay of 2.92 (95% CI 1.9 to 3.94) to 4.17 (95% CI 2.34 to 6.01) years between detection and seeking of care. Parental stress associated with caring for these children was high (mean Self-Reporting Questionnaire score 8.4; 95% CI 6.80 to 9.91). Home management consisted mainly of physical containment. Stigma associated with ID contributed to decreased opportunity for these children and families to participate in community activities. There was a lack of knowledge about causation and effective interventions for ID.

CONCLUSIONS

Our findings suggest that there is significant delay in detection of ID especially in rural setting where more than 70% of population of Pakistan resides. This missed opportunity for rehabilitation in early formative years is a cause of significant distress for the caregivers who rarely receive valid information about course, prognosis and what remedial action to take. There is a need to develop feasible, cost-effective, community level interventions, which can be integrated into existing healthcare systems.

In vivo inhibition of antiphospholipid antibody-induced pathogenicity utilizing the antigenic target peptide domain I of beta2-glycoprotein I: proof of concept

SUMMARY OBJECTIVES

In the antiphospholipid syndrome (APS), the immunodominant epitope for the majority of circulating pathogenic antiphospholipid antibodies (aPLs) is the N-terminal domain I (DI) of beta(2)-glycoprotein I. We have previously shown that recombinant DI inhibits the binding of aPLs in fluid phase to immobilized native antigen, and that this inhibition is greater with the DI(D8S/D9G) mutant and absent with the DI(R39S) mutant. Hence, we hypothesized that DI and DI(D8S/D9G) would inhibit aPL-induced pathogenicity in vivo.

METHODS

C57BL/6 mice (n = 5, each group) were injected with purified IgG derived from APS patients (IgG-APS, 500 microg) or IgG from normal healthy serum (IgG-NHS) and either recombinant DI, DI(R39S), DI(D8S/D9G), or an irrelevant control peptide (at 10-40 microg). Outcome variables measured were femoral vein thrombus dynamics in treated and control groups following standardized vessel injury, expression of vascular cell adhesion molecule-1 (VCAM-1) on the aortic endothelial surface, and tissue factor (TF) activity in murine macrophages.

RESULTS

IgG-APS significantly increased thrombus size as compared with IgG-NHS. The IgG-APS thrombus enhancement effect was abolished in mice pretreated with recombinant DI (P

CONCLUSION

Our findings in this proof-of-concept study support the development of recombinant DI or the novel variant DI(D8S/D9G) as a potential future therapeutic agent for APS.

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Key Words Collapse

MESH Headings

• Animals
• Antibodies, Antiphospholipid/immunology
• Antibodies, Antiphospholipid/physiology
• Enzyme-Linked Immunosorbent Assay
• Macrophages, Peritoneal/metabolism
• Mice
• Mice, Inbred C57BL
• Thromboplastin/metabolism
• beta 2-Glycoprotein I/chemistry
• beta 2-Glycoprotein I/metabolism

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Grants

• R01 AR056745 NIAMS NIH HHS
• Arthritis Research UK

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In vitro inhibition of food spoilage and foodborne pathogenic bacteria by essential oil and leaf extracts of Magnolia liliflora Desr

The aim of this study was to examine the chemical composition of the essential oil isolated from the floral parts of Magnolia liliflora Desr. by hydrodistillation, and to test the efficacy of essential oil and various leaf extracts against a diverse range of microorganisms comprising food spoilage and foodborne pathogenic bacteria. The chemical composition of essential oil was analyzed by GC-MS. It was determined that 52 compounds, which represented 78.07% of total oil, were present in the oil. The oil contained mainly levoxine (15.59%), methylcyclopropane (24.26%), 2-beta-pinene (5.3%), caryophyllene oxide (4.01%), and beta-caryophyllene (1.7%). The oil (1000 ppm/disc) and leaf extracts (1500 ppm/disc) exhibited promising antibacterial effects against the tested pathogens as a diameter of zones of inhibition (9 to 18 and 7 to 12 mm) and MIC values (125 to 1000 and 500 to 3000 microg/mL), respectively. Also, the oil had a potent detrimental effect on the viable count of the tested bacteria. The results obtained in this study support the role of essential oil and the leaf extracts derived from M. liliflora as a remarkable approach to inhibit the growth of food spoilage and foodborne pathogens.

