Comparison of Serum Amylase and Lipase Levels between Predialysis and Maintenance Haemodialysis CKD Patients

This cross sectional study was done to compare serum levels of amylase and lipase between predialysis and maintenance haemodialysis chronic kidney disease (CKD) patients and also to find out their relationship between degrees of renal impairment in Mymensingh Medical College Hospital and National Institute of Kidney Diseases and Urology, Dhaka, Bangladesh from May 2016 to April 2017. A total of 80 patients were included purposively as study subjects and made into two groups namely predialysis CKD group comprising 50 patients and other as maintenance haemodialysis group comprising of 30 patients. Among the predialysis group majority of the CKD was caused by glomerulonephritis (48%) followed by diabetes (26%), HTN (2%) and large portion undiagnosed (24%) whereas in the haemodialysis group ESRD was caused by diabetes (46%) followed by glomerulonephritis (16%), HTN (13%) and undiagnosed (23%). This study showed that mean serum amylase (158±718U/L vs. 111±41U/L) did not significantly differ between study groups except being above reference level but serum lipase (739±888U/L vs. 434±214U/L) was significantly higher in the predialysis group. There was a correlation between rising serum creatinine with serum amylase and lipase.

National survey of UK general practice pharmacy services

Background

The Clinical Pharmacists in General Practice (CPGP) initiative aims to recruit over 2000 clinical pharmacists in general practice (GP) surgeries in England by 2020. This study aimed to explore the services delivered by all GP pharmacy professionals (GPPPs; pharmacists/pharmacy technicians) across the UK.

Methods

30-item e-questionnaire was developed using SurveyMonkey platform and piloted during one-to-one cognitive interviews with GPPPs. The survey was distributed via the Primary Care Pharmacy Association, social media sites, collaborating GP organisations and via emails to participants of CPGP pilot. Three reminders were sent out 1 week apart. University ethics approval was obtained.

Results

Ninety-one responses were received between November 2018 and March 2019 (89% pharmacists, 52% from CPGP pilot). Participants provided an average of 9 services (95% CI 8.3-9.9). Over 90% of pharmacists delivered medication reviews and over 80% managed patients with polypharmacy. More pharmacists within than outside of the CPGP pilot managed repeat prescribing requests (70% vs. 47%, p = 0.035). Technicians took responsibility for primarily non-clinical services such as service commissioning (90%), management of safety alerts/drug recalls (80%), standard operating procedures (80%) and education & training (80%). Over 40% of GPPPs not providing care home services wished to do so by 2024. Four technicians wanted to be more involved in medication reviews. The main perceived benefits of GP pharmacy services included identifying medicines-related issues (93%), utilisation of pharmacy professionals’ skills (93%) and a reduction in medication waste (92%).

Conclusions

GPPPs provide a range of clinical and non-clinical services which may benefit public health at an individual and healthcare system levels. Pharmacists within the pilot are more likely to deliver repeat prescribing services. Future GP pharmacy landscape will likely include additional services to care homes.

Key messages

GPPPs including pharmacy technicians provide clinical and non-clinical services, appropriate to their scope of practice, to benefit patients, healthcare systems and themselves. Developing future GP pharmacy services to care homes offers further opportunities to benefit a vulnerable group of patients with long-term illnesses.

[Reserpine Is the New Addition into the Repertoire of AcrB Efflux Pump Inhibitors]

Acriflavine resistance protein B (AcrB) serves as prototype for multidrug resistance (MDR) efflux transporters of resistance nodulation division (RND) superfamily. AcrB has been proven as potential drug target with many synthetic and natural inhibitors have been identified such as those belonging to pyranopyridine, naphthamide and pimozide classes. The plant derived alkaloid inhibitors represented by reserpine has been found to inhibit both ATP binding cassette and major facilitator efflux transporters. In this study we report the reserpine induced inhibition of RND transporter AcrB. The preliminary docking analysis hints that reserpine shares its binding site with ciprofloxacin, a known substrate of AcrB and could possibly act as competitive inhibitor. For in vitro validation, AcrB from Salmonella typhi was cloned under the control of tac promoter and resulting vector was introduced into E. coli C41(DE3). Under autoinduced conditions, cells overexpressing AcrB transporter were subjected to combined dose of ciprofloxacin and reserpine. The combined exposure resulted in enhanced ciprofloxacin-induced growth inhibition of cells expressing AcrB transporter as compared to control cells transformed with vector of backbone sequence. Time kill analysis further confirmed these findings. To the best of our knowledge, this is first study to show that exposure to reserpine induces inhibition of AcrB. The assay developed in this study allows simple and reproducible detection of substrate/inhibitor effects upon AcrB and related efflux transporters.

