Health care risk factors among women and personal behaviours among men explain the high prevalence of hepatitis C virus infection in Karachi, Pakistan

To estimate the prevalence and identify factors associated with hepatitis C virus (HCV) infection among men and women in Karachi, Pakistan. We conducted a cross-sectional study of adult men and women in a peri-urban community of Karachi (Jam Kandah). Households were selected through systematic sampling from within all villages in the study area. All available adults within each household were interviewed about potential HCV risk factors. A blood specimen was collected to test for anti-HCV antibodies by enzyme immunoassay. We used generalized estimating equations while accounting for correlation of responses within villages to identify the factors associated with HCV infection. Of 1997 participants, 476 (23.8%) were anti-HCV positive. Overall, HCV infection was significantly associated with increasing age, ethnicity, and having received > or =2 blood transfusions, > or =3 hospitalizations, dental treatment and >5 injections among women. Among women, > or =2 blood transfusions [adjusted odds ratio (aOR) = 2.32], >5 injections during the past 6 months (aORs = 1.47), dental treatment (aOR = 1.31) and increasing age(aOR = 1.49), while among men, extramarital sexual intercourse (aOR = 2.77), at least once a week shave from barber (aOR = 5.04), > or =3 hospitalizations (aOR = 2.50) and increasing age (aOR = 1.28) were associated with HCV infection. A very high prevalence of HCV was found in the study population. Among women, unsafe health care practices, while among men extramarital sex, shaving from a barber and hospitalizations were associated with HCV infection. Efforts are needed to improve the safety of medical procedures to reduce the transmission of HCV in Pakistan [Corrections made in Summary after initial online publication.].

Colonic stent versus surgery for the management of acute malignant colonic obstruction: a decision analysis

BACKGROUND

Acute colonic obstruction because of advanced colonic malignancy is a surgical emergency.

AIM

To compare the clinical outcomes and cost-effectiveness of endoscopic self-expanding metal stent (SEMS) vs. surgery for emergent management of acute malignant colonic obstruction in patients with metastatic colorectal cancer over a 6-month period.

METHODS

Decision analysis was used to calculate the cost-effectiveness and success of two competing strategies in a hypothetical patient with metastatic colon cancer presenting with acute, malignant colonic obstruction: (i) emergent colonic stent (SEMS cohort); (ii) emergent surgical resection followed by diversion (surgery cohort).

RESULTS

Self-expanding metal stent resulted in a success and a lower mortality rate when compared to surgery over a 6-month period. Colonic SEMS was also associated with a lower mean cost per patient (USD 27,225 vs. USD 57,398). Mortality in the surgery group was 25 times that of the SEMS cohort. One- and two-way sensitivity analyses identified SEMS as the dominant strategy.

CONCLUSION

Colonic stent insertion is more effective and less costly than surgery for the management of colonic obstruction in patients with metastatic colon cancer.

Attenuating effects of prior oestradiol benzoate priming on 5-HT-mediated lordosis behavior in rats are dose-dependent

The present study was designed to investigate the role of the 5-HT7 receptors in lordosis and compare the lordotic responses with 5-HT1A agent under the influence of different steroid-priming regimens in ovariectomized, non-receptive and receptive rats. 8-OH DPAT, a 5-HT1A agonist and 5-CT, a 5-HT7 agonist inhibited the lordosis differently in non-receptive and receptive rats, however, the response was attenuated in a dose-dependent manner following 5-CT treatment in the first two tests. Treatment with 5-HT1A antagonist, WAY 100 135 caused a protective effect which was evident in the second test only. Priming with 25 microg OB attenuated in the first test in non-receptive rats whereas the same dose repeated a similar pattern in receptive rats. The attenuation of LQ was evident in rats treated with 5-HT7 antagonist, SB 269970-A. This finding shows that WAY 100 135, a 5-HT1A antagonist has potency to attenuate inhibitory influence of 8-OH DPAT by enhancing lordosis behavior acutely in female rats with a low estrous state. Treatment with 5-CT and SB 269970-A as 5-HT7, agonist and antagonist, respectively, have mimicked 5-HT-mediated lordotic response as moderate affinity towards 5-HT1A receptors has been reported. This offers a comparable effect on lordosis as a result of the two 5-HT agents used.