The role of caveolin-1 in cardiovascular regulation

Caveolae are omega-shaped membrane invaginations present in essentially all cell types in the cardiovascular system, and numerous functions have been ascribed to these structures. Caveolae formation depends on caveolins, cholesterol and polymerase I and transcript release factor-Cavin (PTRF-Cavin). The current review summarizes and critically discusses the cardiovascular phenotypes reported in caveolin-1-deficient mice. Major changes in the structure and function of heart, lung and blood vessels have been documented, suggesting that caveolae play a critical role at the interface between blood and surrounding tissue. According to an emerging paradigm, many of these changes are secondary to uncoupling of endothelial nitric oxide synthase. Thus, nitric oxide synthase not only synthesizes more nitric oxide in the absence of caveolin-1, but also more superoxide with potential pathogenic consequences. It is further argued that the vasodilating drive from increased nitric oxide production in caveolin-1-deficient mice is balanced by changes in the vascular media that favour increased dynamic resistance regulation. Harnessing the therapeutic opportunities buried in caveolae, while challenging, could expand the arsenal of treatment options in cancer, lung disease and atherosclerosis.

Why do patients with systemic lupus erythematosus take or fail to take their prescribed medications? A qualitative study in a UK cohort

OBJECTIVE

It has been suggested that low adherence may contribute to poor clinical outcomes in patients with SLE. In this study, we explored the reasons why patients with lupus did or did not take their medications as prescribed.

METHODS

Questionnaires including a 10-cm visual analogue scale (VAS) to assess self-reported adherence to prescribed medications were distributed to 315 patients with SLE. The responses were used to select a purposive sample of subjects who participated in interviews to discuss why they did or did not take their medications.

RESULTS

Of the 315 patients, 220 (70%) completed the questionnaire. Thirty-three patients were interviewed. Themes explaining why patients took their medications regularly included: the fear of worsening disease, the belief that there was no effective therapeutic alternative to their prescribed medications, lack of knowledge about SLE to allow confidence in changing medications and feelings of moral obligation or responsibility to others. Themes explaining why patients did not take their medications regularly included: the belief that lupus could and should be controlled using alternative methods, the belief that long-term use of drugs was not necessary, the fear of drug adverse effects, practical difficulties in obtaining medications, and poor communication between patients and doctors.

CONCLUSION

The patients' reasons for taking or not taking their medications largely related to previous experiences with the disease and/or drugs. However, improvements in communication between doctors and patients may promote better adherence in patients with SLE.

Cluster randomized trial of a parent-based intervention to support early development of children in a low-income country

BACKGROUND

Programmes that promote early psychological development of children in the developed world have been found to be beneficial. However, such programmes are rare in underprivileged parts of the developing world. We adapted one such parent-based programme (Learning Through Play) for a rural Pakistani population and aimed to study if: (1) it was acceptable to community health workers; (2) the programme led to an improvement, after a period of 6 months, in mothers' knowledge and attitudes about early infant development; (3) it led to a reduction in the levels of maternal mental distress in the post-natal period.

METHODS

Using a cluster randomized design with villages as unit of randomization, 163 mothers from 24 villages in a rural sub-district of Rawalpindi, Pakistan, received the 'Learning Through Play' programme, whereas 146 mothers from 24 villages acted as controls. Twenty-four community health workers were trained to carry out the programme. Assessments were conducted using a specially developed 15-item Infant Development Questionnaire and the 20-item Self-Reporting Questionnaire (SRQ).