Frequencies of Different Types of Cleft Lip, Cleft Lip with Palate and Cleft Palate in Bangladeshi Children

Cleft lip and cleft palate, also known as orofacial cleft, is a group of conditions that includes Cleft lip (CL), Cleft palate (CP) and both together (CLP). Cleft lip with/or palate are the major human orofacial congenital malformations seen in live birth as well as in still birth. This descriptive cross sectional study was done to determine how the different types of Cleft lip (CL), Cleft lip with palate (CLP) and Cleft palate (CP) are distributed among Bangladeshi Children. This study was performed at a health screening camp for patients with cleft lip with/or palate at Dhaka Shishu Hospital, Dhaka. A total 30 patients irrespective of their age and gender, presenting with cleft lip with/or palate deformities were included in the study. A questionnaire was constructed to be filled out by the present researcher through a face-to-face interview with the respondent preferably the mother. The data were organized and analyzed through Statistical Package for Social Sciences (SPSS, Version 20). Looking frequencies of different types of cleft lip with/or palate some trends can be noted regarding the laterality, completeness, extent, side involved and involvement of the alveolus. Out of the 14 CL cases, only 1 (7.14%) showed bilateral cleft. This cleft was complete but simple. All the others were unilateral cleft. A vast majority 9(about 65%) of the cleft lips belonged to the unilateral incomplete left sided simple type. One (7.14%) showed unilateral incomplete right sided simple type of CL. Only 2(14.28%) cases involved the alveolus. Out of the 11 CLP cases, unilateral cleft lip was present in 8 (more than 70% cases). Among them 6 cases showed complete cleft lip and 2 cases showed incomplete cleft lip. Out of all CLP cases 1 but all showed complete cleft palate. The most common type of CLP was "unilateral complete left sided compound cleft lip with unilateral complete left sided cleft palate" present in 5 of the children (i.e. more than 45% of the CLP cases and more than 16% of all cleft cases). Out of the 5 CP cases, only 1(20%) had involvement of the uvula plus posterior part of the soft palate. The rest 4(80%) had involvement of soft palate. Cleft lip with/or palate commonly occurred in Bangladeshi children. Genetic and environmental factors cause this birth defect. Therefore, integrated research among those factors is essential to prevent this birth defect.

Restraining the multidrug efflux transporter STY4874 of Salmonella Typhi by reserpine and plant extracts

Efflux-mediated multidrug resistance is a well-known phenomenon facilitated by multidrug resistant (MDR) transporters. One of the approaches to counteract efflux-mediated resistance is the use of MDR pump inhibitors, and thus be used in combination with the conventional antibiotics to treat deadly diseases like typhoid fever. We have previously reported that STY4874, an efflux transporter of Salmonella serotype Typhi, exhibited promising characteristics as MDR pump. In this study, we aimed to get an insight into possible STY4874 inhibitors of plant origin. STY4874 was overexpressed in Escherichia coli and extracts from pomegranate peel, milk thistle seeds and reserpine, a synthetic plant alkaloid, were screened for inhibition of ciprofloxacin efflux. The extracts of milk thistle seeds and reserpine when incubated with ciprofloxacin showed statistically significant STY4874-mediated inhibitory activity, rendering the efflux pump inactive and hence early growth inhibition of host cells compared with cells expressing efflux pump and incubated only with ciprofloxacin. This efflux pump inhibitory activity was further confirmed by time-kill experiments. This study is the first to report on efflux pump inhibition of S. Typhi STY4874 and results can be extended towards its close homologues such as MdfA and MdtM from E. coli. SIGNIFICANCE AND IMPACT OF THE STUDY: Understanding and combating resistance governed by multidrug efflux transporters is an ongoing research intensive area, affecting treatment of various nosocomial and endemic/epidemic infections. Confronting drug resistance requires that inhibitors debilitating the underlying mechanisms should be included in combination therapy. One such example is the prescription of clavulanic acid as combination therapy with amoxicillin, collectively called as co-amoxiclav to combat β-lactamase-mediated resistance. However, research related to finding the inhibitors of efflux transporters, the resistance mechanism distinct from β-lactamase mediated resistance is at an early stage. The current study finds that plant-derived inhibitors can be an option towards restraining efflux-mediated resistance.