Differential expression of platelet-derived growth factor receptor-beta in an aging model of wound repair

Impaired wound healing as a result of age is a well-documented phenomenon. However, the overall deficit in healing is substantially increased when the healing wound of an aged animal is ischemic. We hypothesized that both of these deficits are cytokine mediated. We have studied the messenger RNA expression of platelet-derived growth factor receptor-beta, using the rabbit dermal ulcer model of wound repair, in young (3 to 6 months) and aged (48 months and 60 months) rabbits under normal and ischemic conditions. Platelet-derived growth factor receptor-beta mRNA expression was measured with the use of quantitative reverse transcriptase-polymerase chain reaction with incorporation of a synthetic, nonhomologous DNA fragment complementary to platelet-derived growth factor receptor-beta primers as a competitive internal standard. Results in young rabbits showed a large upregulation of platelet-derived growth factor receptor-beta mRNA expression after wounding. In both aged animal groups, platelet-derived growth factor receptor-beta expression was found to be significantly decreased in nonischemic wounds relative to young nonischemic controls. Ischemia was found to have little effect on platelet-derived growth factor receptor-beta mRNA expression in young animals relative to matched controls. However, ischemia induced a large decrease in the platelet-derived growth factor receptor-beta mRNA levels of wounds of aged animals relative to paired aged nonischemic wounds. Results suggest an age-related delay in platelet-derived growth factor receptor-beta mRNA expression in healing wounds, as well as an age-related decline in responsiveness to confounding ischemia.

Differential effects of oxygen on human dermal fibroblasts: acute versus chronic hypoxia

The observation that many chronic wounds are ischemic has spurred a series of studies evaluating the response of cells exposed to hypoxia. To date, these studies have shown largely beneficial effects from hypoxia, such as increased cellular replication and procollagen synthesis. These findings are counter-intuitive from a clinical standpoint because cellular growth and synthetic function are known to be retarded in chronic ischemic wounds. We have established an in vitro system in which human dermal fibroblasts grown chronically at 5 +/- 3 mm Hg will proliferate at a rate three times slower than those fibroblasts grown under standard culture conditions (namely an oxygen partial pressure of 150 mm Hg). No phenotypic changes are noted in chronically hypoxic cells, and the growth-retarding effects are reversible when the cells are returned to standard oxygen conditions. Competitive reverse transcription-polymerase chain reaction showed that acute exposure to hypoxia (up to 1 week) results in a 6.3-fold increase in the relative expression of transforming growth factor-beta1 messenger RNA, whereas chronic exposure to hypoxia leads to a 3.1-fold decrease in this message. Collagen production measured at both the mRNA and protein level is also decreased in the setting of chronic hypoxia. We propose that this system may be the most appropriate setting for studying the role of oxygen on dermal fibroblasts in ischemic, nonhealing wounds.

Jugular foramen meningocoele in a patient with neurofibromatosis type 1

Objective:

We present a rare case of a jugular foramen meningocoele in a 48-year-old female, with neurofibromatosis type 1, presenting with positional vertigo. We also postulate possible underlying pathophysiological mechanisms.

Method:

We describe the imaging findings of this rare entity and review the literature on skull base meningocoeles, particularly in the context of neurofibromatosis type 1.

Results:

A computed tomography scan revealed smooth expansion of the jugular foramen. Magnetic resonance imaging showed a fluid filled lesion expanding the jugular foramen and communicating with cerebrospinal fluid of the cerebellomedullary cistern superiorly.

Conclusion:

Skull base meningocoeles are a rare entity and we believe that this is the first reported case of a meningocoele causing enlargement of the jugular foramen in a patient with neurofibromatosis type 1. The meningocoele may have resulted from a severe form of dural ectasia or from dysplastic, weakened bone at the skull base.