RESULTS

Over 80% of the community health workers trained found the programme to be relevant and were able to integrate it into their routine work. There was a significant increase in mothers' knowledge and positive attitudes about infant development in the intervention group, compared with the control group. Women in the intervention group answered correctly 4.3 (95% CI 3.7-14.9, P < 0.001) more questions than the control group. There was no difference in levels of mental distress measured by the SRQ.

CONCLUSIONS

The 'Learning Through Play' programme was successfully integrated into the existing health system and accepted by community health workers. The programme succeeded in improving the knowledge and attitudes of mothers about infant development.

Cardiac magnetic resonance imaging in patients with systemic lupus erythematosus

Objectives:

To delineate the cardiac magnetic resonance (MR) appearances of cardiovascular disease (CVD) in patients with systemic lupus erythematosus (SLE), in comparison with transthoracic echocardiographs.

Methods:

Cardiac MR was performed on 22 patients with SLE—11 with previous CVD and 11 matched controls—using late gadolinium contrast enhancement (LGE) to identify areas of myocardial scarring; Transthoracic echocardiography (TTE) was performed on the same day.

Results:

Twenty female and two male patients participated. LGE was seen in 5/11 subjects in the CVD group (4/5 with previous myocardial infarction) and 1/11 in the control group. TTE detected myocardial abnormalities in 2/6 patients with LGE.

Conclusion:

The cardiac MR appearance of CVD in these patients with SLE was suggestive of coronary disease, rather than cumulative inflammatory muscle damage. Cardiac MR detected more abnormalities than TTE. Further studies of cardiac MR in patients with SLE are warranted to investigate these preliminary findings.

Pesticide usage pattern in tea ecosystem, their retrospects and alternative measures

Tea is a perennial plantation crop grown under monoculture providing favorable conditions for a variety of pests. The concept of pest control has undergone a considerable change over the past few decades. In recent years there has been a greater dependence on the use of pesticides (7.35-16.75 kgha(-1)) with little importance laid on other safe control methods for the management of tea pests. Due to this practice, the tea pests showed a higher tolerance/ resistance status due to formation of greater amount of esterases, glutathione S-transferase and acetylcholinesterase. Thus, over reliance on pesticides end up with pesticide residue in made tea (DDT - 10.4-47.1%; endosulfan - 41.1-98.0%; dicofol- 0.0-82.4%; ethion - 0.0-36.2%; cypermethrin - 6.0- 45.1%). The growing concern about the pesticide residue in made tea, its toxicity hazards to consumers, the spiraling cost of pesticides and their application have necessitated a suitable planning which will ensure a safe, economic as well as effective pest management in tea. At present it is a global concern to minimize chemical residue in tea and European union and German law imposed stringent measures for the application of chemicals in tea and fixed MRL values at < or = 0. 1 mgkg(-1) for the most commonly used pesticides which will not be met out in the real practice and has been a major constraint to tea exporting countries like India. In order to regulate the situation of the Indian market at global level, central insecticide board and prevention of food adulteration regulation committee have reviewed the MRL position for tea and has recommended 10 insecticides, 5 acaricides, 9 herbicides and 5 fungicides for use in tea and issued the tea distribution and export control order 2005 which will help the country to limit the presence of undesirable substances in tea. This review attempts to provide the readers with a comprehensive account of pesticide use in North East in tea, surveillance report of the European community regarding the residue level in Assam and Darjeeling tea, recent amendments by international and national regulatory bodies, revised MRL values of pesticides in tea, an update about the current strategies for the management of tea pests with more focus on the use of biological control agents and a possible beneficial role or judicious use of chemical pesticides in complement with other alternative measures to achieve optimum effects in terms of limiting agricultural input, lowering production costs, reducing environmental contamination and the effect on non-target organisms, delaying the development of resistant pest biotypes and above all minimizing the pesticide residues in tea to increase the exports.