Calculation of high-order harmonic generation in laser-produced lithium plasma

We report on detailed calculations of high-order harmonic generation (HHG) spectra from Li, Li⁺, and He using the Lewenstein model. Our model well describes the HHG experiment in Li plasma [J. Phys. B45, 065601 (2012)JPAPEH0953-407510.1088/0953-4075/45/6/065601]. The cutoff position, in the case of neutral lithium atoms (43th harmonic of 800 nm radiation), corresponds to 3.5×10¹⁴  W/cm² laser intensity, as numerically-simulated in the current work. The difference from the experimental value can be well explained by the measurement errors and uncertainty in determining the laser intensity, which is usually around 25%. We found that Li⁺ ions do not contribute to HHG plateau region of the spectra and that those ions start to contribute only at very high intensities. Our calculations show that the application of materials possessing higher ionization potential does not necessarily leads to the extension of HHG cutoff.

Prevalence and predictors of lower urinary tract symptoms in Pakistani men: A cross-sectional study

Objective:

The purpose of this study was to investigate the prevalence and severity of the condition of lower urinary tract symptoms in Pakistani men, determine its predictors and assess its impact on the quality of life.

Methods:

A cross-sectional, population-based study was conducted among men aged 30 years and over in three districts of Punjab province, Pakistan. The modified Urdu version of the International Prostate Symptom Score was used to assess the prevalence and severity of lower urinary tract symptoms. Individuals with total symptom score ⩾8 were considered as having lower urinary tract symptoms. The data were analysed using SPSS version 22. The chi-square test and Mann-Whitney U test were used to assess the difference among categorical and continuous variables, respectively. Moreover, binary logistic regressions were performed to determine the predictors of lower urinary tract symptoms.

Results:

The overall prevalence of lower urinary tract symptoms in our sample was 33.7%. The frequency of individuals having mild, moderate and severe lower urinary tract symptoms was 66.3, 30.3 and 3.4%, respectively. Storage symptoms were more common than voiding symptoms (35.6% vs 28.2%, respectively). Increasing age (one-decade interval age stratum), higher education levels, working status (currently not working), smoking, hypertension, diabetes and renal impairment were positive predictors of lower urinary tract symptoms. Moreover, the condition of lower urinary tract symptoms was associated with a significant reduction in an individual’s quality of life.

Conclusion:

Around one-third of adult Pakistani men suffer from clinically relevant urinary symptoms, with lower urinary tract symptoms sufferers having poor quality of life as compared to non-sufferers. We recommend that the aging population should be made aware of conventional measures to mitigate mild urinary symptoms affecting their routine activities. Level of evidence: 2c

Accreditation and evaluation of veterinary medical institutes - a Pakistani perspective

The Higher Education Commission of Pakistan (HEC) is an independent, autonomous and constitutionally established institution that provides primary funding for higher education in Pakistan, which it also oversees, regulates and accredits. According to the HEC Charter: 'the HEC of Pakistan may set up national or regional evaluation councils or authorise any existing council/or similar body to carry out accreditation of institutions including their departments, facilities and disciplines by giving them appropriate ratings'. At present, 14 accreditation bodies operate under the umbrella of the HEC. Five were established under the HEC's Quality Assurance Agency, while nine councils associated with the accreditation and evaluation of medical institutes are independent bodies that were extant before the HEC was created, and are recognised by the HEC. The authors will discuss the role of the Pakistan Veterinary Medical Council (PVMC), the accreditation of veterinary institutes and associated issues of concern. They suggest that the PVMC should adopt an unbiased approach to new and established veterinary institutes to attain uniform accreditation of all veterinary institutes throughout the country. In addition, the government should consult the accreditation councils and professional bodies before setting up new institutes. The authors also suggest that, instead of placing new veterinary institutes under the aegis of non-veterinary universities, they should be made sub-campuses of established veterinary universities. In time, they will emerge as established institutes in their own right.