The genome of black cottonwood, Populus trichocarpa (Torr. & Gray)

We report the draft genome of the black cottonwood tree, Populus trichocarpa. Integration of shotgun sequence assembly with genetic mapping enabled chromosome-scale reconstruction of the genome. More than 45,000 putative protein-coding genes were identified. Analysis of the assembled genome revealed a whole-genome duplication event; about 8000 pairs of duplicated genes from that event survived in the Populus genome. A second, older duplication event is indistinguishably coincident with the divergence of the Populus and Arabidopsis lineages. Nucleotide substitution, tandem gene duplication, and gross chromosomal rearrangement appear to proceed substantially more slowly in Populus than in Arabidopsis. Populus has more protein-coding genes than Arabidopsis, ranging on average from 1.4 to 1.6 putative Populus homologs for each Arabidopsis gene. However, the relative frequency of protein domains in the two genomes is similar. Overrepresented exceptions in Populus include genes associated with lignocellulosic wall biosynthesis, meristem development, disease resistance, and metabolite transport.

Coronary artery disease is associated with Alzheimer disease neuropathology in APOE4 carriers

OBJECTIVE

To examine the associations between postmortem Alzheimer disease (AD) neuropathology and autopsy-verified cardiovascular disease.

METHODS

The authors examined 99 subjects (mean age at death = 87.6; SD = 8.7) from the Mount Sinai School of Medicine Department of Psychiatry Brain Bank who were devoid of cerebrovascular disease-associated lesions or of non-AD-related neuropathology. Density of neuritic plaques (NPs) and neurofibrillary tangles (NFTs) as well as coronary artery and aortic atherosclerosis, left ventricular wall thickness, and heart weight were measured. Partial correlations were used to assess the associations of the four cardiovascular variables with NPs and NFTs in the hippocampus, entorhinal cortex, and multiple regions of the cerebral cortex after controlling for age at death, sex, dementia severity, body mass index, and ApoE genotype. These analyses were also repeated separately for ApoE4 carriers and noncarriers.

RESULTS

The extent of coronary artery disease and to a lesser extent atherosclerosis were significantly associated with the density of cardinal neuropathologic lesions of AD in this autopsy sample (significant correlations between 0.22 and 0.29). These associations were more pronounced for the ApoE4 allele carriers (n = 42; significant correlations between 0.34 and 0.47).

CONCLUSIONS

The degree of coronary artery disease is independently associated with the cardinal neuropathological lesions of Alzheimer disease. These associations are primarily attributable to individuals with the ApoE4 allele.

An ultrasonic assisted extraction method to release heavy metals from untreated sewage sludge samples

A rapid ultrasound accelerated sequential extraction procedure has been used to develop sequential extraction proposed by BCR protocol (the community Bureau of Reference now the European Union "Measurement and Testing Programme"). The effects of the ultrasonic treatment on the extraction of Cu, Cd, Cr, Pb, Ni and Zn from untreated sewage sludge collected from industrial site of Hyderabad city (Pakistan) were compared with those obtained from conventional sequentional extraction procedure of modified BCR protocol. In BCR method, each extraction steps takes 10h, where as with the use of compromise sonication conditions in ultrasonic bath, steps 1-3 of the sequential extraction (excluding the hydrogen peroxide digestion in step 3, which was not performed with sonication) could be completed in 30, 30 and 30 min, respectively. Extractable Cd, Cr, Pb and Ni contents were obtained by both comparable methodologies were measured by electrothermal atomic absorption spectrometry (ETAAS), while for Cu and Zn Flame atomic absorption spectrometry (FAAS) was used. The validations of both methods were compared by the analysis of certified reference material of soil amended with sewage sludge (BCR 483). According to statistical evaluation of the results, the proposed accelerated extraction method is valid alternative to conventional shaking with much shorter extraction time with p value <0.05. The overall metal recoveries in steps 1-3 (excluding residual step) were 95-100% of those obtained with the conventional BCR protocol, except for Cu extracted (91.6%) as related to indicative values of Cu in BCR 483 obtained in 1-3 steps. The results of the partitioning study of untreated industrial waste water sewage sludge, indicate that more easily mobilized forms (acid exchangeable) were predominant for Cd and Zn, in contrast, the largest amount of Pb and Cr was associated with the iron/manganese oxide and organic matter/sulphide fractions.