Ultrafast x-ray absorption near edge spectroscopy of Fe3O4 using a laboratory based femtosecond x-ray source

Ultrafast time-resolved x-ray absorption near edge spectroscopy (XANES) experiment was performed on a magnetite (Fe₃O₄) film using a femtosecond laser plasma x-ray source delivering Bremsstrahlung radiation. Ultrafast temporal evolution of the XANES of Fe₃O₄ following an excitation by an infra-red (IR) laser pulse was observed in a pump-probe scheme. The Fe K x-ray absorption edge shifts towards low energy upon IR excitation as much as 12 eV, which is mainly attributed to the charge transfer between the Fe ions. The shift in the absorption edge occurred within about 150 fs, typical time of non-thermal electronic redistribution. The charge transfer also causes an ultrafast increase in the IR transmission in the similar time scale.

First Molecular Characterization of Avian Metapneumovirus (aMPV) in Turkish Broiler Flocks

Viral respiratory diseases, including avian metapneumovirus (aMPV), have a significant economic impact on poultry industries. The frequency and genotype diversity of aMPV in Turkish broiler flocks is not known at present. The aim of this study was to report the first molecular identification and phylogeny of aMPV, which is circulating in Turkish broiler flocks. Trachea tissue samples and tracheal swabs were collected from 110 broiler flocks distributed in different geographical regions in Turkey between March 2017 and March 2018. Detection of aMPV was confirmed with the use of universal reverse transcriptase (RT) PCR, and eight (7.2%) broiler farms were positive for aMPV. Sequence analysis of the G gene revealed the exclusive presence of subtype B viruses. Three field isolates clustered closely with a 2002 Israel isolate, indicating a potential transmission route between these two countries and through the Middle East. The remaining five field isolates were closely related to a vaccine strain, even though broiler flocks in Turkey are not routinely vaccinated against aMPV. Therefore, we speculate these five isolates could have originated from nearby vaccinated turkey farms. Additionally, the presence of some nucleotide substitutions compared to the reference vaccine sequence suggests prolonged circulation and evolution of the original vaccine virus or a vaccine subpopulation was selected under field conditions. This evidence emphasizes the need for further detailed and more systemic approaches to evaluate aMPV spread and evolution in order to design effective control strategies.

The effect of transcranial direct current stimulation combined with functional task training on motor recovery in stroke patients

The field of neuromodulation encompasses a wide spectrum of interventional technologies that modify pathological activity within the nervous system to achieve a therapeutic effect. Therapy including transcranial direct current stimulation (tDCS) has all shown promising results across a range of neurological and neuropsychiatric disorders. This article reviews the state-of-the-art of neuromodulation for stroke and discusses the opportunities and challenges available for clinicians and researchers interested in advancing neuromodulation therapy. The annual worldwide incidence of stroke ranges from 27.5 to 63 individuals per 100,000. Stroke, a major cause of adult disability, has devastating effects on patients and their caregivers, which has a tremendous socioeconomic impact on families and healthcare systems around the world. There are only a few treatments available for the improvement of motor function in stroke patients. The majority of these treatments are based on functional motor learning (ML) strategies. Both the mechanisms underlying stroke recovery and the effectiveness of neurorehabilitation interventions still remain poorly understood for widespread implementation, although it strongly depends on the quality of rehabilitation service to reach maximal post-stroke recovery.

A Study of Sacral Index for Identification of Sexual Dimorphism

Sacrum is an important bone for identification of sex in human skeletal system. Being a component of axial skeleton it contributes to formation of pelvic girdle. This cross sectional and descriptive study was done among 150 (59 male and 91 female) fully ossified dry human sacrum in Mymensingh Medical College, Mymensingh, Bangladesh from January 2017 to December 2017. Sample collection was done by non-random purposive sampling technique from Anatomy department of Mymensingh Medical College and Community Based Medical College, Bangladesh, Mymensingh. The parameters included the straight length of sacrum and width of sacrum which was measured by digital vernier slide caliper and was expressed in millimeter (mm) and sacral index was calculated from these measurements. In present study the mean straight length of sacrum in male and in female was 104.27±5.76mm and 92.82±7.59mm respectively. The mean width of sacrum in male and in female was 99.51±5.80mm and 102.98±6.69mm respectively. Mean sacral index were 95.42±3.14 and 111.27±7.66 in male and female respectively. Comparison of straight length and width of sacrum and sacral index were done between male and female by unpaired student 't' test which was statistically significant.

Bt Proteins Have No Detrimental Effects on Larvae of the Green Lacewing, Chrysopa pallens (Rambur) (Neuroptera: Chrysopidae)

Biosafety of a genetically modified crop is required to be assessed prior to its commercialization. For this, a suitable artificial diet was developed and used to establish a dietary exposure test for assessing the toxicity of midgut-active Bt insecticidal proteins on Chrysopa pallens (Rambur). Subsequently, this dietary exposure test was used to evaluate the toxicity of the proteins Cry1Ab, Cry1Ac, Cry1Ah, Cry1Ca, Cry1F, Cry2Aa, Cry2Ab, and Vip3Aa on C. pallens larvae. Temporal stability, bioactivity, and the intake of the insecticidal proteins were confirmed by enzyme-linked immunosorbent assay and a sensitive-insect bioassay. The life history characteristics, such as survival, pupation, adult emergence, 7-day larval weight, larval developmental time, and emerged male and female fresh weights remained unaffected, when C. pallens were fed the pure artificial diet (negative control) and the artificial diets containing 200 μg/g of each purified protein: Cry1Ab, Cry1Ac, Cry1Ah, Cry1Ca, Cry1F, Cry2Aa, Cry2Ab, or Vip3Aa. On the contrary, all of the life history characteristics of C. pallens larvae were adversely affected when fed artificial diet containing boric acid (positive control). The results demonstrate that diets containing the tested concentrations of Cry1Ab, Cry1Ac, Cry1Ah, Cry1Ca, Cry1F, Cry2Aa, Cry2Ab, and Vip3Aa have null effects on C. pallens larvae. The outcome indicates that genetically modified crops expressing the tested Bt proteins are safe for the lacewing, C. pallens.

Protective effects of Herpetospermum caudigerum extracts against liver injury induced by carbon tetrachloride in mouse

Herpetospermum caudigerum (H. caudigerum; HC), popularly known as “Sejimeiduo” in Tibet, it is widely used in Tibetan traditional medicine for the treatment of dyspepsia, liver and colic diseases. This study was designed to evaluate the effect of H. caudigerum extract (HCE) on suppressing liver injury induced by carbon tetra chloride (CCl4). For this purpose, we used CCl4 to induce acute liver injury in mouse model. The protective effects of HCE against liver injury were evaluated by biochemical parameters, histopathological and immunohistochemical staining. The results showed that the superoxide dismutase (SOD) activity was significantly increased with the increasing dose of HCE as compared to the CCl4-treated group (p less than 0.01); while AST and ALT levels in serum, MDA and MPO in liver were reduced in a dose-dependent manner. The histopathology showed that HCE treatment promoted the recovery of histopathological changes in liver in a dose-dependent way. Meanwhile, there was a higher expression of caspase-3 and NF-κB in the nucleus of several liver cells in the CCl4-induced group, and a low expression of caspase-3 and NF-κB were found with the increasing dose of HCE. Therefore, the present study suggests that HCE is a potent hepatoprotective agent that can treat acute liver injury and this ability may be attributed towards its anti-inflammatory and antioxidant potential.

Gut bacteria of cockroaches are a potential source of antibacterial compound(s)

Here, we hypothesized that the microbial gut flora of animals/pests living in polluted environments, produce substances to thwart bacterial infections. The overall aim of this study was to source microbes inhabiting unusual environmental niches for potential antimicrobial activity. Two cockroach species, Gromphadorhina portentosa (Madagascar) and Blaptica dubia (Dubia) were selected. The gut bacteria from these species were isolated and grown in RPMI 1640 and conditioned media were prepared. Conditioned media were tested against a panel of Gram-positive (Methicillin-resistant Staphylococcus aureus, Streptococcus pyogenes, Bacillus cereus) and Gram-negative (Escherichia coli K1, Salmonella enterica, Serratia marcescens, Pseudomonas aeruginosa, Klebsiella pneumoniae) bacteria, as well as the protist pathogen, Acanthamoeba castellanii. The results revealed that the gut bacteria of cockroaches produce active molecule(s) with potent antibacterial properties, as well as exhibit antiamoebic effects. However, heat-inactivation at 95°C for 10 min had no effect on conditioned media-mediated antibacterial and antiamoebic properties. These results suggest that bacteria from novel sources i.e. from the cockroach's gut produce molecules with bactericidal as well as amoebicidal properties that can ultimately lead to the development of therapeutic drugs.

SIGNIFICANCE AND IMPACT OF THE STUDY

The bacteria isolated from unusual dwellings such as the cockroaches' gut are a useful source of antibacterial and antiamoebal molecules. These are remarkable findings that will open several avenues in our search for novel antimicrobials from unique sources. Furthermore studies will lead to the identification of molecules to develop future antibacterials from insects.

FK228 recovers thiram-induced tibial dyschondroplasia in chicken via hypoxia inducible factor-1α

Tibial dyschondroplasia (TD) is a disease of many avian species characterized by an enlarged and avascular lesion in the proximal tibiotarsal bone. The aim of present study was to evaluate the effects of hypoxia-inducible factor-1α(HIF-1α) inhibition on thiram- induced TD using synthetic medicine FK228 and the association between HIF-1α and heat-shock protein 90 (Hsp90). One hundred and fifty broiler chicks were equally divided into 3 groups: control; thiram fed; and FK228 treatment. Expressions of HIF-1α and Hsp90 genes were analyzed by real-time quantitative polymerase chain reaction (RT-qPCR) on day 10 and 14 post-hatch. Western blot analysis of HIF-1α and Hsp90 gene was performed to measure the protein levels at the end of the experiment. Results showed that HIF-1α and Hsp90 levels were significantly (P less than 0.05) up-regulated in the thiram group as compared to the control group. Meanwhile, FK228 (HIF-1α inhibitor) significantly (P less than 0.05) down- regulated the mRNA and protein levels of HIF-1α and Hsp90, restored the size of growth plate and diminished lameness. In conclusion, HIF-1α and Hsp90 play an important role in the formation of avascular growth plate and there is a direct relationship between HIF-1α and Hsp90 for the progression of TD pathogenesis. Therefore, HIF- 1α may prevent and control TD in broiler chickens.

Dengue virus serotypes and epidemiological features of dengue fever in Faisalabad, Pakistan

Dengue infection has become a major public health threat in Pakistan, causing several outbreaks from 1994 to 2012. This cross-sectional study was carried out to determine viral serotypes responsible for major outbreak of dengue fever in Faisalabad, Pakistan during 2011. Total 50 patients (37 males and 13 females) reported within 2-4 days of onset of fever, positive for dengue NS1 antigen, were recruited for this study. The median age of the patients was 29 years. Laboratory findings indicate thrombocytopenia in 92.0%, decreased hemoglobin in 48.0%, and leukopenia in 38.0% patients at the time of admission. Liver enzymes were elevated in 100.0% patients. ALT levels were 7.0 times higher, while AST levels were 7.3 times higher than the normal values in dengue patients. Molecular epidemiology of the dengue fever revealed co-circulation of three different DENV serotypes in Faisalabad population. Among them 82.4% were positive for DENV2; 5.8% with DENV3; and 11.7% were reported with DENV4. Co-circulation of three different DENV serotypes in the city is an alarming situation, which could result in a more severe outbreak of DF (DHF/DSS) in the future.

First characterization of immunogenic conjugates of Vi negative Salmonella Typhi O-specific polysaccharides with rEPA protein for vaccine development

Efficacious typhoid vaccines for young children will significantly reduce the disease burden in developing world. The Vi polysaccharide based conjugate vaccines (Vi-rEPA) against Salmonella Typhi Vi positive strains has shown high efficacy but may be ineffective against Vi negative S. Typhi. In this study, for the first time, we report the synthesis and evaluation of polysaccharide-protein conjugates of Vi negative S. Typhi as potential vaccine candidates. Four different conjugates were synthesized using recombinant exoprotein A of Pseudomonas aeruginosa (rEPA) and human serum albumin (HSA) as the carrier proteins, using either direct reductive amination or an intermediate linker molecule, adipic acid dihydrazide (ADH). Upon injection into mice, a significantly higher antibody titer was observed in mice administrated with conjugate-1 (OSP-HSA) (P=0.0001) and conjugate 2 (OSP-rEPA) (P≤0.0001) as compared to OSP alone. In contrast, the antibody titer elicited by conjugate 3 (OSPADH-HSA) and conjugate 4 (OSPADH-rEPA) were insignificant (P=0.1684 and P=0.3794, respectively). We conclude that reductive amination is the superior method to prepare the S. Typhi OSP glycoconjugate. Moreover, rEPA was a better carrier protein than HSA. Thus OSP-rEPA conjugate seems to be efficacious typhoid vaccines candidate, it may be evaluated further and recommended for the clinical trials.

Long-term follow-up of patients with spontaneous clearance of hepatitis C: does viral clearance mean cure?

Up to 40% of patients with hepatitis C virus (HCV) antibodies are negative for HCV RNA at initial evaluation. If there is a risk of viral re-activation, long term follow-up is required with attendant financial, psychological and medical implications. We investigated the risk of re-activation in the Irish anti-D cohort. Information was obtained from the national hepatitis C database which includes data on patients infected by anti-D immunoglobulin in two large outbreaks, 1977-9 and 1991-94. As part of a screening programme, starting in 1994, 64,907 females exposed to anti-D immunoglobulin were evaluated. Three hundred and forty-seven were found to be antibody positive but HCV RNA negative at initial assessment. 93% had subsequent RNA tests. There was no evidence of HCV recurrence in patients whose infection resolved spontaneously. It appears that two initial sequential negative results for HCV RNA are sufficient to confirm spontaneous viral clearance and probable cure of hepatitis C virus infection.

Aflatoxin, proximate composition and mineral profile of stored broiler feed treated with medicinal plant leaves

OBJECTIVES

In the present investigation, the Morus alba (M. alba), Vitis vinifera (V. vinifera), Ficus religiosa (F. religiosa) and Citrus paradisi (C. paradisi) leaves anti-aflatoxigenic activities were evaluated in Aspergillus flavus (A. flavus) inoculated feed.

METHODS

The broiler feed inoculated with A. flavus was treated with selected medicinal plant leaf powder (5%, 10% and 15% w/w) and stored for the period of six months at 28°C and 16% moisture. The aflatoxins (AFTs) were estimated at the end of each month by Reversed Phase High Performance Liquid Chromatography (RP-HPLC) method along with proximate composition and mineral contents.

RESULTS

Plant leaves controlled AFTs efficiently without affecting the feed proximate composition and mineral contents. The M. alba leaves completely inhibition (100%) the AFTs (B₁ and B₂) in feed at very low concentration (5%). Other plants also showed significant (P<0.05) inhibition of AFTs production without affecting the feed quality over the storage period of six months.

CONCLUSION

Based on promising efficiency of selected medicinal plant leaves, A. flavus produced AFTs could possibly be controlled in stored poultry feed.

Ambulatory screening of diabetic neuropathy and predictors of its severity in outpatient settings

INTRODUCTION

Diabetic neuropathy is one of the most common causes of chronic neuropathic symptomatology and the most disabling and difficult-to-treat diabetic microangiopathic complication. The neuropathies associated with diabetes are typically classified into generalized, focal and multifocal varieties. There exists a scarcity of literature studying the correlation of different patient- and disease-related variables with severity of neuropathy.

OBJECTIVES

This study aims to delineate the prevalence of diabetic neuropathy in type 2 diabetes, describe its characteristics and find out predictors of its severity.

MATERIAL AND METHODS

Eight hundred consecutive diabetic patients presenting to outpatient department (OPD) of Khan Research Labs (KRL) General Hospital and Centre for Diabetes and Liver diseases, Islamabad, during March-June, 2015 were made to complete a self-administered questionnaire (Michigan Neuropathy Screening Instrument-MNSI) and underwent a thorough physical examination according to MNSI protocols. A score of >2 was considered to be diagnostic for DPN. Patient and disease variables were noted. MNSI score was used as an index of severity of diabetic peripheral neuropathy (DPN). Correlation of several patient- and disease-related variables with the severity of DPN was determined using multivariate regression.

RESULTS

Out of a total 800 patients screened, 90 (11.25%) were found to have diabetic neuropathy. Of these 90, 45.5% were males, the median age was 54.47 ± 10.87 years and the median duration of diabetes was 11.12 ± 9.8 years. The most common symptom was found to be numbness (63.6%) followed by generalized body weakness (61.5%). The common findings on physical examination were dry skin/callus (38.7%) and deformities (14.7%). Duration of diabetes was found to be the strongest predictor for development and severity of diabetic neuropathy followed by glycemic controls (HbA1c values) and age.

CONCLUSION

Duration of diabetes rather than diabetic controls predicts better the development and severity of diabetic neuropathy indicating a failure of intensive treatment to avert such complications.

The beam energy feedback system for Beijing electron positron collider II linac

A beam-energy feedback system has been developed for the injection linac to meet the beam quality needed for the Beijing electron positron collider II storage ring. This paper describes the implementation and commissioning of this system in detail. The system consists of an energy measurement unit, application software, and an actuator unit. A non-intersecting beam energy monitor was developed to allow real-time online energy adjustment. The beam energy adjustment is achieved by adjusting the output microwave phase of the RF power source station. The phase control mechanism has also been modified, and a new control method taking the return difference of the phase shifter into account is used to improve the system's performance. This system achieves the design aim and can adjust the beam center energy with a rate of 2 Hz. With the energy feedback system, the stability of the injection rate is better; the fluctuation range is reduced from 20 mA/min to 10 mA/min, while the stability of the beam center energy is maintained within ±0.1%.

Hepatoprotective potential of glyceryl trinitrate against chemically induced oxidative stress and hepatic injury in rats

Glyceryl trinitrate (GTN) has been used widely as a potent vasodilator to treat heart conditions, such as angina pectoris and chronic heart failure. This study aims to elucidate the effect of exogenous nitric oxide (NO) administration, using GTN, on carbon tetrachloride (CCl4)-induced oxidative stress and liver injury in rats. The results obtained demonstrated that NO generated by the administration of GTN affords protection against CCl4-induced oxidative stress and liver injury. Administration of CCl4 resulted in a significant ( p < 0.001) increase in lipid peroxidation and tissue damage markers (aspartate and alanine transaminase and lactate dehydrogenase) release in serum. Parallel to these changes, CCl4 also caused downregulation of antioxidant enzymes including glutathione peroxidase (GPx), glutathione reductase (GR), and glutathione-S-transferase (GST), and several fold induction in γ-glutamyl transpeptidase (GGT) activity. Subsequent administration of GTN resulted in significant ( p < 0.001) recovery of GSH-metabolizing enzymes in a dose-dependent manner. Further, administration of NO inhibitor, NG-nitro-l-arginine methyl ester (l-NAME), exacerbated CCl4-induced oxidative tissue injury. Overall, the study suggests that GTN might suppress oxidant-induced tissue injury and hepatotoxicity in rats.

First reported finding of a Malignant Pleural Mesothelioma in a patient post Liver Transplant

The case history of a liver transplant recipient is presented, who presented with acute dyspnoea after an innocuous fall. His early management was complicated and he was eventually diagnosed with malignant mesothelioma. This is the first such case report in the literature.